{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T17:02:59Z","timestamp":1789405379473,"version":"build-2803163510"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1 TR002345"],"award-info":[{"award-number":["UL1 TR002345"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spine Deform"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Sagittal plane changes after isolated lumbar fusion for pediatric idiopathic scoliosis are under-reported in current literature. Understanding how the thoracic spine compensates after this surgery will help optimize surgical technique. This study aims to determine the thoracic compensation and the change in other sagittal plane variables after lumbar fusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was an IRB approved retrospective study that included patients if they were between 11 and 18 with idiopathic scoliosis with lumbar major patterns that underwent isolated thoracolumbar\/lumbar fusion. Spinal radiographs were reviewed at 3 timepoints: pre-operative, 6\u00a0weeks post-operative, and long-term (at or greater than 2\u00a0years) post-operative to assess sagittal plane parameters. Linear mixed effect model, regression analysis with Pearson\u2019s correlation coefficient, and Fisher exact analyses were used to identify differences across these timepoints for quantitative and categorical variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      45 patients met inclusion criteria. The median age was 15 (range 11\u201318) and average follow up was 4.04\u00a0years. There were 38 female and 7 male patients. The thoracic spine became more kyphotic after surgery (M diff. pre-op to 2\u00a0years T5-T10 = 4.7\u00b0,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). Additionally, 22% developed radiographic proximal junctional kyphosis at 2\u00a0years. The lumbar segments became increasingly more lordotic after surgery (M diff. L1-S1 pre-op to 2\u00a0years = \u2212\u20095.6\u00b0,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). Lower pre-operative sagittal thoracic curvature was significantly associated with increased post-operative thoracic kyphosis (T5-T10 pre- to 2-year post-op\n                      <jats:italic>r<\/jats:italic>\n                      = \u2212\u20090.31,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.04). Lower pre-operative sagittal lumbar curvature was also significantly associated with increased post-operative lumbar lordosis kyphosis (L1-S1 pre- to 2-year post-op\n                      <jats:italic>r<\/jats:italic>\n                      = \u2212\u20090.4,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01). Age, BMI, and number of fused segments did not correlate significantly with thoracic or lumbar change post-operatively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Isolated lumbar fusion for pediatric idiopathic scoliosis is associated with increasing thoracic kyphosis. Additionally, the lumbar spine became more lordotic after surgery. These effects became pronounced in patients with low sagittal plane pre-operative curvature. Anticipating these adaptations will help guide surgical planning to optimize the sagittal plane.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s43390-026-01545-1","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T16:06:24Z","timestamp":1789401984000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Thoracic compensation after pediatric lumbar spinal fusion: adaptations in the sagittal plane"],"prefix":"10.1007","author":[{"given":"Eshan S.","family":"Sane","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake H.","family":"Goldfarb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian E.","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas C.","family":"Speller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel G.","family":"Boebel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon Y.","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Kelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7768-7929","authenticated-orcid":false,"given":"Blake K.","family":"Montgomery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"issue":"6","key":"1545_CR1","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1007\/s00381-020-04608-4","volume":"36","author":"D Addai","year":"2020","unstructured":"Addai D, Zarkos J, Bowey AJ (2020) Current concepts in the diagnosis and management of adolescent idiopathic scoliosis. Childs Nerv Syst 36(6):1111\u20131119. https:\/\/doi.org\/10.1007\/s00381-020-04608-4","journal-title":"Childs Nerv Syst"},{"issue":"21","key":"1545_CR2","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1097\/BRS.0000000000002843","volume":"43","author":"TS Protopsaltis","year":"2018","unstructured":"Protopsaltis TS et al (2018) Identifying thoracic compensation and predicting reciprocal thoracic kyphosis and proximal junctional kyphosis in adult spinal deformity surgery. Spine 43(21):879\u20131486. https:\/\/doi.org\/10.1097\/BRS.0000000000002843","journal-title":"Spine"},{"issue":"1","key":"1545_CR3","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1177\/2192568219879085","volume":"10","author":"HJ Kim","year":"2020","unstructured":"Kim HJ et al (2020) Cervical, thoracic, and spinopelvic compensation after proximal junctional kyphosis (PJK): does location of PJK matter? Glob Spine J 10(1):6\u201312. https:\/\/doi.org\/10.1177\/2192568219879085","journal-title":"Glob Spine J"},{"issue":"4","key":"1545_CR4","doi-asserted-by":"publisher","first-page":"283","DOI":"10.22603\/ssrr.2017-0081","volume":"2","author":"T Yasuda","year":"2018","unstructured":"Yasuda T et al (2018) Postoperative change of thoracic kyphosis after corrective surgery for adult spinal deformity. Spine Surg Relat Res 2(4):283\u2013289. https:\/\/doi.org\/10.22603\/ssrr.2017-0081","journal-title":"Spine Surg Relat