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Longer posterior instrumentation of the thoracolumbar spine, the sacrum, and the pelvis carries a risk for mechanical complications such as non-union and proximal junctional kyphosis (PJK). Modern surgical techniques including circumferential lumbosacral fusion and double rods might lower the risk for non-union. Accurate sagittal alignment planning, setting the lumbar sagittal apex according to pelvic incidence, and segmental lordosis distribution, are mandatory for minimizing the risk of PJK. 2020 Annals of Translational Medicine. All

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