Evidence map›Paper›PMID 42033576›Full record

ArticleSpine deformity2026

Vertebral pelvic angles accurately predict risk of proximal junctional kyphosis following long-segment fusion for adult spinal deformity.

Michael W Fields, Justin K Scheer, Matthew Weintraub, Juan Baltazar, Fthimnir Hassan, Omar Taha, Anastasia M Ferraro, Erik Lewerenz, Matthew J Cooney, Joseph M Lombardi and 3 more

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Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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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

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Michael W FieldsDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA. michaelwilliamfields@gmail.com.ORCID http://orcid.org/0000-0002-6077-1494
Justin K ScheerDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Matthew WeintraubDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Juan BaltazarDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Fthimnir HassanDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Omar TahaDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Anastasia M FerraroDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Erik LewerenzDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Matthew J CooneyDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Joseph M LombardiDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Zeeshan M SardarDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Lawrence G LenkeDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Ronald A LehmanDepartment of Orthopedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeVPAs quantify the spatial relationship of each vertebra to the pelvis and are independent of patient positioning, making them a valuable tool for preoperative planning and intraoperative assessment of sagittal alignment. Given the biomechanical relevance of vertebral pelvic angles (VPAs), their role in predicting proximal junctional kyphosis (PJK) warrants further investigation. We hypothesized that malalignment of VPAs is associated with an increased risk of developing PJK following long-segment fusion for adult spinal deformity (ASD).

methodsASD patients ≥ 18 years undergoing ≥ 5-level posterior spinal instrumentation and fusion (PSIF) to the pelvis from 2015 to 2022 were included. VPAs (C2PA, T1PA, T4PA, T10PA, L1PA) were measured on standardized radiographs preoperatively and immediately postoperatively. PJK was defined radiographically by two criteria: (1) a postoperative proximal junctional sagittal Cobb angle ≥ 10°, and (2) an increase of ≥ 10° compared to the preoperative angle between the UIV and UIV + 2. Associations between VPA changes, published alignment thresholds (L1PA = PI × 0.5 - 19° ± 2°; T4-L1PA mismatch = - 3° to + 1°), and PJK were assessed using ROC analysis and logistic regression.

resultsA total of 266 patients (mean age: 57.5 ± 12.5 years; 74.8% female; mean follow-up: 24.6 ± 13.7 months) were included. Forty-five patients (16.9%) developed PJK, of which 37.8% were symptomatic. VPAs correlated most strongly with pelvic tilt (r up to 0.766). In the overall cohort, mean postoperative VPA values and changes were not significantly different between PJK and no-PJK groups. However, in a subgroup with UIV ≥ T5 (n = 174), patients with PJK demonstrated greater corrections in C2PA (14.3° vs. 8.0°, p < 0.001), T1PA (14.6° vs. 9.0°, p = 0.005), T4PA (12.9° vs. 8.3°, p = 0.016), T10PA (10.1° vs. 6.2°, p = 0.004), and L1PA (8.3° vs. 5.4°, p = 0.006). ROC demonstrated C2PA change held the highest predictive value for PJK (AUC = 0.64), followed by L1PA change (AUC = 0.62). Adherence to the published L1PA threshold and optimizing T4-L1PA mismatch to near neutral was protective against PJK in this cohort.

conclusionOur results demonstrate that greater magnitude correction of VPAs from baseline, particularly C2PA and L1PA, was associated with an increased risk of PJK in longer constructs with a UIV proximal to T5. Furthermore, this study is consistent with prior work suggesting that L1PA and T4-L1 mismatch may be useful parameters when assessing sagittal alignment in relation to PJK risk.

Indexed as

KyphosisPelvisPostoperative ComplicationsSpinal CurvaturesSpinal FusionAdultAgedFemaleHumansMaleMiddle AgedRadiographyRetrospective StudiesProximal junctional kyphosisSagittal alignmentVertebral pelvic angles

Identifiers

PMID42033576

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.