{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:03:50Z","timestamp":1786125830420,"version":"build-2736575974"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) occurred in up to 40% of patients with adult spinal deformity (ASD) who underwent open thoracolumbar fusion. Proximal stabilization techniques have been investigated to prevent PJK\/PJF without conclusive results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To demonstrate reductions in PJK\/PJF with multilevel stabilization screws (MLSSs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      This observational longitudinal cohort study compares MLSSs with standard instrumentation. We reviewed the charts of consecutive patients with ASD undergoing open thoracolumbar fusion (&gt;3 levels, extending cranially above T6 and caudally below L1) from 2009 to 2017 and were followed for &gt;2 yr postoperatively. We defined PJF using the International Spine Study Group criteria and PJK as a Cobb angle increase &gt;10\u00b0. We defined the upper instrumented vertebra as the most cephalad vertebral body with bilateral MLSSs. Confounders, MLSS-specific complications, and radiographic outcomes were collected. We evaluated comparability between groups using univariate analyses. We adjusted for covariates by using multivariable regressions modeling PJF and PJK separately with a\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      -value &lt; .00625 considered significant after the Bonferroni correction. Sensitivity analysis accounted for those lost to follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Seventy-six patients (50 MLSS vs 26 controls) were included. MLSS patients were significantly older (64.5 \u00b1 8.9 vs 54.8 \u00b1 19.9 yr,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .024) and had significantly lower PJF incidence (10.0% vs 30.8%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .023) and less kyphosis (1.3\u00b0 \u00b1 5.3\u00b0 vs 5.2\u00b0 \u00b1 6.3\u00b0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .014). Multivariable analysis demonstrated a significant independent association between MLSSs and decreased odds of PJF (odds ratio: 0.11, 0.02\u20130.53,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .006). Perioperative complications did not significantly differ between cohorts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>MLSSs are safe and efficacious in reducing PJF\/PJK in patients with ASD undergoing open thoracolumbar fusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1227\/ons.0000000000000076","type":"journal-article","created":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T15:14:06Z","timestamp":1642173246000},"page":"150-157","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":14,"title":["Multilevel Stabilization Screws Prevent Proximal Junctional Failure and Kyphosis in Adult Spinal Deformity Surgery: A Comparative Cohort Study"],"prefix":"10.1227","volume":"22","author":[{"given":"Ascher","family":"Kaufmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad","family":"Claus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doris","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor","family":"Hanson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Carr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford","family":"Houseman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teck-Mun","family":"Soo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,1,14]]},"reference":[{"issue":"10193","key":"R1-20251027","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/S0140-6736(19)31125-0","article-title":"Adult 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