{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T01:50:08Z","timestamp":1782352208215,"version":"3.54.5"},"reference-count":78,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T00:00:00Z","timestamp":1716508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Proximal junctional kyphosis (PJK) and failure (PJF), the most prevalent complications following long-segment thoracolumbar fusions for adult spinal deformity (ASD), remain lacking in defined preventive measures. We studied whether one of the previously reported strategies with successful results\u2014a prophylactic augmentation of the uppermost instrumented vertebra (UIV) and supra-adjacent vertebra to the UIV (UIV + 1) with polymethylmethacrylate (PMMA)\u2014could also serve as a preventive measure of PJK\/PJF in minimally invasive surgery (MIS). Materials and Methods: The study included 29 ASD patients who underwent a combination of minimally invasive lateral lumbar interbody fusion (MIS-LLIF) at L1-2 through L4-5, all-pedicle-screw instrumentation from the lower thoracic spine to the sacrum, S2-alar-iliac fixation, and two-level balloon-assisted PMMA vertebroplasty at the UIV and UIV + 1. Results: With a minimum 3-year follow-up, non-PJK\/PJF group accounted for fifteen patients (52%), PJK for eight patients (28%), and PJF requiring surgical revision for six patients (21%). We had a total of seven patients with proximal junctional fracture, even though no patients showed implant\/bone interface failure with screw pullout, probably through the effect of PMMA. In contrast to the PJK cohort, six PJF patients all had varying degrees of neurologic deficits from modified Frankel grade C to D3, which recovered to grades D3 and to grade D2 in three patients each, after a revision operation of proximal extension of instrumented fusion with or without neural decompression. None of the possible demographic and radiologic risk factors showed statistical differences between the non-PJK\/PJF, PJK, and PJF groups. Conclusions: Compared with the traditional open surgical approach used in the previous studies with a positive result for the prophylactic two-level cement augmentation, the MIS procedures with substantial benefits to patients in terms of less access-related morbidity and less blood loss also provide a greater segmental stability, which, however, may have a negative effect on the development of PJK\/PJF.<\/jats:p>","DOI":"10.3390\/medicina60060860","type":"journal-article","created":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T11:17:52Z","timestamp":1716549472000},"page":"860","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Can We Rely on Prophylactic Two-Level Vertebral Cement Augmentation in Long-Segment Adult Spinal Deformity Surgery to Reduce the Incidence of Proximal Junctional Complications?"],"prefix":"10.3390","volume":"60","author":[{"given":"Yoichi","family":"Tani","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-City 573-1010, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiro","family":"Naka","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-City 573-1010, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoto","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-City 573-1010, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koki","family":"Kawashima","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-City 573-1010, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaaki","family":"Paku","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-City 573-1010, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6062-6767","authenticated-orcid":false,"given":"Masayuki","family":"Ishihara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-City 573-1010, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Adachi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-City 573-1010, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muneharu","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-City 573-1010, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichirou","family":"Taniguchi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-City 573-1010, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanori","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-City 573-1010, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"703","DOI":"10.3171\/2022.4.SPINE211432","article-title":"Radiographic and MRI evidence of indirect neural decompression after the anterior column realignment procedure for adult spinal deformity","volume":"37","author":"Tani","year":"2022","journal-title":"J. Neurosurg. Spine"},{"key":"ref_2","first-page":"152","article-title":"Lumbar lordosis restoration by minimally invasive short-segment fusion with anterior column realignment for adult spinal deformity: Minimum 2-year follow-up","volume":"40","author":"Tani","year":"2024","journal-title":"J. Neurosurg. Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1097\/01.brs.0000169451.76359.49","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","year":"2005","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1097\/00007632-199408000-00005","article-title":"An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermann\u2019s disease. A review of 32 patients","volume":"19","author":"Lowe","year":"1994","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1097\/00007632-199904150-00011","article-title":"Proximal kyphosis after posterior spinal fusion in patients with idiopathic scoliosis","volume":"24","author":"Lee","year":"1999","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2350","DOI":"10.1097\/00007632-200211010-00008","article-title":"Sagittal plane analysis of adolescent idiopathic scoliosis: The effect of anterior versus posterior instrumentation","volume":"27","author":"Rhee","year":"2002","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1097\/BRS.0b013e318271319c","article-title":"International Spine Study Group. Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity","volume":"38","author":"Hostin","year":"2013","journal-title":"Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"360","DOI":"10.3171\/2013.5.SPINE12737","article-title":"Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: A comparison of proximal and distal upper instrumented vertebrae","volume":"19","author":"Ha","year":"2013","journal-title":"J. Neurosurg. Spine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E607","DOI":"10.1097\/BRS.0000000000000266","article-title":"Complex Spine Study Group. Characterization and surgical outcomes of proximal junctional failure in surgically treated patients with adult spinal deformity","volume":"39","author":"Yagi","year":"2014","journal-title":"Spine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"125","DOI":"10.3171\/2016.6.SPINE151477","article-title":"The effect of posterior polyester tethers on the biomechanics of proximal junctional kyphosis: A finite element analysis","volume":"26","author":"Bess","year":"2017","journal-title":"J. Neurosurg. Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/j.spinee.2008.01.015","article-title":"Proximal junctional acute collapse cranial to multi-level lumbar fusion: A cost analysis of prophylactic vertebral augmentation","volume":"8","author":"Hart","year":"2008","journal-title":"Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1097\/BSD.0b013e31818d6493","article-title":"Bone cement augmentation in the prevention of adjacent segment failure after multilevel adult deformity fusion","volume":"22","author":"Lattig","year":"2009","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.jspd.2013.01.005","article-title":"Preliminary results of the effect of prophylactic vertebroplasty on the incidence of proximal junctional complications after posterior spinal fusion to the low thoracic spine","volume":"1","author":"Martin","year":"2013","journal-title":"Spine Deform."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1097\/BRS.0000000000001043","article-title":"Prevention of acute proximal junctional fractures after long thoracolumbar posterior fusions for adult spinal deformity using 2-level cement augmentation at the upper instrumented vertebra and the vertebra 1 level proximal to the upper instrumented vertebra","volume":"40","author":"Theologis","year":"2015","journal-title":"Spine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1016\/j.spinee.2017.05.017","article-title":"The effect of prophylactic vertebroplasty on the incidence of proximal junctional kyphosis and proximal junctional failure following posterior spinal fusion in adult spinal deformity: A 5-year follow-up study","volume":"17","author":"Raman","year":"2017","journal-title":"Spine J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1016\/j.spinee.2017.05.015","article-title":"Prophylactic vertebral cement augmentation at the uppermost instrumented vertebra and rostral adjacent vertebra for the prevention of proximal junctional kyphosis and failure following long-segment fusion for adult spinal deformity","volume":"17","author":"Ghobrial","year":"2017","journal-title":"Spine J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.nec.2023.06.004","article-title":"Proximal junctional kyphosis and failure: Strategies for prevention","volume":"34","author":"Arora","year":"2023","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1016\/j.spinee.2013.06.039","article-title":"Use of vertebroplasty to prevent proximal junctional fractures in adult deformity surgery: A biomechanical cadaveric study","volume":"13","author":"Kebaish","year":"2013","journal-title":"Spine J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/2020.5.FOCUS20192","article-title":"The association between lower Hounsfield units of the upper instrumented vertebra and proximal junctional kyphosis in adult spinal deformity surgery with a minimum 2-year follow-up","volume":"49","author":"Duan","year":"2022","journal-title":"Neurosurg. Focus."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"E174","DOI":"10.1097\/BRS.0000000000003798","article-title":"Preoperative Hounsfield Units at the Planned Upper Instrumented Vertebrae May Predict Proximal Junctional Kyphosis in Adult Spinal Deformity","volume":"46","author":"Yao","year":"2020","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Yoshie, N., Maruo, K., Arizumi, F., Kishima, K., Kusukawa, T., and Tachibana, T. (2023). The Relationship between the Hounsfield Units Value of the Upper Instrumented Vertebra and the Severity of Proximal Junctional Fracture after Adult Spinal Deformity Surgery. Medicina, 59.","DOI":"10.3390\/medicina59061086"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1055\/s-0033-1357366","article-title":"Early Proximal Junctional Failure in Patients with Preoperative Sagittal Imbalance","volume":"4","author":"Smith","year":"2013","journal-title":"Evid. Based Spine Care J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"512","DOI":"10.3171\/2017.9.SPINE1710","article-title":"Ligament augmentation for prevention of proximal junctional kyphosis and proximal junctional failure in adult spinal deformity","volume":"28","author":"Safaee","year":"2018","journal-title":"J. Neurosurg. Spine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s43390-020-00278-z","article-title":"SRS Adult Spinal Deformity Committee. State of the art: Proximal junctional kyphosis\u2014Diagnosis, management and prevention","volume":"9","author":"Sardar","year":"2021","journal-title":"Spine Deform."