Objective Proximal junctional kyphosis (PJK) is a frequent postoperative complication following adult spinal deformity (ASD) surgery, whereas proximal junctional failure (PJF) is a less common but clinically more severe complication. Spinopelvic radiographic parameters have been associated with the development of these complications, yet existing studies have reported inconsistent results. This study aimed to investigate the association between spinopelvic parameters and proximal junctional complications (PJK/PJF), including analysis based on age-adjusted pelvic incidence (PI)–lumbar lordosis (LL) mismatch categories.
Methods This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) 2020 guidelines. PubMed, Cochrane Library, and Embase were comprehensively searched from inception through March 2025. Adults (>18 years) who underwent surgery for ASD or long-segment (≥4 levels) spinal fusion were included. Studies were independently selected by 2 reviewers based on preset criteria. Random-effects model was used to calculate mean differences/standardized mean differences for continuous variables and odds ratios (ORs) for categorical outcomes.
Results A total of 47 retrospective studies were included in the meta-analysis. Preoperatively, the PJK group had lower LL and sacral slope (SS) but had higher pelvic tilt (PT), T1PA, and C7-sagittal vertical axis than the non-PJK group. Postoperatively, the PJK group showed significantly lower PI–LL mismatch values and SS and higher PT, thoracic kyphosis, thoracolumbar kyphosis, and T1 pelvic angle. When stratified by the age-adjusted PI–LL formula, overcorrection was associated with significantly higher odds of PJK (OR, 2.67; 95% confidence interval [CI], 1.61–4.42), whereas no significant association was observed for PJF. Using age-specific thresholds, overcorrection was significantly associated with higher odds of PJF (OR, 1.67; 95% CI, 1.10–2.52).
Conclusion Preoperative sagittal imbalance and postoperative spinopelvic differences were associated with proximal junctional complications, whereas associations for PJF were more limited. Age-adjusted overcorrection showed outcome-specific associations with proximal junctional complications, suggesting that age-tailored alignment may be clinically relevant. Given the retrospective aggregate evidence and limited age-adjusted data, future prospective studies with standardized radiographic timing and separate outcome assessment for PJK and PJF are needed to validate these findings.
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Reliability of the Biomechanical Assessment of the Sagittal Thoracic Spine on Radiographs Used in Clinical Practice: A Systematic Literature Review Joseph W. Betz, Douglas F. Lightstone, Jason W. Haas, Paul A. Oakley, Joseph R. Ferrantelli, Ibrahim M. Moustafa, Deed E. Harrison Bioengineering.2026; 13(9): 966. CrossRef
Objective To determine the role of dynamic hip joint coverage in maintaining postoperative sagittal balance in adult spinal deformity (ASD) patients following S2-alar-iliac (S2AI) fixation.
Methods A total of 224 ASD patients who underwent S2AI fixation were enrolled. Patients were stratified into 2 groups based on pre-to-post (from preoperative to postoperative) changes in femoral head coverage (ΔFHC): change group (group C) and noncoverage change group (group NC). Group C was further subdivided according to FHC recovery during follow-up into rebound (group C-R) and nonrebound (group C-NR) groups. Clinical outcomes and radiographic parameters of hip and spinopelvic alignment were assessed preoperatively, at the initial postoperative standing, and at the 2-year follow-up.
Results Compared to group C, patients in group NC demonstrated a higher incidence of sagittal imbalance-related mechanical complications at 2-year follow-up, with a greater tendency for sagittal imbalance progression (p=0.013), a larger post-to-follow-up change in sagittal vertical axis (ΔSVA) (p=0.029), and a higher incidence of proximal junctional kyphosis (PJK) (p=0.031). Although there was no significant difference in PJK incidence between group C-NR and group C-R (p=0.845), group C-NR showed a greater tendency for postoperative sagittal imbalance aggravation (p=0.025), with a significantly larger ΔSVA during follow-up (p=0.002). The optimal cutoff values for predicting postoperative sagittal imbalance aggravation were 3.5% for pre-to-post ΔFHC (area under the curve [AUC]=0.694) and 1.8% for post-to-follow-up ΔFHC (AUC=0.713).
Conclusion Dynamic postoperative changes in hip joint coverage, characterized by the FHC, are associated with postoperative sagittal balance maintenance. Patients with limited pre-to-post and post-to-follow-up changes in the FHC demonstrate compromised hip joint compensatory capacity, thereby increasing the risk of postoperative sagittal imbalance-related mechanical complications.
