Neurosurgery 96:308–317, 2025
• Study Focus: The study investigates risk factors for proximal junctional failure (PJF) in elderly patients undergoing spinal deformity surgery despite achieving optimal sagittal correction.
• Methodology: Retrospective analysis of patients aged 60+ who underwent ≥5-level spinal fusion, focusing on those achieving optimal sagittal correction relative to the sagittal age-adjusted score (SAAS).
• Key Findings: High body mass index (BMI), high lumbar distribution index (LDI), and absence of hook fixation at UIV + 1 are significant risk factors for PJF.
• Statistical Analysis: Multivariate analysis confirmed these risk factors, with BMI and LDI showing significant predictive power for PJF development.
• Clinical Implications: Managing BMI, LDI, and ensuring hook fixation at UIV + 1 could reduce PJF rates, even with optimal sagittal correction.
• Limitations: The study’s generalizability is limited by the predominance of patients with UIV in the lower thoracic spine and inconsistent use of preventive methods.
• Conclusion: Proper management of identified risk factors, along with optimal sagittal correction, may further decrease PJF incidence.
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