Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee
{"title":"成人脊柱畸形患者理想的腰椎后凸矫正，不会对骨盆后倾和骨盆入射减去腰椎后凸造成不利影响：426 个病例的研究。","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee","doi":"10.1097/BRS.0000000000005077","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objectives: </strong>To determine the ideal pelvic incidence (PI)-lumbar lordosis (LL) range to prevent pelvic tilt (PT) undercorrection while avoiding PI-LL overcorrection following adult spinal deformity (ASD) surgery.</p><p><strong>Summary of background: </strong>PI-LL and PT are the important sagittal parameters to be restored to an adequate range by surgery. Ideal PI-LL target without causing PI-LL overcorrection and PT undercorrection has not been documented.</p><p><strong>Methods: </strong>We included patients with ASD undergoing ≥5-level fusion, including the sacrum. Receiver operating characteristic (ROC) curve analysis was performed to calculate the lower limit of the ideal PI-LL without causing PI-LL overcorrection and the upper limit of the ideal PI-LL without causing PT undercorrection. The calculated ideal PI-LL was validated in terms of proximal junctional kyphosis and failure (PJK and PJF) rates and clinical outcomes. Analyses were performed according to age subgroups (below 70 and 70 yr or above).</p><p><strong>Results: </strong>In total, 426 patients were included in the study. Female patients were predominant (85.4%), with a mean age of 69.8 years. The lower limits of PI-LL were calculated as 4.9° for all patients, 2.3° for patients aged below 70 years, and 7.9° for patients aged 70 years or above. Meanwhile, the upper limits of PI-LL were calculated as 12.7° for all patients, 12.5° for patients aged below 70 years, and 13.3° for patients aged 70 years or above. There were no significant differences in the PJK and PJF rates among the new three PI-LL groups. Clinical outcomes were significantly better in patients with the ideal PI-LL group than those in patients with overcorrection or undercorrection groups for all age groups.</p><p><strong>Conclusions: </strong>The ideal PI-LL correction target without adversely impacting PT and PI-LL was calculated at 2.3° to 12.5° for patients aged below 70 years and 7.9° to 13.3° for patients aged 70 years or above. These guideline parameters may help ensure optimal clinical outcomes without increasing the risk of PJK/F.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"694-701"},"PeriodicalIF":2.6000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Ideal Lumbar Lordosis Correction in Patients With Adult Spinal Deformity Without Adversely Impacting Pelvic Tilt and Pelvic Incidence Minus Lumbar Lordosis: A Study of 426 Cases.\",\"authors\":\"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee\",\"doi\":\"10.1097/BRS.0000000000005077\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objectives: </strong>To determine the ideal pelvic incidence (PI)-lumbar lordosis (LL) range to prevent pelvic tilt (PT) undercorrection while avoiding PI-LL overcorrection following adult spinal deformity (ASD) surgery.</p><p><strong>Summary of background: </strong>PI-LL and PT are the important sagittal parameters to be restored to an adequate range by surgery. Ideal PI-LL target without causing PI-LL overcorrection and PT undercorrection has not been documented.</p><p><strong>Methods: </strong>We included patients with ASD undergoing ≥5-level fusion, including the sacrum. Receiver operating characteristic (ROC) curve analysis was performed to calculate the lower limit of the ideal PI-LL without causing PI-LL overcorrection and the upper limit of the ideal PI-LL without causing PT undercorrection. The calculated ideal PI-LL was validated in terms of proximal junctional kyphosis and failure (PJK and PJF) rates and clinical outcomes. Analyses were performed according to age subgroups (below 70 and 70 yr or above).</p><p><strong>Results: </strong>In total, 426 patients were included in the study. Female patients were predominant (85.4%), with a mean age of 69.8 years. The lower limits of PI-LL were calculated as 4.9° for all patients, 2.3° for patients aged below 70 years, and 7.9° for patients aged 70 years or above. Meanwhile, the upper limits of PI-LL were calculated as 12.7° for all patients, 12.5° for patients aged below 70 years, and 13.3° for patients aged 70 years or above. There were no significant differences in the PJK and PJF rates among the new three PI-LL groups. Clinical outcomes were significantly better in patients with the ideal PI-LL group than those in patients with overcorrection or undercorrection groups for all age groups.</p><p><strong>Conclusions: </strong>The ideal PI-LL correction target without adversely impacting PT and PI-LL was calculated at 2.3° to 12.5° for patients aged below 70 years and 7.9° to 13.3° for patients aged 70 years or above. These guideline parameters may help ensure optimal clinical outcomes without increasing the risk of PJK/F.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"694-701\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-05-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005077\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/25 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005077","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/25 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Ideal Lumbar Lordosis Correction in Patients With Adult Spinal Deformity Without Adversely Impacting Pelvic Tilt and Pelvic Incidence Minus Lumbar Lordosis: A Study of 426 Cases.
Study design: Retrospective study.
Objectives: To determine the ideal pelvic incidence (PI)-lumbar lordosis (LL) range to prevent pelvic tilt (PT) undercorrection while avoiding PI-LL overcorrection following adult spinal deformity (ASD) surgery.
Summary of background: PI-LL and PT are the important sagittal parameters to be restored to an adequate range by surgery. Ideal PI-LL target without causing PI-LL overcorrection and PT undercorrection has not been documented.
Methods: We included patients with ASD undergoing ≥5-level fusion, including the sacrum. Receiver operating characteristic (ROC) curve analysis was performed to calculate the lower limit of the ideal PI-LL without causing PI-LL overcorrection and the upper limit of the ideal PI-LL without causing PT undercorrection. The calculated ideal PI-LL was validated in terms of proximal junctional kyphosis and failure (PJK and PJF) rates and clinical outcomes. Analyses were performed according to age subgroups (below 70 and 70 yr or above).
Results: In total, 426 patients were included in the study. Female patients were predominant (85.4%), with a mean age of 69.8 years. The lower limits of PI-LL were calculated as 4.9° for all patients, 2.3° for patients aged below 70 years, and 7.9° for patients aged 70 years or above. Meanwhile, the upper limits of PI-LL were calculated as 12.7° for all patients, 12.5° for patients aged below 70 years, and 13.3° for patients aged 70 years or above. There were no significant differences in the PJK and PJF rates among the new three PI-LL groups. Clinical outcomes were significantly better in patients with the ideal PI-LL group than those in patients with overcorrection or undercorrection groups for all age groups.
Conclusions: The ideal PI-LL correction target without adversely impacting PT and PI-LL was calculated at 2.3° to 12.5° for patients aged below 70 years and 7.9° to 13.3° for patients aged 70 years or above. These guideline parameters may help ensure optimal clinical outcomes without increasing the risk of PJK/F.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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