Distal hyperlordotic distribution does not increase the risk of mechanical complications in adult spinal deformity patients undergoing long-construct fusion to the pelvis with optimal global sagittal alignment.
Lluís Vila, Sleiman Haddad, Eva Jacobs, Susana Núñez-Pereira, Javier Pizones, Anika Pupak, Gina Faragó, Alejandro Gómez-Rice, Ibrahim Obeid, Louis Boissière, Cécile Roscop, Yann Philippe Charles, Ahmet Alanay, Markus Loibl, Frank Kleinstück, Ferran Pellisé
{"title":"Distal hyperlordotic distribution does not increase the risk of mechanical complications in adult spinal deformity patients undergoing long-construct fusion to the pelvis with optimal global sagittal alignment.","authors":"Lluís Vila, Sleiman Haddad, Eva Jacobs, Susana Núñez-Pereira, Javier Pizones, Anika Pupak, Gina Faragó, Alejandro Gómez-Rice, Ibrahim Obeid, Louis Boissière, Cécile Roscop, Yann Philippe Charles, Ahmet Alanay, Markus Loibl, Frank Kleinstück, Ferran Pellisé","doi":"10.1007/s43390-026-01360-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To assess whether distal hyperlordotic distribution (DHD), defined by the Lordosis Distribution Index (LDI) from the Global Alignment and Proportion (GAP) score, increases the risk of mechanical complications (MC) in adult spinal deformity (ASD) patients with optimal postoperative global sagittal alignment and total lordosis after long-construct fusion to the pelvis.</p><p><strong>Methods: </strong>Retrospective analysis of a prospective, multicenter database. ASD patients undergoing fusion from L2 or higher to the pelvis with ≥ 2 years follow-up and optimal postoperative global alignment (RSA = 0) and total lordosis (RLL = 0), according to the GAP score, were included. Patients were classified into Ideal (LDI = 0) and DHD (LDI = 3) groups. Rates of MCs (stratified in PJK or PJF), reoperations, and functional outcomes were compared. A post-hoc non-inferiority analysis utilizing a 10% clinical margin was performed.</p><p><strong>Results: </strong>A total of 125 patients met criteria (91 Ideal; 34 DHD). The DHD group, compared to the Ideal group, had a significantly lower preoperative pelvic incidence (50.9° vs. 57.2°, p = 0.014) and more frequently underwent three-column osteotomies (35.3% vs. 18.7%, p = 0.050). At 2-year follow-up, DHD was statistically non-inferior to the Ideal distribution regarding PJFs (absolute risk difference was -7.3%, 90% CI: -16.1% to 1.5%) and for PJKs (absolute risk difference was 1.5%, 90% CI: -6.0% to 9.0%). Reoperation rates (38.2% vs. 28.6%, p = 0.299) and patient-reported functional outcomes were comparable.</p><p><strong>Conclusion: </strong>In ASD patients with pelvic fixation and optimal global alignment, DHD is statistically non-inferior to ideal distributions regarding the risk of MCs, including PJK and PJF, and reoperations. In addition to this, DHD represents a physiological scenario in patients with lower pelvic incidence. Future predictive models should focus on penalizing distal hypolordosis rather than universally penalizing DHD.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1639-1650"},"PeriodicalIF":1.7000,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine deformity","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s43390-026-01360-8","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/4/7 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: To assess whether distal hyperlordotic distribution (DHD), defined by the Lordosis Distribution Index (LDI) from the Global Alignment and Proportion (GAP) score, increases the risk of mechanical complications (MC) in adult spinal deformity (ASD) patients with optimal postoperative global sagittal alignment and total lordosis after long-construct fusion to the pelvis.
Methods: Retrospective analysis of a prospective, multicenter database. ASD patients undergoing fusion from L2 or higher to the pelvis with ≥ 2 years follow-up and optimal postoperative global alignment (RSA = 0) and total lordosis (RLL = 0), according to the GAP score, were included. Patients were classified into Ideal (LDI = 0) and DHD (LDI = 3) groups. Rates of MCs (stratified in PJK or PJF), reoperations, and functional outcomes were compared. A post-hoc non-inferiority analysis utilizing a 10% clinical margin was performed.
Results: A total of 125 patients met criteria (91 Ideal; 34 DHD). The DHD group, compared to the Ideal group, had a significantly lower preoperative pelvic incidence (50.9° vs. 57.2°, p = 0.014) and more frequently underwent three-column osteotomies (35.3% vs. 18.7%, p = 0.050). At 2-year follow-up, DHD was statistically non-inferior to the Ideal distribution regarding PJFs (absolute risk difference was -7.3%, 90% CI: -16.1% to 1.5%) and for PJKs (absolute risk difference was 1.5%, 90% CI: -6.0% to 9.0%). Reoperation rates (38.2% vs. 28.6%, p = 0.299) and patient-reported functional outcomes were comparable.
Conclusion: In ASD patients with pelvic fixation and optimal global alignment, DHD is statistically non-inferior to ideal distributions regarding the risk of MCs, including PJK and PJF, and reoperations. In addition to this, DHD represents a physiological scenario in patients with lower pelvic incidence. Future predictive models should focus on penalizing distal hypolordosis rather than universally penalizing DHD.
期刊介绍：
Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
