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Introduction <p>Proximal junctional failure (PJF) remains a challenging complication following instrumented posterior fusion for adult spinal deformity (ASD). Although radiographic parameters such as lumbar lordosis (LL) and pelvic incidence–lumbar lordosis mismatch (PI–LL) are frequently cited, their specific association with PJF risk is not fully defined. This systematic review and meta-analysis aimed to clarify whether postoperative LL, changes in LL (ΔLL), postoperative PI–LL, or changes in PI–LL (ΔPI–LL) are predictive of PJF in ASD.</p> Methods <p>Following PRISMA 2020 and Cochrane guidelines, a comprehensive search of PubMed, Embase, Scopus, and Web of Science was conducted through August 2025. Eligible studies included adult cohorts undergoing instrumented fusion for ASD with extractable data on alignment exposures and PJF outcomes. Two independent reviewers performed study selection, data extraction, and quality appraisal using the NIH assessment tool. Random-effects meta-analysis was performed with mean differences (MD) and 95% confidence intervals, with heterogeneity evaluated via <i>I</i><sup>2</sup>.</p> Results <p>From 3449 records, seven retrospective cohorts comprising 710 patients met inclusion. PJF occurred in 123 patients (17.3%), while 587 remained event-free. Absolute postoperative LL did not differ significantly between groups (MD = 0.70, 95% CI −&#xa0;2.02 to 3.42, <i>p</i> = 0.61). However, patients with PJF demonstrated greater ΔLL (MD = 4.24, 95% CI 0.19–8.28, <i>p</i> = 0.04). Postoperative PI–LL was also higher in the PJF group (MD = 4.25, 95% CI 0.46–8.05, <i>p</i> = 0.03). ΔPI–LL was not significantly associated (MD = −&#xa0;0.44, 95% CI −&#xa0;7.23 to 6.34, <i>p</i> = 0.90).</p> Conclusion <p>Greater ΔLL and residual postoperative PI–LL mismatch significantly correlate with PJF, while final LL alone does not. These findings highlight the importance of proportional, age-adjusted alignment strategies and cautious correction magnitude to reduce mechanical failure risk in ASD surgery.</p>

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Association between lumbar lordosis and proximal junctional failure following adult spinal deformity surgery: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年2月22日

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  • Abdullah M. Alharran,
  • AbdulMuhsen AlQallaf,
  • Mohammad Mohammad,
  • Mohammad Salem Alajmi,
  • Mohammad Alkaak,
  • Salem Y. Alenezi,
  • Fahad Mohammad,
  • Ahmad Al Ahmad,
  • Nizar Algarni,
  • Yousef Marwan

摘要

Introduction

Proximal junctional failure (PJF) remains a challenging complication following instrumented posterior fusion for adult spinal deformity (ASD). Although radiographic parameters such as lumbar lordosis (LL) and pelvic incidence–lumbar lordosis mismatch (PI–LL) are frequently cited, their specific association with PJF risk is not fully defined. This systematic review and meta-analysis aimed to clarify whether postoperative LL, changes in LL (ΔLL), postoperative PI–LL, or changes in PI–LL (ΔPI–LL) are predictive of PJF in ASD.

Methods

Following PRISMA 2020 and Cochrane guidelines, a comprehensive search of PubMed, Embase, Scopus, and Web of Science was conducted through August 2025. Eligible studies included adult cohorts undergoing instrumented fusion for ASD with extractable data on alignment exposures and PJF outcomes. Two independent reviewers performed study selection, data extraction, and quality appraisal using the NIH assessment tool. Random-effects meta-analysis was performed with mean differences (MD) and 95% confidence intervals, with heterogeneity evaluated via I2.

Results

From 3449 records, seven retrospective cohorts comprising 710 patients met inclusion. PJF occurred in 123 patients (17.3%), while 587 remained event-free. Absolute postoperative LL did not differ significantly between groups (MD = 0.70, 95% CI − 2.02 to 3.42, p = 0.61). However, patients with PJF demonstrated greater ΔLL (MD = 4.24, 95% CI 0.19–8.28, p = 0.04). Postoperative PI–LL was also higher in the PJF group (MD = 4.25, 95% CI 0.46–8.05, p = 0.03). ΔPI–LL was not significantly associated (MD = − 0.44, 95% CI − 7.23 to 6.34, p = 0.90).

Conclusion

Greater ΔLL and residual postoperative PI–LL mismatch significantly correlate with PJF, while final LL alone does not. These findings highlight the importance of proportional, age-adjusted alignment strategies and cautious correction magnitude to reduce mechanical failure risk in ASD surgery.