{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T19:40:13Z","timestamp":1772307613210,"version":"3.50.1"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"\nOBJECTIVE<\/jats:title>\nThe objective of this study was to identify the effect of baseline cervical deformity (CD) on proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in patients with adult spinal deformity (ASD).<\/jats:p>\n<\/jats:sec>\n\nMETHODS<\/jats:title>\nThis study was a retrospective analysis of a prospectively collected, multicenter database comprising ASD patients enrolled at 13 participating centers from 2009 to 2018. Included were ASD patients aged > 18 years with concurrent CD (C2\u20137 kyphosis < \u221215\u00b0, T1S minus cervical lordosis > 35\u00b0, C2\u20137 sagittal vertical axis > 4 cm, chin-brow vertical angle > 25\u00b0, McGregor\u2019s slope > 20\u00b0, or C2\u2013T1 kyphosis > 15\u00b0 across any three vertebrae) who underwent surgery. Patients were grouped according to four deformity classification schemes: Ames and Passias CD modifiers, sagittal morphotypes as described by Kim et al., and the head versus trunk balance system proposed by Mizutani et al. Mean comparison tests and multivariable binary logistic regression analyses were performed to assess the impact of these deformity classifications on PJK and PJF rates up to 3 years following surgery.<\/jats:p>\n<\/jats:sec>\n\nRESULTS<\/jats:title>\nA total of 712 patients with concurrent ASD and CD met the inclusion criteria (mean age 61.7 years, 71% female, mean BMI 28.2 kg\/m2<\/jats:sup>, and mean Charlson Comorbidity Index 1.90) and underwent surgery (mean number of levels fused 10.1, mean estimated blood loss 1542 mL, and mean operative time 365 minutes; 70% underwent osteotomy). By approach, 59% of the patients underwent a posterior-only approach and 41% underwent a combined approach. Overall, 277 patients (39.1%) had PJK by 1 year postoperatively, and an additional 189 patients (26.7%) developed PJK by 3 years postoperatively. Overall, 65 patients (9.2%) had PJF by 3 years postoperatively. Patients classified as having a cervicothoracic deformity morphotype had higher rates of early PJK than flat neck deformity and cervicothoracic deformity patients (p = 0.020). Compared with the head-balanced patients, trunk-balanced patients had higher rates of PJK and PJF (both p < 0.05). Examining Ames modifier severity showed that patients with moderate and severe deformity by the horizontal gaze modifier had higher rates of PJK (p < 0.001).<\/jats:p>\n<\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nIn patients with concurrent cervical and thoracolumbar deformities undergoing isolated thoracolumbar correction, the use of CD classifications allows for preoperative assessment of the potential for PJK and PJF that may aid in determining the correction of extending fusion levels.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.5.spine22752","type":"journal-article","created":{"date-parts":[[2023,7,22]],"date-time":"2023-07-22T15:56:36Z","timestamp":1690041396000},"page":"742-750","source":"Crossref","is-referenced-by-count":2,"title":["The impact of baseline cervical malalignment on the development of proximal junctional kyphosis following surgical correction of thoracolumbar adult spinal deformity"],"prefix":"10.3171","volume":"39","author":[{"given":"Lara","family":"Passfall","sequence":"first","affiliation":[{"name":"Division of Spine Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, New York Spine Institute, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bailey","family":"Imbo","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, New York Spine Institute, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Breton","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":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Schoenfeld","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Brigham and Women\u2019s Center for Surgery and Public Health, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Themistocles","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan H.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaled M.","family":"Kebaish","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins Medical Center, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey L.","family":"Gum","sequence":"additional","affiliation":[{"name":"Norton Leatherman Spine Center, Louisville, Kentucky;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heiko","family":"Koller","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Technical University of Munich (TUM), Klinikum Rechts Der Isar, Munich, Germany;"},{"name":"Department for Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. Kojo","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Hostin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Southwest Scoliosis Center, Dallas, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munish","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neel","family":"Anand","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Cedars-Sinai Health Center, Los Angeles, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank J.","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Departments of Neurosurgery and Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric O.","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"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":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, New York Spine Institute, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"J Korean Neurosurg Soc","first-page":"167","article-title":"Restoration of sagittal balance in spinal deformity surgery","volume":"61","author":"Makhni MC","year":"2018","unstructured":"Makhni MC, Shillingford JN, Laratta JL, Hyun SJ, Kim YJ. 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