{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:07:59Z","timestamp":1782914879886,"version":"3.54.5"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The objective of this study was to calibrate an updated predictive model incorporating novel clinical, radiographic, and prophylactic measures to assess the risk of proximal junctional kyphosis (PJK) and failure (PJF).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Operative patients with adult spinal deformity (ASD) and baseline and 2-year postoperative data were included. PJK was defined as \u2265 10\u00b0 in sagittal Cobb angle between the inferior uppermost instrumented vertebra (UIV) endplate and superior endplate of the UIV + 2 vertebrae. PJF was radiographically defined as a proximal junctional sagittal Cobb angle \u2265 15\u00b0 with the presence of structural failure and\/or mechanical instability, or PJK with reoperation. Backstep conditional binary supervised learning models assessed baseline demographic, clinical, and surgical information to predict the occurrence of PJK and PJF. Internal cross validation of the model was performed via a 70%\/30% cohort split. Conditional inference tree analysis determined thresholds at an alpha level of 0.05.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Seven hundred seventy-nine patients with ASD (mean 59.87 \u00b1 14.24 years, 78% female, mean BMI 27.78 \u00b1 6.02 kg\/m<jats:sup>2<\/jats:sup>, mean Charlson Comorbidity Index 1.74 \u00b1 1.71) were included. PJK developed in 50.2% of patients, and 10.5% developed PJF by their last recorded visit. The six most significant demographic, radiographic, surgical, and postoperative predictors of PJK\/PJF were baseline age \u2265 74 years, baseline sagittal age-adjusted score (SAAS) T1 pelvic angle modifier &gt; 1, baseline SAAS pelvic tilt modifier &gt; 0, levels fused &gt; 10, nonuse of prophylaxis measures, and 6-week SAAS pelvic incidence minus lumbar lordosis modifier &gt; 1 (all p &lt; 0.015). Overall, the model was deemed significant (p &lt; 0.001), and internally validated receiver operating characteristic analysis returned an area under the curve of 0.923, indicating robust model fit.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>PJK and PJF remain critical concerns in ASD surgery, and efforts to reduce the occurrence of PJK and PJF have resulted in the development of novel prophylactic techniques and enhanced clinical and radiographic selection criteria. This study demonstrates a validated model incorporating such techniques that may allow for the prediction of clinically significant PJK and PJF, and thus assist in optimizing patient selection, enhancing intraoperative decision making, and reducing postoperative complications in ASD surgery.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.4.spine221412","type":"journal-article","created":{"date-parts":[[2023,6,3]],"date-time":"2023-06-03T16:53:31Z","timestamp":1685811211000},"page":"311-319","source":"Crossref","is-referenced-by-count":15,"title":["Calibration of a comprehensive predictive model for the development of proximal junctional kyphosis and failure in adult spinal deformity patients with consideration of contemporary goals and techniques"],"prefix":"10.3171","volume":"39","author":[{"given":"Peter S.","family":"Tretiakov","sequence":"first","affiliation":[{"name":"Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, New York;"},{"name":"Department of Orthopaedic Surgery, New York Spine Institute, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breton G.","family":"Line","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke\u2019s\/Rocky Mountain Hospital for Children, Denver, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassel G.","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan H.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Gum","sequence":"additional","affiliation":[{"name":"Norton Leatherman Spine Center, Louisville, Kentucky;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Themistocles","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Kojo","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Soroceanu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin K.","family":"Scheer","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert K.","family":"Eastlack","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Mundis","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierce D.","family":"Nunley","sequence":"additional","affiliation":[{"name":"Spine Institute of Louisiana, Shreveport, Louisiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric O.","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Kebaish","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins Medical Center, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, University of Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Lenke","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Columbia University, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Hostin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Southwest Scoliosis Center, Dallas, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munish C.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke\u2019s\/Rocky Mountain Hospital for Children, Denver, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, New York;"},{"name":"Department of Orthopaedic Surgery, New York Spine Institute, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"25","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"2093","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 D","year":"2014","unstructured":"Lau D, Clark AJ, Scheer JK,  Proximal junctional kyphosis and failure after spinal deformity surgery: a systematic review of the literature as a background to classification development. 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Korean J Spine. 2017;14(4):126\u2013132."},{"issue":"5","key":"b4","series-title":"J Am Acad Orthop Surg","first-page":"318","article-title":"Proximal junctional kyphosis","volume":"24","author":"Kim HJ","year":"2016","unstructured":"Kim HJ, Iyer S. Proximal junctional kyphosis. J Am Acad Orthop Surg. 2016;24(5):318\u2013326."},{"issue":"1","key":"b5","series-title":"Global Spine J","first-page":"32","article-title":"Surgical, radiographic, and patient-related risk factors for proximal junctional kyphosis: a meta-analysis","volume":"9","author":"Kim JS","year":"2019","unstructured":"Kim JS, Phan K, Cheung ZB,  Surgical, radiographic, and patient-related risk factors for proximal junctional kyphosis: a meta-analysis. Global Spine J. 2019;9(1):32\u201340."},{"key":"b6","series-title":"Spine","article-title":"The benefit of addressing malalignment in revision surgery for proximal junctional kyphosis following ASD surgery","author":"Passias PG","unstructured":"Passias PG, Krol O, Williamson TK,  The benefit of addressing malalignment in revision surgery for proximal junctional kyphosis following ASD surgery. Spine. Published online September 8, 2022. doi:10.1097\/BRS.0000000000004476"},{"issue":"24","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"E1444","article-title":"Results of revision surgery for proximal junctional kyphosis following posterior segmental instrumentation: minimum 2-year postrevision follow-up","volume":"41","author":"Kim YC","year":"2016","unstructured":"Kim YC, Lenke LG, Bridwell KH,  Results of revision surgery for proximal junctional kyphosis following posterior segmental instrumentation: minimum 2-year postrevision follow-up. 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Neurosurgery. 2017;80(2):279\u2013286."},{"issue":"22","key":"b13","series-title":"Spine (Phila Pa 1976)","first-page":"E1328","article-title":"Development of validated computer-based preoperative predictive model for proximal junction failure (PJF) or clinically significant PJK with 86% accuracy based on 510 ASD patients with 2-year follow-up","volume":"41","author":"Scheer JK","year":"2016","unstructured":"Scheer JK, Osorio JA, Smith JS,  Development of validated computer-based preoperative predictive model for proximal junction failure (PJF) or clinically significant PJK with 86% accuracy based on 510 ASD patients with 2-year follow-up. Spine (Phila Pa 1976). 2016;41(22):E1328\u2013E1335."},{"issue":"1","key":"b14","series-title":"Spine Deform","first-page":"121","article-title":"Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications","volume":"10","author":"Lafage R","year":"2022","unstructured":"Lafage R, Smith JS, Elysee J,  Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications. 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