Tapered Rods For The Prevention Of PJK After Spinal Deformity Surgery

Introduction: Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) can be
catastrophic complications associated with adult spinal deformity (ASD) surgery. These
complications are significantly influenced by instrumentation configuration. Multiple
adjuvant methods, including tethers and tapered rod constructs, have been developed
to prevent PJK. We aimed to investigate the utility of tapered rod constructs in
preventing PJK and/or PJF after ASD surgery.

Methods: We conducted a retrospective chart review to identify patients aged ≥50 years who had
received ASD surgery involving 5 or more thoracolumbar levels. Demographic,
spinopelvic parameters, and procedure-related variables were collected. Univariate
analysis and multivariate logistic regression were performed to determine if the use of
tapered rods was a protective factor for PJK/PJF.

Results: A total of 60 patients were included (mean age, 64.1 ± 6.8 years). Among them, 21
patients (35%) developed PJK/PJF, with only 5 of these patients having undergone a
construct with tapered rods. On multivariate analysis, preoperative SVA was associated
with PJK (odds ratio = 1.5, 95% CI = 1.48-1.83, P<.001), and the use of tapered rods
was found to be a protective factor (odds ratio = 0.45, 95% CI = 0.35-0.65, P< .001).

Conclusion : The use of tapered rods during spinal deformity surgery was a protective factor against
PJK/PJF. A randomized controlled study is recommended to further validate these
findings.