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Surgical technique: proximal extension of instrumentation using sublaminar bands for salvage of postoperative proximal junctional failure in pediatric patients

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Abstract

Purpose

Proximal junctional failure is a complication that can occur following posterior spine surgery with instrumentation. The ability to surgically revise this complication is important for the spine surgeon, yet there is little literature on the topic, especially for pediatric patients.

Methods

The technique we describe involves proximal extension of the existing instrumentation using paired levels of sublaminar bands that allows for a smooth transition of forces at the junction of instrumented and non-instrumented regions of the spine.

Results

The results of this technique have been promising with a case series demonstrating improved radiographic and clinical outcomes for eight children at a minimum of 1 year follow-up.

Conclusion

This a reliable, effective, and safe technique for salvage of PJF in children that uses posterior osteotomies and proximal extension of the instrumentation using sublaminar bands, resulting in gradual load sharing correction to restore sagittal balance.

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Funding

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Authors and Affiliations

  1. KU School of Medicine, Kansas City, KS, USA

    Mason A. Fawcett

  2. Department of Orthopaedic Surgery and Musculoskeletal Sciences, Children’s Mercy Hospital, Kansas City, MO, USA

    Richard M. Schwend

Authors
  1. Mason A. Fawcett
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  2. Richard M. Schwend
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Contributions

Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work: Mason Fawcett and Richard Schwend. Drafted the work or revised it critically for important intellectual content: Mason Fawcett and Richard Schwend. Approved the version to be published: Mason Fawcett and Richard Schwend. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Mason Fawcett and Richard Schwend.

Corresponding author

Correspondence to Mason A. Fawcett.

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Fawcett, M.A., Schwend, R.M. Surgical technique: proximal extension of instrumentation using sublaminar bands for salvage of postoperative proximal junctional failure in pediatric patients. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00851-w

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