Justin S. Smith

Rethinking sagittal alignment: the value of evaluating spinal shape in conjunction with T4-L1 pelvic angle measurement to prevent proximal junctional failure.

OBJECTIVE The T4-L1 pelvic angle (T4-L1PA) has been proposed as a novel alignment target associated with mechanical complications in long-segment adult spinal deformity (ASD) surgery. However, its relationship to proximal junctional failure (PJF) and its relevance in shorter thoracolumbar constructs remain unclear. The...

Postoperative thoracic kyphosis morphology following adult spinal deformity surgery: an analysis of fused and unfused segments.

C2 Coronal Angle (C2C): A Novel Predictor of Outcomes Following Adult Thoracolumbar Spinal Deformity Surgery.

STUDY DESIGN Retrospective analysis of a multicenter series of deformity patients undergoing thoracolumbar instrumentation to the pelvis. OBJECTIVE Introduce the C2 coronal angle (C2C) as a novel metric, assess its association with quality-of-life and neck-specific outcomes, and compare the strength of this associati...

AO Spine Clinical Practice Recommendations: Proximal Junctional Kyphosis and Failure Prevention

Prevention of PJK/PJF requires a multimodal approach integrating patient biology, surgical technique, construct design, and individualized alignment goals, and consideration of prophylactic junctional protection in high-risk patients.

Loss of patient-reported outcome benefit over 8-year follow-up for operatively treated adult symptomatic lumbar scoliosis patients who required revision surgery for mechanical complications.

The need for better techniques to reduce mechanical complications in ASLS surgery is emphasized, with patients with ≥ 2 revisions experienced the greatest impact on both their ODI score and SRS-22r subscore.