{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:38:31Z","timestamp":1753879111614,"version":"3.41.2"},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82272540"],"award-info":[{"award-number":["82272540"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Late\u2010onset neurological deficit is a severe complication usually attributed to the medullary compression at the apex as the kyphotic deformity develops gradually. However, little is known about another rare cause of proximal adjacent segment degeneration (ASD) above the kyphosis. This study aimed to report the surgical outcome of rigid posttraumatic thoracolumbar kyphosis combined with neurological deficits and to illustrate the different causes of late\u2010onset spinal cord dysfunction and their relationship to spinopelvic alignment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective cohort study, 39 patients with rigid posttraumatic thoracolumbar kyphosis who underwent surgical correction were enrolled. All patients had late\u2010onset spinal cord dysfunction, and the causes were classified according to the location of the lesion. Patients were divided into Group A (patients without proximal ASD) and Group B (patients with proximal ASD). Neurologic status was graded using the American Spinal Injury Association (ASIA) Impairment Scale. The visual analog scale (VAS) and Japanese Orthopedic Association scores\u201029 (JOA\u201029) were utilized for clinical assessment. Radiographic parameters of X\u2010ray and MRI were compared between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010three patients (59.0%) had neurological deficits only resulting from the kyphosis itself, and 10 patients (25.6%) had developed neurological dysfunction related to thoracic stenosis above the kyphosis. The remaining six patients (15.4%) had coexisting compression both at and above the kyphotic apex. All the ASD occurred in the lower thoracic spine, and the level of T10\/11 was the most involved site. Patients who developed proximal ASD had significantly smaller adjacent thoracic kyphosis (ATK) (1.2\u2009\u00b1\u20099.6 vs. 14.4\u2009\u00b1\u200911.6, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). These patients had significantly worse preoperative ASIA grades and lower JOA\u201029 at final follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Proximal ASD above kyphosis could cause late\u2010onset neurological deterioration. Compensatory lordosis in the lower thoracic spine might be associated with degenerative spinal stenosis. The dominant compensatory mechanism might be a decisive factor in developing proximal ASD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.70075","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T07:49:48Z","timestamp":1747986588000},"page":"2048-2056","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Late\u2010Onset Spinal Cord Dysfunction in Rigid Posttraumatic Thoracolumbar Kyphosis: Radiographic Analysis of Neurological Compromise"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7449-4176","authenticated-orcid":false,"given":"Jiaqi","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Orthopedics Peking University Third Hospital  Beijing China"},{"name":"Beijing Key Laboratory of Spinal Disease Research Peking University Third Hospital  Beijing China"},{"name":"Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education Peking University Third Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yinhao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Peking University Third Hospital  Beijing China"},{"name":"Beijing Key Laboratory of Spinal Disease Research Peking University Third Hospital  Beijing China"},{"name":"Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education Peking University Third Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Peking University Third Hospital  Beijing China"},{"name":"Department of Spinal Surgery Peking University People's Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weishi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Peking University Third Hospital  Beijing China"},{"name":"Beijing Key Laboratory of Spinal Disease Research Peking University Third Hospital  Beijing China"},{"name":"Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education Peking University Third Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200112151-00019"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2346560.280"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jot.2019.12.003"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-018-5605-1"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199610010-00016"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632\u2010198505000\u201000003"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2017.11.008"},{"issue":"6","key":"e_1_2_11_9_1","first-page":"891","article-title":"Post\u2010Traumatic Kyphosis. A Review of Forty\u2010Eight Surgically Treated Patients","volume":"63","author":"Malcolm B. W.","year":"1981","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.BRS.0000090889.45158.5A"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-023-04189-3"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.3171\/2019.3.SPINE18937"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2019.1624428"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318189594f"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632\u2010199605010\u201000022"},{"issue":"4","key":"e_1_2_11_16_1","first-page":"305","article-title":"Acute Thoracolumbar Spinal Cord Injury: Relationship of Cord Compression to Neurological Outcome","volume":"100","author":"Skeers P.","year":"2018","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-009-1117-3"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.6.210062"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-023-07780-8"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.13822"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2142340.170"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-017-0840-1"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70075","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T07:34:15Z","timestamp":1751441655000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.70075"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,23]]},"references-count":21,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1111\/os.70075"],"URL":"https:\/\/doi.org\/10.1111\/os.70075","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"type":"print","value":"1757-7853"},{"type":"electronic","value":"1757-7861"}],"subject":[],"published":{"date-parts":[[2025,5,23]]},"assertion":[{"value":"2024-12-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}