• Nathan A Shlobin, Nancy Le, Justin K Scheer, and Lee A Tan.
• Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
• World Neurosurg. 2022 May 1; 161: 179-189.e1.

ObjectiveProximal junctional kyphosis (PJK) is a widely recognized complication of adult spinal deformity surgery, and various PJK prevention strategies have been reported in recent years. The goal of the present study was to perform a systematic review of the PJK prevention strategies, report on their effectiveness, and delineate future directions for investigation regarding PJK prevention.MethodsA systematic review was conducted using PubMed, Embase, and Scopus to identify studies examining PJK prevention techniques. The titles and abstracts were screened, and those studies progressing to the full text review were screened using prespecified inclusion and exclusion criteria. The studies were organized thematically for analysis.ResultsThe search identified a total of 382 studies, 23 of which were included. The overall quality of evidence was level III. The reported PJK prevention strategies included optimization of postoperative sagittal alignment by avoiding over- or undercorrection, prophylactic vertebral cement augmentation, the use of a transverse process hook at upper instrumented vertebra, the use of more flexible rod constructs, novel pedicle screw insertion techniques, the use of junctional tethers, and teriparatide therapy, which seemed to reduce the PJK rates.ConclusionsThe reports of PJK prevention strategies were heterogeneous, and high-level evidence regarding any particular technique remains limited. Further development of additional PJK prevention techniques and validation of their efficacy in clinical practice are needed to optimize the outcomes of adult spinal deformity surgery.Copyright © 2022 Elsevier Inc. All rights reserved.

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