{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:58:40Z","timestamp":1785473920260,"version":"3.56.0"},"reference-count":48,"publisher":"The Korean Spinal Neurosurgery Society","issue":"4","license":[{"start":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T00:00:00Z","timestamp":1735603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["e-neurospine.org"],"crossmark-restriction":true},"short-container-title":["Neurospine"],"published-print":{"date-parts":[[2024,12,31]]},"abstract":"<jats:p>Objective: To identify the risk factors for proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery despite ideal sagittal correction according to age-adjusted alignment target.Methods: The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of &gt;28\u00b0 plus a difference in PJA of &gt;22\u00b0 or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF.Results: The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001\u20131.129; p=0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001\u20131.013; p=0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205\u201319.621; p=0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109\u20131.164; p&lt;0.001) were significant risk factors for PJF development.Conclusion: A sizeable proportion of patients (21.9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.<\/jats:p>","DOI":"10.14245\/ns.2448734.367","type":"journal-article","created":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T04:43:31Z","timestamp":1735533811000},"page":"1080-1090","update-policy":"https:\/\/doi.org\/10.14245\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Proximal Junctional Failure Development Despite Achieving Ideal Sagittal Correction According to Age-Adjusted Alignment Target in Patients With Adult Spinal Deformity: Risk Factor Analysis of 196 Cases Undergoing Low Thoracic to Pelvic 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