Comparison of Hook Fixation and Vertebroplasty for Prevention of Proximal Junctional Failure: A Retrospective Cohort Study.

Abstract

Study DesignRetrospective cohort study.ObjectiveTo compare the association of vertebroplasty and hook fixation at the uppermost instrumented vertebra (UIV) with proximal junctional failure (PJF) after long-segment fusion for degenerative sagittal imbalance (DSI).MethodsA total of 139 patients with DSI who underwent posterior fusion from T9/T10 to the pelvis between 2016 and 2022 were retrospectively reviewed. Patients were categorized into three groups according to proximal junctional strategy: vertebroplasty (n = 21), hook fixation (n = 47), and control (n = 71). The primary outcome was PJF incidence; secondary outcomes included proximal junctional kyphosis (PJK), distal junctional failure, rod breakage, and changes in global sagittal alignment. Multivariate logistic regression was performed to identify independent factors associated with PJF.ResultsThe overall incidence of PJF was significantly lower in the intervention group (vertebroplasty or hook) than in controls (5.9% vs 21.1%, <i>P</i> = 0.009). Within the intervention subgroups, hook fixation showed a lower PJF rate (4.3%) than vertebroplasty (9.5%), although the difference was not statistically significant (<i>P</i> = 0.544). Multivariate analysis demonstrated that hook fixation was independently associated with reduced PJF (OR 0.04, <i>P</i> = 0.015). The incidence of PJK did not differ significantly among groups (<i>P</i> = 0.640).ConclusionsIn this retrospective cohort, hook fixation was associated with a lower incidence of PJF, whereas vertebroplasty did not reach statistical significance. These findings suggest that proximal junctional strategies may influence PJF. Prospective randomized controlled trials are needed to confirm these findings and define optimal prophylactic strategies.