Are We Getting Better at Achieving Optimal Lumbar Segmental Sagittal Alignment in Complex Adult Spine Deformity Surgery?

作者：Peter G. Passias, Oluwatobi Onafowokan, Renaud Lafage, Justin S. Smith, Kojo Hamilton, Andrew J. Schoenfeld, Anthony Yung, Max R. Fisher, Bassel G. Diebo, Alan H. Daniels, Robert K. Eastlack, Gregory M. Mundis, Breton Line, Nitin Agarwal, Juan S. Uribe, Michael Wang, Richard G. Fessler, Themistocles S. Protopsaltis, David O. Okonkwo, Khaled Kebaish, Alex Soroceanu, Praveen V. Mummaneni, Dean Chou, Han Jo Kim, Richard A. Hostin, Munish C. Gupta, Christopher P. Ames, Frank Schwab, Christopher I. Shaffrey, Shay Bess, Lawrence G. Lenke, Virginie Lafage, International Spine Study Group · 发表于：Spine · 年份：2025 · DOI：10.1097/brs.0000000000005476 · 被引用次数：1 · 研究领域：Scoliosis diagnosis and treatment、Spine and Intervertebral Disc Pathology、Cervical and Thoracic Myelopathy

STUDY DESIGN: Retrospective multicenter study. OBJECTIVE: To investigate how advances in spine realignment have impacted lumbar segmental alignment. SUMMARY OF BACKGROUND DATA: The understanding of spine alignment and adult spinal deformity (ASD) management continues to advance. It remains unknown how these advances have influenced lumbar segmental alignment changes in the setting of surgical correction. METHODS: Patients undergoing primary thoracolumbar fusion for ASD were stratified based on enrolment in two distinct multicenter registries; forming an 'Early' (2008-2017) and a 'Late cohort' (2018-present). Patients were further stratified based on pelvic incidence (PI) and Roussouly type. Segmental alignment was determined based on published values of asymptomatic individuals. Pelvic incidence-based alignment and Roussouly-based alignment were determined in alignment with previously published normative values. Means comparisons tests and multivariate analyses compared segmental and regional parameters between groups. RESULTS: One thousand two hundred forty patients included (622 EARLY, 618 LATE). The mean age was 61.4±14.5 years, body mass index (BMI) was 28.0±5.8 kg/m 2 , and Charlson comorbidity index (CCI) was 1.55±1.70. 70.2% of patients were female sex. LATE consistently displayed better L5 to S1 alignment across all PI and Roussouly types ( P =0.001). However, EARLY demonstrated better L4 to 5 alignment ( P =0.001). Improved alignment in L5 to S1, L4 to 5, and L3 to 4...