Our Summary

Spinal fusion is a surgery to connect two or more vertebrae in your spine, eliminating any movement between them. However, this procedure can sometimes lead to a problem called proximal junctional kyphosis (PJK), which is a type of spinal curvature that can cause pain and other issues. This study aimed to identify the best levels of the spine to fuse to prevent PJK.

The researchers used computer simulations based on CT scans of a healthy adult’s spine. They looked at nine common methods for spinal fusion surgery. They compared the stress on different parts of the spine after these different surgeries while the simulated spine was in an upright position.

The study found that there was more stress on certain parts of the spine when no fusion was done. When they did simulate fusion, the highest stress levels were seen in specific areas - T2 and L2 in medical terms.

There was some disagreement about whether to fuse at the T10 level, and the study points out that they only simulated conditions with gravity’s force. They suggest that more research is needed before we can make final decisions about the best ways to prevent PJK after spinal fusion surgery.

FAQs

  1. What is proximal junctional kyphosis (PJK) and how is it related to spinal fusion surgery?
  2. What did the study find about the best levels of the spine to fuse to prevent PJK?
  3. Why does the study suggest that more research is needed to prevent PJK after spinal fusion surgery?

Doctor’s Tip

In light of this research, a doctor might advise a patient undergoing spinal fusion surgery to discuss with their surgeon the specific levels of the spine that will be fused to minimize the risk of developing PJK. It is important to have a thorough discussion with your healthcare provider about the potential risks and benefits of the surgery and to follow their post-operative instructions carefully to ensure the best possible outcome. Additionally, maintaining a healthy lifestyle, including regular exercise and proper nutrition, can help support the healing process and overall spine health after surgery.

Suitable For

Patients who are typically recommended spinal fusion surgery include those with:

  1. Degenerative disc disease
  2. Scoliosis
  3. Spinal stenosis
  4. Spondylolisthesis
  5. Herniated disc
  6. Spinal fractures
  7. Spinal tumors

It is important for patients to discuss their specific condition and treatment options with their healthcare provider to determine if spinal fusion surgery is the best course of action for them.

Timeline

Before spinal fusion:

  1. Patient experiences chronic back pain, numbness, weakness, or other symptoms.
  2. Patient undergoes various non-surgical treatments such as physical therapy, medication, or injections.
  3. If non-surgical treatments fail, patient and surgeon decide on spinal fusion surgery as a last resort.

After spinal fusion:

  1. Patient undergoes pre-operative preparations such as blood tests, imaging tests, and consultations with the surgical team.
  2. Patient undergoes spinal fusion surgery, which typically lasts a few hours and involves connecting the vertebrae with metal hardware and bone grafts.
  3. Patient stays in the hospital for a few days for monitoring and post-operative care.
  4. Patient undergoes a rehabilitation program to regain strength and mobility in the spine.
  5. Patient experiences gradual improvement in symptoms over several weeks to months.
  6. Patient follows up with the surgeon for regular check-ups and monitoring of the fusion’s success.
  7. Patient resumes normal activities with reduced pain and improved spinal stability.

What to Ask Your Doctor

Some questions a patient should ask their doctor about spinal fusion in relation to PJK include:

  1. What is the likelihood of developing proximal junctional kyphosis (PJK) after spinal fusion surgery?
  2. What are the potential risk factors for developing PJK?
  3. What specific levels of the spine are typically fused during spinal fusion surgery?
  4. Is there a way to determine if I am at a higher risk for PJK before undergoing surgery?
  5. What steps can be taken during surgery to reduce the risk of developing PJK?
  6. How often do patients experience PJK after spinal fusion surgery?
  7. What are the symptoms of PJK and how is it typically treated?
  8. Are there any lifestyle changes or precautions I can take to reduce my risk of developing PJK post-surgery?
  9. Are there any specific exercises or physical therapy techniques that can help prevent PJK after spinal fusion surgery?
  10. What ongoing monitoring or follow-up care will be recommended to ensure early detection and management of PJK if it does occur?

Reference

Authors: Zhu WY, Zang L, Li J, Guan L, Hai Y. Journal: Braz J Med Biol Res. 2019;52(5):e7748. doi: 10.1590/1414-431X20197748. Epub 2019 Apr 25. PMID: 31038576