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"Adjacent segment disease"

Original Article

Cervical Spine — Swedish Spine Society

A Nationwide Registry Study Comparing Long-term Risk of Adjacent Segment Disease Requiring Reoperation Following Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty
Zehra Nazar, Victor Gabriel El-Hajj, Erik Edström, Adrian Elmi-Terander, Victor Egon Staartjes
Neurospine 2026;23(3):526-535.   Published online July 31, 2026
DOI: https://doi.org/10.14245/ns.26520482.0241

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A Nationwide Registry Study Comparing Long-term Risk of Adjacent Segment Disease Requiring Reoperation Following Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty
Neurospine. 2026;23(3):526-535.   Published online July 31, 2026
DOI: https://doi.org/10.14245/ns.26520482.0241
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A Nationwide Registry Study Comparing Long-term Risk of Adjacent Segment Disease Requiring Reoperation Following Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty
Neurospine. 2026;23(3):526-535.   Published online July 31, 2026
DOI: https://doi.org/10.14245/ns.26520482.0241
Close
Objective
Adjacent segment disease (ASD) is a recognized long-term complication after anterior cervical discectomy and fusion (ACDF). Cervical disc arthroplasty (CDA) was introduced as a motion-preserving alternative, thought to reduce stress at adjacent levels and lower ASD risk. This study aimed to compare the risk of ASD requiring reoperation after ACDF and CDA and identify factors associated with ASD.
Methods
This retrospective cohort study used prospectively collected data from the Swedish Spine Registry (Swespine) and included adult patients undergoing anterior cervical surgery for degenerative cervical disease between 2006 and 2026. ASD was defined as a secondary operation at an adjacent level ≥12 months after the index procedure. Cumulative incidence was estimated using Kaplan-Meier analysis, and associations with ASD were evaluated using multivariable Cox proportional hazards regression. Radiological or conservatively treated ASD were not assessed.
Results
A total of 9,338 patients were included (ACDF, n=9,005; CDA, n=333). During 45,666 person-years follow-up, 509 ASD events occurred (incidence rate 11.1 per 1,000 person-years). Cumulative incidence was 4.9% at 5 years and 10.4% at 10 years. CDA was associated with lower ASD hazard than ACDF (hazard ratio [HR], 0.61) though this association was not significant after propensity score matching (HR, 0.88). Multilevel procedures (HR, 0.61), increasing age (HR, 0.96 per year), and radiculopathy were associated with lower risk, while myelopathy or stenosis was associated with higher risk (HR, 1.22).
Conclusion
The long-term risk of ASD requiring reoperation was lower than previously reported. After adjustment, CDA was associated with lower ASD risk compared to ACDF, although the absolute difference was small, and the clinical significance remains uncertain.

Citations

Citations to this article as recorded by  Crossref logo
  • A Commentary on “A Nationwide Registry Study Comparing Long-term Risk of Adjacent Segment Disease Requiring Reoperation Following Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty”
    Samuel K. Cho
    Neurospine.2026; 23(3): 536.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the July 2026 Issue
    Inbo Han
    Neurospine.2026; 23(3): 513.     CrossRef
  • 634 View
  • 20 Download
  • 2 Crossref

Review Article

Meta-analysis

Efficacy of Proximal Junctional Tethering in Spinal Fusion Surgery for Preventing Proximal Junctional Kyphosis and Proximal Junctional Failure: A Meta-analysis
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
Neurospine 2025;22(3):663-677.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550726.363

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Efficacy of Proximal Junctional Tethering in Spinal Fusion Surgery for Preventing Proximal Junctional Kyphosis and Proximal Junctional Failure: A Meta-analysis
Neurospine. 2025;22(3):663-677.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550726.363
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Efficacy of Proximal Junctional Tethering in Spinal Fusion Surgery for Preventing Proximal Junctional Kyphosis and Proximal Junctional Failure: A Meta-analysis
Neurospine. 2025;22(3):663-677.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550726.363
Close
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.
  • 5,618 View
  • 78 Download

