• Zicheng Lu, Tianhao Wang, Wei Wei, Jianheng Liu, Xinran Ji, and Yongfei Zhao.
• Medical School of Chinese PLA, Beijing, China; Department of Orthopaedics, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China.
• World Neurosurg. 2024 Oct 16; 193: 171-7.

ObjectiveThis study aimed to identify surgical, patient-specific, and radiographic risk factors for proximal junctional failure (PJF), a complex complication following adult spinal deformity (ASD) surgery.MethodsA systematic literature search was performed using PubMed, Embase, and the Cochrane Library. The literature on the risk factors for PJF after ASD surgery was included. The study patients were diagnosed with ASD and underwent surgery for ASD. PJF is defined as the occurrence of proximal junctional kyphosis, accompanied by one or more of the following characteristics: a fracture of the vertebral body at the upper instrumented vertebra (UIV) or UIV + 1 level, disruption of the posterior ligaments, or dislodgement of the instrumentation at the UIV. proximal junctional kyphosis, on the other hand, is determined by 2 criteria: a proximal junctional sagittal Cobb angle 1) of 10° and 2) at least 10° greater than the preoperative value.ResultsOur pooled analysis of 11 unique studies (2037 patients) revealed significant differences in several preoperative and postoperative measures between PJF and non-PJF groups.ConclusionsIn ASD patients, the presence of concurrent osteoporosis or paravertebral muscle wasting significantly increases the risk of developing PJF. The use of bicortical screws, UIV screw angle exceeding 1°, and positioning the UIV in the lower thoracic or lumbar region also further elevate this risk. Lower preoperative SS, higher preoperative PI-LL, higher preoperative pelvic tilt, higher preoperative SVA, higher postoperative LL, and a greater change in LL characterize patients with PJF.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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