Objective Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common complications following long-segment spinal fusion, particularly in adult spinal deformity (ASD) correction surgery. Various surgical techniques have been proposed to prevent these complications, but high-quality evidence remains limited. This study aimed to evaluate the effectiveness of surgical strategies for preventing PJK and PJF after ASD correction or long-segment spinal fusion in adults.
Methods A systematic search was conducted in PubMed, Embase, and the Cochrane Library through March 2025. Eligible studies included adults who underwent ASD surgery or long-segment (≥4 levels) posterior spinal fusion, comparing PJK or PJF incidence across surgical techniques such as tethering, hook fixation, prophylactic vertebral augmentation, rod characteristics, and upper instrumented vertebra (UIV) level. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Results Thirty-eight retrospective studies were included in the systematic review and 33 in the meta-analysis. Spinous process tethering reduced PJK incidence (OR, 0.35; 95% CI, 0.22–0.56). Hook fixation (OR, 0.34; 95% CI, 0.21–0.55) and prophylactic vertebral augmentation (OR, 0.58; 95% CI, 0.35–0.95) reduced PJF incidence. Lower PJK rates were observed with UIV at T10 or above (OR, 0.15; 95% CI, 0.03–0.64) and lower PJF rates with UIV at L1 or above (OR, 0.29; 95% CI, 0.14–0.61).
Conclusion Surgical strategies such as tethering, hook fixation, and prophylactic vertebral augmentation may reduce the risk of PJK/PJF. Additionally, placing the UIV at or slightly above T10 may enhance junctional stability. Further prospective studies are needed to validate these findings and guide preventive strategies.
Objective To determine the optimal targets of the L1 pelvic angle (L1PA) that minimize the risk of both proximal junctional kyphosis (PJK) and pelvic nonresponse (PNR) following adult spinal deformity (ASD) surgery.
Methods A retrospective study was conducted on 323 patients who underwent fusion surgery from the low thoracic spine (T9–12) to the pelvis and were followed up for 2 years. Risk factors for PJK and PNR were evaluated separately using multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve analyses were performed to identify L1PA cutoff values predictive of PJK and PNR across 3 pelvic incidence (PI) categories: <45°, 45°–60°, and ≥60°. L1PA thresholds were defined to delineate “ideal” alignment.
Results Risk factor analyses revealed that low L1PA was an independent risk factor for PJK (odds ratio [OR], 0.927; p=0.019), while high PI–LL (OR, 1.101; p<0.001) and high L1PA (OR, 1.249; p<0.001) were significant risk factors for PNR. On ROC curve analyses, optimal L1PA ranges were 2.5°–4.5° for PI<45°, 8.7°–12.6° for PI 45°–60°, and 15.1°–17.3° for PI≥60°. Patients within these ideal L1PA ranges had significantly lower rates of both PJK and PNR compared to those exceeding ideal L1PA ranges.
Conclusion This study demonstrated that optimal correction based on these L1PA targets reduced the risk of both PJK and PNR. Therefore, these L1PA targets can serve as reliable alignment goals to optimize surgical outcomes in ASD surgery.
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Effects of Knee Osteoarthritis on Compensatory Mechanisms Post-Spinal Deformity Correction Yoon Ha Hwang, Dongkyu Kim, Hyun-Jun Jang, Bong Ju Moon, Jeong-Yoon Park, Kyung-Hyun Kim Journal of Korean Neurosurgical Society.2026; 69(5): 744. CrossRef
Objective Spinal fusion surgery is effective for treating various adult spinal deformities. However, spinal fusion surgery is associated with the risk of adjacent segment disease (ASD; 5%–30%), particularly proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Proximal junctional tethering (PJT) has become a popular technique owing to increasing evidence that it can decrease the rate of PJK or PJF.
Methods A literature search was conducted using PubMed, Embase, and Cochrane Library. Twelve eligible studies were identified. These studies were predominantly retrospective in nature and compared the incidence of PJK or PJF in adults undergoing spinal fusion surgery with or without PJT. Risk of bias was assessed using the Newcastle-Ottawa scale. All outcomes were analyzed using R software (ver. 4.4.1).
