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.
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.
Objective To elucidate the clinical outcomes of craniocervical realignment surgery in patients with craniovertebral junction (CVJ) kyphosis accompanied by negative sagittal imbalance, and to identify radiological predictors associated with favorable outcomes.
Methods A retrospective analysis was performed on 28 patients who underwent craniocervical realignment between 2014 and 2022 for CVJ kyphosis with accompanying negative sagittal imbalance. Clinical outcomes were evaluated using the Neck Disability Index (NDI), visual analogue scale for neck pain, and the Japanese Orthopaedic Association (JOA) score. Radiographic parameters included the C0–2 angle and the C2–7 sagittal vertical axis (SVA). Favorable outcomes were defined as an improvement of more than 20 points in the NDI and a JOA recovery rate exceeding 50%. Multiple linear regression and receiver operating characteristic (ROC) curve analyses were conducted to identify independent predictors and to determine optimal threshold values.
Results Significant improvements in both clinical outcomes and radiographic alignment were observed in association with craniocervical realignment surgery. Patients who achieved favorable outcomes exhibited greater postoperative changes in the C0–2 angle and the C2–7 SVA. Multivariate analysis identified changesm in the C0–2 angle (p=0.019) and C2–7 SVA (p=0.010) as independent predictors of NDI improvement, while age (p=0.033) and C2–7 SVA change (p=0.037) were independently associated with the JOA recovery rate. ROC curve analysis determined optimal cutoff values of ≥10.65° for C0–2 angle change and ≥19.2 mm for C2–7 SVA change, with corresponding area under the curve values of 0.872 and 0.802, respectively.
Conclusion Craniocervical realignment appears to be a viable surgical option for patients with CVJ kyphosis and negative sagittal imbalance. Postoperative changes in C0–2 angle and C2–7 SVA were found to be associated with favorable clinical and functional outcomes, suggesting their potential role as prognostic factors.
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Predictive value of C0–C2 and C1–C2 angles for postoperative lower cervical alignment following posterior atlantoaxial fixation and fusion: a retrospective single-center study Beiping OuYang, Hongyan Sun, Kaiwei Zhang, Li Zhang European Spine Journal.2026;[Epub] 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.
Objective To investigate the correlation between paraspinal sarcopenia (PS) and sagittal imbalance (SI) in degenerative kyphosis (DK), and to explore the correlation between paraspinal muscle (PSM) function loss and morphology change in DK.
Methods One hundred thirty-eight patients with DK and 204 with lumbar spinal stenosis (LSS) were enrolled. The spinopelvic parameters and sagittal vertical axis (SVA) were measured. Patients were divided into the sagittal balance (SB, SVA ≤ 5 cm, n = 61) and SI (SVA > 5 cm, n = 77) groups. Sagittal balanced LSS patients were served as control group. PSM function was evaluated by measuring the maximal voluntary exertion (MVE) and endurance time (ET). Magnetic resonance imaging-derived cross-sectional area (CSA) and fat infiltration rate (FI%) of PSM at T10–L5 were normalized to intervertebral disc CSA. Psoas CSA and FI% were calculated at L3–4 disc level. The correlation assessment using Spearman rank correlation coefficient and multiple linear regression. Logistic regression was used to identify the risk factors of SI.
Results Significantly lower ET, MVE, relative CSA (rCSA) and higher rFI% was found in the SI group than in the SB and control. The PS were correlated with spinopelvic parameters and regional kyphosis, while lack of correlation was found between the rFI% and MVE. Logistic regression and Youden index analysis showed ET < 15.5 seconds, MVE < 1.3 N/kg, and rCSA (L1–5) atrophy to be potential risk factors for SI in DK.
Conclusion DK patients with SI demonstrate acerbated PS that indicated by significant PSM dysfunction and morphological alterations. We highlight the significance of PSM combined evaluation and revealed that PS plays an indispensable role in the progression of SI, providing novel insights into the underlying sagittal compensatory mechanisms.
