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Differential Risk Factors for Proximal Junctional Kyphosis Between T8-T10 and T11-L1 Upper Instrumented Vertebrae in
Se-Jun Park1, Jin-Sung Park1, Dong-Ho Kang1
1Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Neurosurgery
|January 9, 2026
Summary
Proximal junctional kyphosis (PJK) risk varies by upper instrumented vertebrae (UIV) level in adult spinal deformity surgery. T11-L1 UIV levels show higher PJK rates, influenced by osteoporosis and lordosis correction, while T8-T10 UIV levels are affected by age and alignment.
Area of Science:
- Spine surgery
- Orthopedics
- Biomechanical engineering
Background:
- Proximal junctional kyphosis (PJK) is a common complication after adult spinal deformity surgery.
- Current strategies often group lower thoracic upper instrumented vertebrae (UIV) from T8-L1, potentially masking sublevel-specific risk factors.
- Understanding these differences is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To compare the risk factors for PJK in adult spinal deformity patients based on the UIV level: T8-T10 versus T11-L1.
- To identify independent predictors of PJK for each UIV subgroup.
- To inform surgical planning for PJK risk mitigation.
Main Methods:
- Retrospective review of 334 adult spinal deformity patients undergoing fusion from T8-L1 to sacrum/pelvis.
- Patients were divided into Group I (UIV T11-L1, N=157) and Group II (UIV T8-T10, N=177).
- Demographic, surgical, and radiographic data were analyzed using logistic regression and ROC analyses.
Main Results:
- PJK occurred in 29.7% of patients, with a higher incidence in Group I (35.7%) compared to Group II (24.3%).
- Preoperative proximal junctional angle was a predictor in both groups.
- Independent predictors for Group I included osteoporosis and postoperative lumbar lordosis change; for Group II, advanced age and PI-LL overcorrection were significant.
Conclusions:
- Preoperative proximal junctional angle is a universal PJK predictor.
- Surgical planning should consider UIV level-specific risk factors, including patient age, bone health, and desired coronal/sagittal alignment.
- Tailoring UIV selection and correction strategies can help reduce PJK incidence.
Keywords:
Adult spinal deformityLower thoracic fusionProximal junctional kyphosisRisk factorT11-L1T8-T10Upper instrumented vertebraMore Related Videos
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