Results We included 8 retrospective cohort studies and 3 propensity-score-matched analyses; these studies comprised 1,424 patients. PJT was associated with a significant decrease in the odds of development of PJK (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.27–0.71) and PJF (OR, 0.36; 95% CI, 0.19–0.69) compared with control. Subgroup analysis results revealed no significant difference in ASD rates between geographical locations, between tethering with and without crosslinks, and between specific tethering techniques.
Conclusion PJT significantly reduces the odds of both PJK and PJF in adults undergoing spinal fusion surgery.
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AO Spine Clinical Practice Recommendations: Proximal Junctional Kyphosis and Failure Prevention Juan P. Sardi, Ahmed Shawky, Sultan Aldebeyan, Fred Nicholls, Nelson Astur, Charles Fisher, Eric O. Klineberg, Justin S. Smith Global Spine Journal.2026;[Epub] CrossRef
Objective We aimed to investigate the incidence of delayed-onset neurological deficits (DONDs), DOND-related reoperation rates following adult spinal deformity (ASD) surgery, and efficacy of transverse process hooks (TPHs) at the uppermost instrumented vertebra (UIV) compared to pedicle screws (PSs).
Methods We included 90 consecutive patients who underwent instrumented fusion from the sacrum to the distal thoracic spine for ASD, with a minimum follow-up of 24 months. Clinical and radiological outcomes were compared between 33 patients in the TPH group and 57 patients in the PS group, using the Scoliosis Research Society-22 Outcomes questionnaire (SRS-22), Medical Outcomes Study Questionnaire Short-Form 36 (SF-36), and various spinal sagittal parameters.
Results While absent in the TPH group, myelopathy occurred in 15.8% of the PS group, wherein 15 patients underwent reoperation. The change in the proximal junctional angle, from the pre- to postoperative assessment, was lower in the TPH group than in the PS group (0.2 vs. 6.6, p=0.002). Postoperative facet degeneration in the PS group progressed more significantly than in the TPH group (0.5 vs. 0.1, p=0.002). Surgical outcomes were comparable for both groups, except for the back visual analogue scale (3.5 vs. 4.1, p=0.010) and SRS-22 domains, including pain and satisfaction (3.3 vs. 2.9, p=0.033; 3.7 vs. 3.3, p=0.041). No intergroup difference was observed in SF-36.
Conclusion Using TPHs at the UIV level can prevent DOND, and thereby prevent postoperative myelopathy that necessitates reoperation; thus, TPHs is preferable over PSs in ASD surgery.
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Clinical and radiological outcomes of transverse process hooks versus pedicle screws at the upper instrumented vertebra in adult spinal deformity patients undergoing three-column osteotomy: A retrospective comparative study Mohsen Rostami, Sadegh Bagherzadeh, Navid Moghadam, Faramarz Roohollahi, Cesar Carballo Cuello, Jay Kumar, Mark Greenberg, Puya Alikhani Clinical Neurology and Neurosurgery.2026; 261: 109263. CrossRef
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Objective Few studies have reported radiographic and clinical outcomes of transverse process hook (TPH) placement at the proximal thoracic upper instrumented vertebra (UIV) in adult spinal deformity (ASD) surgery. This study aims to investigate radiographic and clinical outcomes of TPH placement at the UIV for ASD surgery.
Methods This is a retrospective cohort of 56 patients with ASD (age, 59 ± 13 years; followup, 44 ± 19 months) from Johns Hopkins Hospital, who underwent long posterior spinal fusion to the proximal thoracic spine (T2–5). Visual analogue scale (VAS) for back pain, Oswestry Disability Index (ODI), 36-item Short Form health survey scores, thoracic kyphosis (TK), lumbar lordosis, sacral slope, pelvic tilt, pelvic incidence, proximal junctional kyphosis (PJK) angle, PJK incidence, pattern of PJK, grades of TPH dislodgement, revision surgery, and factors associated with high-grade TPH dislodgement were analyzed.
Results VAS for back pain and ODI values improved significantly from preoperatively to final follow-up. Mean change in PJK angle was 12° (range, 0.5°–43°). Twenty patients (36%) developed PJK, of whom 13 had compression fractures at 1 vertebra distal to the UIV (UIV–1). Final TPH position was stable in 42 patients (75%). In most patients (86%), TPH dislodgement did not progress after 6-month postoperative follow-up. Three patients (5.3%) underwent revision surgery to extend the fusion because of symptomatic PJK. Unstable TPH position was associated only with revision surgery and TK.
