{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:43:04Z","timestamp":1786124584764,"version":"build-2736575974"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2017,10,12]],"date-time":"2017-10-12T00:00:00Z","timestamp":1507766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NEUROSURGERY","NEUROS"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Proximal junctional kyphosis (PJK) following adult spinal deformity (ASD) surgery is a well-documented complication, but associations between radiographic PJK and cervical malalignment onset remain unexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To study cervical malalignment in ASD surgical patients that develop PJK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Retrospective review of prospective multicenter database. Inclusion: primary ASD patients (\u22655 levels fused, upper instrumented vertebra [UIV] at T2 or above, and 1-yr minimum follow-up) without baseline cervical deformity (CD), defined as \u22652 of the following criteria: T1 slope minus cervical lordosis &lt; 20\u00b0, cervical sagittal vertical axis &lt; 4 cm, C2-C7 cervical lordosis &lt; 10\u00b0. PJK presence (&lt;10\u00b0 change in UIV and UIV + 2 kyphosis) and angle were identified 1 yr postoperative. Propensity score matching between PJK and nonPJK groups controlled for baseline alignment. Preoperative and 1-yr postoperative cervical alignment were compared between PJK and nonPJK patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      One hundred sixty-three patients without baseline CD (54.9 yr, 83.9% female) were included. PJK developed in 60 (36.8%) patients, with 27 (45%) having UIV above T7. PJK patients had significantly greater baseline T1 slope in unmatched and propensity score matching comparisons (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05). At 1 yr postoperative, PJK patients had significantly higher T1 slope (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), C2-T3 Cobb (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .04), and C2-T3 sagittal vertical axis (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02). New-onset CD rate in PJK patients was 15%, and 16.5% in nonPJK patients (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; .05). Increased PJK magnitude was associated with increasing T1 slope and C2-T3 SVA (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Patients who develop PJK following surgical correction of ASD have a 15% incidence of development of new-onset CD. Patients developing PJK following surgical correction of ASD tend to have an increased preoperative T1 slope. Increased progression of C2-T3 Cobb angle and C2-T3 SVA are associated with development of PJK following surgical correction of thoracolumbar deformity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyx479","type":"journal-article","created":{"date-parts":[[2017,8,25]],"date-time":"2017-08-25T23:08:05Z","timestamp":1503702485000},"page":"675-682","source":"Crossref","is-referenced-by-count":13,"title":["Cervical Alignment Changes in Patients Developing Proximal Junctional Kyphosis Following Surgical Correction of Adult Spinal Deformity"],"prefix":"10.1227","volume":"83","author":[{"given":"Peter G","family":"Passias","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha R","family":"Horn","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrus M","family":"Jalai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subaraman","family":"Ramchandran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory W","family":"Poorman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Sciubba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Soroceanu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D Kojo","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Eastlack","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munish","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Rocky Mountain Scoliosis and Spine, Denver, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,10]]},"reference":[{"issue":"2","key":"bib1-20231011","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/BRS.0b013e3181c91180","article-title":"Revision rates following primary adult spinal deformity surgery: six hundred forty-three consecutive patients followed-up to twenty-two years postoperative","volume":"35","author":"Pichelmann","year":"2010","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"bib2-20231011","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","volume":"19","author":"Ha","year":"2013","journal-title":"J Neurosurg Spine"},{"key":"bib3-20231011","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"},{"issue":"4","key":"bib4-20231011","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1007\/s00586-016-4653-7","article-title":"Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA","volume":"26","author":"Protopsaltis","year":"2016","journal-title":"Eur Spine J"},{"issue":"6","key":"bib5-20231011","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/j.spinee.2008.01.015","article-title":"Proximal junctional acute collapse cranial to multi-level lumbar fusion: a cost analysis of prophylactic vertebral augmentation","volume":"8","author":"Hart","year":"2008","journal-title":"Spine J"},{"issue":"20","key":"bib6-20231011","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 (Phila Pa 