I mentioned in a previous blog that I’ve been working on a new technique to help fix severe kyphosis at the the cervico-thoracic junction. One of the potential complications from kyphosis and some scoliosis surgeries is that patients can develop a fracture and/or spondylolisthesis/slippage at the top of the fusion. This is called proximal junctional kyphosis or PJK. We see it mostly in our older guests who have more osteoporosis, although I’ve seen it happen in some younger patients as well and even a couple teenagers.

Often the way we fix this is by using a tapered rod, which goes from a standard 5.5 or 6 mm in diameter down to a smaller diameter to allow for fixation to the cervical spine. These rods, however, can appear a bit too weak when you are trying to lever the spine into a better non-kyphotic posture, even though we also do a bone wedge or osteotomy to help free up the spine so it will be able to move.

Wearing my engineer hat, I remembering success many of us had using Luque boxes, which were a very strong stainless steel rectangle we used to use for spine fracture treatment with sublaminar wires. We can’t even get Luque boxes anymore, and the small supply we had at “Big Duke” have apparently been used up! I wondered if we could use a Luque Box like construct to help provide a strong reinforcement at top of the construct which could then be connected to the old hardware. The lower cervical spine could be connected to this frame using sublaminar strong fibrous tapes called “Universal Clamps” from Zimmer, and also pedicle screws as needed in the upper thoracic and possibly C7 as well.