{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:07:58Z","timestamp":1782914878290,"version":"3.54.5"},"reference-count":36,"publisher":"Elsevier BV","issue":"7","license":[{"start":{"date-parts":[[2017,7,1]],"date-time":"2017-07-01T00:00:00Z","timestamp":1498867200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.jp","clinicalkey.com","clinicalkey.es","clinicalkey.com.au","clinicalkey.fr","thespinejournalonline.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["The Spine Journal"],"published-print":{"date-parts":[[2017,7]]},"DOI":"10.1016\/j.spinee.2017.02.005","type":"journal-article","created":{"date-parts":[[2017,2,25]],"date-time":"2017-02-25T03:30:53Z","timestamp":1487993453000},"page":"962-968","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":96,"title":["Rod stiffness as a risk factor of proximal junctional kyphosis after adult spinal deformity surgery: comparative study between cobalt chrome multiple-rod constructs and titanium alloy two-rod constructs"],"prefix":"10.1016","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3793-2904","authenticated-orcid":false,"given":"Sanghyun","family":"Han","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Jae","family":"Hyun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8547-8545","authenticated-orcid":false,"given":"Ki-Jeong","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae-Ahn","family":"Jahng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subum","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Chul","family":"Rhim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.spinee.2017.02.005_bib0010","doi-asserted-by":"crossref","first-page":"2726","DOI":"10.1007\/s00586-014-3531-4","article-title":"Proximal junctional kyphosis following adult spinal deformity surgery","volume":"23","author":"Cho","year":"2014","journal-title":"Eur Spine J"},{"key":"10.1016\/j.spinee.2017.02.005_bib0015","doi-asserted-by":"crossref","first-page":"95","DOI":"10.3340\/jkns.2010.47.2.95","article-title":"Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients: a long-term follow-up data","volume":"47","author":"Hyun","year":"2010","journal-title":"J Korean Neurosurg Soc"},{"key":"10.1016\/j.spinee.2017.02.005_bib0020","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1007\/s11999-011-2179-1","article-title":"Combined anterior-posterior surgery is the most important risk factor for developing proximal junctional kyphosis in idiopathic scoliosis","volume":"470","author":"Kim","year":"2012","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.spinee.2017.02.005_bib0025","doi-asserted-by":"crossref","first-page":"E729","DOI":"10.1097\/BRS.0b013e3181ae2ab2","article-title":"Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up","volume":"34","author":"Denis","year":"2009","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0030","doi-asserted-by":"crossref","DOI":"10.1097\/BRS.0b013e3181eeaee2","article-title":"Incidence, risk factors and classification of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis","volume":"36","author":"Yagi","year":"2011","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0035","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1097\/BRS.0b013e31824e4888","article-title":"Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years of follow-up","volume":"37","author":"Yagi","year":"2012","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0040","doi-asserted-by":"crossref","first-page":"E576","DOI":"10.1097\/BRS.0000000000000246","article-title":"Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections","volume":"39","author":"Kim","year":"2014","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0045","doi-asserted-by":"crossref","DOI":"10.1097\/BRS.0b013e3182a51d43","article-title":"Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity","volume":"38","author":"Maruo","year":"2013","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0050","doi-asserted-by":"crossref","first-page":"360","DOI":"10.3171\/2013.5.SPINE12737","article-title":"Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: a comparison of proximal and distal upper instrumented vertebrae: clinical article","volume":"19","author":"Ha","year":"2013","journal-title":"J Neurosurg Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0055","doi-asserted-by":"crossref","first-page":"2731","DOI":"10.1097\/BRS.0b013e31815a7ead","article-title":"Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3 different types of posterior segmental spinal instrumentation and fusions: incidence and risk factor analysis of 410 cases","volume":"32","author":"Kim","year":"2007","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0060","first-page":"199","article-title":"Proximal junctional kyphosis in adult reconstructive spine surgery results from incomplete restoration of the lumbar lordosis relative to the magnitude of the thoracic kyphosis","volume":"31","author":"Mendoza-Lattes","year":"2011","journal-title":"Iowa Orthop J"},{"key":"10.1016\/j.spinee.2017.02.005_bib0065","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1097\/BRS.0b013e31817c0428","article-title":"Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up","volume":"33","author":"Kim","year":"2008","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0070","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1097\/BRS.0b013e3182815b42","article-title":"Proximal junctional kyphosis results in inferior SRS pain subscores in adult deformity patients","volume":"38","author":"Kim","year":"2013","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0075","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.injury.2010.01.001","article-title":"Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis","volume":"41","author":"Wang","year":"2010","journal-title":"Injury"},{"key":"10.1016\/j.spinee.2017.02.005_bib0080","first-page":"1","article-title":"Incidence and risk factors for proximal junctional kyphosis: a meta-analysis","author":"Liu","year":"2016","journal-title":"Eur Spine J"},{"key":"10.1016\/j.spinee.2017.02.005_bib0085","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1227\/NEU.0b013e3182672aab","article-title":"Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity","volume":"71","author":"Smith","year":"2012","journal-title":"Neurosurgery"},{"key":"10.1016\/j.spinee.2017.02.005_bib0090","doi-asserted-by":"crossref","first-page":"994","DOI":"10.3171\/2014.9.SPINE131176","article-title":"Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity","volume":"21","author":"Smith","year":"2014","journal-title":"J Neurosurg Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0095","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1097\/BRS.0000000000000556","article-title":"Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies","volume":"39","author":"Hyun","year":"2014","journal-title":"Spine"},{"issue":"Suppl. 