Original Articles

Biomechanics

Biomechanical Impact of Cement Augmentation on Pedicle Screw Fixation and Adjacent Segment Disease in Multilevel Lumbar Fusion: A Finite Element Analysis
Min-Young Jo, Sung-Jae Lee, Je-Hoon An, Young-Hoon Kim, Jun-Seok Lee, Hyung-Youl Park
Neurospine 2025;22(3):763-773.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550294.147

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Biomechanical Impact of Cement Augmentation on Pedicle Screw Fixation and Adjacent Segment Disease in Multilevel Lumbar Fusion: A Finite Element Analysis
Neurospine. 2025;22(3):763-773.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550294.147
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Biomechanical Impact of Cement Augmentation on Pedicle Screw Fixation and Adjacent Segment Disease in Multilevel Lumbar Fusion: A Finite Element Analysis
Neurospine. 2025;22(3):763-773.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550294.147
Close
Objective
Cement augmentation is widely used to enhance pedicle screw fixation, particularly in osteoporotic patients. However, its effects on adjacent segment disease (ASD) and implant failure in multilevel lumbar interbody fusion remain unclear. This study aimed to assess the effectiveness of cement augmentation in preventing implant failure and its impact on ASD risk using finite element analysis (FEA).
Methods
A FEA of L2–S1 multilevel lumbar interbody fusion was performed to evaluate the biomechanical effects of cement augmentation. Three models were analyzed under normal and osteoporotic conditions: type 1 (no augmentation), type 2 (upper instrumented vertebra [UIV] augmentation), and type 3 (UIV and UIV+1 augmentation). Range of motion (ROM), intradiscal pressure (IDP), screw pull-out risk, and implant failure were assessed.
Results
Cement augmentation significantly reduced screw pull-out risk, particularly in osteoporotic conditions, where type 1 exhibited a failure rate of 91.5%, while type 2 and type 3 remained below 39%. Cement augmentation did not demonstrate a substantial impact on ASD development, as ROM and IDP changes remained within a minimal range in this FEA model. However, osteoporosis was associated with a substantial increase in IDP, with a result as high as 809%. Despite its benefits, augmentation at UIV+1 increased the risk of pedicle screw breakage and vertebral body fracture, with L1 (UIV+1) lower endplate fracture rate of 82.7% in type 3, compared to 56.6% in type 2 and 52.8% in type 1.
Conclusion
Cement augmentation effectively improves screw fixation and does not appear to significantly increase ASD risk based on this FEA study. Limiting cement augmentation to the UIV level in lumbar multilevel fusion may help reduce the risk of implant failure, though further clinical validation is required to confirm these biomechanical findings.

Citations

Citations to this article as recorded by  Crossref logo
  • Enhancing Predictive Accuracy in Finite Element Analysis of Cement Augmentation: Methodological Considerations – A Commentary on “Biomechanical Impact of Cement Augmentation on Pedicle Screw Fixation and Adjacent Segment Disease in Multilevel Lumbar Fusio
    Fan Mo, Shaoqi He
    Neurospine.2026; 23(2): 500.     CrossRef
  • Reply Letter: A Commentary on “Biomechanical Impact of Cement Augmentation on Pedicle Screw Fixation and Adjacent Segment Disease in Multilevel Lumbar Fusion: A Finite Element Analysis”
    Hyung-Youl Park
    Neurospine.2026; 23(2): 502.     CrossRef
  • 5,846 View
  • 76 Download
  • 3 Web of Science
  • 2 Crossref

Regular Issue

Distal Junctional Failure After Fusion Stopping at L5 in Patients With Adult Spinal Deformity: Incidence, Risk Factors, and Radiographic Criteria
Sung Ho Do, Sungsoo Bae, Dae Jean Jo, Ho Yong Choi
Neurospine 2024;21(3):856-864.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448122.061

