Reoperation risk by subtype in proximal junctional kyphosis and the impact of osteoporosis treatment in adult spinal deformity surgery

PJK subtype meaningfully stratifies reoperation risk after ASD surgery. Integrating subtype with bone quality assessment can refine perioperative decision-making, identify patients who may benefit from intensified junctional protection, and inform surveillance. Preoperative anabolic therapy emerges as a potentially modifiable factor linked with reduced reoperation, warranting prospective evaluation. These findings support a practical, subtype-guided strategy that couples surgical planning with bone health optimization to reduce failure and reoperation burden.