{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T04:25:39Z","timestamp":1793679939599,"version":"4.5.1"},"reference-count":44,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"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":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>\n                      Retrospective\n                      <jats:bold>,<\/jats:bold>\n                      Single-center.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate preoperative cervical range-of-motion via cervical flexion-extension radiographs and its relation to the development of PJK\/PJF following ASD correction in patients with a UIV in the upper thoracic spine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with an UIV between T1-T4, preoperative cervical flexion\/extension radiographs and instrumented to the pelvis, and minimum 1yr follow-up were included. Cervical measurements included range-of-motion (ROM), flexion, extension and cervical SVA (cSVA). Patients were stratified into 3 groups: No-PJK, asymptomatic PJK (A-PJK) and symptomatic PJK including PJF (S-PJK\/PJF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      151 patients were included: Mean age 59.6 \u00b1 8.0\u00a0yrs, BMI of 25.1 \u00b1 4.5, 88.7% (n = 134) were female. PJK status: No PJK = 111 (73.5%) patients, A-PJK = 21 (13.9%), S-PJK\/PJF = 19 (12.6%). S-PJK\/PJF patients, however, were more likely to be diagnosed with osteopenia\/osteoporosis(S-PJK\/PJF: 68.4% vs A-PJK: 23.8% vs No PJK: 52.3%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.0138). S-PJK\/PJF patients had significantly less cervical flexion (No PJK: 19.5 \u00b1 14.2 vs A-PJK: 19.9 \u00b1 10.9 vs S-PJK\/PJF: 7.7 \u00b1 11.9,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.0029) and ROM than the other groups (No PJK: 52.8 \u00b1 17.7 vs A-PJK: 53.1 \u00b1 14.5 vs S-PJK\/PJF: 39.2 \u00b1 17.9,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.0085). On multivariable models for the development of S-PJK\/PJF, reduced baseline cervical flexion and ROM were independent risk factors yielding threshold values of 22.8\u00b0 and 48.2\u00b0, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multivariable models for the development of S-PJK\/PJF demonstrated that reduced baseline cervical ROM and flexion were independent risk factors yielding threshold values of 48.2\u00b0 and 22.8\u00b0, respectively. All of S-PJK\/PJF patients had preop flexion &lt;22.8\u00b0. Flexion-extension radiographs provide a quick and easy option at a relatively low cost to offer additional information that may aid in surgical planning and shared decision making with the patient regarding potential outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261449777","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T07:22:10Z","timestamp":1778224930000},"page":"3970-3981","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Reduced Preoperative Cervical Spine Flexion-Extension Range of Motion Is Associated With the Development of Upper Thoracic Proximal Junction Kyphosis in Adult Spinal Deformity Patients"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2536-601X","authenticated-orcid":false,"given":"Justin K.","family":"Scheer","sequence":"first","affiliation":[{"name":"Cedars-Sinai Medical 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J.","family":"Lee","sequence":"additional","affiliation":[{"name":"The Och Spine Hospital\/Columbia University Irving Medical Center"},{"name":"Midwest Orthopedics at Rush University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven G.","family":"Roth","sequence":"additional","affiliation":[{"name":"The Och Spine Hospital\/Columbia University Irving Medical Center"},{"name":"University of Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8419-3134","authenticated-orcid":false,"given":"Alexander","family":"Tuchman","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corey T.","family":"Walker","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"Lombardi","sequence":"additional","affiliation":[{"name":"The Och Spine 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