Evidence map›Paper›PMID 42171733›Full record

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

Thoracic spine degeneration in adult spinal deformity patients: impact on baseline alignment, reciprocal changes, and proximal junctional kyphosis.

Bassel G Diebo, Manjot Singh, Joseph E Nassar, Richard Hostin, Munish C Gupta, Eric O Klineberg, Gregory M Mundis, David O Okonkwo, Kojo D Hamilton, Peter G Passias and 12 more

Abstract read
PubMed Publisher
In one paragraph

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. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

22 authors.

Bassel G DieboDepartment of Orthopedics, Brown University, Providence, USA. dr.basseldiebo@gmail.com.
Manjot SinghDepartment of Orthopedics, Brown University, Providence, USA. manjot_singh@brown.edu.
Joseph E NassarDepartment of Orthopedics, Brown University, Providence, USA.ORCID http://orcid.org/0000-0002-2475-4996
Richard HostinSouthwest Scoliosis Institute, Fort Worth, USA.
Munish C GuptaWashington University in St. Louis, St Louis, USA.
Eric O KlinebergThe University of Texas Health Science Center at Houston, Houston, USA.
Gregory M MundisSan Diego Spine Institute, San Diego, USA.
David O OkonkwoDepartment of Neurological Surgery, Division of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Kojo D HamiltonDepartment of Neurological Surgery, Division of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Peter G PassiasDepartments of Neurosurgery and Orthopedic Surgery, Duke University, Durham, USA.
Themistocles S ProtopsaltisDepartment of Orthopedic Surgery, New York University Langone Medical Center, New York, USA.
Han Jo KimHospital for Special Surgery, New York, USA.
Jeffrey L GumNorton Healthcare, Louisville, USA.
Justin S SmithUniversity of Virginia Health System, Charlottesville, USA.
Khaled M KebaishJohns Hopkins University, Baltimore, USA.
Lawrence G LenkeColumbia University, New York, USA.
Shay BessDenver International Spine Center, Denver, USA.
Frank J SchwabDepartment of Orthopaedic Surgery, Lenox Hill Hospital, New York, USA.
Renaud LafageDepartment of Orthopaedic Surgery, Lenox Hill Hospital, New York, USA.
Virginie LafageDepartment of Orthopaedic Surgery, Lenox Hill Hospital, New York, USA.
Alan H DanielsDepartment of Orthopedics, Brown University, Providence, USA.
International Spine Study GroupInternational Spine Study Group, Denver, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo evaluate the impact of thoracic spine degeneration in adult spinal deformity (ASD) patients on radiographic outcomes.

methodsPrimary ASD patients undergoing thoracolumbar fusion with T9-L1 upper instrumented vertebra (UIV) and S1/ilium lower instrumented vertebra were included. Thoracic spine degeneration was assessed radiographically using Kellgren-Lawrence (KL) grading and segmented into T1-T5, T5-T9, and T9-L1 arcs per Lafage criteria. Arc degeneration was defined as ≥ 2 levels with KL grade 3 + in an arc and thoracic spine degeneration as ≥ 1 degenerated arc. Proximal zone degeneration was KL grade 3 + in the two levels above the UIV and distal zone degeneration was KL grade 3 + in unfused thoracic levels outside the proximal zone. Patients with no degenerated levels served as controls.

resultsAmong 272 patients (mean age 65.1years, 74% female, mean Charlson Comorbidity Index 1.9), 19, 81, and 100 patients had T1-T5, T5-T9, and T9-L1 arc degeneration, respectively, corresponding to 151 degenerated and 72 control patients. Degenerated patients exhibited higher thoracic kyphosis (36.1° vs. 27.6°), reduced expected thoracic compensation via hypokyphosis (- 0.7° vs. 8.8°), and higher lumbar lordosis (38.6° vs. 32.3°) (p < 0.05). At six weeks, degenerated patients had smaller reciprocal kyphotic changes (1.6° vs. 5.8°). At two years, they had higher proximal junctional kyphosis (PJK)-Normative rates (38% vs. 24%) (p < 0.05). Proximal zone sub-analysis showed that two-year PJK-Normative rates (43% vs. 32% vs. 24%) decreased incrementally from proximal to distal zone degeneration to controls (p < 0.05).

conclusionOver half of ASD patients exhibited thoracic spine degeneration, predominantly in the lower arcs (T5-L1). This was associated with reduced thoracic hypokyphosis, smaller six-week reciprocal kyphotic changes, and higher two-year PJK rates. Proximal zone degeneration predicted junctional failure. Surgical planning should consider thoracic degeneration and compensatory mechanisms, with careful UIV selection to ensure sustained correction. LEVEL OF EVIDENCE: IV.

Indexed as

Adult spinal deformityKellgren-Lawrence gradingPostoperative compensationSurgical planningThoracic kyphosisThoracic spine degeneration

Identifiers

PMID42171733

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.