The Evaluation, Prevention, and Management of Distal Junctional Problems in Adult Cervical Deformity

Following surgical correction for adult cervical deformity, distal junctional problems-both kyphosis and failure-are a common and challenging occurrence. Here, we discuss the evaluation of distal junctional kyphosis (DJK) patients, including standard methods for diagnosing DJK, and distinguish it from distal junctional failure (DJF). We also highlight various risk factors for DJK development, both modifiable and nonmodifiable. We then discuss strategies for prevention, including bone health optimization, correction alignment targets, lower instrumented vertebra (LIV) selection, and approach and surgical technique considerations. We close with a discussion of nonoperative and operative management, including our approach to revision surgery following DJF.