{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T02:15:29Z","timestamp":1789265729854,"version":"build-2803163510"},"reference-count":66,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) remain difficult problems following correction of adult spinal deformity (ASD). The goal of this study was to perform a comprehensive evaluation of risk factors associated with PJK and PJF using advanced statistical methods through inverse probability weighting (IPW).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Patients who presented to the authors\u2019 institution with symptomatic ASD from 2013 to 2021 and who underwent thoracolumbar fusion ending in the pelvis were included in the study. The primary outcomes were development of PJK and PJF following ASD correction. PJK was classified using Glattes\u2019 criteria. PJF was defined as a proximal junctional angle > 20\u00b0 from preoperative measures or complications at the upper instrumented vertebra (UIV) including vertebral body fracture, instability, and\/or hardware failure. Patient charts and images (radiography, CT, and MRI) were used to extract demographics, measures of sagittal and coronal balance on pre- and postoperative radiography, operative techniques, and bone health metrics. Propensity score generation with IPW was used to control for confounding variables.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n In total, 187 patients were included in the study with a median follow-up of 24.6 months. Sixty-nine patients (36.9%) developed PJK, while 26 (13.9%) developed PJF. Kaplan-Meier analysis showed that both PJK and PJF largely occurred within the 1st year of index ASD correction. IPW showed that patients who developed PJK had a larger correction in the sagittal plane including global lumbar lordosis (p < 0.001) and sagittal vertical axis (p = 0.020). PJF development was associated with factors at the UIV including low Hounsfield units (p = 0.026) and cranially directed screws at the UIV (p = 0.040).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n PJK and PJF remain challenging postoperative complications following correction of ASD. In this large retrospective study that utilized IPW analysis, the authors found factors unique to each outcome. These results suggest that increased correction in the sagittal plane is more commonly associated with PJK, while junctional factors including bone quality and cranially directed screws at the UIV are associated with PJF. These findings can inform pre- and intraoperative medical and surgical strategies to reduce the incidence of PJK and PJF following ASD correction.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.12.spine24899","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T16:52:01Z","timestamp":1743267121000},"page":"748-757","source":"Crossref","is-referenced-by-count":5,"title":["The influence of the magnitude of sagittal correction and local junctional factors on proximal junctional kyphosis and failure following correction of adult spinal deformity: an inverse probability weighted analysis"],"prefix":"10.3171","volume":"42","author":[{"given":"Yohannes","family":"Ghenbot","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Arena","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mert Marcel","family":"Dagli","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominick","family":"Macaluso","sequence":"additional","affiliation":[{"name":"Biostatistics Analysis Center, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sennay","family":"Ghenbot","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor","family":"Wathen","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harmon","family":"Khela","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan S.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Santangelo","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josh","family":"Gobulovsky","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnny","family":"Wright","sequence":"additional","affiliation":[{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Heintz","sequence":"additional","affiliation":[{"name":"Biostatistics Analysis Center, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zarina S.","family":"Ali","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil R.","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William C.","family":"Welch","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jang W.","family":"Yoon","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Arlet","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali K.","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"224","article-title":"The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases","volume":"41","author":"Bess S","year":"2016","unstructured":"Bess S, Line B, Fu KM, The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases. Spine (Phila Pa 1976). 2016;41(3):224\u2013233."},{"issue":"4","key":"b2","series-title":"Spine Surg Relat Res","first-page":"337","article-title":"Cone of Economy with the Chain of Balance\u2014historical perspective and proof of concept","volume":"6","author":"Hasegawa K","year":"2022","unstructured":"Hasegawa K, Dubousset JF. Cone of Economy with the Chain of Balance\u2014historical perspective and proof of concept. Spine Surg Relat Res. 2022;6(4):337\u2013349."},{"issue":"1","key":"b3","series-title":"Neurosurgery","first-page":"25","article-title":"Epidemiology and socioeconomic trends in adult spinal deformity care","volume":"87","author":"Safaee MM","year":"2020","unstructured":"Safaee MM, Ames CP, Smith JS. Epidemiology and socioeconomic trends in adult spinal deformity care. Neurosurgery. 2020;87(1):25\u201332."},{"issue":"20","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"1402","article-title":"Marked increase in spinal deformity surgery throughout the United States","volume":"46","author":"Beschloss A","year":"2021","unstructured":"Beschloss A, Dicindio C, Lombardi J, Marked increase in spinal deformity surgery throughout the United States. Spine (Phila Pa 1976). 2021;46(20):1402\u20131408."},{"issue":"14","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"1643","article-title":"Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis","volume":"30","author":"Glattes RC","year":"2005","unstructured":"Glattes RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A, Edwards C II. Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. 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Sarcopenia in paraspinal muscle as a risk factor of proximal junctional kyphosis and proximal junctional failure after adult spinal deformity surgery. J Neurosurg Spine. 2023;40(3):324\u2013330."},{"issue":"12","key":"b12","series-title":"Spine (Phila Pa 1976)","first-page":"1077","article-title":"Scoliosis Research Society\u2014Schwab adult spinal deformity classification: a validation study","volume":"37","author":"Schwab F","year":"2012","unstructured":"Schwab F, Ungar B, Blondel B, Scoliosis Research Society\u2014Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976). 2012;37(12):1077\u20131082."},{"issue":"4","key":"b13","series-title":"Spine J","first-page":"556","article-title":"Novel MRI-based score for assessment of bone density in operative spine patients","volume":"20","author":"Ehresman J","year":"2020","unstructured":"Ehresman J, Pennington Z, Schilling A, Novel MRI-based score for assessment of bone density in operative spine patients. 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Spine Surg Relat Res. 2022;6(4):337\u2013349."},{"issue":"1","key":"b3","series-title":"Neurosurgery","first-page":"25","article-title":"Epidemiology and socioeconomic trends in adult spinal deformity care","volume":"87","author":"Safaee MM","year":"2020","unstructured":"Safaee MM, Ames CP, Smith JS. Epidemiology and socioeconomic trends in adult spinal deformity care. Neurosurgery. 2020;87(1):25\u201332."},{"issue":"20","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"1402","article-title":"Marked increase in spinal deformity surgery throughout the United States","volume":"46","author":"Beschloss A","year":"2021","unstructured":"Beschloss A, Dicindio C, Lombardi J, Marked increase in spinal deformity surgery throughout the United States. 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