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Background: PJF is a known complication following posterior spinal fusion surgery and can be most simply defined as any adverse event necessitating surgical revision of the proximal instrumentation of the spine. PJF is associated with pain, decreased neurologic function, infection, and increased morbidity. Very little literature exists on this topic in children or on specific surgical techniques for revision surgery.

Methods: The revision technique involves extending the spine instrumentation proximally with paired sets of sublaminar bands used as anchors. The bands are gradually and sequentially tightened, bringing the spine into a corrected sagittal position. Patients who underwent this procedure and had at least two years of follow-up were identified. Demographic and clinical data, as well as plain radiographic and CT sagittal spine parameters were analyzed before the surgery and at the most recent follow-up.

Results: Eight children, average age 14 years, 10 months, were included in the study with an average follow-up time of 31 months. The revision surgery occurred approximately three years following the initial surgery. There was 20° (ranging from an increase of 18° to a decrease of 46°) mean kyphotic angle correction at the site of the failure and 16° (ranging from an increase of 24° to a decrease of 78°) mean cervical lordosis correction, utilizing an average of 6 bands. Before revision, all patients reported neck/upper back pain, with rod prominence. At the most recent post revision visit, pain was markedly reduced, and rod prominence had resolved. One patient reported an increased satisfaction with appearance, and another noted that maintaining horizontal gaze was easier.

Conclusion: Children who received this surgical technique for their PJF experienced resolution of pain and upper rod prominence and improved cervical spine sagittal radiographic parameters that was maintained at 2 years after revision surgery.

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A New Surgical Technique For Salvage Of Post-Operative Proximal Junctional Failure In Pediatric Patients–A Case Series