Beyond Kyphosis

作者：Virginie Lafage, Ayman A. Mohamed, Christopher Katchis, Alan H. Daniels, Bassel G. Diebo, Christopher P. Ames, Shay Bess, Douglas C. Burton, Robert K. Eastlack, Munish Kumar Gupta, Richard A. Hostin, Khaled Kebaish, Han Jo Kim, Eric O. Klineberg, Gregory M. Mundis, David O. Okonkwo, Christopher I. Shaffrey, Justin S. Smith, Renaud Lafage, Frank Schwab, International Spine Study Group · 发表于：Spine · 年份：2025 · DOI：10.1097/brs.0000000000005509 · 被引用次数：3 · 研究领域：Scoliosis diagnosis and treatment、Spine and Intervertebral Disc Pathology、Cervical and Thoracic Myelopathy

STUDY DESIGN: Retrospective cohort study based on a multicenter adult spinal deformity (ASD) database. OBJECTIVE: To characterize distinct patterns of proximal junctional failure (PJF) beyond kyphosis-based definitions and evaluate their morphology, timing, and clinical implications. SUMMARY OF BACKGROUND DATA: Proximal junctional kyphosis (PJK) is commonly defined by angular measurements, yet many patients develop other junctional complications-such as vertebral fractures, disc degeneration, or instrumentation failure-without measurable kyphosis. These "non-kyphotic" failures are under-recognized in current classification systems, limiting clinical decision-making and preventive strategies. METHODS: Data from 185 ASD patients who either met Lovecchio's radiographic PJK criteria or underwent revision surgery with proximal extension were retrospectively reviewed. Three independent readers qualitatively classified failure morphology at the proximal junction. Free-text reports were standardized and categorized into vertebral, soft-tissue/disc, or diffuse degenerative failure modes. An unsupervised cluster analysis was used to identify failure patterns based on imaging features and time to onset. Relationships between failure types, UIV level, prophylactic measures, and timing were analyzed. RESULTS: Among 1,506 enrolled patients, 185 (12.3%) developed proximal junctional complications (median age 67.5 yr; 86.5% female). Failure modes included vertebral (66%), soft tissue/disc (6...