Proximal junctional kyphosis and failure—diagnosis, prevention, and treatment

Ngoc Lam M. Nguyen, Christopher Y. Kong, Robert A. Hart

Research output: Contribution to journalReview articlepeer-review

62 Scopus citations


Technical advancements have enabled the spinal deformity surgeon to correct severe spinal mal-alignment. However, proximal adjacent segment pathology (ASP) remains a significant issue. Examples include proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Agreement on the definition, classification, and pathophysiology of PJK and PJF remains incomplete, and an understanding of the risk factors, means of prevention, and treatment of this problem remains to be elucidated. In general, PJK is a relatively asymptomatic radiographic diagnosis managed with patient reassurance and monitoring. On the other hand, PJF is characterized by mechanical instability, pain, and more severe kyphosis, with potential for neurologic compromise. Patients who develop PJF more often require revision surgery than those with PJK. This chapter will review the current understanding of PJK and PJF.

Original languageEnglish (US)
Pages (from-to)299-308
Number of pages10
JournalCurrent Reviews in Musculoskeletal Medicine
Issue number3
StatePublished - Sep 1 2016


  • Acute proximal junctional collapse
  • Acute proximal junctional failure
  • Adjacent segment degeneration
  • Proximal junctional failure
  • Proximal junctional kyphosis
  • Topping off syndrome

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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