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.