Two kinds of patients can keep you up at night: ones who sneezed too hard and got a screw pullout—and those who come back at 3 months with a broken upper instrumented vertebra. Sound familiar?
Adult spinal deformity (ASD) surgery is obviously challenging: you dodge proximal junctional kyphosis (PJK), sidestep rod fractures, and hope your fusion holds longer than your last vacation. But even if you get the alignment just right, the upper instrumented vertebra (UIV) still might call it quits.
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