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Comprehensive analysis of risk factors for degenerative spinal deformity Quankai Wang, Junhui Chu, Weiyu Jiang European Journal of Medical Research.2026;[Epub] CrossRef
Associations Between Paraspinal Muscle Degeneration, Trunk Isokinetic Strengths, and Spinopelvic Alignment in Patients Undergoing Lumbar Fusion: A Cross-Sectional Study Jiahua Feng, Fangyi Wei, Zhongning Xu, Jintao Ao, Tenghui Ge, Renxian Wang, Fangfang Duan, Jingye Wu, Zhao Lang, Ling Wang, Yuqing Sun Journal of Clinical Medicine.2026; 15(15): 5812. CrossRef
Objective To analyze long-term clinical and radiological outcomes after multilevel anterior osteotomy with posterior instrumentation in patients with ossification of posterior longitudinal ligament (OPLL)-induced myelopathy and cervical kyphosis.
Methods Patients who underwent multilevel anterior osteotomy with posterior instrumentation for OPLL-induced myelopathy and cervical kyphosis and had a minimum of 5-year follow-up were included. Clinical outcomes (Japanese Orthopaedic Association score system for cervical myelopathy [C-JOA], 12-item Short Form health survey [SF-12], Neck Disability Index [NDI]) and radiological parameters (C2–7 lordosis, center of gravity of the head [CGH]-C7 sagittal vertical axis [SVA], T1 slope) were analyzed at the preoperative, immediate postoperative, and latest follow-up timepoints.
Results Twenty-eight patients were included. The average follow-up period was 66.4 months. All clinical outcome parameters showed significant improvement. C-JOA, SF-12, and NDI showed significant improvement at latest follow-up (p<0.001). C2–7 lordosis increased significantly immediately postoperatively (-6.0°±10.4°) compared to preoperatively (+9.2°±9.6°), and was largely maintained at latest follow-up (-5.7°±9.4°). T1 slope significantly increased between the immediate postoperative timepoint (21.9°±7.7°) and latest follow-up (24.2°±9.5°) (p=0.046). CGH-C7 SVA significantly increased between the immediate postoperative timepoint (22.7±14.8 mm) and latest follow-up (32.2±22.6 mm) (p=0.046).
Conclusion Multilevel anterior osteotomy with posterior instrumentation is a safe and effective surgical option for OPLL-induced myelopathy with kyphotic cervical alignment. Future studies are required to investigate the forward tilting of cervical spine over time after surgery.
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Objective To examine the factors influencing cervical sagittal alignment (CSA) after posterior correction and fusion surgery (PSF) for patients with Lenke type 2 adolescent idiopathic scoliosis (AIS).
Methods A total of 102 female patients with Lenke 2 AIS and a minimum 2-year follow-up were included. The upper instrumented vertebra was T2 in all patients. Sagittal and coronal parameters were measured before and 2 years after surgery. Patients were categorized into cervical malalignment (CM) and noncervical malalignment (NCM) groups following Passias’ criteria. Radiographic factors influencing CSA were analyzed.
Results Preoperatively, 57 patients (55.9%) were assigned to the CM group and 45 patients (44.1%) to the NCM groups. The cervical lordosis (CL) in CM group was more kyphotic (19.3° vs. 3.3°), smaller proximal thoracic kyphosis (PTK; 9.7° vs. 15.4°), and smaller T1 slope (7.1° vs. 14.0°) than those in the NCM group. Main thoracic kyphosis (MTK) did not show significantly difference between the 2 groups (11.3° vs. 14.4°). Two years after surgery, the CM group demonstrated significant improvements in CSA. PTK increased from 9.7° to 13.5°, T1 slope increased from 7.1° to 10.5°, and cervical kyphosis improved from -19.3° to -8.8°, while MTK remained unchanged (11.3° vs. 11.6°).
Conclusion PSF significantly improved CSA in patients with preoperative CM. Increased PTK, correlated with improved CL, suggests that PSF-induced PTK enhancement, rather than MTK, drives T1 slope and subsequent CSA improvement.
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Objective To assess the effectiveness of vertebral cement augmentation (VCA) at upper instrumented vertebra (UIV) and UIV+1 in preventing proximal junction complications in correction surgery for adult spinal deformity patients.
