Objective: To identify the risk factors for proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery despite ideal sagittal correction according to age-adjusted alignment target. Methods: The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of >28° plus a difference in PJA of >22° or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF. Results: The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001–1.129; p=0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001–1.013; p=0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205–19.621; p=0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109–1.164; p<0.001) were significant risk factors for PJF development. Conclusion A sizeable proportion of patients (21.9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.

Objective: To identify the risk factors for proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery despite ideal sagittal correction according to age-adjusted alignment target. Methods: The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of >28° plus a difference in PJA of >22° or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF. Results: The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001–1.129; p=0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001–1.013; p=0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205–19.621; p=0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109–1.164; p<0.001) were significant risk factors for PJF development. Conclusion A sizeable proportion of patients (21.9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.

Objective: To identify the risk factors for proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery despite ideal sagittal correction according to age-adjusted alignment target. Methods: The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of >28° plus a difference in PJA of >22° or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF. Results: The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001–1.129; p=0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001–1.013; p=0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205–19.621; p=0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109–1.164; p<0.001) were significant risk factors for PJF development. Conclusion A sizeable proportion of patients (21.9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.

Objective: To identify the risk factors for proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery despite ideal sagittal correction according to age-adjusted alignment target. Methods: The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of >28° plus a difference in PJA of >22° or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF. Results: The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001–1.129; p=0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001–1.013; p=0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205–19.621; p=0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109–1.164; p<0.001) were significant risk factors for PJF development. Conclusion A sizeable proportion of patients (21.9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.

Objective: To identify the risk factors for proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery despite ideal sagittal correction according to age-adjusted alignment target. Methods: The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of >28° plus a difference in PJA of >22° or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF. Results: The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001–1.129; p=0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001–1.013; p=0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205–19.621; p=0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109–1.164; p<0.001) were significant risk factors for PJF development. Conclusion A sizeable proportion of patients (21.9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.

Sleep disorders and normal pressure hydrocephalus (NPH) are increasingly important issues observed in neurological disorders. However, the correlation between these diseases has not been sufficiently studied. Thus, we discuss the correlation between sleep disorders and the clinical features of NPH. Methods: Overall, 40 patients with idiopathic NPH were included in the study. To evaluate the sleep disorders and psychiatric problems, surveys were administered, including the 36-Item Short Form Survey, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Berlin Questionnaire, STOP-Bang Questionnaire, Hospital Anxiety and Depression Scale (HADS), Morningness-Eveningness Questionnaire, and the REM Sleep Behavior Disorder Screening Questionnaire. To evaluate the severity of dementia and ataxia, all of the patients completed the Korean mini-mental state examination; Korea frontal assessment battery score, amd unified Parkinson’s disease rating scale-motor scores before and after cerebrospinal fluid (CSF) drainage. The Pearson’s chi-square test, independent Student’s t-test, Mann–Whitney U test, and linear regression analysis were used to analyze the relationship between sleep disorders and symptom improvement after CSF drainage. Results: Of the 40 patients, 21 patients had poor sleep quality (PSQI>5), 8 patients had insomnia (ISI≥8), 11 patients had daytime sleepiness (ESS≥11), 9 (STOP-Bang≥3) to 13 (Berlin≥2 categories) patients had sleep apnea, 13 patients were anxious (HAS≥8), and 27 patients were depressed (HDS≥8). A linear regression analysis showed that sleep apnea was significantly correlated with cognitive function, and insomnia was correlated with cognitive, motor, and frontal lobe functions. Additionally, patients with severe sleep apnea demonstrated a greater recovery of cognitive function after CSF drainage. Conclusions: Obstructive sleep apnea (OSA) is closely related to the clinical symptoms and treatment effectiveness of NPH. The diagnosis and proper treatment of OSA is expected to improve the prognosis of patients with NPH.