SymposiumPrevention of Proximal Junctional Kyphosis or Failure: Soft Landings and Tension Band AugmentationMehta, Vikram A. MD, MPH; Wang, Timothy Y. MD; Sankey, Eric W. MD; Goodwin, C. Rory MD, PhD; Abd-El-Barr, Muhammad M. MD, PhD; Karikari, Isaac O. MDAuthor Information Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, NC V.A.M. and T.Y.W. are cofirst authors. C.R.G. is supported by grants from NIH/NINDS K12 NRCDP Physician Scientist Award (2K12NS080223-06) and Robert Wood Johnson Harold Amos Medical Faculty Development Program (RWJ 76238). M.M.A. is a consultant for spineology. I.O.K. is a consultant for Nuvasive, Member of Advisory Board for Johnson & Johnson Adult Deformity Group. The remaining authors declare that they have nothing to disclose. For reprint requests, or additional information and guidance on the techniques described in the article, please contact Vikram A. Mehta, MD, MPH, at [email protected] or by mail at Duke University Medical Center, 20 Duke Medicine Circle , Durham, NC 27710. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques. Techniques in Orthopaedics: March 2021 - Volume 36 - Issue 1 - p 30-34 doi: 10.1097/BTO.0000000000000526 Buy Metrics Abstract As adult spinal deformity surgery becomes more prevalent, the rates of proximal junctional kyphosis (PJK) will rise proportionally. The exact mechanism of PJK is unknown. However, it is thought to be multifactorial and includes violation of the facets and disruption of the posterior ligamentous complex. There are multiple techniques that are aimed at reducing the pathologic forces at the interface of the proximal aspect of the construct and normal anatomy. In this review, the authors shall discuss the causes of PJK and new techniques such as spinous process hooks, transitional rods, and tethering that have been developed to reduce the rates of PJK. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.