Objective: To investigate the clinical outcome and preventive effect of
polyetheretherketone(
PEEK) rod hybrid surgery on proximal junction failure(PJF) after long-segment fusion of adult spinal
deformity. Methods: A retrospective study was conducted to analyze patients with degenerative
scoliosis/
kyphosis who underwent long-segment
decompression and fusion surgery at Department of Orthopedics, Peking University First Hospital from January 2017 to December 2021. A total of 75 patients were included in the study, including 14 males and 61 females, aged (67.2±6.8)years (range:55 to 84 years). According to the operation method chosen by the patients, the patients were divided into
PEEK rod hybrid group (20 cases) and traditional
titanium rod group (55 cases). The general information of the patients was collected, and the coronal and sagittal parameters of the spine were measured before operation, at 1 month after operation, and at the last follow-up. The clinical effect of surgery was judged by the visual analogue scale (VAS) and Oswestry disability index (ODI). Whether proximal junctional
kyphosis (PJK) and PJF occurred during the follow-up and the time of occurrence were recorded. Comparisons between groups were performed using independent sample t test, Mann-Whitney U test, χ2 test and Fisher's exact probability method. The data before and after surgery in the same group were compared using the paired sample t test and the Wilcoxon test. Results: There were no significant differences in age, gender, body mass index, bone mineral density, distal instrumented vertebrae, surgical segments,
osteotomy method, operation time, and intraoperative
bleeding between the two groups (all P>0.05). The follow-up time of the
PEEK rod group was shorter(M(IQR)16.5(4.8) vs. 25.0(12.0),Z=-4.230,P<0.01). There were no significant differences in coronal, sagittal parameters, VAS and ODI between the two groups before operation (all P>0.05). Postoperative coronal Cobb angle, pelvic incidence, pelvic tilt, sacral slope, lumbar
lordosis, thoracic
kyphosis, sagittal vertical axis (SVA), VAS and ODI were significantly improved in both groups(all P<0.05). At the last follow-up, the SVA of the
PEEK rod hybrid group was(3.74±2.40)cm, which was significantly lower than that of the
titanium rod group (6.28±4.06)cm (t'=-3.318, P=0.002). At the last follow-up, the ODI of the
PEEK rod hybrid group was 30.7±6.1, significantly better than the
titanium rod group 39.3±17.2(t=-3.203, P=0.046). PJK occurred in 2 patients (10.0%) in the
PEEK rod hybrid group, and no PJF phenomenon was observed. In the
titanium rod group, 18 patients (32.7%) developed PJK, and 11 patients (20.0%) developed PJF. There was a statistically significant difference in the incidence of PJF between the
PEEK rod hybrid group and the
titanium rod group (P=0.031). Conclusions:
PEEK rod hybrid surgery can achieve good clinical results in the treatment of adult spinal
deformities. Compared with traditional
titanium rod surgery, it can significantly reduce the incidence of postoperative PJF and improve the clinical function of patients.