{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T20:51:35Z","timestamp":1779310295532,"version":"3.51.4"},"reference-count":56,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T00:00:00Z","timestamp":1600214400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To analyze ideal indication for combined anterior column realignment (ACR) with short posterior spinal fusion (PSF) and posterior column osteotomy (PCO) for preventing proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) patients with lower lumbar kyphosis and compensatory thoracolumbar lordosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective study was conducted. This study included 27 ASD patients (average age of 66.6\u2009years; one male and 26 females) with lower lumbar kyphosis and compensated thoracolumbar lordosis who underwent short PSF with PCO following ACR from 2006 to 2010. The minimum follow\u2010up period was 5\u2009years. The patients were divided into two groups based on the sagittal vertical axis (SVA) of the last follow\u2010up radiographs, and a comparative analysis was performed evaluating spino\u2010pelvic parameters and clinical outcomes including the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean follow\u2010up time of included patients was 109.7\u2009months, and the mean number of fused segments was 3.7. The uppermost instrumented vertebra was L<jats:sub>2<\/jats:sub> in 18 patients or L<jats:sub>3<\/jats:sub> in nine patients, and lowermost instrumented vertebra was sacrum in all patients. The mean lumbar lordosis (LL) values in the optimal SVA and suboptimal SVA groups were 4.4\u00b0 and 4.2\u00b0 preoperatively (<jats:italic>P<\/jats:italic> =\u20090.639), \u221248.1\u00b0 and \u221235\u00b0 postoperatively (<jats:italic>P<\/jats:italic> =\u20090.007), and \u221245.2\u00b0 and \u221220.7\u00b0 at the last follow\u2010up (<jats:italic>P<\/jats:italic> &lt;\u20090.05). Overcorrection was seen in seven patients in the optimal SVA group, whereas all of the patients of the suboptimal SVA group were in the category of undercorrection (<jats:italic>P<\/jats:italic> =\u20090.021). Pelvic incidence (PI) of optimal SVA group (&lt;50\u2009mm, <jats:italic>n<\/jats:italic> =\u200916) and suboptimal SVA group (\u226550\u2009mm, <jats:italic>n<\/jats:italic> =\u200911) was 44.1\u00b0 and 53.8\u00b0 (<jats:italic>P<\/jats:italic> =\u20090.009). The prevalence of PJK was significantly higher in the suboptimal SVA group (<jats:italic>P<\/jats:italic> =\u20090.008), and last follow\u2010up VAS for back pain (<jats:italic>P<\/jats:italic> &lt;\u20090.05), and postoperative and last follow\u2010up ODI (<jats:italic>P<\/jats:italic> =\u20090.002 and <jats:italic>P<\/jats:italic> &lt;\u20090.05) were statistically larger for the suboptimal group than the optimal group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Combined ACR with short PSF and PCO could effectively prevent sagittal decompensation of PJK and help achieve sagittal balance in the treatment of ASD patients with lower lumbar kyphosis, compensatory thoracolumbar lordosis, and especially low PI (&lt;50\u00b0).<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12645","type":"journal-article","created":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T22:11:56Z","timestamp":1600294316000},"page":"1674-1684","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Spino\u2010Pelvic\u2009Thresholds for\u2009Prevention of\u2009Proximal Junctional Kyphosis Following Combined Anterior Column Realignment and Short Posterior Spinal Fusion in\u2009Degenerative Lumbar Kyphosis"],"prefix":"10.1111","volume":"12","author":[{"given":"Ki Young","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Graduate School, College of Medicine, Kyung Hee University  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1755-526X","authenticated-orcid":false,"given":"Jung\u2010Hee","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Graduate School, College of Medicine, Kyung Hee University  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyung\u2010Chung","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Graduate School, College of Medicine, Kyung Hee University  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang\u2010Kyu","family":"Im","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Graduate School, College of Medicine, Kyung Hee University  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong\u2010Gune","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Sanggye Paik Hospital, Inje University  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sun Hwan","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Graduate School, College of Medicine, Kyung Hee University  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,9,16]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181ee6bd4"},{"key":"e_1_2_6_3_1","doi-asserted-by":"crossref","first-page":"2668","DOI":"10.1007\/s00586-016-4441-4","article-title":"Overcorrection of lumbar lordosis for adult spinal deformity with sagittal imbalance: comparison of radiographic outcomes between overcorrection and undercorrection","volume":"25","author":"Lee JH","year":"2016","journal-title":"Eur Spine J"},{"key":"e_1_2_6_4_1","first-page":"213","article-title":"Sagittal plane alignment of the spine and gravity: a radiological and clinical evaluation","volume":"71","author":"Legaye J","year":"2005","journal-title":"Acta Orthop Belg"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.D.02043"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181a13c08"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31819d0c86"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000238970.67552.f5"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s005860050038"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199710150-00025"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199908150-00013"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000155425.04536.f7"},{"key":"e_1_2_6_13_1","doi-asserted-by":"crossref","first-page":"2142","DOI":"10.1016\/j.spinee.2015.05.028","article-title":"Acute proximal junctional failure in patients with preoperative sagittal imbalance","volume":"15","author":"Smith MW","year":"2015","journal-title":"Spine J"},{"key":"e_1_2_6_14_1","doi-asserted-by":"crossref","first-page":"44","DOI":"10.2106\/00004623-200403001-00007","article-title":"Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical Technique","volume":"86","author":"Bridwell KH","year":"2004","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_6_15_1","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1007\/s00586-014-3670-7","article-title":"Pedicle subtraction osteotomies (PSO) in the lumbar spine for sagittal deformities","volume":"24","author":"Berjano P","year":"2015","journal-title":"Eur Spine J"},{"key":"e_1_2_6_16_1","doi-asserted-by":"crossref","first-page":"S171","DOI":"10.1097\/01.brs.0000231963.72810.38","article-title":"Decision making regarding