{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T10:14:23Z","timestamp":1783332863577,"version":"3.54.6"},"reference-count":30,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"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":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective cohort comparative study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate whether specific upper instrumented vertebra (UIV) pedicle screw characteristics\u2014particularly screw slope (UIV SS), tip-to-endplate distance (TED), and tip-to-anterior cortex distance (TAD)\u2014are associated with the development of upper instrumented vertebra fracture (UIVF) following adult spinal deformity (ASD) surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 132 patients (mean age: 68.4\u00a0years) who underwent corrective surgery from 2013 to 2022, with a minimum follow-up of 2\u00a0years. The radiographic parameters and UIV screw characteristics were analyzed. Patients were categorized into UIVF and non-UIVF groups. Logistic regression and Receiver Operating Characteristic (ROC) curve analyses were used to identify the risk factors and cutoff values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      UIVF occurred in 28.8% (38\/132) of the patients. Post-thoracic kyphosis (Post-TK) and TED of the upper UIV screw (Post-TED\n                      <jats:sub>upper<\/jats:sub>\n                      ) were independently associated with UIVF. Cutoff values predictive of UIVF were post-TK &gt; 36.5\u00b0 and Post-TED\n                      <jats:sub>upper<\/jats:sub>\n                      &lt; 6.5\u00a0\n                      <jats:italic toggle=\"yes\">mm<\/jats:italic>\n                      . Patients with a TED\n                      <jats:sub>upper<\/jats:sub>\n                      &lt; 6.5\u00a0\n                      <jats:italic toggle=\"yes\">mm<\/jats:italic>\n                      had a significantly higher incidence of UIVF (HR = 2.417,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.010). Kaplan\u2013Meier analysis showed that UIVF commonly occurred within 3\u00a0months postoperatively. Progressive reduction in TED was observed over time, particularly in the UIVF group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Post- TK &gt; 36.5\u00b0 and Post-TED\n                      <jats:sub>upper<\/jats:sub>\n                      &lt; 6.5\u00a0\n                      <jats:italic toggle=\"yes\">mm<\/jats:italic>\n                      are significant predictors of UIVF. Based on the study findings, a postoperative TED of \u2265 6.5\u00a0mm may be associated with a reduced risk, and could be considered as a potential target in surgical planning, while acknowledging the limitations of the retrospective design and the model\u2019s moderate predictive accuracy.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682251390764","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T10:27:32Z","timestamp":1760696852000},"page":"1878-1888","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Short Distance Between Pedicle Screw Tip and Upper Endplate as a Risk Factor for Upper Instrumented Vertebra Fracture Following Adult Spinal Deformity Surgery"],"prefix":"10.1177","volume":"16","author":[{"given":"Ben-Hai","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin, Taiwan"},{"name":"Department of Orthopedics, The Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China"},{"name":"Department of Orthopedics, The 95th Hospital of Putian, Putian City, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Min","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin, Taiwan"},{"name":"Department of Orthopedics, The Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China"},{"name":"Department of Orthopedics, The 95th Hospital of Putian, Putian City, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1537-0541","authenticated-orcid":false,"given":"Qing-De","family":"Wang","sequence":"additional","affiliation":[{"name":"Zheng Zhou Orthopaedic Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Hsun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erh-Ti","family":"Ernest Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0012-0025","authenticated-orcid":false,"given":"Xue-Peng","family":"Wei","sequence":"additional","affiliation":[{"name":"Zheng Zhou Orthopaedic Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Hao","family":"Tsai","sequence":"additional","affiliation":[{"name":"China Medical University Hospital"},{"name":"China Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chin","family":"Fong","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin, Taiwan"},{"name":"China Medical University Hospital"},{"name":"China Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Jen","family":"Chen","sequence":"additional","affiliation":[{"name":"China Medical University Hospital"},{"name":"China Medical University"},{"name":"Asia University Hospital"},{"name":"China Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsien-Te","family":"Chen","sequence":"additional","affiliation":[{"name":"China Medical University Hospital"},{"name":"China Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0288-9870","authenticated-orcid":false,"given":"Yuan-Shun","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin, Taiwan"},{"name":"China Medical University Hospital"},{"name":"China Medical University"},{"name":"China Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000160842.43482.cd"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000627"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2015.05.028"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181b2e17e"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318271319c"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000266"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-012-2410-0"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181c8f35d"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2021.01.011"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000222"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jspd.2018.12.007"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.5650080915"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000000182o"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002191"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001883"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000004573"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2019.05.198"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000000258"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181895fea"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/21925682251340606"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318225b926"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000222"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000169451.76359.49"},{"key":"e_1_3_6_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2010.02.012"},{"key":"e_1_3_6_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002955"},{"key":"e_1_3_6_27_2","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000001240"},{"key":"e_1_3_6_28_2","doi-asserted-by":"publisher","DOI":"10.3171\/2023.8.SPINE23554"},{"key":"e_1_3_6_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2024.09.101"},{"key":"e_1_3_6_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-016-3676-6"},{"key":"e_1_3_6_31_2","doi-asserted-by":"publisher","DOI":"10.3171\/2020.5.FOCUS"}],"container-title":["Global Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682251390764","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21925682251390764","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682251390764","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T09:19:40Z","timestamp":1783329580000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21925682251390764"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1177\/21925682251390764"],"URL":"https:\/\/doi.org\/10.1177\/21925682251390764","relation":{},"ISSN":["2192-5682","2192-5690"],"issn-type":[{"value":"2192-5682","type":"print"},{"value":"2192-5690","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,17]]}}}