<h3>BACKGROUND CONTEXT</h3> It is unknown whether the biomechanics of the posterior ligamentous complex (PLC) are impaired in individuals undergoing surgery for adult spinal deformity (ASD). Characterizing these properties may improve our understanding of proximial junctional kyphosis (PJK, defined as proximal junctional angle [PJA] of >10deg from UIV-1 to UIV+2), as well as proximal junctional failure (PJF, symptomatic PJK requiring revision). <h3>PURPOSE</h3> Ligament biomechanical properties will be associated with PJK and failure PJF. <h3>STUDY DESIGN/SETTING</h3> A prospective observational study. <h3>METHODS</h3> Intraoperative biopsies of PLC were obtained from 32 consecutive spinal fusions for ASD (>4 levels). Ligament peak force, tensile stress, tensile strain and elastic modulus (EM) were measured with a materials testing system. Biomechanical properties and tissue dimensions were correlated with age, gender, BMI, vitamin D level, osteoporosis, sagittal alignment, PJA and change in PJA preoperatively (PRE), within 3 months (3MO), and at one-year (1YR) postoperatively. <h3>RESULTS</h3> Mean (SD) PLC peak force was 207.8(100.6) N, tensile stress was 3.3(1.5) MPa, tensile strain was 1.9(1.2) mm/mm, and EM was 7.1(5.1) MPa. Mean PLC length was 5.9(2.6) mm, thickness was 3.8(1.5) mm, and width was 17.7(4.7) mm. Longer and thinner ligaments were associated with greater PJA change at 3MO (r=0.38, p=0.04; r=0.34, p=0.08 respectively), and thinner ligaments were associated with greater PJA change at 1YR (r=0.57, p=0.01). Greater EM was associated with greater 3MO (r=0.43, p=0.03) and 1YR (r=0.54, p=0.03) PJA. Age was associated with 3MO PJA (r=0.41, p=0.03). EM remained related to PJA when correcting for age (p=0.01). Five had a change in PJA of >10° from PRE to 1YR while PJA change from 3MO to 1YR was 0.6°(3.6). EM was significantly higher in individuals who required revision surgery within 1YR (16.2 (9.7) MPa) versus those who did not (6.5(3.6) MPa, p=0.003). Neither PRE sagittal alignment nor change at 3MO were related to change in PJA or need for revision surgery (p>0.10). At 1YR, three had PJF (2 for PJK, 1 discitis). <h3>CONCLUSIONS</h3> Biomechanical properties of the PLC may be associated with higher risk for proximal failure. Ligaments that are longer, thinner and less elastic are associated with higher postoperative PJA. Furthermore, stiffer EM of the ligament is associated with the need for revision surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.