Abstract
Background Proximal junctional failure (PJF) following multilevel thoracolumbar instrumented to the pelvis for adult spinal deformity (ASD) is relatively uncommon but considerably disabling. While the leading etiology is mechanical, other rarer etiologies can play a role in its development. The purpose of this study was to present a case series of ASD patients who experienced PJF secondary to proximal junctional spondylodiscitis (PJS) after long-segment thoracolumbar posterior instrumented fusions.
Methods Adult patients who underwent posterior instrumented fusions at a single academic center between 2017 and 2020 and subsequently developed PJS were retrospectively reviewed. Patient demographics, operative details, clinical presentation, culture data, and management approach were evaluated.
Results Three patients developed PJS and were included for analysis (mean age 67 years [range, 58–76]; women: 2). Indication for all index operations was symptomatic ASD after failed conservative management. Clinical presentation ranged from mild back pain to severe neurological compromise. Average time to infection and PJF after the index procedure was 11 months (range, 3 months–2 years). All 3 patients were successfully managed with urgent revision surgery including surgical debridement and postoperative antibiotics.
Conclusion PJS is a rare yet potentially devastating complication following long-segment posterior thoracolumbar instrumented fusions for ASD. It is critical that surgeons maintain a high index of suspicion of infection when managing PJF given the potential neurological morbidity of PJS.
Clinical Relevance This report highlights a rare but important cause of PJF following ASD surgery. It is critical that one maintains a high index of suspicion of infection when managing PJF.
Level of Evidence 4.
- proximal junctional spondylodiscitis
- proximal junctional failure
- proximal junctional kyphosis
- adult spinal deformity
- infection
Footnotes
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests The authors report no conflicts of interest in this work.
Disclosures Joseph Mendelis and Nicole Hung have nothing to disclose. Vedat Deviren is a con-sultant for and receives royalties from Alphatec Spine. Christopher Ames receives royalties from Stryker, Zimmer-Biomet, DePuy Synthes, Nuvasive, Next Orthosurgical, K2M, and Medicrea. He also discloses consulting fees from DePuy Synthes, Medtronic, and K2M and receives research support from Titan Spine and Depuy Synthes. Aaron Clark discloses consulting fees and research support from Nuvasive. Alekos Theologis discloses research support from Stryker/K2M, royalties from Alphatec Spine, consulting fees from Depuy Spine, Alphatec Spine, SpineArt, Stryker/K2M, Surgalign, and Restor3D, as well as being on the surgeon advisory board for Ulrich Medical.
Ethics Approval The study was approved by our institutional review board. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
- This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2022 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.