{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T09:49:06Z","timestamp":1789984146551,"version":"4.0.1"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Proximal junctional failure (PJF) is a significant mechanical complication following corrective surgery for adult spinal deformity (ASD), often resulting in structural failure at the uppermost instrumented vertebra and necessitating revision surgery. Early identification of patients at high risk for PJF remains clinically important but challenging due to the multifactorial and nonlinear nature of risk factors. This study aimed to evaluate the predictive performance of five machine learning (ML) models\u2014Random Forest, Logistic Regression, Support Vector Machine (SVM), Decision Tree, and Naive Bayes\u2014in identifying patients at risk for PJF using both preoperative and postoperative spinal alignment parameters. A retrospective cohort of 92 ASD patients who underwent two-stage corrective surgery, including lateral lumbar interbody fusion (LLIF), was analyzed. Radiographic parameters were measured preoperatively and approximately six weeks postoperatively. Six alignment-related features were selected through a combination of univariate statistical testing and Random Forest\u2013based feature importance ranking: preoperative PI\u2013LL, preoperative PT, postoperative PI\u2013LL, postoperative and preoperative TK, and change in lumbar lordosis (\u0394LL). Each ML model was trained and tested using five independent stratified 80:20 train-test splits. Among the models, Random Forest achieved the highest mean accuracy (78.4%) and area under the curve (AUC\u2009=\u20090.704). The predicted probabilities for PJF were significantly higher in the PJF group compared to non-PJF cases (0.306\u2009\u00b1\u20090.181 vs. 0.186\u2009\u00b1\u20090.164,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.0057). Cross-validation confirmed model robustness (fivefold: 79.4%, tenfold: 77.3%). These findings suggest that Random Forest can serve as a reliable tool for preoperative and early postoperative PJF risk stratification based on alignment correction. Future work should incorporate bone mineral density, comorbidities, and multicenter validation to enhance clinical applicability.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-24872-1","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T11:20:18Z","timestamp":1763637618000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predicting proximal junctional failure in adult spinal deformity patients using machine learning models based on spinal alignment parameters"],"prefix":"10.1038","volume":"15","author":[{"given":"Akihiko","family":"Hiyama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Sakai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Katoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiko","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"24872_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.wneu.2024.09.101","volume":"193","author":"Z Lu","year":"2024","unstructured":"Lu, Z. et al. Risk factors of proximal junctional failure after adult spinal deformity surgery: A systematic review and meta-analysis. World Neurosurg 193, 1\u20137. https:\/\/doi.org\/10.1016\/j.wneu.2024.09.101 (2024).","journal-title":"World Neurosurg"},{"key":"24872_CR2","doi-asserted-by":"publisher","first-page":"876","DOI":"10.14245\/ns.2346566.283","volume":"20","author":"M Yagi","year":"2023","unstructured":"Yagi, M., Yamanouchi, K., Fujita, N., Funao, H. & Ebata, S. Proximal junctional failure in adult spinal deformity surgery: An in-depth review. Neurospine 20, 876\u2013889. https:\/\/doi.org\/10.14245\/ns.2346566.283 (2023).","journal-title":"Neurospine"},{"key":"24872_CR3","doi-asserted-by":"publisher","unstructured":"Yagi, M. et al. Characterization and surgical outcomes of proximal junctional failure in surgically treated patients with adult spinal deformity. Spine (Phila Pa 1976) 39, E607\u2013614, https:\/\/doi.org\/10.1097\/brs.0000000000000266 (2014).","DOI":"10.1097\/brs.0000000000000266"},{"key":"24872_CR4","doi-asserted-by":"publisher","unstructured":"Schwab, F. et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 37, 1077\u20131082, https:\/\/doi.org\/10.1097\/BRS.0b013e31823e15e2 (2012).","DOI":"10.1097\/BRS.0b013e31823e15e2"},{"key":"24872_CR5","doi-asserted-by":"publisher","unstructured":"Rose, P. S. et al. Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine (Phila Pa 1976) 34, 785\u2013791, https:\/\/doi.org\/10.1097\/BRS.0b013e31819d0c86 (2009).","DOI":"10.1097\/BRS.0b013e31819d0c86"},{"key":"24872_CR6","doi-asserted-by":"publisher","unstructured":"Yamato, Y. et al. Calculation of the target lumbar lordosis angle for restoring an optimal pelvic tilt in elderly patients with adult spinal deformity. Spine (Phila Pa 1976) 41, E211\u2013217, https:\/\/doi.org\/10.1097\/brs.0000000000001209 (2016).","DOI":"10.1097\/brs.0000000000001209"},{"key":"24872_CR7","doi-asserted-by":"publisher","first-page":"3638","DOI":"10.1007\/s00586-016-4563-8","volume":"25","author":"S Inami","year":"2016","unstructured":"Inami, S. et al. Optimum pelvic incidence minus lumbar lordosis value can be determined by individual pelvic incidence. Eur. Spine J. 25, 3638\u20133643. https:\/\/doi.org\/10.1007\/s00586-016-4563-8 (2016).","journal-title":"Eur. Spine J."},{"key":"24872_CR8","doi-asserted-by":"publisher","first-page":"3675","DOI":"10.1007\/s00586-016-4702-2","volume":"25","author":"K Hasegawa","year":"2016","unstructured":"Hasegawa, K. et al. Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects. Eur. Spine J. 25, 3675\u20133686. https:\/\/doi.org\/10.1007\/s00586-016-4702-2 (2016).","journal-title":"Eur. Spine J."},{"key":"24872_CR9","doi-asserted-by":"publisher","unstructured":"Ames, C. P. et al. Artificial intelligence based hierarchical clustering of patient types and intervention categories in adult spinal deformity surgery: towards a new classification scheme that predicts quality and value. Spine (Phila Pa 1976) 44, 915\u2013926, https:\/\/doi.org\/10.1097\/brs.0000000000002974 (2019).","DOI":"10.1097\/brs.0000000000002974"},{"key":"24872_CR10","doi-asserted-by":"publisher","first-page":"1998","DOI":"10.1007\/s00586-019-06079-x","volume":"28","author":"CP Ames","year":"2019","unstructured":"Ames, C. P. et al. Development of predictive models for all individual questions of SRS-22R after adult spinal deformity surgery: a step toward individualized medicine. Eur Spine J. 28, 1998\u20132011. https:\/\/doi.org\/10.1007\/s00586-019-06079-x (2019).","journal-title":"Eur Spine J."},{"key":"24872_CR11","doi-asserted-by":"publisher","unstructured":"Ames, C. P. et al. Development of deployable predictive models for minimal clinically important difference achievement across the commonly used health-related quality of life instruments in adult spinal deformity surgery. Spine (Phila Pa 1976) 44, 1144\u20131153, https:\/\/doi.org\/10.1097\/brs.0000000000003031 (2019).","DOI":"10.1097\/brs.0000000000003031"},{"key":"24872_CR12","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1186\/s12874-022-01758-8","volume":"22","author":"A Pfob","year":"2022","unstructured":"Pfob, A., Lu, S. C. & Sidey-Gibbons, C. 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World Neurosurg. 170, e271\u2013e282. https:\/\/doi.org\/10.1016\/j.wneu.2022.11.001 (2023).","journal-title":"World Neurosurg."},{"key":"24872_CR17","doi-asserted-by":"publisher","first-page":"12039","DOI":"10.1038\/s41598-019-48539-w","volume":"9","author":"A Hiyama","year":"2019","unstructured":"Hiyama, A. et al. Changes in spinal alignment following eXtreme lateral interbody fusion alone in patients with adult spinal deformity using computed tomography. Sci. Rep. 9, 12039. https:\/\/doi.org\/10.1038\/s41598-019-48539-w (2019).","journal-title":"Sci. Rep."},{"key":"24872_CR18","doi-asserted-by":"publisher","first-page":"e706","DOI":"10.1016\/j.wneu.2022.05.030","volume":"164","author":"A Hiyama","year":"2022","unstructured":"Hiyama, A., Sakai, D., Katoh, H., Sato, M. & Watanabe, M. Relationship between hounsfield units of upper instrumented vertebrae, proximal junctional failure, and global alignment and proportion score in female patients with adult spinal deformity. World Neurosurg. 164, e706\u2013e717. https:\/\/doi.org\/10.1016\/j.wneu.2022.05.030 (2022).","journal-title":"World Neurosurg."},{"key":"24872_CR19","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2023.07.006","author":"A Hiyama","year":"2023","unstructured":"Hiyama, A., Sakai, D., Katoh, H., Sato, M. & Watanabe, M. Comparative analysis of hounsfield units and vertebral bone quality scores for predicting proximal junctional failure in female adult spinal deformity patients undergoing planned 2-stage corrective surgery with lateral lumbar interbody fusion. World Neurosurg. https:\/\/doi.org\/10.1016\/j.wneu.2023.07.006 (2023).","journal-title":"World Neurosurg."},{"key":"24872_CR20","doi-asserted-by":"publisher","first-page":"126","DOI":"10.14245\/kjs.2017.14.4.126","volume":"14","author":"SJ Hyun","year":"2017","unstructured":"Hyun, S. J. et al. Proximal junctional kyphosis and proximal junctional failure following adult spinal deformity surgery. Korean J. 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