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Distal Junctional Failure After Fusion Stopping at L5 in Patients With Adult Spinal Deformity: Incidence, Risk Factors, and Radiographic Criteria
Neurospine. 2024;21(3):856-864.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448122.061
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Distal Junctional Failure After Fusion Stopping at L5 in Patients With Adult Spinal Deformity: Incidence, Risk Factors, and Radiographic Criteria
Neurospine. 2024;21(3):856-864.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448122.061
Close
Objective
To identify risk factors and establish radiographic criteria for distal junctional failure (DJF) in patients with adult spinal deformity (ASD), who underwent fusion surgery stopping at L5.
Methods
This retrospective study was undertaken from January 2016 to December 2020. Patients with ASD who underwent fusion surgery (≥5 levels) stopping at L5 were analyzed. DJF was defined as symptomatic adjacent segment pathology at the lumbosacral junction necessitating consideration for revision surgery. Demographic data and radiographic measurements were compared between the DJF and non-DJF groups. Receiver operating characteristic curve analysis was performed to identify the radiographic cutoff value for DJF.
Results
Among 76 patients, 16 (21.1%) experienced DJF. DJF was associated with older age, antidepressant/anxiolytic medication, longer level of fusions, and worse preoperative sagittal alignment. Antidepressant/anxiolytic medication (odds ratio, 5.60) and preoperative pelvic incidence (PI)–lumbar lordosis (LL) mismatch>40° (odds ratio, 5.87) were independent risk factors for DJF. Without both factors, the incidence of DJF has been greatly reduced (9.1%). Two radiographic criteria were determined for DJF: last distal junctional angle (DJA)>-5° and Δ last DJA–post DJA>5°. When both criteria were met, the sensitivity and specificity of the DJF were 93.3% and 91.7%, respectively.
Conclusion
Use of antidepressant/anxiolytic medication and preoperative PI–LL mismatch >40° were independent risk factors for DJF. DJF could be diagnosed using postoperative changes in the DJA. If both criteria were met, DJF could be strongly suggested.

Citations

Citations to this article as recorded by  Crossref logo
  • L5 vs. pelvic fixation as the lowest instrumented vertebra in long-segment fusion for adult spinal deformity: a systematic review and meta-analysis
    Sadegh Bagherzadeh, Faramarz Roohollahi, Natalie J. Bales, Anjali Pradhan, Sawyer Bauer, Katherine E. Baker, Joshua Vignolles-Jeong, Dana Saleh, Diego Soto Rubio, Patrick Kim, Waseem Aziz, Mark Greenberg, Mohsen Rostami, Puya Alikhani
    Spine Deformity.2026; 14(4): 1063.     CrossRef
  • Does Preoperative Spinal Alignment Influence Surgical Outcomes When Postoperative Alignment and Fixation Strategies Are Matched in ASD Correction?
    Donghua Huang, Zhan Wang, Michael Jian-Wen Chen, Annika Bay, Robert N. Uzzo, Gabrielle Dykhouse, Atahan Durbas, Andrea Pezzi, Stephane Owusu-Sarpong, Luis Felipe Colon, Kasra Araghi, Quante Singleton, Farah Musharbash, Sereen Halayqeh, Matthew E. Cunningh
    Spine.2026; 51(11): 761.     CrossRef
  • L5 Is a Reliable Lower Instrumented Vertebra in Selected Adult Spinal Deformity Patients
    Susana Núñez-Pereira, Sleiman Haddad, Lluís Vila, Anika Pupak, Eva Jacobs, Alejandro Gómez-Rice, Manuel Ramírez-Valencia, Louis Boissière, Javier Pizones, Yann-Philippe Charles, Ibrahim Obeid, Ahmet Alanay, Frank S. Kleinstueck, Ferran Pellisé
    Global Spine Journal.2026;[Epub]     CrossRef
  • An Innovative Technique of Revision Surgery for Distal Junctional Failure
    Masato Tanaka, Savvas Moschos, Chen B Jein, Aman Verma, Mohammed A Rezk Sharaf E H
    Cureus.2025;[Epub]     CrossRef
  • Distal Junctional Kyphosis and Failure in Adult Deformity Surgery Down to L5: Commentary on “Distal Junctional Failure After Fusion Stopping at L5 in Patients With Adult Spinal Deformity: Incidence, Risk Factors, and Radiographic Criteria”
    Teppei Suzuki, Takashi Yurube
    Neurospine.2024; 21(3): 865.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the September 2024 Issue
    Inbo Han
    Neurospine.2024; 21(3): 743.     CrossRef
  • 6,480 View
  • 130 Download
  • 5 Web of Science
  • 6 Crossref
Pelvic Incidence–Lumbar Lordosis Mismatch Is Predisposed to Adjacent Segment Degeneration After Single-Level Anterior Lumbar Interbody Fusion: A Retrospective Case-Control Study
Sun Geon Yoon, Hyung Chang Lee, Sang-Min Lee
Neurospine 2023;20(1):301-307.   Published online March 31, 2023
DOI: https://doi.org/10.14245/ns.2244934.467

