Long-segment spinal fusion problems are well-known, such as proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Previous research has shown that ligament augmentation can reduce the incidence of PJF by reducing junctional stress and strengthening the upper instrumented vertebrae (UIVs) and neighboring segments. However, long-term data on the effectiveness of ligament augmentation in avoiding PJF is lacking. The authors of this study wanted to see if ligament augmentation had any effect on PJF rates in a group of adult spinal deformity patients who had been followed for at least a year.

The researchers found a total of 242 patients having ligament augmentation (166 women [68.6%]) with an average age of 66 years. The average number of fused levels was ten, with the subsequent UIV distribution: 90 upper thoracic UIVs (37.2%) and 152 lower thoracic UIVs (62.8%). Only ligament augmentation (OR 0.184, 95% CI 0.071–0.478, p = 0.001) and the number of fused levels (OR 0.762, 95% CI 0.620–0.937, p = 0.010) were linked to a lower risk of PJF reoperation in a multivariate model.

Ligament augmentation was linked to a lower rate of PJF reoperation after 12 months in a group of adult patients with spinal deformities. Patients with lower thoracic UIV had the most substantial reduction. These findings imply that ligament augmentation may be a useful adjuvant for PJF reduction in selected patients; nevertheless, long-term follow-up is required.