Proximal Junctional Spondylodiscitis Following Adult Spinal Deformity Surgery: Case Series and Review of the Literature

Joseph R Mendelis; Nicole J Hung; Vedat Deviren; Christopher P Ames; Aaron J Clark; Alekos A Theologis

doi:10.14444/8327

Proximal Junctional Spondylodiscitis Following Adult Spinal Deformity Surgery: Case Series and Review of the Literature

Int J Spine Surg. 2022 Dec;16(6):1054-1060. doi: 10.14444/8327. Epub 2022 Jul 13.

Authors

Joseph R Mendelis^#¹, Nicole J Hung^#¹, Vedat Deviren¹, Christopher P Ames², Aaron J Clark², Alekos A Theologis³

Affiliations

¹ Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA.
² Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
³ Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA alekos.theologis@ucsf.edu.

^# Contributed equally.

PMID: 35831064
PMCID: PMC9807054
DOI: 10.14444/8327

Abstract

Background: Proximal junctional failure (PJF) following multilevel thoracolumbar instrumented to the pelvis for adult spinal deformity (ASD) is relatively uncommon but considerably disabling. While the leading etiology is mechanical, other rarer etiologies can play a role in its development. The purpose of this study was to present a case series of ASD patients who experienced PJF secondary to proximal junctional spondylodiscitis (PJS) after long-segment thoracolumbar posterior instrumented fusions.

Methods: Adult patients who underwent posterior instrumented fusions at a single academic center between 2017 and 2020 and subsequently developed PJS were retrospectively reviewed. Patient demographics, operative details, clinical presentation, culture data, and management approach were evaluated.

Results: Three patients developed PJS and were included for analysis (mean age 67 years [range, 58-76]; women: 2). Indication for all index operations was symptomatic ASD after failed conservative management. Clinical presentation ranged from mild back pain to severe neurological compromise. Average time to infection and PJF after the index procedure was 11 months (range, 3 months-2 years). All 3 patients were successfully managed with urgent revision surgery including surgical debridement and postoperative antibiotics.

Conclusion: PJS is a rare yet potentially devastating complication following long-segment posterior thoracolumbar instrumented fusions for ASD. It is critical that surgeons maintain a high index of suspicion of infection when managing PJF given the potential neurological morbidity of PJS.

Clinical relevance: This report highlights a rare but important cause of PJF following ASD surgery. It is critical that one maintains a high index of suspicion of infection when managing PJF.

Keywords: adult spinal deformity; infection; proximal junctional failure; proximal junctional kyphosis; proximal junctional spondylodiscitis.

This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2022 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.