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Pelvic Incidence–Lumbar Lordosis Mismatch Is Predisposed to Adjacent Segment Degeneration After Single-Level Anterior Lumbar Interbody Fusion: A Retrospective Case-Control Study
Neurospine. 2023;20(1):301-307.   Published online March 31, 2023
DOI: https://doi.org/10.14245/ns.2244934.467
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Pelvic Incidence–Lumbar Lordosis Mismatch Is Predisposed to Adjacent Segment Degeneration After Single-Level Anterior Lumbar Interbody Fusion: A Retrospective Case-Control Study
Neurospine. 2023;20(1):301-307.   Published online March 31, 2023
DOI: https://doi.org/10.14245/ns.2244934.467
Close
Objective
Spinopelvic parameters play important roles in clinical outcomes and disability after short-segment fusion surgery for degenerative spine disease. This study aimed to investigate the relationship between preoperative or postoperative spinopelvic parameters and symptomatic adjacent segment degeneration (ASD) after single-level anterior lumbar interbody fusion (ALIF) surgery at the L4–5 segments.
Methods
All patients who underwent single-level ALIF at the L4–5 level from January 2010 to December 2013 and were followed up for 5 years were analyzed. We collected the degree of degeneration at adjacent segments and preoperative and postoperative spinopelvic parameters. We compared the preoperative and postoperative parameters between patients with and without symptomatic ASD.
Results
Sixty-one patients were included in our study, and 30 patients had symptomatic ASD. Degeneration at adjacent segments and preoperative spinopelvic parameters did not affect the occurrence of symptomatic ASD. Patients with symptomatic ASD had higher postoperative pelvic tilt (PT) and a mismatch between lumbar lordosis (LL) and pelvic incidence (PI) compared to those without. Postoperative PT > 15° and PI–LL mismatch > 10° were significant risk factors for symptomatic ASD.
Conclusion
High PT and PI–LL mismatch were significant risk factors for symptomatic ASD after single-level ALIF surgery. Spine surgeons should consider achieving proper LL to insert the cage at the appropriate angle and prevent a PI–LL mismatch value > 10° after single-level fusion surgery.

