Evidence map›Paper›PMID 40033726›Full record

ArticleAsian spine journal2025

Estimation of proximal junctional failure and associated risk factors in adult spine deformity surgery: an observational study from a single institution.

Vishwajeet Singh, Marcelo Oppermann, Nathan Evaniew, Alexandra Soroceanu, Fred Nicholls, Bradley Jacobs, Kenneth Thomas, Ganesh Swamy

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In one paragraph

Article in Asian spine journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Vishwajeet SinghDivision of Orthopaedic Surgery, Calgary Spine Program, University of Calgary, Calgary, AB, Canada.
Marcelo OppermannDivision of Neurosurgery, Department of Surgery, Western University, London, ON, Canada.
Nathan EvaniewDivision of Orthopaedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada.
Alexandra SoroceanuDivision of Orthopaedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada.
Fred NichollsDivision of Orthopaedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada.
Bradley JacobsDivision of Neurosurgery Spine Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Kenneth ThomasDivision of Orthopaedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada.
Ganesh SwamyDivision of Orthopaedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

STUDY

designA retrospective observational cohort study. PURPOSE: To estimate the proximal junctional failure (PJF) rate and identify associated factors. OVERVIEW OF LITERATURE: Proximal junctional pathologies are challenging and common complications of adult spine deformity (ASD) surgery. However, the PJF rate was not accurately defined within the ASD cohort. A correct estimate of PJF incidence and associated factors will inform clinicians on reoperation risk and prevention strategies.

methodsThis retrospective observational study included patients with degenerative or adult idiopathic thoracolumbar deformity, extended instrumentation, sacropelvic fixation, and more than 2 years of follow-up. Patients with post-traumatic or iatrogenic sagittal malalignment were excluded. Demographic and operative data were obtained from the electronic medical records. Preoperative and followup scoliosis radiographs were reviewed to calculate the spinal alignment parameters. Patients were categorized into the PJF and non- PJF groups using the modified Hart-ISSG criteria, and their demographic, surgical, and radiographic parameters were compared using descriptive statistics. Multivariable logistic regression models were fitted to estimate the association measures of PJF occurrence, and their odds ratios (ORs) were reported with corresponding 95% confidence intervals (CI).

resultsOf the eligible 157 patients who underwent surgery between 2011 and 2018, 130 were included. The mean age was 64.6±8 years, and 73% of the patients were female. Moreover, 42 (32%) and 88 patients (68%) were allocated to the PJF and non-PJF groups, respectively. The mean change in the proximal junctional angle (△PJA) in the PJF group was 26°±8.2°, and 33 patients (79%) had a final PJA >20°, 4 (10%) had an additional upper instrumented vertebra (UIV)/UIV+1 fracture, and 5 (12%) had an additional screw dislodgement or fixation failure. Postoperative changes in PJA (OR, 1.23; 95% CI, 1.12-1.37; p <0.001), thoracic kyphosis (TK; OR, 1.06; 95% CI, 1.02-1.11; p =0.004), and the use of a proximal tether (OR, 0.22; 95% CI, 0.04-0.82; p =0.03) were associated with PJF.

conclusionsIn this study, the PJF rate was 32%, of which 67% of the patients underwent reoperation. Postoperative PJA and TK changes and the use of proximal tethers were significantly associated with PJF.

Indexed as

Adult spinal deformityPostoperative complicationsProximal junction failurScoliosisSpine

Identifiers

PMID40033726
PMCPMC12242246

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