{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T20:51:50Z","timestamp":1779310310905,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T00:00:00Z","timestamp":1664841600000},"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":[[2024,4]]},"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>Objectives<\/jats:title>\n                    <jats:p>To determine if standing pre-discharge radiographs can predict the development of junctional complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Adult spinal deformity patients who underwent fusion of the lumbar spine (\u22655 levels, LIV pelvis) were included. All patients underwent full-length standing radiographs before hospital discharge. Outcomes of interest included 2-year radiographic PJK and proximal junctional failure (PJF). Patients were stratified into 3 exclusive groups: No PJK, PJK, and PJF. Chi-square automatic interaction detection (CHAID) decision tree analysis was utilized to identify pre-discharge proximal junctional angle (PJA) thresholds associated with increased risk of PJK or PJF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 117 study patients had a mean age 65.8 \u00b1 8.5, BMI 27.2 \u00b1 4.9, PI-LL 23.3 \u00b1 17.4, TPA 27.2 \u00b1 11.5. Sample was stratified into 64 (54.7%) No PJK, 39 (33.3%) PJK, 14 (12.0%) PJF. No differences were detected between cohorts in discharge alignment, preop-discharge change, or offset from age-adjusted alignment targets ( P &gt; .005). Decision tree analysis showed that the first branch point depended on the UIV, as most patients with an UT UIV did not develop PJK or PJF (no PJK, 67.4%). For patients with an LT UIV, a second branch point occurred based on the \u0394PJA. 89.5% of LT patients with a \u0394PJA &lt; 4.3\u00b0 were free of radiographic PJK and PJF. The third branch point occurred based on the PJA at discharge. Thus, the highest risk group was comprised of \u0394PJA \u22654.3\u00b0 and PJA &gt; 15.5\u00b0, as 57.1% of developed PJF and 28.6% PJK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Most patients with a lower thoracic UIV, preop-discharge \u0394PJA \u22654.3\u00b0, and discharge PJA &gt; 15.5\u00b0 develop PJF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682221131765","type":"journal-article","created":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T12:41:31Z","timestamp":1664887291000},"page":"970-977","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Can Discharge Radiographs Predict Junctional Complications? A Decision Tree Analysis"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5236-1420","authenticated-orcid":false,"given":"Francis","family":"Lovecchio","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basel","family":"Sheikh Alshabab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachin","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ananth","family":"Punyala","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4174-997X","authenticated-orcid":false,"given":"Bryan","family":"Ang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Izzet","family":"Akosman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Charles Elysee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0119-7111","authenticated-orcid":false,"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,10,4]]},"reference":[{"key":"bibr1-21925682221131765","doi-asserted-by":"publisher","DOI":"10.1093\/ons\/opz128"},{"key":"bibr2-21925682221131765","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31824e4888"},{"key":"bibr3-21925682221131765","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-14-00393"},{"key":"bibr4-21925682221131765","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-020-06320-y"},{"key":"bibr5-21925682221131765","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000266"},{"key":"bibr6-21925682221131765","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000003798"},{"key":"bibr7-21925682221131765","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000003249"},{"key":"bibr8-21925682221131765","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000004027"},{"key":"bibr9-21925682221131765","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyaa311"},{"key":"bibr10-21925682221131765","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2016.07.062"},{"key":"bibr11-21925682221131765","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002146"},{"key":"bibr12-21925682221131765","doi-asserted-by":"publisher","DOI":"10.3171\/2018.6.SPINE161468"},{"key":"bibr13-21925682221131765","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.01594"},{"key":"bibr14-21925682221131765","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002146"},{"key":"bibr15-21925682221131765","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000169451.76359.49"},{"key":"bibr16-21925682221131765","volume-title":"Classification 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