PT  - JOURNAL ARTICLE
AU  - Mendelis, Joseph R.
AU  - Hung, Nicole J.
AU  - Deviren, Vedat
AU  - Ames, Christopher P.
AU  - Clark, Aaron J.
AU  - Theologis, Alekos A.
TI  - Proximal Junctional Spondylodiscitis Following Adult Spinal Deformity Surgery: Case Series and Review of the Literature
AID  - 10.14444/8327
DP  - 2022 Dec 01
TA  - International Journal of Spine Surgery
PG  - 1054--1060
VI  - 16
IP  - 6
4099  - https://www.ijssurgery.com/content/16/6/1054.short
4100  - https://www.ijssurgery.com/content/16/6/1054.full
SO  - Int J Spine Surg2022 Dec 01; 16
AB  - Background Proximal junctional failure (PJF) following multilevel thoracolumbar instrumented to the pelvis for adult spinal deformity (ASD) is relatively uncommon but considerably disabling. While the leading etiology is mechanical, other rarer etiologies can play a role in its development. The purpose of this study was to present a case series of ASD patients who experienced PJF secondary to proximal junctional spondylodiscitis (PJS) after long-segment thoracolumbar posterior instrumented fusions.Methods Adult patients who underwent posterior instrumented fusions at a single academic center between 2017 and 2020 and subsequently developed PJS were retrospectively reviewed. Patient demographics, operative details, clinical presentation, culture data, and management approach were evaluated.Results Three patients developed PJS and were included for analysis (mean age 67 years [range, 58–76]; women: 2). Indication for all index operations was symptomatic ASD after failed conservative management. Clinical presentation ranged from mild back pain to severe neurological compromise. Average time to infection and PJF after the index procedure was 11 months (range, 3 months–2 years). All 3 patients were successfully managed with urgent revision surgery including surgical debridement and postoperative antibiotics.Conclusion PJS is a rare yet potentially devastating complication following long-segment posterior thoracolumbar instrumented fusions for ASD. It is critical that surgeons maintain a high index of suspicion of infection when managing PJF given the potential neurological morbidity of PJS.Clinical Relevance This report highlights a rare but important cause of PJF following ASD surgery. It is critical that one maintains a high index of suspicion of infection when managing PJF.Level of Evidence 4.