Hybrid Posterior Fixation Incorporating Cervical Facet Fixation for the Treatment of Proximal Junctional Failure.

Introduction: Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are well-recognized complications following long thoracolumbar fusion constructs and frequently require complex revision surgery. Achieving stable fixation and solid arthrodesis at proximal levels is particularly challenging in the setting of advanced degeneration and altered anatomy. This case review describes a hybrid fixation strategy incorporating cervical facet fixation to address these challenges. Case Report: A 76-year-old female presented 21 months after T4-pelvis fusion with progressive PJF, resulting in upper thoracic kyphotic deformity, focal spinal stenosis, and progressive myelopathic symptoms. Imaging demonstrated a fracture at T4, grade 2 T3-4 anterolisthesis, and significant kyphosis with compromise of the spinal canal. The patient underwent revision surgery consisting of C2-T4 posterior fusion with decompression and posterior column osteotomies. A hybrid construct was utilized, including cervical lateral mass fixation, thoracic pedicle fixation, and intervening zero-profile cervical facet fixation. Cervical facet fixation was employed to provide supplemental stabilization while preserving posterior fusion surface area and accommodating degenerative anatomy without extensive osteophyte resection. Conclusion: At 2-year follow-up, the patient demonstrated maintained sagittal alignment and radiographic evidence of solid arthrodesis without hardware failure or progression of deformity.