Methods A literature search was conducted on Web of Science, PubMed, and Cochrane Library databases for comparative studies published before December 30th, 2024. Two reviewers independently screened eligible articles based on the inclusion and exclusion criteria, assessed study quality with Newcastle-Ottawa scale, and extracted data like study characteristics, surgical details, primary and secondary outcomes. Data analysis was performed using Review Manager 5.4 and Stata software.
Results Of all 513 papers screened, a meta-analysis was conducted on 7 articles, which included 333 cases in the VCA group and 827 cases in the control group. Patients in the VCA group had significantly older age and lower T score than patients in the control group. Although there was no statistically significant difference in the incidence of proximal junctional failure between the 2 groups, the results of the meta-analysis showed that the incidence of proximal junctional failure and the need for revision surgery were reduced by 36% and 71%, respectively, in the VCA group. One study reported 2 clinically silent pulmonary cement embolism and 1 patient requiring surgical decompression for cement leak into the spinal canal.
Conclusion This meta-analysis supported the use of VCA in corrective surgery for spinal deformities patients, especially in patients with advanced age and osteoporosis.
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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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Objective To identify risk factors and establish radiographic criteria for distal junctional failure (DJF) in patients with adult spinal deformity (ASD), who underwent fusion surgery stopping at L5.
Methods This retrospective study was undertaken from January 2016 to December 2020. Patients with ASD who underwent fusion surgery (≥5 levels) stopping at L5 were analyzed. DJF was defined as symptomatic adjacent segment pathology at the lumbosacral junction necessitating consideration for revision surgery. Demographic data and radiographic measurements were compared between the DJF and non-DJF groups. Receiver operating characteristic curve analysis was performed to identify the radiographic cutoff value for DJF.
Results Among 76 patients, 16 (21.1%) experienced DJF. DJF was associated with older age, antidepressant/anxiolytic medication, longer level of fusions, and worse preoperative sagittal alignment. Antidepressant/anxiolytic medication (odds ratio, 5.60) and preoperative pelvic incidence (PI)–lumbar lordosis (LL) mismatch>40° (odds ratio, 5.87) were independent risk factors for DJF. Without both factors, the incidence of DJF has been greatly reduced (9.1%). Two radiographic criteria were determined for DJF: last distal junctional angle (DJA)>-5° and Δ last DJA–post DJA>5°. When both criteria were met, the sensitivity and specificity of the DJF were 93.3% and 91.7%, respectively.
Conclusion Use of antidepressant/anxiolytic medication and preoperative PI–LL mismatch >40° were independent risk factors for DJF. DJF could be diagnosed using postoperative changes in the DJA. If both criteria were met, DJF could be strongly suggested.
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Objective To establish a novel classification system for predicting the risk of intraoperative neurophysiological monitoring (IONM) events in surgically-treated patients with kyphotic deformity.
Methods Patients with kyphotic deformity who underwent surgical correction of cervicothoracic, thoracic, or thoracolumbar kyphosis in our center from July 2005 to December 2020 were recruited. We proposed a classification system to describe the morphology of the spinal cord on T2-weighted sagittal magnetic resonance imaging: type A, circular/symmetric cord with visible cerebrospinal fluid (CSF) between the cord and vertebral body; type B, circular/oval/symmetric cord with no visible CSF between the cord and vertebral body; type C, spinal cord that is fattened/deformed by the vertebral body, with no visible CSF between the cord and vertebral body. Furthermore, based on type C, the spinal cord compression ratio (CR) < 50% was defined as the subtype C-, while the spinal cord CR ≥ 50% was defined as the subtype C+. IONM event was documented, and a comparative analysis was made to evaluate the prevalence of IONM events among patients with diverse spinal cord types.
