PT  - JOURNAL ARTICLE
AU  - Hills, Jeffrey
AU  - Kelly, Michael P.
TI  - Defining Clinically Relevant Proximal Junctional Kyphosis
AID  - 10.14444/8516
DP  - 2023 Sep 12
TA  - International Journal of Spine Surgery
PG  - 8516
4099  - https://www.ijssurgery.com/content/early/2023/09/11/8516.short
4100  - https://www.ijssurgery.com/content/early/2023/09/11/8516.full
AB  - Proximal junctional kyphosis and failure are not infrequent complications of adult spinal deformity reconstructions. Efforts to define proximal junctional kyphosis have ranged from expert opinions to statistical analyses of large databases. These approaches fail to recognize that proximal junctional kyphosis/failure/breakdown is likely a spectrum of manifestations secondary to spinal fusions and spinal alignment. The dichotomization (clinically irrelevant vs clinically relevant) of continuous measures will lead to misclassification and misdiagnosis. As adult spinal deformity moves to a precision-medicine-based approach (also known as personalized medicine), work is required to develop probabilistic models to inform patients and surgeons about the likely survivorship of a proximal junctional failure. As such, it is likely better to call proximal junctional segment kyphosis without symptoms “asymptomatic proximal junctional kyphosis” rather than to determine thresholds for “symptomatic” or “clinically relevant.”