Conclusion TPH placement at the proximal thoracic UIV for long fusion showed favorable clinical and radiographic outcomes in terms of the incidence of PJK and mean PJK angle at mean 44-month follow-up. TPHs placed in the proximal thoracic UIV were in stable position in 75% of patients. Compression fracture at UIV–1 was the most common pattern of PJK. PJK angle progression was greater in revision cases and in patients with greater preoperative thoracic kyphosis.
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Neurospine 2023;20(4):1272-1280. Published online December 31, 2023
Objective Although adult spinal deformity (ASD) surgery aims to restore and maintain alignment, proximal junctional kyphosis (PJK) may occur. While existing scoring systems predict PJK, they predominantly offer a generalized 3-tier risk classification, limiting their utility for nuanced treatment decisions. This study seeks to establish a personalized risk calculator for PJK, aiming to enhance treatment planning precision.
Methods Patient data for ASD were sourced from the Korean spinal deformity database. PJK was defined a proximal junctional angle (PJA) of ≥ 20° at the final follow-up, or an increase in PJA of ≥ 10° compared to the preoperative values. Multivariable analysis was performed to identify independent variables. Subsequently, 5 machine learning models were created to predict individualized PJK risk post-ASD surgery. The most efficacious model was deployed as an online and interactive calculator.
Results From a pool of 201 patients, 49 (24.4%) exhibited PJK during the follow-up period. Through multivariable analysis, postoperative PJA, body mass index, and deformity type emerged as independent predictors for PJK. When testing machine learning models using study results and previously reported variables as hyperparameters, the random forest model exhibited the highest accuracy, reaching 83%, with an area under the receiver operating characteristics curve of 0.76. This model has been launched as a freely accessible tool at: (https://snuspine.shinyapps.io/PJKafterASD/).
Conclusion An online calculator, founded on the random forest model, has been developed to gauge the risk of PJK following ASD surgery. This may be a useful clinical tool for surgeons, allowing them to better predict PJK probabilities and refine subsequent therapeutic strategies.
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Proximal junction kyphosis (PJK) is a common imaging finding after long-level fusion, and proximal junctional failure (PJF) is an aggravated form of the progressive disease spectrum of PJK. This includes vertebral fracture of upper instrumented vertebra (UIV) or UIV+1, instability between UIV and UIV+1, neurological deterioration requiring surgery. Many studies have reported on PJK and PJF after long segment instrumentation for adult spinal deformity (ASD). In particular, for spine deformity surgeons, risk factors and prevention strategies of PJK and PJF are very important to minimize reoperation. Therefore, this review aims to help reduce the occurrence of PJK and PJF by updating the latest contents of PJK and PJF by 2023, focusing on the risk factors and prevention strategies of PJK and PJF. We conducted a search on multiple database for articles published until February 2023 using the search keywords “proximal junctional kyphosis,” “proximal junctional failure,” “proximal junctional disease,” and “adult spinal deformity.” Finally, 103 papers were included in this study. Numerous factors have been suggested as potential risks for the development of PJK and PJF, including a high body mass index, inadequate postoperative sagittal balance and overcorrection, advanced age, pelvic instrumentation, and osteoporosis. Recently, with the increasing elderly population, sarcopenia has been emphasized. The quality and quantity of muscle in the surgical site have been suggested as new risk factor. Therefore, spine surgeon should understand the pathophysiology of PJK and PJF, as well as individual risk factors, in order to develop appropriate prevention strategies for each patient.
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Objective To introduce a new sagittal parameter, uppermost instrumented vertebra-pelvic tilt angle (UIVPTA), and to determine the effects on the proximal junctional kyphosis (PJK) development in adult spinal deformity (ASD) surgery.
Methods Patients ≥ 60 years with ASD who underwent low thoracic spine to pelvis fusion with a minimum of 2-years of follow-up were included in this study. Two groups were created according to PJK development. Various clinical and radiographic factors were compared between PJK and non-PJK groups to identify the risk factors for PJK. Cutoff value of UIVPTA for PJK development was calculated using receiver operating characteristic curve according to different pelvic incidence groups. Linear regression analysis was performed to identify factors to affect UIVPTA.
