Lafage R, et al. - This study was performed to determine the role of sagittal orientation of the construct at the upper instrumented levels in the development of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) patients. According to findings, the presence of a more posterior construct inclination was noted in those who developed PJK. The previous notion that PJK may develop in response to excessive spinal realignment was supported. Furthermore, the risk of PJK may be attenuated via proper rod contouring, especially at the proximal end.