Researchers conducted a retrospective cohort study. For a study, they sought to compare pedicle screws (PSs) and transverse process hooks (TPHs) as anchors in elderly patients with adult spinal deformity at the uppermost instrumented vertebra (UIV) in the lower thoracic spine. Investigators looked back at 53 patients aged 65 and higher who had a spinal fusion from the pelvis to T9 or T10, with a minimum of a year of follow-up. At the UIV, 28 patients with TPHs and 25 patients PSs were compared in terms of radiographic results, including proximal junctional kyphosis (PJK) and implant failure incidence. The radiography readings for pelvic incidence-lumbar lordosis (42.8 vs 49.0 degrees, postoperative: 9.9 vs 7.3 degrees) and the sagittal vertical axis (preoperative: 109.3 vs 106.8 mm; postoperative: 21.9 vs 11.2 mm) were identical in both the TPH and PS groups. At the 1-year follow-up, however, the incidence of PJK was substantially higher in the TPH group (35.7%) than in the PS group (8.0%) (P=0.012). In the TPH group, PJK was linked to a UIV or UIV1 fracture and posterior TPH dislodgement. In older patients undergoing spinopelvic fusion, rigid fixation with PSs at the UIV in the lower thoracic spine produced superior radiographic results than TPHs.
