European Spine Journal

, Volume 23, Issue 12, pp 2726–2736

Proximal junctional kyphosis following adult spinal deformity surgery

Review Article

DOI: 10.1007/s00586-014-3531-4

Cite this article as:
Cho, S.K., Shin, J.I. & Kim, Y.J. Eur Spine J (2014) 23: 2726. doi:10.1007/s00586-014-3531-4



Proximal junctional kyphosis (PJK) is a common radiographic finding following long spinal fusions. Whether PJK leads to negative clinical outcome is currently debatable. A systematic review was performed to assess the prevalence, risk factors, and treatments of PJK.


Literature search was conducted on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials using the terms ‘proximal junctional kyphosis’ and ‘proximal junctional failure’. Excluding reviews, commentaries, and case reports, we analyzed 33 studies that reported the prevalence rate, risk factors, and discussions on PJK following spinal deformity surgery.


The prevalence rates varied widely from 6 to 61.7 %. Numerous studies reported that clinical outcomes for patients with PJK were not significantly different from those without, except in one recent study in which adult patients with PJK experienced more pain. Risk factors for PJK included age at operation, low bone mineral density, shorter fusion constructs, upper instrumented vertebrae below L2, and inadequate restoration of global sagittal balance.


Prevalence of PJK following long spinal fusion for adult spinal deformity was high but not clinically significant. Careful and detailed preoperative planning and surgical execution may reduce PJK in adult spinal deformity patients.


Proximal junctional kyphosis Proximal junctional failure Adult scoliosis Adult spinal deformity Scoliosis 

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Samuel K. Cho
    • 1
  • John I. Shin
    • 1
  • Yongjung J. Kim
    • 2
  1. 1.Department of Orthopaedic SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of Orthopaedic SurgeryColumbia University College of Physicians and SurgeonsNew YorkUSA

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