{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:08:00Z","timestamp":1782914880351,"version":"3.54.5"},"reference-count":27,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T00:00:00Z","timestamp":1571270400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Develop a simple scoring system to estimate proximal junctional kyphosis (PJK) risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 417 adult spinal deformity (ASD) patients (80% females, 57.8 years) with 2-year follow-up were included. PJK was defined as a &gt;10\u00b0 kyphotic angle between the upper-most instrumented vertebra (UIV) and the vertebrae 2 levels above the UIV (UIV+2). Based on a previous literature review, the following point score was attributed to parameters likely to impact PJK development: age &gt;55 years (1\u2009point), fusion to S1\/ilium (1\u2009point), UIV in the upper thoracic spine (UIV-UT: 1\u2009point), UIV in the lower thoracic region (UIV-LT: 2 points), flattening of the thoracic kyphosis (TK) relative to the lumbar lordosis (LL; ie, \u25b5LL \u2212 \u25b5TK) greater than 10\u00b0 (1\u2009point).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>At 2 years, the overall PJK rate was 43%. The odds ratios for each risk factor were the following: age &gt;55 years (2.52), fusion to S1\/ilium (5.17), UIV-UT (6.63), UIV-LT (8.24), and \u25b5LL \u2212 \u25b5TK &gt;10\u00b0 (1.59). Analysis by risk factor revealed a significant impact on PJK (no PJK vs PJK): age &gt;55 years (28% vs 51%, P &lt; .001), LIV S1\/ilium (16.3% vs 51.4%, P &lt; .001), UIV in lower thoracic spine (12.0% vs 38.7% vs 52.9%, P &lt; .001), and a &gt;10\u00b0 surgical reduction in TK relative to LL increase (40.0% vs 51.5%, P &lt; .001). The PJK rate by point score was as follows: 1 = 17%, 2 = 29%, 3 = 40%, 4 = 53%, and 5 = 69%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A pragmatic scoring system was developed that is tied to the increasing risk of PJK. These findings are helpful for surgical planning and preoperative counseling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2192568219882350","type":"journal-article","created":{"date-parts":[[2019,10,18]],"date-time":"2019-10-18T02:54:20Z","timestamp":1571367260000},"page":"863-870","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":35,"title":["Risk Factor Analysis for Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery: A New Simple Scoring System to Identify High-Risk Patients"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4820-1835","authenticated-orcid":false,"given":"Renaud","family":"Lafage","sequence":"first","affiliation":[{"name":"Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Beyer","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY, USA"},{"name":"SUNY Downstate Medical Center, Brooklyn, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Klineberg","sequence":"additional","affiliation":[{"name":"University of California Davis, Sacramento, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Burton","sequence":"additional","affiliation":[{"name":"University of Kansas Medical Center, Kansas City, KS, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Denver International Spine Center, Denver, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2170-3592","authenticated-orcid":false,"given":"Han 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France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"University of Virginia Medical Center, Charlottesville, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Mundis","sequence":"additional","affiliation":[{"name":"San Diego Center for Spinal Disorders, La Jolla, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY, 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