Results One hundred fifity-one patients were included in this study. There were 135 female patients (89.4%). Mean age was 70.5 years. PJK developed in 65 patients (43.0%). Multivariate analysis showed that overcorrection relative to age-adjusted pelvic incidence (PI) minus lumbar lordosis (LL) (PI–LL) target and lower UIVPTA were independent risk factors for PJK. The cutoff value of UIVPTA for PJK development was calculated as 4.0° in patients with PI less than 45°, 9.5° in patients with PI between 45° and 60°, and 13.0° in patients with PI greater than 60°. Linear regression analysis showed that UIVPTA was positively affected by postoperative values of LL (coefficient = 0.505), PI–LL (coefficient = 0.674), and pelvic tilt (coefficient = 0.286).
Conclusion Optimal correction within the age-adjusted PI–LL combined with keeping UIVPTA within optimal range is suggested for the prevention of PJK.
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Jean Charles Le Huec, Zeeshan M. Sardar, Emanuele Quarto, Meghan Cerpa, Michael P. Kelly, Kazuhiro Hasegawa, Hwee Weng Dennis Hey, Hee-Kit Wong, Hend Riahi, Lawrence G. Lenke, Stéphane Bourret, MEANS study group
Neurospine 2022;19(4):883-888. Published online December 31, 2022
Objective The role of the craniocervical complex in spinal sagittal alignment has rarely been analyzed but it may play a fundamental role in postoperative mechanical complications. The aim of the study is to analyze the normative value of the cervical inclination angle (CIA) in an adult asymptomatic multiethnic population.
Methods Standing full-spine EOS of adult asymptomatic volunteers from 5 different countries were analyzed. The CIA was analyzed globally and then in each decade of life. Different ethnicities were compared. Comparisons between different groups was performed using a t-test and statistical significance was considered with a p-value < 0.05.
Results EOS of 468 volunteers were analyzed. The global mean CIA was 80.2° with a maximum difference of 9° between T1 and T12 (p < 0.001). The CIA remains constant until 60 years old then decreases significantly passing from a mean value before 20 years old of 82.25° to 73.65° after 70 years old. A statistically significant difference was found between the Arabics and other ethnicities with the formers having an inferior CIA: this was related to a mean older age (p < 0.05) and higher body mass index (p < 0.05) in the Arabics.
Conclusion The CIA remains constant until 60 years old and then reduces slightly but never under 70°. This angle is helpful to evaluate the lever arm at the upper instrumented vertebra after an adult spinal deformity surgery and could predict the occurrence of a proximal junctional kyphosis when its value is lower than normal. Further clinical studies must confirm this theory.
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Objective To investigate prevention of proximal junctional kyphosis (PJK) and failure (PJF) following adult spinal deformity (ASD) surgery utilizing a novel technique of posterior ligament augmentation with polyester fiber tether.
Methods This study evaluated ASD adult patients who underwent posterior decompression and instrumented fusion from the thoracolumbar junction (T9–L1) to the pelvis from 2011–2017. Basic demographic data were obtained. Radiographic outcomes included proximal junctional angle (PJA), sagittal vertical axis, PJK, and PJF. The study population was divided into patients who had ASD surgery with and without ligamentous augmentation.
Results A total of 43 subjects were evaluated, including 20 without and 23 with ligamentous augmentation. PJA increased over time for both groups. PJA was smaller for the augmented group, and rate of increase in PJA was slower in the augmented group (p < 0.0001). The rate of PJK was significantly higher in the nonaugmented group (p = 0.01). PJF was significantly less common in the augmented group (p = 0.003). Time to revision surgery was lower in the nonaugmented group (p = 0.003).
Conclusion Our novel ligament augmentation technique utilizing polyethylene tape is an effective technique to slow progression of the PJA and lower the risk for proximal junctional disease in ASD surgery.
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Proximal junctional kyphosis (PJK) is a difficult complication to manage following adult spinal deformity surgery. Particularly in spinal fusions from the lower thoracic spine down to pelvis, PJK is a major consideration. While the open posterior approach allows for excellent visualization and preparation of bony surfaces for fusion, disruption of posterior soft tissue structures increases risk of PJK postoperatively. Minimally invasive approaches, on the other hand, preserve posterior ligamentous structures and musculature at the proximal fusion levels however prevent the access afforded by an open approach. We describe here the hybrid open muscle-sparing approach—a technique that allows for decortication of bony surfaces as well as clear exposure of anatomic landmarks for freehand pedicle screw placement, while protecting the posterior soft tissue structures to reduce risk of PJK.
