I just finished helping Suzanne, who is a 63 yo woman with history of previous revision T11-Iliac wing instrumentation and fusion.
She did great for quite a while, but then developed proximal junctional kyphosis of 26 degrees at level just above her fusion with severe pain, deformity and thoracic spinal stenosis.
We fixed this today using a thoracic osteotomy, and extension instrumentation and fusion with a more flexible titanium rod, and a special less invasive technique at the top to gently transfer the load to the top T2 segment using sub laminar fiber wire wrapped twice around the lamina on each side to form a "lasso". At recent SRS meeting this fall in Loiusville, many of us from around the around the world brainstormed during a special seminar on PJK to come up with new solutions, and this idea was spurred on by that dialogue as well as discussions with our NC State Bioengineering lab where we are building special computer models (finite element models) of the human spine with instrumentation constructs.
I was able to get a complete correction of that 26 degree junctional kyphosis with use of the osteotomy, laminectomy and instrumentation techniques.
New technique worked smoothly. Brittaney was my assist this morning and did a great job along with motorcycle Dan "Scrubs" my scrub tech, and Sandra, and of course, Nurse Kelly!
We will be tracking the outcomes of this patient, along with our other patients as we continue to seek to improve surgical techniques to increase quality of life while decreasing complications and using scarce resources wisely.
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Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com