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1055\/s-0034-1386755","article-title":"Predictive factors for acute proximal junctional failure after adult deformity surgery with upper instrumented vertebrae in the thoracolumbar spine","volume":"5","author":"Annis","year":"2014","journal-title":"Evid. Based Spine Care J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1227\/neu.0000000000002291","article-title":"Vertebral Bone Quality Score Independently Predicts Proximal Junctional Kyphosis and\/or Failure After Adult Spinal Deformity Surgery","volume":"92","author":"Kuo","year":"2023","journal-title":"Neurosurgery"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1097\/BRS.0b013e31824fffb9","article-title":"Upper instrumented vertebral fractures in long lumbar fusions: What are the associated risk factors?","volume":"37","author":"Lewis","year":"2012","journal-title":"Spine"},{"key":"ref_28","unstructured":"Bridwell, K.H., and DeWald, R.L. (2011). The Textbook of Spinal Surgery, Wolters Kluwer\/Lippincott Williams & Wilkins. [3rd ed.]."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"E10","DOI":"10.3171\/2022.10.FOCUS22609","article-title":"A triple minimally invasive surgery combination for subacute osteoporotic lower lumbar vertebral collapse with neurological compromise: A potential alternative to the vertebral corpectomy\/expandable cage strategy","volume":"54","author":"Tani","year":"2023","journal-title":"Neurosurg. Focus."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.spinee.2005.08.012","article-title":"Extreme lateral interbody fusion (XLIF): A novel surgical technique for anterior lumbar interbody fusion","volume":"6","author":"Ozgur","year":"2006","journal-title":"Spine J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"727","DOI":"10.3171\/2015.10.SPINE15450","article-title":"Indirect decompression and vertebral body endplate strength after lateral interbody spacer impaction: Cadaveric and foamblock models","volume":"24","author":"Kwon","year":"2016","journal-title":"J. Neurosurg. Spine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s12178-017-9444-1","article-title":"Lateral lumbar interbody fusion\u2013outcomes and complications","volume":"10","author":"Salzmann","year":"2017","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1097\/BRS.0b013e3182458b2f","article-title":"Subsidence of polyetheretherketone intervertebral cages in minimally invasive lateral retroperitoneal transpsoas lumbar interbody fusion","volume":"37","author":"Le","year":"2012","journal-title":"Spine"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"110","DOI":"10.3171\/2013.4.SPINE12319","article-title":"Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion","volume":"19","author":"Marchi","year":"2013","journal-title":"J. Neurosurg. Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"E626","DOI":"10.1016\/j.wneu.2022.03.087","article-title":"Choice of spinal interbody fusion cage material and design influences subsidence and osseointegration performance","volume":"162","author":"Fogel","year":"2022","journal-title":"World Neurosug."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"E175","DOI":"10.1097\/BRS.0000000000000703","article-title":"Effect of indirect neural decompression through oblique lateral interbody fusion for degenerative lumbar disease","volume":"40","author":"Fujibayashi","year":"2015","journal-title":"Spine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1016\/S0142-9612(00)00305-7","article-title":"Self-organization mechanism in a bone-like hydroxyapatite\/collagen nanocomposite synthesized in vitro and its biological reaction in vivo","volume":"22","author":"Kikuchi","year":"2001","journal-title":"Biomaterials"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.jos.2016.01.007","article-title":"Efficacy and safety of porous hydroxyapatite\/type 1 collagen composite implantation for bone regeneration: A randomized controlled study","volume":"21","author":"Sotome","year":"2016","journal-title":"J. Orthop. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1016\/j.jos.2021.07.019","article-title":"A new technique useful for lumbosacral percutaneous pedicle screw placement without fluoroscopy or computer-aided navigation systems","volume":"27","author":"Tani","year":"2022","journal-title":"J. Orthop. Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1097\/BRS.0000000000004263","article-title":"Threshold-based monitoring of compound muscle action potentials for percutaneous pedicle screw placement in the lumbosacral spine: Can we rely on stimulation of the uninsulated screw to provide a valid safety warning?","volume":"47","author":"Tani","year":"2021","journal-title":"Spine"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Tani, Y., Saito, T., Taniguchi, S., Ishihara, M., Paku, M., Adachi, T., and Ando Mand Kotani, Y. (2022). A new treatment algorithm that incorporates minimally invasive surgery for pyogenic spondylodiscitis in the thoracic and lumbar spines: The results of Its clinical application to a series of 34 patients. Medicina, 58.","DOI":"10.3390\/medicina58040478"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2245","DOI":"10.1097\/BRS.0b013e3181f5cfae","article-title":"Sacropelvic Fixation Techniques and Complications","volume":"35","author":"Kebaish","year":"2010","journal-title":"Spine"},{"key":"ref_43","first-page":"1897","article-title":"Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: Technical aspects","volume":"18","author":"Jensen","year":"1997","journal-title":"Am. J. Neuroradiol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Razi, A.E., and Hershman, S.H. (2020). Vertebral Compression Fractures in Osteoporotic and Pathologic Bone, Springer.","DOI":"10.1007\/978-3-030-33861-9"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Razi, A.E., and Hershman, S.H. (2020). Vertebral Compression Fractures in Osteoporotic and Pathologic Bone, Springer.","DOI":"10.1007\/978-3-030-33861-9"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1097\/BRS.0b013e31823e15e2","article-title":"Scoliosis Research Society-Schwab adult spinal deformity classification: A validation study","volume":"37","author":"Schwab","year":"2012","journal-title":"Spine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/00003086-198705000-00029","article-title":"Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits","volume":"218","author":"Bradford","year":"1987","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1097\/BRS.0b013e3181c8f35d","article-title":"Proximal junctional vertebral fracture in adults after spinal deformity surgery using pedicle screw constructs analysis of morphological features","volume":"35","author":"Watanabe","year":"2010","journal-title":"Spine"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1097\/BRS.0b013e31817c0428","article-title":"Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: Minimum five-year follow-up","volume":"33","author":"Kim","year":"2008","journal-title":"Spine"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2134","DOI":"10.1097\/BRS.0b013e3181b2e17e","article-title":"Risk factors and outcomes for catastrophic failures at the top of long pedicle screw constructs: A matched cohort analysis performed at a single center","volume":"34","author":"Bridwell","year":"2009","journal-title":"Spine"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1097\/BRS.0b013e3182815b42","article-title":"Proximal junctional kyphosis results in inferior SRS pain subscores in adult deformity patients","volume":"38","author":"Kim","year":"2013","journal-title":"Spine"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1227\/NEU.0b013e31828bacd8","article-title":"Proximal junctional kyphosis in primary adult deformity surgery: Evaluation of 20 degrees as a critical angle","volume":"72","author":"Bridwell","year":"2013","journal-title":"Neurosurgery"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1097\/01.brs.0000256915.90236.17","article-title":"Evaluation of spinal kinematics following lumbar total disc replacement and circumferential fusion using in vivo fluoroscopy","volume":"32","author":"Auerbach","year":"2007","journal-title":"Spine"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1097\/BRS.0b013e31824e4888","article-title":"Incidence, risk factors, and natural course of proximal junctional kyphosis: Surgical outcomes review of adult idiopathic scoliosis. minimum 5 years of follow-up","volume":"37","author":"Yagi","year":"2012","journal-title":"Spine"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1186\/s13018-018-0960-5","article-title":"Exploratory analysis of predictors of revision surgery for proximal junctional kyphosis or additional postoperative vertebral fracture following adult spinal deformity surgery in elderly patients: A retrospective cohort study","volume":"13","author":"Uei","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/BRS.0000000000002355","article-title":"Low bone-mineral density is a significant risk for proximal junctional failure after surgical correction of adult spinal deformity: A propensity score-matched analysis","volume":"43","author":"Yagi","year":"2018","journal-title":"Spine"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"E60","DOI":"10.1097\/BRS.0b013e3181eeaee2","article-title":"Incidence, risk factors and classification of proximal junctional kyphosis: Surgical outcomes review of adult idiopathic scoliosis","volume":"36","author":"Yagi","year":"2010","journal-title":"Spine"},{"key":"ref_58","first-page":"199","article-title":"Proximal junctional kyphosis in adult reconstructive spine surgery results from incomplete restoration of the lumbar lordosis relative to the magnitude of the thoracic kyphosis","volume":"31","author":"Ries","year":"2011","journal-title":"Iowa Orthop. J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"E1469","DOI":"10.1097\/BRS.0b013e3182a51d43","article-title":"Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity","volume":"38","author":"Maruo","year":"2013","journal-title":"Spine"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/BRS.0000000000003249","article-title":"Effective prevention of proximal junctional failure in adult spinal deformity surgery requires a combination of surgical implant prophylaxis and avoidance of sagittal alignment