Smith\u2010Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity","volume":"31","author":"Bridwell KH","year":"2006","journal-title":"Spine (Phila Pa 1976)"},{"key":"e_1_2_6_17_1","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1097\/01.BRS.0000090891.60232.70","article-title":"Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance","volume":"28","author":"Bridwell KH","year":"2003","journal-title":"Spine (Phila Pa 1976)"},{"key":"e_1_2_6_18_1","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\u2010term follow\u2010up data","volume":"47","author":"Hyun SJ","year":"2010","journal-title":"J Korean Neurosurg Soc"},{"key":"e_1_2_6_19_1","doi-asserted-by":"crossref","first-page":"252","DOI":"10.3109\/02688697.2013.835369","article-title":"Analysis of the incidence and risk factors for the progression of proximal junctional kyphosis following surgical treatment for lumbar degenerative kyphosis: minimum 2\u2010year follow\u2010up","volume":"28","author":"Lee JH","year":"2014","journal-title":"Br J Neurosurg"},{"key":"e_1_2_6_20_1","doi-asserted-by":"crossref","first-page":"2653","DOI":"10.1097\/BRS.0b013e31815a5a9d","article-title":"Is the T9, T11, or L1 the more reliable proximal level after adult lumbar or lumbosacral instrumented fusion to L5 or S1?.","volume":"32","author":"Kim YJ","year":"2007","journal-title":"Spine (Phila Pa 1976)"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000169451.76359.49"},{"key":"e_1_2_6_22_1","doi-asserted-by":"crossref","first-page":"E1469","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 K","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000246"},{"key":"e_1_2_6_24_1","doi-asserted-by":"crossref","first-page":"2694","DOI":"10.1097\/BRS.0b013e31815a590b","article-title":"Lumbar degenerative kyphosis: radiologic analysis and classifications","volume":"32","author":"Jang JS","year":"2007","journal-title":"Spine (Phila Pa 1976)"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198811000-00019"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181e88be6"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12357"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.3171\/SPI-07\/10\/387"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.3171\/2014.1.SPINE13569"},{"key":"e_1_2_6_30_1","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/BSD.0b013e318287bdc1","article-title":"Anterior column realignment (ACR) for focal kyphotic spinal deformity using a lateral transpsoas approach and ALL release","volume":"27","author":"Akbarnia BA","year":"2014","journal-title":"J Spinal Disord Tech"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.3171\/2010.1.FOCUS09272"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.3171\/2010.1.FOCUS09282"},{"key":"e_1_2_6_33_1","doi-asserted-by":"crossref","first-page":"E9","DOI":"10.3171\/2010.1.FOCUS09286","article-title":"Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes","volume":"28","author":"Wang MY","year":"2010","journal-title":"Neurosurg Focus"},{"key":"e_1_2_6_34_1","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1227\/NEU.0000000000001203","article-title":"Anterior longitudinal ligament release from the minimally invasive lateral retroperitoneal transpsoas approach: technical note","volume":"12","author":"Beckman JM","year":"2016","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"e_1_2_6_35_1","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s00586-015-3930-1","article-title":"Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study","volume":"24","author":"Berjano P","year":"2015","journal-title":"Eur Spine J"},{"key":"e_1_2_6_36_1","doi-asserted-by":"crossref","first-page":"515","DOI":"10.3171\/2014.2.SPINE1347","article-title":"Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study","volume":"20","author":"Manwaring JC","year":"2014","journal-title":"J Neurosurg Spine"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318191e792"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-013-2895-1"},{"key":"e_1_2_6_39_1","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/01.brs.0000153698.94091.f8","article-title":"Is there an optimal patient stance for obtaining a lateral 36\u2033 radiograph?: a critical comparison of three techniques","volume":"30","author":"Horton WC","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31823b0892"},{"key":"e_1_2_6_41_1","first-page":"261","article-title":"Outline for the study of scoliosis","volume":"5","author":"Cobb J","year":"1948","journal-title":"Instr Course Lect AAOS"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-011-1924-1"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000232709.48446.be"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181eeaee2"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199809150-00018"},{"key":"e_1_2_6_46_1","first-page":"271","article-title":"The Oswestry low back pain disability questionnaire","volume":"66","author":"Fairbank JC","year":"1980","journal-title":"Physiotherapy"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200012150-00006"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(76)90113-5"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(83)90088-X"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12503"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200109150-00017"},{"key":"e_1_2_6_52_1","doi-asserted-by":"crossref","first-page":"2030","DOI":"10.1097\/01.brs.0000179085.92998.ee","article-title":"Comparison of Smith\u2010Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance","volume":"30","author":"Cho KJ","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"key":"e_1_2_6_53_1","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1097\/01.brs.0000238969.59928.73","article-title":"Sagittal thoracic decompensation following long adult lumbar spinal instrumentation and fusion to L5 or S1: causes, prevalence, and risk factor analysis","volume":"31","author":"Kim YJ","year":"2006","journal-title":"Spine (Phila Pa 1976)"},{"key":"e_1_2_6_54_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181bdad89"},{"key":"e_1_2_6_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2012.12.024"},{"key":"e_1_2_6_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2016.03.044"},{"key":"e_1_2_6_57_1","doi-asserted-by":"publisher","DOI":"10.3171\/2016.4.SPINE16157"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.12645","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.12645","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.12645","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,3]],"date-time":"2023-09-03T13:24:10Z","timestamp":1693747450000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.12645"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,16]]},"references-count":56,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1111\/os.12645"],"URL":"https:\/\/doi.org\/10.1111\/os.12645","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,16]]},"assertion":[{"value":"2019-10-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}