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HRQOL and radiographic parameters were collected at final follow-up. For postoperative residual Cobb angle (CA), patients were divided as follows: group (0) (CA\u2009&lt;\u200910\u00b0), group (+) (CA 10\u00b0\u223c20 \u00b0), and group (++) (CA\u2009&gt;\u200920\u00b0). For postoperative coronal vertical axis (CVA), patients were separated as follows: group (0) (CVA\u2009&lt;\u20092\u00a0cm), group (+) (CVA 2\u2009\u223c\u20093\u00a0cm), and group (++) (CVA\u2009&gt;\u20093\u00a0cm). Patients were also grouped by the sagittal modifiers as group (0), group (+), and group (++) according to the Scoliosis Research Society (SRS)-Schwab classification, respectively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Visual analog scale (VAS) for back was significantly lower in CA 10\u00b0\u223c20\u00b0 group compared to other groups. Patients with remnant CA\u2009&gt;\u200920\u00b0 showed worse Oswestry Disability Index (ODI), SRS-22 and the 36-item Short Form Health Survey (SF-36) - physical component scores (PCS). Sagittal vertical axis (SVA) showed significant correlation with HRQOLs after surgery, and the statistical significance of ODI, SRS-22 and SF-36 scores was observed among subgroups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In long-level fused spine, residual CA\u2009&gt;\u200920\u00b0 resulted in worse clinical outcomes and was recommended to avoid during surgery. And 10\u00b0 to 20\u00b0 residual CA was acceptable in DLS patients and even better than Cobb angle\u2009&lt;\u200910\u00b0 in several HRQOLs, therefore strictly pursing upright alignment seems unnecessary. SVA also showed effectiveness in assessing HRQOL in the fixed spine.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00586-024-08372-w","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T16:01:43Z","timestamp":1721404903000},"page":"3872-3879","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of postoperative spinal malalignment on postoperative health-related quality of life after long-level fixation for degenerative lumbar scoliosis: does residual coronal angularity matter?"],"prefix":"10.1007","volume":"33","author":[{"given":"Jiaqi","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinhao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9413-6141","authenticated-orcid":false,"given":"Yan","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weishi","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongqiang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,19]]},"reference":[{"key":"8372_CR1","doi-asserted-by":"publisher","first-page":"408","DOI":"10.3171\/2019.2.Spine181486","volume":"31","author":"K Hayashi","year":"2019","unstructured":"Hayashi K, Boissi\u00e8re L, Guevara-Villaz\u00f3n F, Larrieu D, N\u00fa\u00f1ez-Pereira S, Bourghli A, Gille O, Vital JM, Pellis\u00e9 F, S\u00e1nchez P\u00e9rez-Grueso FJ, Kleinst\u00fcck F, Acaro\u011flu E, Alanay A, Obeid I (2019) Factors influencing patient satisfaction after adult scoliosis and spinal deformity surgery. 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