Harris AB, Kebaish FN, Puvanesarajah V, et al. - In this retrospective review, researchers ascertained if the cranial-caudal trajectory of upper instrumented vertebra (UIV) pedicle screws and UIV screw-vertebra angle are correlated with proximal junctional kyphosis (PJK) and/or proximal junctional failure (PJF) after long posterior spinal fusion in patients with adult spinal deformity (ASD). Between 2008 and 2015, 96 patients with ASD who underwent fusion from T9-T12 to the pelvis (> 5 vertebrae fused) were included. In long thoracic fusion to the pelvis for ASD, UIV-PVA ≥ 3° was linked to 2.7-fold greater chances of PJK and 3.6-fold greater chances of PJF compared with UIV-PVA < 3°. UIV-RVA was not related to PJK or PJF.