{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T05:46:30Z","timestamp":1781588790349,"version":"3.54.5"},"reference-count":32,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To identify radiographic and clinical predictors of fracture-type proximal junctional kyphosis (PJFx) and associated myelopathy (PJFx-M), with the goal of facilitating timely surgical intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 438 patients with adult spinal deformity who underwent long-segment fusion surgery at our institution between 2013 and 2023. Risk factors for PJFx and PJFx-M were analyzed, focusing on demographic and radiographic parameters. In PJFx-M cases, we specifically assessed sliding length, screw protrusion, and superior articular facet fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PJFx occurred in 102 patients (23.3%). Significant risk factors for PJFx included a lower Hounsfield unit (HU) value at the upper instrumented vertebra (UIV) and reduced preoperative lumbar lordosis. PJFx-M was identified in 10 patients (2.3%). Radiographic predictors of PJFx-M included increased sliding length, screw protrusion into the upper vertebra, and bilateral superior articular facet fractures (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Additionally, a fall within 1\u00a0month of symptom onset was frequently observed in PJFx-M cases. PJFx-M was not associated with demographic factors or body mass index.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lower HU at the UIV and reduced preoperative lumbar lordosis were key predictors of PJFx. PJFx-M should be suspected in the presence of increased sliding length, screw protrusion into the upper vertebra, superior articular facet fractures, and a recent fall. These findings highlight the importance of vigilant postoperative radiographic and clinical monitoring to enable early detection and intervention, potentially preventing neurological deterioration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682251359948","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T09:41:32Z","timestamp":1752140492000},"page":"895-903","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Management and Risk Factors of Fracture-Type Proximal Junctional Kyphosis: Focus on Myelopathy and Intervention"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8057-7237","authenticated-orcid":false,"given":"Atsuyuki","family":"Kawabata","sequence":"first","affiliation":[{"name":"Kudanzaka 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