Citations

Citations to this article as recorded by  Crossref logo
  • Sagittal Alignment and Clinical Outcomes After Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using a Single Expandable Cage: One Year Follow-up
    Sub-Ri Park, Namhoo Kim, Ji-Won Kwon, Kyung-Soo Suk, Hak-Sun Kim, Seong-Hwan Moon, Si-Young Park, Byung Ho Lee, Jae-Won Shin, Jin-Oh Park
    World Neurosurgery.2026; 205: 124698.     CrossRef
  • Individuals Over 75 Year Old Experience Greater Revisions Following Transforaminal Lumbar Interbody Fusion (TLIF): A Propensity Matched Study
    Gregory Snigur, Alejandro Perez-Albela, Puru Sadh, Ishan Shah, Maria Jensen, Kaitlyn Crow, Timothy Jeng, Bassel G. Diebo, Alan H. Daniels, Bryce A. Basques
    Global Spine Journal.2026; 16(5): 2320.     CrossRef
  • Research Progress of Adjacent Segment Degeneration after Lumbar Fusion
    健威 吴
    Advances in Clinical Medicine.2026; 16(02): 265.     CrossRef
  • Examining the Role of Pre-Operative Retrolisthesis in Single-Level Lumbar Fusion: Impact on Reoperation Rates
    Hershil Alkesh Patel, Rohan I. Suresh, Sapan Patel, Abel K. Lindley, Ethan Yang, Gerald Kidd, Evan Honig, Ryan Curto, Usman Zareef, Hans Prakash, Amil Sahai, Husni Alasadi, Alexander Padovano, Louis J. Bivona, Daniel Cavanaugh, Eugene Y. Koh, Steven C. Lu
    Journal of Clinical Medicine.2026; 15(11): 4063.     CrossRef
  • The A-Palp: A Digitized Manual Palpation Method for Sagittal Spine Assessment—A Study of Reliability over Time and Between Operators
    Guillaume Claus, Joe Abi Nader, Laurent Fabeck, Alphonse Lubansu, Patrick Salvia, Benoit Beyer, Véronique Feipel
    Biomechanics.2026; 6(2): 47.     CrossRef
  • Sarcopenia Predicts the Development of Early Adjacent Segment Disease After Transforaminal Lumbar Interbody Fusion
    Brandon M. Wilkinson, Brendan Maloney, Jian Li, Hanish Polavarapu, Dan Draytsel, Ali Hazama
    Neurosurgery.2025; 96(5): 1044.     CrossRef
  • Revision surgery rates following transforaminal lumbar interbody fusion in patients with and without osteoporosis
    Ashley Knebel, Manjot Singh, Michael J. Farias, Brian McCrae, Lauren Fisher, Joseph E. Nassar, Bassel G. Diebo, Alan H. Daniels
    The Spine Journal.2025; 25(8): 1582.     CrossRef
  • Safety and Utility of Bilateral-contralateral Decompression for Adjacent Segment Stenosis After Lumbar Interbody Fusion Using Unilateral Biportal Endoscopy
    Dong Hyun Lee, Choon Keun Park, Jae-Won Jang, Dong-Geun Lee
    Clinical Spine Surgery.2025; 38(10): E488.     CrossRef
  • The relationship between spinopelvic alignment and knee osteoarthritis in female patients: A cross-sectional study
    Öykü Tomay Aksoy, Bülent Bütün
    Journal of Back and Musculoskeletal Rehabilitation.2025; 38(5): 995.     CrossRef
  • Influence of pelvic incidence–lumbar lordosis mismatch on surgical outcomes of total hip arthroplasty: a retrospective cohort study
    Hisatoshi Ishikura, Toru Nishiwaki, Maaya Kudo, Shunsuke Minoji, Takeyuki Tanaka, Sakae Tanaka
    European Journal of Orthopaedic Surgery & Traumatology.2025;[Epub]     CrossRef
  • Letter to the editor concerning “ALIF vs. posterior fusion for lumbar degenerative disease: comparable efficacy but elevated risk of severe complications-a systematic review and meta-analysis” by FJ Onishi, et al. (Eur spine J [2025]; doi: 10.1007/s00586-
    Aécio Rubens Dias Pereira Filho, Francisco Cialdine Frota Carneiro Júnior, Vinicius de Meldau Benites
    European Spine Journal.2025; 34(10): 4833.     CrossRef
  • Principles of Level Selection for Instrumentation in Adult Thoracolumbar Spinal Deformity Surgery
    Zeeshan M. Sardar, Josephine R. Coury, Katherine Dong, Anson G. Bautista, Lawrence G. Lenke, Justin L. Reyes
    Journal of Bone and Joint Surgery.2025; 107(20): 2322.     CrossRef
  • Correlation Between Spinopelvic Sagittal Alignment Parameters and Low Back Pain
    Muhammad Bilal, Faizan Ali Janjua, Abdullah Jan, Asif Ali Jatoi, Muhammad Asad Qureshi, Ejaz Aslam
    Pakistan Journal of Health Sciences.2025; : 20.     CrossRef
  • Spino-pelvic parameters and back pain in patients without coronal deformity or history of spinal surgery: A cross-sectional analysis
    Fernando Moreno-Mateo, Silvia Santiago Maniega, Almudena Llorente Peris, Rubén Hernádez Ramajo, David César Noriega González
    Journal of Back and Musculoskeletal Rehabilitation.2024; 37(5): 1171.     CrossRef
  • Segmental Sagittal Alignment in Lumbar Spinal Fusion: A Review of Evidence-Based Evaluation of Preoperative Measurement, Surgical Planning, Intraoperative Execution, and Postoperative Evaluation
    Alan H. Daniels, Mariah Balmaceno-Criss, Christopher L. McDonald, Manjot Singh, Ashley Knebel, Michael J. Kuharski, Mohammad Daher, Daniel Alsoof, Renaud Lafage, Virginie Lafage, Bassel G. Diebo
    Operative Neurosurgery.2024; 27(5): 533.     CrossRef
  • Re-Evaluating the Long-Term Efficacy of Semi-Rigid Fixation Using a Nitinol Spring Rod in Lumbar Surgery: A Retrospective Study on an Effective Alternative for Reducing Adjacent Segment Disease
    Hyun-Jun Jang, Bong-Ju Moon, Dong-Kyu Chin
    Applied Sciences.2024; 14(11): 4574.     CrossRef
  • Relationships Between Skeletal Muscle Mass, Lumbar Lordosis, and Chronic Low Back Pain in the Elderly
    Myung Woo Park, Sang Jun Park, Sun Gun Chung
    Neurospine.2023; 20(3): 959.     CrossRef
  • 14,543 View
  • 304 Download
  • 16 Web of Science
  • 17 Crossref
Ligament Augmentation With Mersilene Tape Reduces the Rates of Proximal Junctional Kyphosis and Failure in Adult Spinal Deformity
Pope Rodnoi, Hai Le, Luke Hiatt, Joseph Wick, Joshua Barber, Yashar Javidan, Rolando Roberto, Eric O. Klineberg
Neurospine 2021;18(3):580-586.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2142420.210

