{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:14:48Z","timestamp":1793297688641,"version":"4.5.0"},"reference-count":28,"publisher":"The Korean Spinal Neurosurgery Society","issue":"4","license":[{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"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":[[2025,12,31]]},"abstract":"<jats:p>Objective: To determine the optimal targets of the L1 pelvic angle (L1PA) that minimize the risk of both proximal junctional kyphosis (PJK) and pelvic nonresponse (PNR) following adult spinal deformity (ASD) surgery.Methods: A retrospective study was conducted on 323 patients who underwent fusion surgery from the low thoracic spine (T9\u201312) to the pelvis and were followed up for 2 years. Risk factors for PJK and PNR were evaluated separately using multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve analyses were performed to identify L1PA cutoff values predictive of PJK and PNR across 3 pelvic incidence (PI) categories: &lt;45\u00b0, 45\u00b0\u201360\u00b0, and \u226560\u00b0. L1PA thresholds were defined to delineate \u201cideal\u201d alignment.Results: Risk factor analyses revealed that low L1PA was an independent risk factor for PJK (odds ratio [OR], 0.927; p=0.019), while high PI\u2013LL (OR, 1.101; p&lt;0.001) and high L1PA (OR, 1.249; p&lt;0.001) were significant risk factors for PNR. On ROC curve analyses, optimal L1PA ranges were 2.5\u00b0\u20134.5\u00b0 for PI&lt;45\u00b0, 8.7\u00b0\u201312.6\u00b0 for PI 45\u00b0\u201360\u00b0, and 15.1\u00b0\u201317.3\u00b0 for PI\u226560\u00b0. Patients within these ideal L1PA ranges had significantly lower rates of both PJK and PNR compared to those exceeding ideal L1PA ranges.Conclusion: This study demonstrated that optimal correction based on these L1PA targets reduced the risk of both PJK and PNR. Therefore, these L1PA targets can serve as reliable alignment goals to optimize surgical outcomes in ASD surgery.<\/jats:p>","DOI":"10.14245\/ns.2550908.454","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T23:10:08Z","timestamp":1767136208000},"page":"987-997","update-policy":"https:\/\/doi.org\/10.14245\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Establishing Optimal L1 Pelvic Angle Targets to Minimize Both Proximal Junctional Kyphosis and Pelvic Nonresponse in Adult Spinal Deformity Surgery"],"prefix":"10.14245","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2412-9437","authenticated-orcid":true,"given":"Se-Jun","family":"Park","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6517-8609","authenticated-orcid":true,"given":"Jin-Sung","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9114-0150","authenticated-orcid":true,"given":"Dong-Ho","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1373-4815","authenticated-orcid":true,"given":"Chong-Suh","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8151-1084","authenticated-orcid":true,"given":"Hyun-Jun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5355","reference":[{"key":"ref1","first-page":"1077","volume-title":"Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study","author":"Schwab","year":"2012"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000001240"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2346420.210"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000002346"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000004464"},{"key":"ref6","first-page":"1399","volume-title":"The T4-L1-Hip axis: defining a normal sagittal spinal alignment","author":"Hills","year":"2022"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000003063"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.31616\/asj.2023.0339"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2024.08.015"},{"key":"ref10","first-page":"899","volume-title":"Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle","author":"Bridwell","year":"2013"},{"key":"ref11","first-page":"1017","volume-title":"Minimum clinically important difference in patient-reported outcome measures in de novo degenerative lumbar scoliosis: is it appropriate to apply the values of adult spine deformity?","author":"Yuan","year":"2023"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcm.2016.02.012"},{"key":"ref13","first-page":"1295","volume-title":"Characteristics of spinal morphology according to the \u201ccurrent\u201d and \u201ctheoretical\u201d roussouly classification systems in a diverse, asymptomatic cohort: Multi-Ethnic Alignment Normative Study (MEANS)","author":"Shen","year":"2025"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1177\/21925682241235607"},{"key":"ref15","first-page":"694","volume-title":"Ideal lumbar lordosis correction in patients with adult spinal deformity without adversely impacting pelvic tilt and pelvic incidence minus lumbar lordosis: a study of 426 cases","author":"Park","year":"2025"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.14444\/8254"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2021.10.019"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1007\/s43390-021-00397-1"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.31616\/asj.2024.0405"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1177\/21925682251347909"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1177\/21925682211047461"},{"key":"ref22","first-page":"2224","volume-title":"Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery","author":"Schwab","year":"2010"},{"key":"ref23","first-page":"1661","volume-title":"Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery","author":"Yilgor","year":"2017"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000002146"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1177\/21925682221150770"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyaa311"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2449174.587"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.31616\/asj.2023.0138"}],"container-title":["Neurospine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-neurospine.org\/upload\/pdf\/ns-2550908-454.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-neurospine.org\/journal\/view.php?doi=10.14245\/ns.2550908.454","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-neurospine.org\/upload\/pdf\/ns-2550908-454.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T23:34:18Z","timestamp":1767137658000},"score":1,"resource":{"primary":{"URL":"http:\/\/e-neurospine.org\/journal\/view.php?doi=10.14245\/ns.2550908.454"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,31]]},"references-count":28,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,12]]}},"URL":"https:\/\/doi.org\/10.14245\/ns.2550908.454","relation":{},"ISSN":["2586-6583","2586-6591"],"issn-type":[{"value":"2586-6583","type":"print"},{"value":"2586-6591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,31]]},"assertion":[{"value":"2025-06-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-31","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-31","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}