1976)"},{"issue":"6","key":"bib7-20231011","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1227\/NEU.0b013e31828bacd8","article-title":"Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle","volume":"72","author":"Bridwell","year":"2013","journal-title":"Neurosurgery"},{"issue":"1","key":"bib8-20231011","doi-asserted-by":"crossref","first-page":"E60","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 (Phila Pa 1976)"},{"issue":"17","key":"bib9-20231011","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 (Phila Pa 1976)"},{"issue":"10","key":"bib10-20231011","doi-asserted-by":"crossref","first-page":"S148","DOI":"10.1016\/j.spinee.2015.07.157","article-title":"Postsurgical predictors of proximal junctional kyphosis in adolescent idiopathic scoliosis","volume":"15","author":"Bjerke-Kroll","year":"2015","journal-title":"Spine J"},{"issue":"14","key":"bib11-20231011","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1097\/01.brs.0000169451.76359.49","article-title":"Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis","volume":"30","author":"Glattes","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"issue":"21","key":"bib12-20231011","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1097\/BRS.0b013e3181dc846c","article-title":"Subsequent vertebral fractures following spinal fusion surgery for degenerative lumbar disease: a mean ten-year follow-up","volume":"35","author":"Toyone","year":"2010","journal-title":"Spine (Phila Pa 1976)"},{"issue":"22 suppl","key":"bib13-20231011","doi-asserted-by":"crossref","first-page":"S144","DOI":"10.1097\/BRS.0b013e31826d611b","article-title":"Proximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery: a systematic review","volume":"37","author":"Kim","year":"2012","journal-title":"Spine (Phila Pa 1976)"},{"issue":"5","key":"bib14-20231011","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1097\/BRS.0000000000000746","article-title":"Postoperative cervical deformity in 215 thoracolumbar patients with adult spinal deformity: prevalence, risk factors, and impact on patient-reported outcome and satisfaction at 2-year follow-up","volume":"40","author":"Passias","year":"2015","journal-title":"Spine (Phila Pa 1976)"},{"key":"bib15-20231011","article-title":"Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal parameter, the CTPA","author":"Protopsaltis","year":"2013","journal-title":"IMAST Podium Paper Presented at the 20th International Meeting on Advanced Spine Techniques"},{"issue":"25","key":"bib16-20231011","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1097\/BRS.0000000000000627","article-title":"Proximal junctional kyphosis and failure after spinal deformity surgery: a systematic review of the literature as a background to classification development","volume":"39","author":"Lau","year":"2014","journal-title":"Spine (Phila Pa 1976)"},{"key":"bib17-20231011","article-title":"Classification and severity scale: development and validation of a standardized system","author":"Hart","year":"2013","journal-title":"2013 Annual Meeting of the AANS\/CNS Section on Disorders of the Spine and Peripheral Nerves"},{"issue":"3","key":"bib18-20231011","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/BRS.0000000000001326","article-title":"The clinical correlation of the Hart-ISSG proximal junctional kyphosis severity scale with health-related quality-of-life outcomes and need for revision surgery","volume":"41","author":"Lau","year":"2016","journal-title":"Spine (Phila Pa 1976)"},{"issue":"7","key":"bib19-20231011","doi-asserted-by":"crossref","first-page":"E396","DOI":"10.1097\/BRS.0000000000001264","article-title":"Relationship between T1 slope and cervical alignment following multi-level posterior cervical fusion surgery: impact of T1 slope minus cervical lordosis","volume":"41","author":"Hyun","year":"2016","journal-title":"Spine (Phila Pa 1976)"},{"issue":"5","key":"bib20-20231011","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1097\/BRS.0000000000001221","article-title":"Impact of cervical sagittal alignment parameters on neck disability","volume":"41","author":"Iyer","year":"2016","journal-title":"Spine (Phila Pa 1976)"},{"issue":"11","key":"bib21-20231011","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/j.spinee.2010.08.031","article-title":"The use of the T1 sagittal angle in predicting overall sagittal balance of the spine","volume":"10","author":"Knott","year":"2010","journal-title":"Spine J"},{"issue":"suppl 2","key":"bib22-20231011","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1007\/s00586-013-2676-x","article-title":"Junctional spinal disorders in operated adult spinal deformities: present understanding and future perspectives","volume":"22","author":"Arlet","year":"2013","journal-title":"Eur Spine J"},{"issue":"8","key":"bib23-20231011","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1016\/j.spinee.2015.04.007","article-title":"Magnitude of preoperative cervical lordotic compensation and C2-T3 angle are correlated to increased risk of postoperative sagittal spinal pelvic malalignment in adult thoracolumbar deformity patients at 2-year follow-up","volume":"15","author":"Passias","year":"2015","journal-title":"Spine J"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00006123-201810000-00010","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:42:58Z","timestamp":1786120978000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00006123-201810000-00010"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,12]]},"references-count":23,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyx479","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10,12]]}}}