Results A total of 294 patients were reviewed, including 73 in type A; 153 in type B; 53 in subtype C- and 15 in subtype C+. Lower extremity transcranial motor-evoked potentials and/or somatosensory evoked potentials were lost intraoperatively in 41 cases (13.9%), among which 4 patients with type C showed no return of spinal cord monitoring data. The 14 subtype C+ patients (93.3%) had IONM events. Univariate logistic regression analysis showed that patients with a type C spinal cord (subtype C-: odds ratio [OR], 10.390; 95% confidence interval [CI], 2.215–48.735; p = 0.003; subtype C+, OR, 497.000; 95% CI, 42.126– 5,863.611; p < 0.001) are at significantly higher risk of a positive IONM event during deformity correction compared to those with a type A. In further multiple logistic regression analysis, the spinal cord classification (OR, 5.371; 95% CI, 2.966–9.727; p < 0.001) was confirmed as an independent risk factor for IONM events.
Conclusion We presented a new spinal cord classification system based on the relative position of the spinal cord and vertebrae to predict the risk of IONM events in patients with kyphotic deformity. In patients with type C spinal cord, especially those in C+ cases, it is essential to be aware of potential IONM events, and adopt standard operating procedures to facilitate neurological recovery.
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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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Effects of paraspinal muscle atrophy and fatty degeneration on segmental kyphosis after conservative treatment of osteoporotic vertebral compression fracture (OVCF) in postmenopausal women Inwook Seo, Minjoon Cho, Taehoon Kang, Sungtaek Chung, Jae Hyup Lee European Spine Journal.2026; 35(5): 2622. CrossRef
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
Proximal Junctional Kyphosis Prevention in Adult Spinal Deformity Surgery: A Technical Review of Tethering and Adjunctive Strategies Paritash Tahmasebpour, Pawel P. Jankowski, Jason Liang, Joshua Lin, Kyriakos D. Chatzis, Peter S. Tretiakov, Spencer Matthews, Louis Boissiere, John F. Burke, Christopher I. Shaffrey, Aaron Hockley, Peter Passias Operative Neurosurgery.2026;[Epub] CrossRef
Objective To compare the clinical outcomes and biomechanical characteristics of 1-, 2-, and 3-level pedicle subtraction osteotomy (PSO), and establish selection criteria based on preoperative radiographic parameters.
Methods Patients undergone PSO to treat ankylosing spondylitis from February 2009 to May 2019 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled. According to the quantity of osteotomy performed, the participants were divided into group A (1-level PSO, n = 24), group B (2-level PSO, n = 19), and group C (3-level PSO, n = 11). Clinical outcomes were assessed before surgery and at the final follow-up. Comparisons of the radiographic parameters and quality-of-life indicators were performed among and within these groups, and the selection criteria were established by regression. Finite element analysis was conducted to compare the biomechanical characteristics of the spine treated with different quantity of osteotomies under different working conditions.
Results Three-level PSO improved the sagittal parameters more significantly, but resulted in longer operative time and greater blood loss (p < 0.05). Greater stress was found in the proximal screws and proximal junction area of the vertebra in the model simulating 1-level PSO. Larger stress of screws and vertebra was observed at the distal end in the model simulating 3-level PSO.
Conclusion Multilevel PSO works better for larger deformity correction than single-level PSO by allowing greater sagittal parameter correction and obtaining a better distribution of stress in the hardware construct, although with longer operation time and greater blood loss. Three-level osteotomy is recommended for the patients with preoperative of global kyphosis > 85.95°, T1 pelvic angle > 62.3°, sagittal vertical alignment > 299.55 mm, and pelvic tilt+ chin-brow vertical angle > 109.6°.
A novel pre-contoured V-shaped rod in one-level pedicle subtraction osteotomy for the treatment of rigid lumbar kyphosis caused by ankylosing spondylitis: technical note and case series Hongtao Ding, Cheng Zeng, Andrew Y. Xu, Audrey Y. Su, Jeffrey J. Yeung, Xin Chen, Huadong Wang, Yanbin Zhang, Kai Yan, Yonggang Xing, Da He, Bin Xiao BMC Musculoskeletal Disorders.2025;[Epub] CrossRef
Advances in Molecular Research on Hip Joint Impingement—A Vascular Perspective Riana Maria Huzum, Marius Valeriu Hînganu, Bogdan Huzum, Delia Hînganu Biomolecules.2024; 14(7): 784. CrossRef
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