The complications and risk factors associated with adult spinal deformity (ASD) surgery, particularly focusing on proximal junctional kyphosis (PJK). The study involves 80 patients aged 50-80 years and evaluates demographic factors, comorbidities, and surgical outcomes. It identifies that PJK is a frequent and significant complication following ASD surgery, affecting around 25% of patients, with higher risks linked to certain surgical techniques and patient characteristics such as age, hypertension, and osteoporosis. The research highlights the importance of careful preoperative evaluation, customized surgical approaches, and postoperative care to minimize complications like PJK. It emphasizes the need for improved surgical techniques and preventive strategies to enhance patient outcomes in this high-risk cohort.