{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T21:13:25Z","timestamp":1793826805739,"version":"4.6.1"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2019,9,17]],"date-time":"2019-09-17T00:00:00Z","timestamp":1568678400000},"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":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Distal junctional kyphosis (DJK) development after cervical deformity (CD)-corrective surgery is a growing concern for surgeons and patients. Few studies have investigated risk factors that predict the occurrence of DJK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To predict DJK development after CD surgery using predictive modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>CD criteria was at least one of the following: C2-C7 Coronal\/Cobb\u00a0&gt;\u00a010\u00b0, C2-7 sagittal vertical axis (cSVA)\u00a0&gt;\u00a04 cm, chin-brow vertical angle\u00a0&gt;\u00a025\u00b0. DJK was defined as the development of an angle &lt;\u221210\u00b0 from the end of fusion construct to the second distal vertebra, and change in this angle by &lt;\u221210\u00b0 from baseline to postoperative. Baseline demographic, clinical, and surgical information were used to predict the occurrence of DJK using generalized linear modeling both as one overall model and as submodels using baseline demographic and clinical predictors or surgical predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>One hundred seventeen CD patients were included. At any postoperative visit up to 1 yr, 23.1% of CD patients developed DJK. DJK was predicted with high accuracy using a combination of baseline demographic, clinical, and surgical factors by the following factors: preoperative neurological deficit, use of transition rod, C2-C7 lordosis (CL)&lt;\u221212\u00b0, T1 slope minus CL\u00a0&gt;\u00a031\u00b0, and cSVA\u00a0&gt;\u00a054 mm. In the model using only baseline demographic\/clinical predictors of DJK, presence of comorbidities, presence of baseline neurological deficit, and high preoperative C2-T3 angle were included in the final model (area under the curve\u00a0=\u00a087%). The final model using only surgical predictors for DJK included combined approach, posterior upper instrumented vertebrae below C4, use of transition rod, lack of anterior corpectomy, more than 3 posterior osteotomies, and performance of a 3-column osteotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Preoperative assessment and consideration should be given to these factors that are predictive of DJK to mitigate poor outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyz347","type":"journal-article","created":{"date-parts":[[2019,8,30]],"date-time":"2019-08-30T07:48:04Z","timestamp":1567151284000},"page":"E38-E46","source":"Crossref","is-referenced-by-count":35,"title":["Predicting the Occurrence of Postoperative Distal Junctional Kyphosis in Cervical Deformity Patients"],"prefix":"10.1227","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1479-4070","authenticated-orcid":false,"given":"Peter G","family":"Passias","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha R","family":"Horn","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheongeun","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, 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G","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M","family":"Sciubba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins Medical Center, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan H","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brown University Medical Center, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric O","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California Davis, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas C","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Denver International Spine Center, Presbyterian\/St. Luke's Medical Center and Rocky Mountain 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