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The purpose of this review is the current understanding of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following adult spinal deformity (ASD) surgery. We carried out a systematic search of PubMed for literatures published up to September 2017 with “proximal junctional kyphosis,” “proximal junctional failure,” and “adult spinal deformity” as search terms. A total of 98 literatures were searched. The 37 articles were included in this review. PJK is multifactorial in origin and likely results from variable risk factors. PJF is a progressive form of the PJK spectrum including bony fracture, subluxation between UIV and UIV+1, failure of fixation, neurological deficit, which may require revision surgery for proximal extension of fusion. Soft tissue protections, adequate selection of the UIV, prophylactic rib fixation, hybrid instrumentation such as hooks, vertebral cement augmentation at UIV and UIV+1, adequate selection material of rods and age-appropriate spinopelvic alignment goals are strategies to minimize PJK and PJF. The ability to perform aggressive global realignment of spinal deformities has also led to the discovery of new complications such as the PJK and PJF. Continuous research on PJK and PJF should be proceeded in order to comprehend the pathophysiology of these complications.
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The Comparison of Spinopelvic Parameters, Complications, and Clinical Outcomes After Spinal Fusion to S1 with or without Additional Sacropelvic Fixation for Adult Spinal Deformity Bo Han, Peng Yin, Yong Hai, Yunzhong Cheng, Li Guan, Yuzeng Liu Spine.2021; 46(17): E945. CrossRef
A Novel Weave Tether Technique for Proximal Junctional Kyphosis Prevention in 71 Adult Spinal Deformity Patients: A Preliminary Case Series Assessing Early Complications and Efficacy Emily P Rabinovich, Thomas J Buell, Juan P Sardi, Bruno C R Lazaro, Christopher I Shaffrey, Justin S Smith Operative Neurosurgery.2021; 21(6): 393. CrossRef
Commentary: A Novel Weave Tether Technique for Proximal Junctional Kyphosis Prevention in 71 Adult Spinal Deformity Patients: A Preliminary Case Series Assessing Early Complications and Efficacy Michael J Strong, Timothy J Yee, Whitney E Muhlestein, Yamaan S Saadeh, Paul Park Operative Neurosurgery.2021; 21(6): E469. CrossRef
The Incidence of Adding-On or Distal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Treated by Anterior Spinal Fusion to L3 Was Significantly Higher Than by Posterior Spinal Fusion to L3 Seung-Jae Hyun, Lawrence G. Lenke, Yongjung Kim, Keith H. Bridwell, Meghan Cerpa, Kathy M. Blanke Neurospine.2021; 18(3): 457. CrossRef
Correlation of Acetabular Anteversion and Thoracic Kyphosis Postoperatively with Proximal Junctional Failure in Adult Spinal Deformity Fused to Pelvis Zi‐fang Zhang, Deng‐bin Qi, Tian‐hao Wang, Zheng Wang, Guo‐quan Zheng, Yan Wang Orthopaedic Surgery.2021; 13(8): 2289. CrossRef
Pelvic and sacral morphology and their correlation with pelvic incidence, lumbar lordosis, and lumbar alignment changes between standing and sitting postures Hwee Weng Dennis Hey, Jun-Hao Tan, Bernard Ong, Akshay Kumar, Gabriel Liu, Hee-Kit Wong Clinical Neurology and Neurosurgery.2021; 211: 107019. CrossRef
Correlation of vertebral trabecular attenuation in Hounsfield units and the upper instrumented vertebra with proximal junctional failure after surgical treatment of degenerative lumbar disease Qi Wang, Chi Wang, Xiaobo Zhang, Fanqi Hu, Wenhao Hu, Teng Li, Yan Wang, Xuesong Zhang Journal of Neurosurgery: Spine.2021; 34(3): 456. CrossRef
Incidence of Acute, Progressive, and Delayed Proximal Junctional Kyphosis Over an 8-Year Period in Adult Spinal Deformity Patients Frank A Segreto, Peter G Passias, Renaud Lafage, Virginie Lafage, Justin S Smith, Breton G Line, Gregory M Mundis, Cole A Bortz, Nicholas D Stekas, Samantha R Horn, Bassel G Diebo, Avery E Brown, Yael Ihejirika, Pierce D Nunley, Alan H Daniels, Munish C G Operative Neurosurgery.2020; 18(1): 75. CrossRef
Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data Ho Yong Choi, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim Journal of Korean Neurosurgical Society.2020; 63(1): 99. CrossRef
Surgical Outcomes According to Dekyphosis in Patients with Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine Soo Yeon Kim, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng Journal of Korean Neurosurgical Society.2020; 63(1): 89. CrossRef
Understanding Thoracic Spine Morphology, Shape, and Proportionality Renaud Lafage, Jeremy Steinberger, Sebastien Pesenti, Ayman Assi, Jonathan C. Elysee, Sravisht Iyer, Lawrence G. Lenke, Frank J. Schwab, Han Jo Kim, Virginie Lafage Spine.2020; 45(3): 149. CrossRef
Association of Frailty and Self-Care Activity With Sagittal Spinopelvic Alignment in the Elderly Tae Woo Kim, Jae Keun Oh, Ji Yeon Lee, Samuel K. Cho, Seong Bae An, Hyeong Seok Jeon, Hyung Cheol Kim, Kwang Joon Kim, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Do Heum Yoon, Chang Oh Kim, Yoon Ha World Neurosurgery.2020; 138: e759. CrossRef
Changes in Thoracic Kyphosis and Thoracolumbar Kyphosis in Asymptomatic Korean Male Subjects Aged >50 Years: Do They Progress Above T5, T10, T12, or L2? Jae-Hong Park, Youngbae B. Kim, Seung-Jae Hyun, Kyu-Bok Kang, Pil-Sun Park Asian Spine Journal.2020; 14(2): 192. CrossRef
Should Thoracolumbar Junction Be Always Avoided as Upper Instrumented Vertebra in Long Instrumented Fusion for Adult Spinal Deformity? Se-Jun Park, Chong-Suh Lee, Jin-Sung Park, Kyung-Jun Lee Spine.2020; 45(10): 686. CrossRef
Assessment of Patient Outcomes and Proximal Junctional Failure Rate of Patients with Adult Spinal Deformity Undergoing Caudal Extension of Previous Spinal Fusion Alan H. Daniels, Daniel B.C. Reid, Wesley M. Durand, Breton Line, Peter Passias, Han Jo Kim, Themistocles Protopsaltis, Virginie LaFage, Justin S. Smith, Christopher Shaffrey, Munish Gupta, Eric Klineberg, Frank Schwab, Doug Burton, Shay Bess, Christopher World Neurosurgery.2020; 139: e449. CrossRef
Bicortical Screw Purchase at Upper Instrumented Vertebra (UIV) Can Cause UIV Fracture After Adult Spinal Deformity Surgery: A Finite Element Analysis Study Seong-Hyun Wui, Seung-Jae Hyun, Bokku Kang, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun Jib Kim Neurospine.2020; 17(2): 377. CrossRef
Current concepts in level selection for fusion in the adolescent idiopathic scoliosis patient PaulJaewook Park, Andrew Sawires, LawrenceG Lenke Indian Spine Journal.2020; 3(2): 160. CrossRef
Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders Jong Joo Lee, Sung Han Oh, Yeong Ha Jeong, Sang Man Park, Hyeong Seok Jeon, Hyung-Cheol Kim, Seong Bae An, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Do Heum Yoon, Jun Jae Shin, Yoon Ha Neurospine.2020; 17(3): 513. CrossRef
LLIF IN THE CORRECTION OF DEGENERATIVE SCOLIOSIS IN ELDERLY PATIENTS VLADIMIR SERGEEVICH KLIMOV, IVAN IGOREVICH VASILENKO, JAMIL AFETOVICH RZAEV, ALEXEY VLADIMIROVICH EVSYUKOV, ROMAN VLADIMIROVICH KHALEPA, EVGENIYA VALERYEVNA AMELINA, SERGEY OLEGOVYCH RYABYKH, PRIYANK SINHA, MARCEL IVANOV Coluna/Columna.2020; 19(4): 243. CrossRef
Management of adult spine deformity in the elderly Rahul Sachdev, Emmanuel L. McNeely, Rafa Rahman, Charles F. Land, Brian J. Neuman Seminars in Spine Surgery.2020; 32(4): 100831. CrossRef
Surgical Outcomes and Complications Following All Posterior Approach for Spinal Deformity Associated with Neurofibromatosis Type-1 Byoung-Joo Park, Seung-Jae Hyun, Seong-Hyun Wui, Jong-Myung Jung, Ki-Jeong Kim, Tae-Ahn Jahng Journal of Korean Neurosurgical Society.2020; 63(6): 738. CrossRef
