{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T09:10:36Z","timestamp":1769850636414,"version":"3.49.0"},"reference-count":8,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n A 58-year-old female with a history of L2-5 fusion at an outside institution presented with 9 months of mechanical back pain, inability to achieve upright posture, subjective lower extremity weakness, and pain when ambulating. Imaging demonstrated proximal junctional failure (PJF) with resulting sagittal and coronal plane defects secondary to the formation of an L1\/2 vertebral pseudoarticulation.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n Surgery was undertaken to revise and extend the previous construct from T10-ilium. After subperiosteal exposure and pedicle screw replacement, left L5 laminectomy and L5-S1 total lumbar interbody fusion were performed to maximize lumbosacral lordosis. An L1\/2 revision laminectomy was performed, and the disc space was distracted with laminar spreaders to reduce the pseudoarticulation. Deformity correction was finally achieved with a 4-rod construct and placement of a proximal tether to prevent recurrence of proximal junctional kyphosis (PJK). The patient recovered well initially, with maintained alignment at 6-month follow-up. At 7 months, multiple falls precipitated the development of PJK, necessitating rostral extension of the construct. Further falls led to unilateral rod fracture and loosening of pelvic pedicle screws. Another revision was performed, replacing the rod and upsizing the pelvic screws, achieving a favorable structural outcome.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Pathology of the uppermost instrumented vertebra is a recognized complication of spinal fusion. It can manifest as PJK or progress to PJF, in which kyphosis is accompanied by structural or instrument failure with symptoms requiring surgical revision. Presentation is variable, and reoperation requires an individualized approach. This case demonstrates the challenges inherent to adult spinal deformity surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_1344_2025","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T08:21:26Z","timestamp":1769761286000},"page":"55","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Correction of vertebral pseudoarticulation: An unusual driver of adult sagittal and coronal plane deformity"],"prefix":"10.25259","volume":"17","author":[{"given":"Miles A.","family":"McAllister","sequence":"first","affiliation":[{"name":"School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Galgano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"10.25259\/SNI_1344_2025\/ref-1","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/BRS.0000000000005096","article-title":"Heterogeneity in the definitions of proximal junctional kyphosis and failure in spinal deformity literature: A tower of babel","volume":"50","author":"Akosman","year":"2025","journal-title":"Spine (Phila Pa 1976)"},{"key":"10.25259\/SNI_1344_2025\/ref-2","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1097\/BRS.0000000000004364","article-title":"Evolution of proximal junctional kyphosis and proximal junctional failure rates over 10 years of enrollment in a prospective multicenter adult spinal deformity database","volume":"47","author":"Alshabab","year":"2022","journal-title":"Spine (Phila Pa 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failure","volume":"33","author":"Kim","year":"2025","journal-title":"J Am Acad Orthop Surg"},{"key":"10.25259\/SNI_1344_2025\/ref-6","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1097\/BRS.0b013e31817c0428","article-title":"Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: Minimum five-year follow-up","volume":"33","author":"Kim","year":"2008","journal-title":"Spine (Phila Pa 1976)"},{"key":"10.25259\/SNI_1344_2025\/ref-7","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1097\/BRS.0000000000000627","article-title":"Proximal junctional kyphosis and failure after spinal deformity surgery: A systematic review of the literature as a background to classification development","volume":"39","author":"Lau","year":"2014","journal-title":"Spine (Phila Pa 1976)"},{"key":"10.25259\/SNI_1344_2025\/ref-8","doi-asserted-by":"crossref","first-page":"E607","DOI":"10.1097\/BRS.0000000000000266","article-title":"Characterization and surgical outcomes of proximal junctional failure in surgically treated patients with adult spinal deformity","volume":"39","author":"Yagi","year":"2014","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["Surgical Neurology 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