Article In Press | Published on: September 03, 2026
Volume: 2, Issue: 1
1. Orthopedic Spine Surgery, Longview Regional Medical Center, 3000 N. 4th St., Longview, TX 75605, USA.
DOI: 10.66609/JSCRR-rpc.25.00417
Corresponding Author: Babajide Ogunseinde, MD, Longview Regional Medical Center, 3000 N. 4th St., Longview, TX 75605, USA.
Citation: B. Ogunseinde. (2026). The Junctional Ladder Technique: A Muscle-Sparing Hybrid Instrumentation Strategy for Adult Spinal Deformity Correction and Proximal Junctional Kyphosis Mitigation, Journal of Surgical Case Reports and Research, 2(2); DOI: 10.66609/JSCRR-rpc.25.00417
Copyright: © 2026 Babajide Ogunseinde, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) remain important complications after long-segment adult spinal deformity reconstruction. Abrupt construct stiffness, disruption of the posterior tension band, paraspinal muscle injury, poor bone quality, and aggressive sagittal correction may increase junctional stress.
Technique: The Junctional Ladder Technique combines percutaneous corticocancellous pedicle screws with tower attachments at the lower-thoracic proximal construct and modular reduction-head screws in the open lumbar and lumbopelvic construct. The intended biomechanical and biologic rationale is to preserve proximal thoracolumbar musculature and posterior soft tissues while permitting controlled deformity correction and rod reduction. When clinically indicated, distal fixation may include S2-alar-iliac (S2AI) screws and bilateral sacroiliac (SI) joint fusion implants; this distal SI fusion component is separate from the proximal junctional protection strategy.
Cases: Two adults with symptomatic degenerative thoracolumbar scoliosis and sagittal malalignment underwent long-segment reconstruction using the Junctional Ladder Technique. Both had failed nonoperative treatment. Postoperative imaging demonstrated substantial coronal correction and maintained proximal alignment at six months, without radiographic PJK or clinical PJF in the available follow-up. Both patients had more than 50% improvement in recorded visual analog scale and Oswestry Disability Index measures.
Conclusion: These two cases demonstrate the feasibility of a hybrid muscle-sparing proximal construct for adult spinal deformity correction. The technique should be regarded as hypothesis-generating rather than proven preventive therapy. Larger comparative cohorts with standardized, longer-term radiographic and patient-reported outcomes are required.
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