{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:46:04Z","timestamp":1791895564333,"version":"4.3.4"},"reference-count":27,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"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"],"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 whether thoracic compensation (TC) assessed against the deformity burden is associated with proximal junctional kyphosis (PJK) after lower thoracic fusion for adult spinal deformity (ASD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We reviewed 343 patients fused from T9-L1 to the sacrum or pelvis with a pelvic incidence (PI) minus lumbar lordosis (LL) mismatch above 20\u00b0. Expected thoracic kyphosis (TK) was derived from the PI-LL mismatch using published equations, and a measured TK below it defined TC. PJK was defined as a proximal junctional angle of 20\u00b0 or more, or revision, within two years. Multivariable logistic regression adjusted for patient, operative, and radiographic covariates including two measures of correction adequacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PJK occurred in 60 of 124 patients (48.4%) without TC and 68 of 219 (31.1%) with TC (P = 0.002). Correction was equivalent for PI-LL, the L1 pelvic angle (L1PA), and pelvic tilt, yet the TC present group restored more TK (19.1\u00b0 vs. 11.0\u00b0) while reaching a lower postoperative value (21.5\u00b0 vs. 33.7\u00b0, both P &lt; 0.001). TC remained associated with a lower risk of PJK after adjustment (odds ratio 0.431, 95% CI 0.261-0.713, P = 0.001), consistently across eight prespecified subgroups. Relative to TC without overcorrection, the odds ratio reached 3.41 (95% CI 1.37-8.46) when TC was absent and the L1PA offset indicated overcorrection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TC assessed against the deformity burden was associated with a lower risk of PJK despite a larger reciprocal increase in TK. Risk was highest when TC was absent and lordosis overcorrected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261496815","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:38:43Z","timestamp":1791635923000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Thoracic Compensation is Associated With a Lower Risk of Proximal Junctional Kyphosis After Lower Thoracic Fusion for Adult Spinal Deformity"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4020-7690","authenticated-orcid":false,"given":"Tae Soo","family":"Shin","sequence":"first","affiliation":[{"name":"Samsung Medical Center"},{"name":"Sungkyunkwan University School of 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Young","family":"Jung","sequence":"additional","affiliation":[{"name":"Samsung Medical Center"},{"name":"Sungkyunkwan University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Won","family":"Hur","sequence":"additional","affiliation":[{"name":"Samsung Medical Center"},{"name":"Sungkyunkwan University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2412-9437","authenticated-orcid":false,"given":"Se-Jun","family":"Park","sequence":"additional","affiliation":[{"name":"Samsung Medical Center"},{"name":"Sungkyunkwan University School of 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