Efficacy of Proximal Junctional Tethering in Spinal Fusion Surgery for Preventing Proximal Junctional Kyphosis and Proximal Junctional Failure: A Meta-analysis.

IF 3.6 2区医学 Q1 CLINICAL NEUROLOGY

Neurospine Pub Date : 2025-09-01 Epub Date: 2025-09-30 DOI:10.14245/ns.2550726.363

Yu-Chi Hsu, Hsuan-Tung Lee, Ying-Fong Su, Yang-Ching Chen, Serena S Hu, Ching-Chi Hsu, Pei-I Tsai, Wei-Bin Hsu, Den-Tai Lin, Ching-Yu Lee, Tsung-Jen Huang, Tan Lam Minh Nguyen, Meng-Huang Wu

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Abstract

Objective: Spinal fusion surgery is effective for treating various adult spinal deformities. However, spinal fusion surgery is associated with the risk of adjacent segment disease (ASD; 5%-30%), particularly proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Proximal junctional tethering (PJT) has become a popular technique owing to increasing evidence that it can decrease the rate of PJK or PJF.

Methods: A literature search was conducted using PubMed, Embase, and Cochrane Library. Twelve eligible studies were identified. These studies were predominantly retrospective in nature and compared the incidence of PJK or PJF in adults undergoing spinal fusion surgery with or without PJT. Risk of bias was assessed using the Newcastle-Ottawa scale. All outcomes were analyzed using R software (ver. 4.4.1).

Results: We included 8 retrospective cohort studies and 3 propensity-score-matched analyses; these studies comprised 1,424 patients. PJT was associated with a significant decrease in the odds of development of PJK (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.27-0.71) and PJF (OR, 0.36; 95% CI, 0.19-0.69) compared with control. Subgroup analysis results revealed no significant difference in ASD rates between geographical locations, between tethering with and without crosslinks, and between specific tethering techniques.

Conclusion: PJT significantly reduces the odds of both PJK and PJF in adults undergoing spinal fusion surgery.

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在脊柱融合术中使用近端结扎术预防近端结扎后凸和近端结扎失败的疗效：一项荟萃分析。

目的：脊柱融合术是治疗各种成人脊柱畸形的有效方法。然而，脊柱融合手术与相邻节段疾病（ASD; 5%-30%）的风险相关，特别是近端关节后凸（PJK）和近端关节功能衰竭（PJF）。由于越来越多的证据表明它可以降低PJK或PJF的发生率，近端接合栓（PJT）已成为一种流行的技术。方法：利用PubMed、Embase、Cochrane图书馆进行文献检索。确定了12项符合条件的研究。这些研究主要是回顾性的，比较了有或没有PJT的成人脊柱融合手术中PJK或PJF的发生率。偏倚风险采用纽卡斯尔-渥太华量表进行评估。所有结果使用R软件进行分析。4.1.1)。结果：我们纳入了8项回顾性队列研究和3项倾向-评分匹配分析；这些研究包括1424名患者。与对照组相比，PJT与PJK（比值比[OR]， 0.44； 95%可信区间[CI]， 0.27-0.71）和PJF（比值比[OR]， 0.36; 95% CI, 0.19-0.69）发生的几率显著降低相关。亚组分析结果显示，地理位置、系带与非系带以及特定系带技术之间的ASD发生率无显著差异。结论：PJT可显著降低脊柱融合术成人发生PJK和PJF的几率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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