{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T01:25:53Z","timestamp":1782350753120,"version":"3.54.5"},"reference-count":29,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T00:00:00Z","timestamp":1724371200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Distal junctional failure (DJF) is less commonly described than proximal junctional failure following posterior spinal fusion, and particularly adult spinal deformity (ASD) surgery. We describe a case series of patients with DJF, taking into account sagittal spinopelvic alignment, and suggest potential risk factors in light of the current literature. Methods: We performed a single-center, retrospective review of posterior spinal fusion patients with DJF who underwent subsequent revision surgery between June 2009 and January 2019. Demographics and surgical details were collected. Radiographical measurements included the following: preoperative and postoperative sagittal and coronal alignment for each index or revision surgery. The upper-instrumented vertebra (UIV), lower instrumented vertebra (LIV), and fusion length were recorded. Results: Nineteen cases (64.7 \u00b1 13.5 years, 12 women, seven men) were included. The mean follow-up was 4.7 \u00b1 2.4 years. The number of instrumented levels was 6.79 \u00b1 2.97. Among the patients, 84.2% (n = 16) presented at least one known DJF risk factor. LIV was frequently L5 (n = 10) or S1 (n = 2). Six patients had an initial circumferential fusion at the distal end. Initial DJFs were vertebral fracture distal to the fusion (n = 5), screw pull-out (n = 9), spinal stenosis (n = 4), instability (n = 4), and one early DJK. The distal mechanical complications after a first revision included screw pull-out (n = 4), screw fracture (n = 3), non-union (n = 2), and an iatrogenic spondylolisthesis. Conclusions: In this case series, insufficient sagittal balance restoration, female gender, osteoporosis, L5 or S1 LIV in long constructs were associated with DJF. Restoring spinal balance and circumferentially fusing the base of constructs represent key steps to maintain correction and prevent revisions.<\/jats:p>","DOI":"10.3390\/jcm13174981","type":"journal-article","created":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T12:53:19Z","timestamp":1724417599000},"page":"4981","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Distal Junctional Failure: A Feared Complication of Multilevel Posterior Spinal Fusions"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3401-1838","authenticated-orcid":false,"given":"Soufiane","family":"Ghailane","sequence":"first","affiliation":[{"name":"Department of Spinal Surgery Unit, H\u00f4pital Priv\u00e9 Francheville, 24000 P\u00e9rigueux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houssam","family":"Bouloussa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO 64108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Fernandes Marques","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade do Litoral Alentejano, Servi\u00e7o de Ortopedia, Monte do Gilbardinho, 7540-230 Santiago do Cac\u00e9m, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0479-3162","authenticated-orcid":false,"given":"Jean-Etienne","family":"Castelain","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Unit, H\u00f4pital Priv\u00e9 Francheville, 24000 P\u00e9rigueux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0074-9244","authenticated-orcid":false,"given":"Vincent","family":"Challier","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Unit, H\u00f4pital Priv\u00e9 Francheville, 24000 P\u00e9rigueux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Campana","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Unit, H\u00f4pital Priv\u00e9 Francheville, 24000 P\u00e9rigueux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cl\u00e9ment","family":"Jacquemin","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Unit, H\u00f4pital Priv\u00e9 Francheville, 24000 P\u00e9rigueux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Marc","family":"Vital","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Unit 1, Universit\u00e9 de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Am\u00e9lie Raba L\u00e9on, 33076 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Gille","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Unit 1, Universit\u00e9 de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Am\u00e9lie Raba L\u00e9on, 33076 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1007\/s00586-013-2676-x","article-title":"Junctional spinal disorders in operated adult spinal deformities: Present understanding and future perspectives","volume":"22","author":"Arlet","year":"2013","journal-title":"Eur. 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