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Ligament Augmentation With Mersilene Tape Reduces the Rates of Proximal Junctional Kyphosis and Failure in Adult Spinal Deformity
Neurospine. 2021;18(3):580-586.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2142420.210
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Ligament Augmentation With Mersilene Tape Reduces the Rates of Proximal Junctional Kyphosis and Failure in Adult Spinal Deformity
Neurospine. 2021;18(3):580-586.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2142420.210
Close
Objective
To investigate prevention of proximal junctional kyphosis (PJK) and failure (PJF) following adult spinal deformity (ASD) surgery utilizing a novel technique of posterior ligament augmentation with polyester fiber tether.
Methods
This study evaluated ASD adult patients who underwent posterior decompression and instrumented fusion from the thoracolumbar junction (T9–L1) to the pelvis from 2011–2017. Basic demographic data were obtained. Radiographic outcomes included proximal junctional angle (PJA), sagittal vertical axis, PJK, and PJF. The study population was divided into patients who had ASD surgery with and without ligamentous augmentation.
Results
A total of 43 subjects were evaluated, including 20 without and 23 with ligamentous augmentation. PJA increased over time for both groups. PJA was smaller for the augmented group, and rate of increase in PJA was slower in the augmented group (p < 0.0001). The rate of PJK was significantly higher in the nonaugmented group (p = 0.01). PJF was significantly less common in the augmented group (p = 0.003). Time to revision surgery was lower in the nonaugmented group (p = 0.003).
Conclusion
Our novel ligament augmentation technique utilizing polyethylene tape is an effective technique to slow progression of the PJA and lower the risk for proximal junctional disease in ASD surgery.

Citations

Citations to this article as recorded by  Crossref logo
  • Differential Risk Factors for Proximal Junctional Kyphosis Between T8-T10 and T11-L1 Upper Instrumented Vertebrae in Adult Spinal Deformity
    Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee
    Neurosurgery.2026;[Epub]     CrossRef
  • Proximal Junctional Kyphosis Prevention in Adult Spinal Deformity Surgery: A Technical Review of Tethering and Adjunctive Strategies
    Paritash Tahmasebpour, Pawel P. Jankowski, Jason Liang, Joshua Lin, Kyriakos D. Chatzis, Peter S. Tretiakov, Spencer Matthews, Louis Boissiere, John F. Burke, Christopher I. Shaffrey, Aaron Hockley, Peter Passias
    Operative Neurosurgery.2026;[Epub]     CrossRef
  • Proximal junctional kyphosis above long spinal fusions
    Léonard Chatelain, Abbas Dib, Louise Ponchelet, Emmanuelle Ferrero
    Orthopaedics & Traumatology: Surgery & Research.2025; 111(1): 104065.     CrossRef
  • Effects of Transverse Process Hook Fixation for Preventing Proximal Junctional Kyphosis/Failure in Adult Spinal Deformity Surgery: A Multiple Regression Analysis Adjusting for Confounding Factors
    Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee
    Global Spine Journal.2025; 15(7): 3138.     CrossRef
  • Risk Factor Analysis for Proximal Junctional Kyphosis in Neuromuscular Scoliosis: A Single-Center Study
    Tobias Lange, Kathrin Boeckenfoerde, Georg Gosheger, Sebastian Bockholt, Albert Schulze Bövingloh
    Journal of Clinical Medicine.2025; 14(11): 3646.     CrossRef
  • Posterior Ligamentous Augmentation is Associated With Reduced Rates of Proximal Junctional Kyphosis and Failure in Adult Spinal Deformity Surgery
    Pavlos Texakalidis, Stavros Matsoukas, Mykhaylo Krushelnytskyy, Kevin Swong, Najib El Tecle, Tyler R. Koski, Nader S. Dahdaleh
    Spine.2025; 50(13): 932.     CrossRef
  • Efficacy of Proximal Junctional Tethering in Spinal Fusion Surgery for Preventing Proximal Junctional Kyphosis and Proximal Junctional Failure: A Meta-analysis
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Review Article

