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Risk Factors of Revision Surgery After Acute Proximal Junctional Fracture Following Adult Spinal Deformity Surgery
Tae Soo Shin1, Jin-Sung Park1, Dong-Ho Kang1
1Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea.
Neurosurgery
|June 30, 2026
Summary
Acute proximal junctional fracture (APJFx) after spinal surgery is common. Overcorrection of pelvic incidence minus lumbar lordosis (PI-LL) and increased proximal junctional angle predict revision surgery needs.
Area of Science:
- Spine surgery
- Orthopedics
- Neurosurgery
Background:
- Acute proximal junctional fracture (APJFx) is a complication of adult spinal deformity surgery.
- APJFx can lead to revision surgery, but its clinical course is variable.
- Identifying risk factors for revision is crucial for patient management.
Purpose of the Study:
- To identify independent risk factors for revision surgery after APJFx.
- To guide the timing and necessity of revision surgery in these patients.
Main Methods:
- Retrospective study of 80 patients with APJFx within 6 months of multilevel spinal fusion.
- Analysis of demographic, surgical, and radiographic variables.
- Multivariate logistic regression and ROC analysis to identify predictors of revision surgery.
Main Results:
- 35 patients (43.8%) underwent revision surgery, mostly within 24 months.
- Independent predictors of revision were PI-LL overcorrection (OR=1.76) and proximal junctional angle >22.5° (OR=1.10).
- Patients with both factors had a 71.4% revision rate, vs. 17.6% with neither.
Conclusions:
- Revision surgery is frequent after APJFx, especially with PI-LL overcorrection and increased proximal junctional angle.
- Risk stratification based on these factors can inform surgical decisions and surveillance.
- These findings aid in optimizing management strategies for APJFx.