overcorrection","volume":"45","author":"Line","year":"2020","journal-title":"Spine"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"E576","DOI":"10.1097\/BRS.0000000000000246","article-title":"Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections","volume":"39","author":"Kim","year":"2014","journal-title":"Spine"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1097\/00007632-200211150-00003","article-title":"Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion","volume":"27","author":"Eck","year":"2002","journal-title":"Spine"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1097\/01.brs.0000162441.23824.95","article-title":"Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: An in vitro human cadaveric model","volume":"30","author":"Dmitriev","year":"2005","journal-title":"Spine"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"715","DOI":"10.3171\/2009.7.SPINE094","article-title":"Effect of lumbar total disc arthroplasty on the segmental motion and intradiscal pressure at the adjacent level: An in vitro biomechanical study: Presented at the 2008 Joint Spine Section Meeting Laboratory investigation","volume":"11","author":"Ingalhalikar","year":"2009","journal-title":"J. Neurosurg. Spine."},{"key":"ref_65","unstructured":"Bridwell, K.H., and DeWald, R.L. (2011). The Textbook of Spinal Surgery, Wolters Kluwer\/Lippincott Williams & Wilkins. [3rd ed.]."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"S185","DOI":"10.1097\/01.brs.0000232811.08673.03","article-title":"Debate: Determining the upper instrumented vertebra in the management of adult degenerative dcoliosis stopping at T10 versus L1","volume":"31","author":"Shufflebarger","year":"2006","journal-title":"Spine"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1097\/BRS.0000000000004364","article-title":"Evolution of Proximal Junctional Kyphosis and Proximal Junctional Failure Rates Over 10 Years of Enrollment in a Prospective Multicenter Adult Spinal Deformity Database","volume":"47","author":"Alshabab","year":"2022","journal-title":"Spine"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"S144","DOI":"10.1097\/BRS.0b013e31826d611b","article-title":"Proximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery: A systematic review","volume":"37","author":"Kim","year":"2012","journal-title":"Spine"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/BRS.0b013e3181c77f8c","article-title":"Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation","volume":"35","author":"Helgeson","year":"2010","journal-title":"Spine"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"E687","DOI":"10.1097\/BRS.0b013e318246d4f2","article-title":"The use of a transition rod may prevent proximal junctional kyphosis in the thoracic spine after scoliosis surgery: A finite element analysis","volume":"37","author":"Cahill","year":"2012","journal-title":"Spine"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1097\/BRS.0b013e318198c62d","article-title":"The effect of posterior thoracic spine anatomical structures on motion segment flexion stiffness","volume":"34","author":"Anderson","year":"2009","journal-title":"Spine"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1748-7161-7-16","article-title":"Proximal junctional vertebral fracture-subluxation after adult spine deformity surgery. Does vertebral augmentation avoid this complication? A case report","volume":"7","year":"2012","journal-title":"Scoliosis"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/01.brs.0000207466.40955.31","article-title":"The biomechanics of 1, 2, and 3 levels of vertebral augmentation with polymethylmethacrylate in multilevel spinal segments","volume":"31","author":"Kayanja","year":"2006","journal-title":"Spine"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1007\/s11999-011-2179-1","article-title":"Combined Anterior-Posterior Surgery is the Most Important Risk Factor for Developing Proximal Junctional Kyphosis in Idiopathic Scoliosis","volume":"470","author":"Kim","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"E500","DOI":"10.1097\/BRS.0000000000000222","article-title":"Biomechanical risk factors for proximal junctional kyphosis","volume":"39","author":"Cammarata","year":"2014","journal-title":"Spine"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1093\/ons\/opx054","article-title":"Proximal junctional kyphosis prevention strategies: A video technique guide","volume":"13","author":"Safaee","year":"2017","journal-title":"Oper. Neurosurg."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.jspd.2013.05.008","article-title":"Type of anchor at the proximal fusion level has a significant effect on the incidence of proximal junctional kyphosis and outcome in adults after long posterior spinal fusion","volume":"1","author":"Hassanzadeh","year":"2013","journal-title":"Spine Deform."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1007\/s00586-021-06761-z","article-title":"Rod contour and overcorrection are risk factors of proximal junctional kyphosis after adult spinal deformity correction surgery","volume":"30","author":"Ishihara","year":"2021","journal-title":"Eur. Spine J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/6\/860\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:48:23Z","timestamp":1760107703000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/6\/860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,24]]},"references-count":78,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["medicina60060860"],"URL":"https:\/\/doi.org\/10.3390\/medicina60060860","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,24]]}}}