The Option of Motion Preservation in Cervical Spondylosis: Cervical Disc Arthroplasty Update
Chih-Chang Chang, Wen-Cheng Huang, Jau-Ching Wu, Praveen V. Mummaneni
Neurospine 2018;15(4):296-305.   Published online December 14, 2018
DOI: https://doi.org/10.14245/ns.1836186.093

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The Option of Motion Preservation in Cervical Spondylosis: Cervical Disc Arthroplasty Update
Neurospine. 2018;15(4):296-305.   Published online December 14, 2018
DOI: https://doi.org/10.14245/ns.1836186.093
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The Option of Motion Preservation in Cervical Spondylosis: Cervical Disc Arthroplasty Update
Neurospine. 2018;15(4):296-305.   Published online December 14, 2018
DOI: https://doi.org/10.14245/ns.1836186.093
Close
Cervical disc arthroplasty (CDA), or total disc replacement, has emerged as an option in the past two decades for the management of 1- and 2-level cervical disc herniation and spondylosis causing radiculopathy, myelopathy, or both. Multiple prospective randomized controlled trials have demonstrated CDA to be as safe and effective as anterior cervical discectomy and fusion, which has been the standard of care for decades. Moreover, CDA successfully preserved segmental mobility in the majority of surgical levels for 5–10 years. Although CDA has been suggested to have long-term efficacy for the reduction of adjacent segment disease in some studies, more data are needed on this topic. Surgery for CDA is more demanding for decompression, because indirect decompression by placement of a tall bone graft is not possible in CDA. The artificial discs should be properly sized, centered, and installed to allow movement of the vertebrae, and are commonly 6 mm high or less in most patients. The key to successful CDA surgery includes strict patient selection, generous decompression of the neural elements, accurate sizing of the device, and appropriately centered implant placement.

Citations

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  • 37 Web of Science
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Clinical Article

Radiologic Changes of Operated and Adjacent Segments after Anterior Cervical Microforaminotomy
Jang Ho Ahn, Moon Sun Park, Seong Min Kim, Seung Young Chung, Do Sung Lee, Ki Seok Park
Korean J Spine 2016;13(3):134-138.   Published online September 30, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.3.134

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Radiologic Changes of Operated and Adjacent Segments after Anterior Cervical Microforaminotomy
Korean J Spine. 2016;13(3):134-138.   Published online September 30, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.3.134
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Radiologic Changes of Operated and Adjacent Segments after Anterior Cervical Microforaminotomy
Korean J Spine. 2016;13(3):134-138.   Published online September 30, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.3.134
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Objective

Anterior cervical microforaminotomy (ACMF) is a motion-preserving surgical procedure. The purpose of this study is to assess radiologic changes of operated and adjacent segments after ACMF.

Methods

We retrospectively reviewed 52 patients who underwent ACMF between 1998 and 2008. From X-ray film-based changes, disc height and sagittal range of motion (ROM) of operated and adjacent segments were compared at preoperative and last follow-up periods. Radiological degeneration of both segments was analyzed as well.

