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  • Semitendinosus Graft for Interspinous Ligament Reinforcement of the Proximal Adjacent Segment in Multilevel Instrumentation to the Upper Thoracic Spine: Report of a Novel Technique for Proximal Juncti

    Final Number:

    Martin H. Pham MD; Alexander Tuchman MD; Lance Smith MD; Vivek Mehta MD; Frank L. Acosta MD

    Study Design:

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves 2016 Annual Meeting

    Introduction: Proximal junctional kyphosis (PJK) is an increasingly recognized complication following long-segment posterior spinal fusion for adult spinal deformity. We describe here a novel technique for interspinous ligament reinforcement at the proximal adjacent levels utilizing a cadaveric semitendinosus tendon graft secured with an Ethibond No. 2 double filament via the Krackow suture weave.

    Methods: All patients who had undergone interspinous ligamentous reinforcement with a cadaveric semitendinosus tendon graft as a surgical adjunct to their long-segment fusion for adult spinal deformity correction by the senior author (F.L.A.) were retrospectively reviewed. In all patients, the interspinous ligamentous reinforcement was created by using a cadaveric semitendinosus tendon graft with a Krakow weave (Figure 1). This tendon graft was then interwoven between the spinous processes from 1 level above the uppermost instrumented vertebra (UIV) to 1-2 levels below the UIV (Figures 2 and 3).

    Results: A total of 3 patients were identified who had received interspinous ligamentous reinforcement. All 3 patients were female with an average age at time of surgery of 57 years (range, 53-65 years). All patients had sagittal imbalance and scoliosis. Patient 1 underwent a T4-pelvis posterior spinal fusion with an L4 pedicle subtraction osteotomy, whereas patients 2 and 3 underwent a T2-pelvis and T4-pelvis posterior spinal fusion with multiple Smith-Petersen osteotomies, respectively. Average postoperative clinical and radiographic follow-up was 2.7 months (range, 2.3-2.8 months). The proximal junctional angle increased postoperatively an average of 2 degrees (range, 1-4 degrees). No hardware failure, implant loosening, or PJK was noted on radiographic follow-up.

    Conclusions: Interspinous ligament reinforcement at the proximal adjacent level with a cadaveric semitendinosus tendon graft is a novel and feasible technique as a prevention strategy for PJK. More clinical data with longer follow-up will be needed to determine if this will be a durable option for utilization in the adult spinal deformity population.

    Patient Care: This will improve patient care by describing another possible prevention strategy for proximal junctional kyphosis.

    Learning Objectives: By the conclusion of this session, participants should be able to describe the important of PJK and consider the use of a cadaveric semitendinosus tendon graft with the Krakow suture technique as a prevention strategy for this condition.


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