ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Abdominal wall tension after spinal deformity correction compromises postoperative biomechanics and may contribute to proximal junctional kyphosis.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Letter to the Editor concerning "Abdominal wall tension after spinal deformity correction compromises postoperative biomechanics and May contribute to proximal junctional kyphosis" by Jolas E, et al. (Eur Spine J [2025]; doi: 10.1007/s00586-025-09063-w).European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
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15 authors.
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No grant is acknowledged in the PubMed record.
Abstract
purposeProximal junctional kyphosis (PJK) is a common complication after fusion surgery for adult spinal deformity (ASD). Tissue adaptation to deformity may cause abdominal wall shortening/stiffening. This study evaluated, using musculoskeletal modeling, the effect of these adaptations and sarcopenia on trunk muscle effort required to maintain postoperative alignment in PJK patients versus controls.
methodsASD patient data was grouped by mechanical complication status: PJK (N=44), other (N=56), none (N=260). Spinopelvic landmarks were annotated in pre-op, post-op, and follow-up X-ray images. Patient-specific musculoskeletal models of corresponding alignments were built. Forces due to stretching of the abdominal wall beyond pre-op length (assumed slack) were applied, representing abdominal wall stiffness. Sarcopenia was implemented by reducing paraspinal muscle strength based on patient age and gender. Inverse-static simulations predicted overall muscle effort by summing muscle activities.
resultsPostoperatively, the abdominal wall was more elongated in the PJK group (+8.4%[-0.3;20.0]) versus the no-complication group (+2.4%[-4.9;10.2], p<0.01) due to larger preoperative deformities and greater surgical correction. This elongation correlated more with pelvic tilt change (r=-0.53) than lumbar lordosis correction (r=0.16). Greater muscle effort was estimated for post-op alignment in the PJK group (12.40[6.42;28.6]) versus the no-complication group (8.42[4.34;13.3], p<0.05). Muscle effort was reduced at follow-up in groups with mechanical complications.
conclusionAlignment restoration tensions abdominal structures, requiring increased extensor muscle forces to maintain postoperative alignment. Patients might develop PJK to reduce unsustainable muscle effort or due to spinal structure failure. More attention should be given to pelvic reciprocal changes to improve surgical planning and perioperative rehabilitation.
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