{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:41:18Z","timestamp":1792636878977,"version":"4.5.0"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Proximal junctional kyphosis (PJK) is a complication of surgical management for adult spinal deformity (ASD) with a multifactorial etiology. Many risk factors are controversial, and their relative importance is not fully understood. The authors aimed to elucidate the association between bone mineral density (BMD) and PJK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A systematic literature search was performed using PubMed and Web of Science keywords of \"Proximal Junctional Kyphosis [MeSH] OR Proximal Junctional Failure [MeSH]\" AND \"Bone Mineral Density [MeSH] OR Hounsfield Units [MeSH] OR DEXA [MeSH]\" set to the date range of January 2002 to July 2022. Studies required a minimum of 10 patients and 12 months of follow-up. Articles were included if they were in the English language and presented a primary retrospective cohort that included a comparison of patients with and without PJK, as well as a radiographic biomarker for BMD, such as Hounsfield units (HU) or T-score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      A total of 18 unique studies with 2185 patients who underwent ASD surgery were identified. Of these, 537 patients (24.6%) developed PJK. Eight studies provided T-scores that were amenable to comparison, which found that patients who developed PJK were found to have lower BMD T-scores by a mean of \u22120.69 (95% CI \u22120.88 to \u22120.50; I\n                      <jats:sup>2<\/jats:sup>\n                      = 63.9%, p &lt; 0.001). The HU at the UIV among patients with the PJK group (n = 101) compared with the non-PJK group (n = 156) was found to be significantly lower (mean difference \u221232.35, 95% CI \u221246.05 to \u221218.65; I\n                      <jats:sup>2<\/jats:sup>\n                      = 28.7%, p &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This meta-analysis suggests that low preoperative BMD as measured by T-score and a diagnosis of osteoporosis were associated with higher postoperative PJK. Additionally, lower HU on CT at the UIV were found to be significant risk factors for postoperative PJK as well. These findings suggest that more attention to preoperative BMD is a risk factor for PJK among ASD patients is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2023.2.spine221101","type":"journal-article","created":{"date-parts":[[2023,4,7]],"date-time":"2023-04-07T09:51:56Z","timestamp":1680861116000},"page":"82-91","source":"Crossref","is-referenced-by-count":35,"title":["The association between bone mineral density and proximal junctional kyphosis in adult spinal deformity: a systematic review and meta-analysis"],"prefix":"10.3171","volume":"39","author":[{"given":"Jeffrey W.","family":"Chen","sequence":"first","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin G.","family":"McCandless","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center School of Medicine, Jackson, Mississippi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archis R.","family":"Bhandarkar","sequence":"additional","affiliation":[{"name":"Mayo Clinic Alix School of Medicine, Rochester; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick M.","family":"Flanigan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Lakomkin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony L.","family":"Mikula","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgos D.","family":"Michalopoulos","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Clin Spine Surg","first-page":"E178","article-title":"Incidence and risk factors for proximal junctional kyphosis: results of a multicentric study of adult scoliosis","volume":"31","author":"Sebaaly A","year":"2018","unstructured":"Sebaaly A, Sylvestre C, El Quehtani Y,  Incidence and risk factors for proximal junctional kyphosis: results of a multicentric study of adult scoliosis. 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