Incidence of proximal junctional kyphosis was high, but SRS-24 scores were not significantly affected in patients with PJK. The sagittal C7 plumb was not significantly more positive in PJK patients. No patient, radiographic, or instrumentation variables were identified as risk factors for developing PJK.

With a minor revision of question 18 (related to going out) the internal consistency of the SRS-22 Function domain has been improved in idiopathic scoliosis patients < 18 years of age. Deletion of question 15 (related to financial considerations) has a variable, small effect depending on patient group. Retention of question 15 is recommended unless a cultural variable, such as differences in healthcare payment schemes, substantially lowers domain psychometric properties.

Posterior thoracic skeletal structures involved in upper instrumented vertebra exposure andanchor placement were found to contribute to adjacent segment flexion stiffness. Although stiffness loss was small after individual procedures, the effects were additive for routinely used combinations.