Early catastrophic proximal junctional fracture after spinal instrumentation in geriatric patients

Aim: The purpose of this investigation was to evaluate the effectiveness of pedicle screw fixation and bilateral hooks in the prevention of proximal junctional kyphosis (PJK) and proximal junctional proximal junctional insufficiency/failure (PJI) among high-risk elderly patients. Material and Methods: This retrospective study included 56 high-risk elderly patients who underwent long-segment spinal instrumentation and fusion between 2021 and 2024. Group A consisted of 26 patients who received pedicle screw fixation, while Group B comprised 30 patients who underwent bilateral hook placement during surgery. The primary outcomes were the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Preoperative and postoperative assessments, including the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI) for functional status, and the 36-Item Short Form Health Survey (SF-36) for quality of life, were retrieved from patient medical records. Results: PJK occurred in 26.9% of the pedicle screw group (Group A) compared with 6.7% in the bilateral-hook group (Group B), while PJF rates were 19.2% and 3.3%, respectively (p < 0.05). Neurologic deficits developed in 11.5% in Group A and 3.3% in Group B (p = 0.044). Significant improvements were observed in postoperative VAS, ODI, and SF-36 scores in both groups, with Group B showing better outcomes (p < 0.001). Age over 70 years (OR 1.68–2.24), T-score ≤ −2.5 (OR 1.92), number of previous operations (OR 1.64–2.86), an upper-instrumented vertebra at T10 or above (OR 1.78), and pedicle screw fixation (OR 2.84) were independent risk factors for increasing the risk of developing PJK/PJF. Conclusion: This study indicates that the use of bilateral hooks reduces the risk of proximal junctional kyphosis and proximal junctional fracture in elderly high-risk patients after spinal fusion compared with pedicle screw fixation alone. Bilateral-hook placement was associated with lower complication rates and better clinical outcomes in terms of pain reduction, functional improvement, and return to daily activities.