Results

The mean follow-up period was 48.2 months. There were 78 operated, 52 upper adjacent, and 38 lower adjacent segments. There were statistically significant differences in the ROM and disc height of operated segment between preoperative and last follow-up periods. However, there were no statistically significant differences in the ROM and disc height of adjacent segment between both periods. Radiological degenerative changes of operated segments were observed in 30%. That of adjacent segments was observed in 11 and 11% at upper and lower segments, respectively.

Conclusion

After mean 4-year follow-up periods, there were degenerative changes of operated segments. However, ACMF preserved motion and prevented degenerative changes of adjacent segments.

Citations

Citations to this article as recorded by  Crossref logo
  • Clinical and radiological outcomes of anterior cervical foraminotomy: Insights from a pioneering Australian case series and systematic review
    Jiahua Huang, Daniel Liu, Keshan Murugananthan, Saeed Kohan
    Journal of Clinical Neuroscience.2025; 142: 111698.     CrossRef
  • Anterior Endoscopic Cervical Discectomy: Surgical Technique and Literature Review
    Yong Ahn
    Neurospine.2023; 20(1): 11.     CrossRef
  • Long-term Radiological Evidence of Affected and Adjacent Segment Disease after Anterior Cervical Foraminotomy
    Yasufumi OHTAKE, Junya HANAKITA, Toshiyuki TAKAHASHI, Manabu MINAMI, Hirohiko NAKAMURA, Taigo KAWAOKA
    Neurologia medico-chirurgica.2020; 60(10): 492.     CrossRef
  • 9,852 View
  • 110 Download
  • 3 Crossref

Original Article

Preliminary Report on Usefulness of Adjacent Interspinous Stabilization using Interspinous Spacer Combined with Posterior Lumbosacral Spinal Fusion in Degenerative Lumbar Disease.
Dong Cheon Kim, Woo Jin Choe, Sang Keun Jang
Korean J Spine 2009;6(3):149-155.

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Preliminary Report on Usefulness of Adjacent Interspinous Stabilization using Interspinous Spacer Combined with Posterior Lumbosacral Spinal Fusion in Degenerative Lumbar Disease.
Korean J Spine. 2009;6(3):149-155.
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Preliminary Report on Usefulness of Adjacent Interspinous Stabilization using Interspinous Spacer Combined with Posterior Lumbosacral Spinal Fusion in Degenerative Lumbar Disease.
Korean J Spine. 2009;6(3):149-155.
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OBJECTIVE
Posterior lumbar or lumbosacral spinal fusion in degenerative lumbar disease has the problems of adjacent level disease as well as surgical complications. An interspinous device used for dynamic stabilization can also be applied to the adjacent segment for spinal fusion to reduce the severity of these problems. The authors reviewed the adjacent interspinous stabilization using an interspinous spacer(CoflexTM paradigm spine,Germany) combined with posterior lumbar or lumbosacral spinal fusion in degenerative lumbar disease.
Method
From January 2007 to July 2008, ten patients with degenerative lumbar disease underwent posterior lumbar or lumbosacral spinal fusion with adjacent interspinous stabilization using CoflexTM. The indications for this type were adjacent segmental disc protrusion, adjacent segmental degenerative changes or high surgical risk groups, such as elderly patients or osteoporotic patients undergoing multiple leveled fusions. CoflexTM was inserted into the adjacent segmental interspinous space. The control group consisted of fifteen patients, who underwent posterior lumbar or lumbosacral spinal fusion without interspinous stabilization. The radiological parameters and clinical outcomes were compared. All patients were followed-up for more than twelve months.
RESULTS
The visual analogue scale(VAS) in both groups postoperatively and at the twelve month follow-up were improved. In the CoflexTM group, the postoperative and twelve month follow-up X-ray showed no significant change in posterior disc height, interpedicular height, segmental lordotic angle, flextion-extension angulation and translation and no significant segmental instability. The control group showed a higher level of segmental lordotic angle, translation and a lower posterior disc height, interpedicular height, flextion-extension angulation and three patients showed adjacent segmental instability.
CONCLUSION
CoflexTM can be used to stabilize the adjacent segment of spinal fusion in degenerative lumbar disease and might be effective in preventing adjacent segmental degeneration. However, further study will be needed to confirm this observation.
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