Junctional kyphosis and junctional failure after multi-segmental posterior cervicothoracic fusion – A retrospective analysis of 64 patients Alexander Spiessberger, Nicholas Dietz, BasilErwin Gruter, Justin Virojanapa, Peter Hollis, Ahmad Latefi Journal of Craniovertebral Junction and Spine.2020; 11(4): 310. CrossRef
Surgery-related predictable risk factors influencing postoperative clinical outcomes for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: a multicenter retrospective study Hirokazu Saiwai, Seiji Okada, Mitsumasa Hayashida, Katsumi Harimaya, Yoshihiro Matsumoto, Ken-ichi Kawaguchi, Kazu Kobayakawa, Takeshi Maeda, Hideki Ohta, Kenzo Shirasawa, Kuniyoshi Tsuchiya, Kazumasa Terada, Kouzo Kaji, Takeshi Arizono, Taichi Saito, Mas Journal of Neurosurgery: Spine.2020; 32(5): 703. CrossRef
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 Ping-Guo Duan, Praveen V. Mummaneni, Joshua Rivera, Jeremy M. V. Guinn, Minghao Wang, Zhuo Xi, Bo Li, Hao-Hua Wu, Christopher P. Ames, Shane Burch, Sigurd H. Berven, Dean Chou Neurosurgical Focus.2020; 49(2): E7. CrossRef
Rod fracture after multiple-rod constructs for adult spinal deformity Jong-myung Jung, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng Journal of Neurosurgery: Spine.2020; 32(3): 407. CrossRef
Clinical Efficacy of Intra-Operative Cell Salvage System in Major Spinal Deformity Surgery Ho Yong Choi, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim Journal of Korean Neurosurgical Society.2019; 62(1): 53. CrossRef
Effect of Vertebroplasty at the Upper Instrumented Vertebra and Upper Instrumented Vertebra +1 for Prevention of Proximal Junctional Failure in Adult Spinal Deformity Surgery: A Comparative Matched-Cohort Study Sanghyun Han, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Se-Il Jeon, Seong-Hyun Wui, Jin Young Lee, Subum Lee, Seung-Chul Rhim, Sungkyun Chung, Jeesoo Jang, Byoung Hun Lee World Neurosurgery.2019; 124: e436. CrossRef
Predictive formula of ideal lumbar lordosis and lower lumbar lordosis determined by individual pelvic incidence in asymptomatic elderly population Seung-Jae Hyun, Sanghyun Han, Youngbae B. Kim, Yongjung J. Kim, Gyu-Bok Kang, Ji-Young Cheong European Spine Journal.2019; 28(9): 1906. CrossRef
Comparison of loss of correction between PSO and VCD technique in treating thoracolumbar kyphosis secondary to ankylosing spondylitis, a minimum 2 years follow-up Yao Wang, Chao Xue, Kai Song, Tianhao Wang, Wenhao Hu, Fanqi Hu, Yongyu Hao, Zhifa Zhang, Chunguo Wang, Xiaoxi Yang, Tianqi Fan, Guoquan Zheng, Zheng Wang, Yan Wang, Xuesong Zhang Journal of Orthopaedic Surgery and Research.2019;[Epub] CrossRef
Kyphectomy and interbody fixation using lag screws in a child with myelomeningocele kyphosis: a technical case report Seong-Hyun Wui, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun Jib Kim Child's Nervous System.2019; 35(8): 1407. CrossRef
Anatomic Trajectory Screw Fixation at Upper Instrumented Vertebra Is a Substantial Risk Factor for Proximal Junctional Kyphosis Jong-Myung Jung, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim, Yunhee Choi World Neurosurgery.2019; 129: e522. CrossRef
Relationship Between Cervical Sagittal Alignment and Patient Outcomes After Anterior Cervical Fusion Surgery Involving 3 or More Levels Se-Il Jeon, Seung-Jae Hyun, Sanghyun Han, Byoung Hun Lee, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim World Neurosurgery.2018; 113: e548. CrossRef
Total Deformity Angular Ratio as a Risk Factor for Complications after Posterior Vertebral Column Resection Surgery Byoung Hun Lee, Seung-Jae Hyun, Sanghyun Han, Se-Il Jeon, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim Journal of Korean Neurosurgical Society.2018; 61(6): 723. CrossRef
Spinal Deformity Surgery : It Becomes an Essential Part of Neurosurgery Seung-Jae Hyun, Jong-myung Jung Journal of Korean Neurosurgical Society.2018; 61(6): 661. CrossRef
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