{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T20:31:57Z","timestamp":1783024317329,"version":"3.54.6"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The aim of this study was to investigate the risk of upper instrumented vertebra (UIV) fractures associated with UIV screw fixation (unicortical vs bicortical) and polymethylmethacrylate (PMMA) augmentation after adult spinal deformity surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for \u2265 4 levels (that is, the lower instrumented vertebra at the sacrum or pelvis and the UIV of the thoracolumbar spine [T9\u2013L2]) were retrospectively reviewed. Age, sex, follow-up duration, sagittal UIV angle immediately postoperatively including several balance-related parameters (lumbar lordosis [LL], pelvic incidence, and sagittal vertical axis), bone mineral density, UIV screw fixation type, UIV PMMA augmentation, and UIV fracture were evaluated. Patients were divided into 3 groups: Group U, 15 patients with unicortical screw fixation at the UIV; Group P, 16 with bicortical screw fixation and PMMA augmentation at the UIV; and Group B, 21 with bicortical screw fixation without PMMA augmentation at the UIV.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The mean number of levels fused was 6.5 \u00b1 2.5, 7.5 \u00b1 2.5, and 6.5 \u00b1 2.5; the median age was 50 \u00b1 29, 72 \u00b1 6, and 59 \u00b1 24 years; and the mean follow-up was 31.5 \u00b1 23.5, 13 \u00b1 6, and 24 \u00b1 17.5 months in Groups U, P, and B, respectively (p &gt; 0.05). There were no significant differences in balance-related parameters (LL, sagittal vertical axis, pelvic incidence\u2013LL, and so on) among the groups. UIV fracture rates in Groups U (0%), P (31.3%), and B (42.9%) increased in sequence by group (p = 0.006). UIV bicortical screw fixation increased the risk for UIV fracture (OR 5.39; p = 0.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Bicortical screw fixation at the UIV is a major risk factor for early UIV compression fracture, regardless of whether a thoracolumbosacral orthosis is used. To reduce the proximal junctional failure, unicortical screw fixation at the UIV is essential in adult spinal deformity correction surgery.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.10.spine16535","type":"journal-article","created":{"date-parts":[[2017,3,3]],"date-time":"2017-03-03T15:02:23Z","timestamp":1488553343000},"page":"638-644","source":"Crossref","is-referenced-by-count":15,"title":["Association between bicortical screw fixation at upper instrumented vertebra and risk for upper instrumented vertebra fracture"],"prefix":"10.3171","volume":"26","author":[{"given":"Young-Seop","family":"Park","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University Graduate School of Medicine, Jinju; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Jae","family":"Hyun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho Yong","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki-Jeong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae-Ahn","family":"Jahng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Evid Based Spine Care J","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1055\/s-0034-1386755","article-title":"Predictive factors for acute proximal junctional failure after adult deformity surgery with upper instrumented vertebrae in the thoracolumbar spine","volume":"5","author":"Annis P,","year":"2014","unstructured":"Annis P, Lawrence BD, Spiker WR, Zhang Y, Chen W, Daubs MD, : Predictive factors for acute proximal junctional failure after adult deformity surgery with upper instrumented vertebrae in the thoracolumbar spine. 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