European Spine Journal - 2026-03-07 - Journal Article
Correction of proximal junctional failure using transforaminal thoracic interbody fusion: a technical note.
Ladd B, Jones K, Polly D
Topics
Key Takeaway
TTIF achieved mean 15° kyphosis correction and 12.2% ODI improvement at 1 year in 22 patients with thoracic proximal junctional failure, with 100% arthrodesis rate.
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Summary
This single-center retrospective study evaluated TTIF as a posterior-only, pedicle-sparing revision strategy for thoracic PJF in 22 patients from 2014–2020. Mean kyphosis correction was 15° ± 10° (range 0°–40°), all but one patient met sagittal alignment goals, and 100% achieved arthrodesis. Mean ODI improved 12.2% ± 20.0% at 1 year (p=0.048), though the wide range (-18.0% to 54.7%) indicates heterogeneous functional outcomes.
Key Limitation
The wide ODI range (-18.0% to 54.7%) and small heterogeneous cohort (n=22) prevent determining which patient or deformity characteristics predict meaningful functional benefit from TTIF versus alternative revision strategies.
Original Abstract
OBJECTIVE
Proximal Junctional Failure (PJF) is a known complication of instrumented spine surgery. When a construct ends in the lower thoracic spine, PJF occurring at the suprajacent level can be difficult to adequately correct. Transforaminal Thoracic Interbody Fusion (TTIF) is a posterior-only pedicle-sparring approach that may offer effective correction of thoracic PJF.
METHODS
This report details a single-center retrospective review of patients who underwent TTIF for PJF correction from 2014-2020. Demographic data, operative details, and Oswestry Disability Index (ODI) was included for all patients with at least 1 year follow-up. Preoperative and postoperative full-spine radiographs were assessed for correction of proximal junctional kyphosis (PJK). Surgical complications were recorded.
RESULTS
A total of 22 patients underwent TTIF for PJF correction. Average kyphosis correction was 15° ± 10° (range 0° - 40°). All patients achieved correction to their physiologic sagittal alignment goals, except for one patient that experienced neuromonitoring changes during correction. All cases demonstrated arthrodesis. Mean ODI improvement at 1 year was 12.2% ± 20.0% (range -18.0% - 54.7%; p=0.048).
CONCLUSIONS
TTIF is a viable and technically reproducible posterior-only approach for the surgical correction of thoracic PJF.