Neurospine.
2025 Sep;22(3):663-677. 10.14245/ns.2550726.363.
Efficacy of Proximal Junctional Tethering in Spinal Fusion Surgery for Preventing Proximal Junctional Kyphosis and Proximal Junctional Failure: A Meta-analysis
- Hsu YC1
- Lee HT
1 - Su YF2
- Chen YC3,4
- Hu SS5
- Hsu CC6
- Tsai PI7
- Hsu WB2,8
- Lin DT7
- Lee CY2,8
- Huang TJ2,8
- Nguyen TLM9,10
- Wu MH2,8
- Affiliations
-
- 1School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- 2Department of Orthopedic Surgery, Taipei Medical University Hospital, Taipei, Taiwan
- 3Department of Family Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- 4Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- 5Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA
- 6Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
- 7Biomedical Technology and Device Research Labs, Industrial Technology Research Institute, Hsinchu, Taiwan
- 8Department of Orthopedics, College of Medicine, Taipei Medical University, Taipei, Taiwan
- 9The International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- 10Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- KMID: 2571885
- DOI: http://doi.org/10.14245/ns.2550726.363
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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