Impact of T4-L1-Hip Axis Normalization on Outcomes and Complications in Adult Spinal Deformity

作者：Sarthak Mohanty, Zeeshan M. Sardar, Justin L. Reyes, Fthimnir M. Hassan, Michael P. Kelly, Josephine R. Coury, Elisabeth Geraghty, Nathan J. Lee, Justin K. Scheer, Steven G. Roth, Chun Wai Hung, Ronald A. Lehman, Joseph M. Lombardi, Lawrence G. Lenke · 发表于：Journal of Bone and Joint Surgery · 年份：2026 · DOI：10.2106/jbjs.25.01263 · 研究领域：Scoliosis diagnosis and treatment、Spine and Intervertebral Disc Pathology、Orthopaedic implants and arthroplasty

BACKGROUND: In asymptomatic adults, a harmonious T4-L1-hip axis requires a T4-pelvic angle (T4PA) within 4° of the L1-pelvic angle (L1PA). We evaluated whether T4PA-L1PA mismatch is associated with mechanical complications (MCs) and patient-reported outcomes (PROs) after long-segment surgery for adult spinal deformity (ASD). METHODS: This single-center retrospective study involved a cohort of patients with ASD undergoing >6-level posterior spinal fusion (PSF) for spinal deformity. T4PA - L1PA was assessed at 6 weeks and followed for ≥2 years. The primary outcome was MCs (implant-related reoperations, with a particular focus on proximal junctional failure [PJF]) events. Multivariable logistic regression included linear and quadratic terms for T4PA - L1PA, adjusted for the Charlson Comorbidity Index (CCI), preoperative alignment, upper instrumented vertebra (UIV), pelvic fixation, and correction magnitude. Predicted probability curves depicted MC risk across the T4PA - L1PA spectrum. Secondary outcomes were attainment of the minimal clinically important difference (MCID) for the Scoliosis Research Society (SRS)-22r and Oswestry Disability Index (ODI). RESULTS: The study included 427 patients (mean age, 61.16 ± 14.82 years; 285 [66.7%] female; mean of 12.50 ± 4.16 instrumented levels), with 78.7% undergoing pelvic fixation; 66 (15.5%) underwent MC-related reoperations. In multivariable analysis (area under the curve [AUC] = 0.72, p < 0.001), higher CCI (OR = 1.21, p = 0.029), pe...