{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T14:27:35Z","timestamp":1768832855588,"version":"3.49.0"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>A tether pedicle screw (TPS) enables individual stepless pretensioning and is placed at one or two levels above the upper instrumented vertebra (UIV+1 and UIV+2, respectively). This study aimed to evaluate a novel customized TPS for the prevention of proximal junctional kyphosis (PJK) and to investigate the potential to generate a smoother force transition from cranial to long fusion during trunk flexion, instead of an abrupt change at the UIV, following adult spinal deformity surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A finite element model was designed based on an adult patient with spinal deformity instrumented from T10 to S1. Five different sagittal balance types and implant configurations were tested. The proximal range of motion (ROM) and intervertebral stress were examined, with a special focus on their respective discontinuities.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Tension shielding at UIV\/UIV+1 by the TPS was consistent irrespective of sagittal profiles. The use of TPSs at UIV+1 and UIV+2 increased the efficacy in reducing spinal ROM discontinuity at UIV\/UIV+1, as compared with the use of TPSs at UIV+1 only. Through the use of two pairs of TPSs cranial to the UIV, the optimal tension configuration could be defined to avoid a reduction effect at UIV+1. Neither the addition of transition rods to the TPSs nor the use of transition rods in combination with standard pedicle screws improved the junctional mechanics when compared with TPSs at UIV+1\/UIV+2.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>A smoother motion discontinuity at the UIV can be achieved via implementation of a TPS strategy. This new technology shows favorable in silico mechanics for reducing the risk of PJK.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.12.spine23792","type":"journal-article","created":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T16:55:17Z","timestamp":1713286517000},"page":"611-621","source":"Crossref","is-referenced-by-count":3,"title":["The potential of proximal junctional kyphosis prevention using a novel tether pedicle screw construct: an in silico study comparing the influence of standard and dynamic techniques on adjacent-level range of motion and load pattern"],"prefix":"10.3171","volume":"40","author":[{"given":"Sebastian","family":"Decker","sequence":"first","affiliation":[{"name":"Department of Trauma Surgery, Hannover Medical School, Hannover, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heiko","family":"Koller","sequence":"additional","affiliation":[{"name":"International Center for Spinal Disease and Deformities, Asklepios Clinics Bad Abbach, Germany;"},{"name":"Paracelsus Medical University, Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Overes","sequence":"additional","affiliation":[{"name":"Ignite Concepts GmbH, Biberist, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Montali","sequence":"additional","affiliation":[{"name":"Technology Transfer, AO Foundation, Davos, Switzerland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julien","family":"Clin","sequence":"additional","affiliation":[{"name":"Numalogics, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bahe","family":"Hachem","sequence":"additional","affiliation":[{"name":"Numalogics, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"Eur Spine J","first-page":"2726","article-title":"Proximal junctional kyphosis following adult spinal deformity surgery","volume":"23","author":"Cho SK","year":"2014","unstructured":"Cho SK, Shin JI, Kim YJ. Proximal junctional kyphosis following adult spinal deformity surgery. Eur Spine J. 2014;23(12):2726\u20132736."},{"issue":"8","key":"b2","series-title":"Global Spine J","first-page":"1934","article-title":"Complications in the elderly population undergoing spinal deformity surgery: a systematic review and meta-analysis","volume":"12","author":"Alvarez Reyes A","year":"2022","unstructured":"Alvarez Reyes A, Jack AS, Hurlbert RJ, Ramey WL. Complications in the elderly population undergoing spinal deformity surgery: a systematic review and meta-analysis. Global Spine J. 2022;12(8):1934\u20131942."},{"issue":"3","key":"b3","series-title":"Asian Spine J","first-page":"440","article-title":"Proximal junctional kyphosis in adult spinal deformity: definition, classification, risk factors, and prevention strategies","volume":"16","author":"Kim HJ","year":"2022","unstructured":"Kim HJ, Yang JH, Chang DG,  Proximal junctional kyphosis in adult spinal deformity: definition, classification, risk factors, and prevention strategies. Asian Spine J. 2022;16(3):440\u2013450."},{"issue":"19","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"1681","article-title":"Hospital readmission after spine fusion for adult spinal deformity","volume":"38","author":"Schairer WW","year":"2013","unstructured":"Schairer WW, Carrer A, Deviren V,  Hospital readmission after spine fusion for adult spinal deformity. Spine (Phila Pa 1976). 2013;38(19):1681\u20131689."},{"issue":"3","key":"b5","series-title":"Eur Spine J","first-page":"613","article-title":"Proximal junctional kyphosis in adult scoliosis: comparison of four radiological predictor models","volume":"27","author":"Sebaaly A","year":"2018","unstructured":"Sebaaly A, Riouallon G, Obeid I,  Proximal junctional kyphosis in adult scoliosis: comparison of four radiological predictor models. Eur Spine J. 2018;27(3):613\u2013621."},{"issue":"25","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"2093","article-title":"Proximal junctional kyphosis and failure after spinal deformity surgery: a systematic review of the literature as a background to classification development","volume":"39","author":"Lau D","year":"2014","unstructured":"Lau D, Clark AJ, Scheer JK,  Proximal junctional kyphosis and failure after spinal deformity surgery: a systematic review of the literature as a background to classification development. 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