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Sagittal balance is more than just alignment: why PJK remains an unresolved problem

Overview of attention for article published in Scoliosis and Spinal Disorders, January 2016
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About this Attention Score

  • Good Attention Score compared to outputs of the same age (70th percentile)

Mentioned by

3 tweeters
2 Facebook pages


41 Dimensions

Readers on

122 Mendeley
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Sagittal balance is more than just alignment: why PJK remains an unresolved problem
Published in
Scoliosis and Spinal Disorders, January 2016
DOI 10.1186/s13013-016-0064-0
Pubmed ID

Steven D. Glassman, Mark P. Coseo, Leah Y. Carreon


The durability of adult spinal deformity surgery remains problematic. Revision rates above 20 % have been reported, with a range of causes including wound infection, nonunion and adjacent level pathology. While some of these complications have been amenable to changes in patient selection or surgical technique, Proximal Junctional Kyphosis (PJK) remains an unresolved challenge. This study examines the contributions of non-mechanical factors to the incidence of postoperative sagittal imbalance and PJK after adult deformity surgery. We reviewed a consecutive series of adult spinal deformity patients who required revision for PJK from 2013 to 2015 and examined in their medical records in detail. Neurologic disorders were identified in 22 (76 %) of the 29 PJK cases reviewed in this series. Neurologic disorders included Parkinson's disease (1), prior stroke (5), metabolic encephalopathy (2), seizure disorder (1), cervical myelopathy (7), thoracic myelopathy (1), diabetic neuropathy (5) and other neuropathy (4). Other potential comorbidities affecting standing balance included untreated cataracts (9), glaucoma (1) and polymyositis (1). Eight patients were documented to have frequent falls, with twelve cases having a fall right before symptoms related to the PJK were noted. PJK is an important contributing factor to the substantial and unsustainable rate of revision surgery following adult deformity correction. Multiple efforts to avoid PJK via alterations in surgical technique have been largely unsuccessful. This study suggests that non-mechanical neuromuscular co-morbidities play an important role in post-operative sagittal imbalance and PJK. Recognizing the multi-factorial etiology of PJK may lead to more successful strategies to avoid PJK and improve surgical outcomes.

Twitter Demographics

The data shown below were collected from the profiles of 3 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 122 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Lebanon 1 <1%
United States 1 <1%
Unknown 120 98%

Demographic breakdown

Readers by professional status Count As %
Researcher 19 16%
Student > Ph. D. Student 14 11%
Other 11 9%
Student > Postgraduate 11 9%
Student > Master 11 9%
Other 30 25%
Unknown 26 21%
Readers by discipline Count As %
Medicine and Dentistry 56 46%
Engineering 11 9%
Nursing and Health Professions 9 7%
Neuroscience 5 4%
Biochemistry, Genetics and Molecular Biology 3 2%
Other 6 5%
Unknown 32 26%

Attention Score in Context

This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 January 2016.
All research outputs
of 9,727,301 outputs
Outputs from Scoliosis and Spinal Disorders
of 32 outputs
Outputs of similar age
of 341,442 outputs
Outputs of similar age from Scoliosis and Spinal Disorders
of 4 outputs
Altmetric has tracked 9,727,301 research outputs across all sources so far. This one has received more attention than most of these and is in the 73rd percentile.
So far Altmetric has tracked 32 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 5.1. This one scored the same or higher as 17 of them.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 341,442 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 70% of its contemporaries.
We're also able to compare this research output to 4 others from the same source and published within six weeks on either side of this one. This one has scored higher than 2 of them.