Retrospective case-control study OBJECTIVES: The purpose of this study was to review the outcomes of patients undergoing prophylactic CA of pedicle screws and adjacent levels in patients undergoing spinal fusion.
Between 2003 and 2018, 59 patients underwent CA of pedicle screws for spinal fusion. Most patients (83%) underwent postoperative CA, while 17% underwent intraoperative CA. Outcomes of CA techniques were compared and patients undergoing CA for a thoracolumbar fusion (n=51) were compared to a cohort not undergoing CA (n=39). Mean follow-up was 3-years.
In patients receiving CA, survival free of PJK was 94%, 60%, and 20% at 2-, 5-, and 10-years postoperatively. Survival free of revision was 95%, 83%, and 83% at 2-, 5-, and 10-years postoperatively. The development of PJK (p=0.02, OR 24.44) was associated with revision surgery. There were 4 (7%) cardiopulmonary complications. Those who received CA for a thoracolumbar fusion were older (70 vs 65 years) and were more likely to have osteoporosis (53% vs 5%) than those who did not. CA was associated with a decreased risk of PJK (p=0.009, OR 0.16) while osteoporosis (p=0.05, OR 4.10) and fusion length ≥ 8 (p=0.06, 2.65) were associated with PJK. PJK was associated with revision surgery (OR 12.65, p=0.006).
CA allows for substantial rates of radiographic PJK; however, this typically does not result in a need for revision surgery and leads to revision and PJK rates that are comparable to patients undergoing long segment fusions without osteoporosis.

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