1","key":"10.1016\/j.spinee.2017.02.005_bib0100","doi-asserted-by":"crossref","first-page":"44","DOI":"10.2106\/00004623-200400001-00007","article-title":"Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance","volume":"86","author":"Bridwell","year":"2004","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.spinee.2017.02.005_bib0105","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1097\/BRS.0b013e31819c94cc","article-title":"A correlation of radiographic and functional measurements in adult degenerative scoliosis","volume":"34","author":"Ploumis","year":"2009","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0110","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1097\/BRS.0b013e31819d0c86","article-title":"Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy","volume":"34","author":"Rose","year":"2009","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0115","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1097\/01.brs.0000238968.82799.d9","article-title":"Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases","volume":"31","author":"Kim","year":"2006","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0120","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1227\/NEU.0000000000001240","article-title":"Different risk factors of proximal junctional kyphosis and proximal junctional failure following long instrumented fusion to the sacrum for adult spinal deformity: survivorship analysis of 160 patients","volume":"80","author":"Park","year":"2017","journal-title":"Neurosurgery"},{"key":"10.1016\/j.spinee.2017.02.005_bib0125","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1097\/BRS.0b013e318271319c","article-title":"Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity","volume":"38","author":"Hostin","year":"2013","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0130","doi-asserted-by":"crossref","first-page":"E9","DOI":"10.3171\/2014.3.FOCUS13541","article-title":"Long fusion from sacrum to thoracic spine for adult spinal deformity with sagittal imbalance: upper versus lower thoracic spine as site of upper instrumented vertebra","volume":"36","author":"Fujimori","year":"2014","journal-title":"Neurosurg Focus"},{"key":"10.1016\/j.spinee.2017.02.005_bib0135","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1016\/j.spinee.2015.03.004","article-title":"Outrigger rod technique for supplemental support of posterior spinal arthrodesis","volume":"15","author":"Palumbo","year":"2015","journal-title":"Spine J"},{"key":"10.1016\/j.spinee.2017.02.005_bib0140","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jspd.2015.06.005","article-title":"Preventing instrumentation failure in three-column spinal osteotomy: biomechanical analysis of rod configuration","volume":"4","author":"Jager","year":"2016","journal-title":"Spine Deform"},{"key":"10.1016\/j.spinee.2017.02.005_bib0145","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/0921-5093(90)90097-M","article-title":"Young's modulus and damping of Ti\u22c56Al\u22c54V alloy as a function of heat treatment and oxygen concentration","volume":"128","author":"Lee","year":"1990","journal-title":"Mater Sci Eng A Struct Mater"},{"key":"10.1016\/j.spinee.2017.02.005_bib0150","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1016\/0956-716X(93)90331-L","article-title":"On the young's moduli of Ti\u22c56Al\u22c54V alloys","volume":"29","author":"Fan","year":"1993","journal-title":"Scr Metall Mater"},{"key":"10.1016\/j.spinee.2017.02.005_bib0155","series-title":"Biomechanical characterization of cobalt-chromium alloy spinal rods","author":"Daniel","year":"2009"},{"key":"10.1016\/j.spinee.2017.02.005_bib0160","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.1016\/j.biomaterials.2005.10.003","article-title":"Magnesium and its alloys as orthopedic biomaterials: a review","volume":"27","author":"Staiger","year":"2006","journal-title":"Biomaterials"},{"key":"10.1016\/j.spinee.2017.02.005_bib0165","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1243\/09544119JEIM763","article-title":"The fatigue life of contoured cobalt chrome posterior spinal fusion rods","volume":"225","author":"Nguyen","year":"2011","journal-title":"Proc Inst Mech Eng H"},{"key":"10.1016\/j.spinee.2017.02.005_bib0170","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1097\/BRS.0b013e31822a982f","article-title":"Growing rod fractures: risk factors and opportunities for prevention","volume":"36","author":"Yang","year":"2011","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0175","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/BRS.0b013e3181c77f8c","article-title":"Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation","volume":"35","author":"Helgeson","year":"2010","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0180","doi-asserted-by":"crossref","DOI":"10.1097\/BRS.0000000000000894","article-title":"Proximal junctional failure after long-segment instrumentation for degenerative lumbar kyphosis with ankylosing spinal disorder","volume":"40","author":"Ikegami","year":"2015","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2017.02.005_bib0185","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1007\/s11999-012-2771-z","article-title":"Reply to letter to the editor: combined anterior-posterior surgery is the most important risk factor for developing proximal junctional kyphosis in idiopathic scoliosis","volume":"471","author":"Kim","year":"2013","journal-title":"Clin Orthop Relat Res"}],"container-title":["The Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1529943017300724?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1529943017300724?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2020,10,3]],"date-time":"2020-10-03T03:03:09Z","timestamp":1601694189000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1529943017300724"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7]]},"references-count":36,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2017,7]]}},"alternative-id":["S1529943017300724"],"URL":"https:\/\/doi.org\/10.1016\/j.spinee.2017.02.005","relation":{},"ISSN":["1529-9430"],"issn-type":[{"value":"1529-9430","type":"print"}],"subject":[],"published":{"date-parts":[[2017,7]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Rod stiffness as a risk factor of proximal junctional kyphosis after adult spinal deformity surgery: comparative study between cobalt chrome multiple-rod constructs and titanium alloy two-rod constructs","name":"articletitle","label":"Article Title"},{"value":"The Spine Journal","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.spinee.2017.02.005","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2017 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}