Res"},{"issue":"2","key":"1545_CR5","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1007\/s43390-021-00429-w","volume":"10","author":"M Erkilinc","year":"2022","unstructured":"Erkilinc M et al (2022) Proximal junctional kyphosis in pediatric spinal deformity surgery: a systematic review and critical analysis. Spine Deform 10(2):257\u2013266. https:\/\/doi.org\/10.1007\/s43390-021-00429-w","journal-title":"Spine Deform"},{"issue":"18","key":"1545_CR6","doi-asserted-by":"publisher","first-page":"2045","DOI":"10.1097\/01.brs.0000179084.45839.ad","volume":"30","author":"YJ Kim","year":"2005","unstructured":"Kim YJ et al (2005) Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: minimum 5-year follow-up. Spine 30(18):2045\u20132050. https:\/\/doi.org\/10.1097\/01.brs.0000179084.45839.ad","journal-title":"Spine"},{"issue":"2","key":"1545_CR7","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1097\/BRS.0b013e3181c77f8c","volume":"35","author":"MD Helgeson","year":"2010","unstructured":"Helgeson MD et al (2010) Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation. Spine 35(2):177\u2013181. https:\/\/doi.org\/10.1097\/BRS.0b013e3181c77f8c","journal-title":"Spine"},{"issue":"6","key":"1545_CR8","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1302\/1863-2548.14.200155","volume":"14","author":"DA Burton","year":"2020","unstructured":"Burton DA et al (2020) Sagittal spinopelvic changes after posterior spinal fusion in adolescent idiopathic scoliosis. J Child Orthop 14(6):544\u2013553. https:\/\/doi.org\/10.1302\/1863-2548.14.200155","journal-title":"J Child Orthop"},{"issue":"3","key":"1545_CR9","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1097\/BRS.0000000000001326","volume":"41","author":"D Lau","year":"1976","unstructured":"Lau D, Funao H, Clark AJ et al (1976) The clinical correlation of the Hart-ISSG proximal junctional kyphosis severity scale with health-related quality-of-life outcomes and need for revision surgery. Spine (Phila Pa 1976) 41(3):213\u2013223. https:\/\/doi.org\/10.1097\/BRS.0000000000001326","journal-title":"Spine (Phila Pa 1976)"},{"issue":"5","key":"1545_CR10","doi-asserted-by":"publisher","first-page":"313","DOI":"10.22038\/ABJS.2022.61439.3014","volume":"11","author":"H Ghandhari","year":"2023","unstructured":"Ghandhari H, Ameri E, Nikouei F, Mahdavi SM, Chehrassan M, Motalebi M (2023) Selective thoracolumbar\/lumbar fusion in adolescent idiopathic scoliosis: a comprehensive review of the literature. Arch Bone Jt Surg 11(5):313\u2013320. https:\/\/doi.org\/10.22038\/ABJS.2022.61439.3014","journal-title":"Arch Bone Jt Surg"},{"issue":"21","key":"1545_CR11","doi-asserted-by":"publisher","first-page":"2346","DOI":"10.1097\/00007632-200211010-00007","volume":"27","author":"VMD Deviren","year":"2002","unstructured":"Deviren VMD, Berven SMD, Kleinstueck FMD, Antinnes JMD, Smith JAMD, Hu SSMD (2002) Predictors of flexibility and pain patterns in thoracolumbar and lumbar idiopathic scoliosis. Spine 27(21):2346\u20132349","journal-title":"Spine"},{"key":"1545_CR12","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024.1387841","volume":"12","author":"J Zhao","year":"2024","unstructured":"Zhao J, Huang C, Liu Y, Liu D, Liao D (2024) Systematic review and meta-analysis for the proximal junctional kyphosis in adolescent idiopathic scoliosis. Front Pediatr 12:1387841. https:\/\/doi.org\/10.3389\/fped.2024.1387841","journal-title":"Front Pediatr"},{"issue":"6","key":"1545_CR13","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.14444\/8194","volume":"15","author":"A Albayar","year":"2021","unstructured":"Albayar A, Ramayya A, Sullivan PZ et al (2021) Postoperative sagittal spinal alignment changes following corrective surgery in adult spinal deformity. Int J Spine Surg 15(6):1082\u20131089. https:\/\/doi.org\/10.14444\/8194","journal-title":"Int J Spine Surg"},{"issue":"4","key":"1545_CR14","doi-asserted-by":"publisher","first-page":"283","DOI":"10.22603\/ssrr.2017-0081","volume":"2","author":"T Yasuda","year":"2018","unstructured":"Yasuda T, Hasegawa T, Yamato Y et al (2018) Postoperative change of thoracic kyphosis after corrective surgery for adult spinal deformity. Spine Surg Relat Res 2(4):283\u2013289. https:\/\/doi.org\/10.22603\/ssrr.2017-0081","journal-title":"Spine Surg Relat Res"},{"issue":"24","key":"1545_CR15","doi-asserted-by":"publisher","first-page":"2731","DOI":"10.1097\/BRS.0b013e31815a7e","volume":"32","author":"YJ Kim","year":"2007","unstructured":"Kim YJ, Lenke LG, Bridwell KH, Kim J, Cho SK, Cheh G, Yoon J (2007) Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3 different types of posterior segmental spinal instrumentation and fusions: incidence and risk factor analysis of 410 cases. Spine 32(24):2731\u20132738. https:\/\/doi.org\/10.1097\/BRS.0b013e31815a7e","journal-title":"Spine"},{"issue":"14","key":"1545_CR16","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1097\/01.brs.0000169451.76359.49","volume":"30","author":"RC Glattes","year":"2005","unstructured":"Glattes RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A, Edwards C 2nd (2005) Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine (Phila Pa 1976) 30(14):1643\u20131649. https:\/\/doi.org\/10.1097\/01.brs.0000169451.76359.49","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"1545_CR17","doi-asserted-by":"publisher","first-page":"29","DOI":"10.21037\/atm.2019.10.49","volume":"8","author":"O Kubat","year":"2020","unstructured":"Kubat O, Ovadia D (2020) Frontal and sagittal imbalance in patients with adolescent idiopathic deformity. Ann Transl Med 8(2):29. https:\/\/doi.org\/10.21037\/atm.2019.10.49","journal-title":"Ann Transl Med"},{"issue":"Suppl 2","key":"1545_CR18","doi-asserted-by":"publisher","first-page":"S203","DOI":"10.1007\/s00586-012-2571-x","volume":"22","author":"P Roussouly","year":"2013","unstructured":"Roussouly P, Labelle H, Rouissi J, Bodin A (2013) Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults. Eur Spine J 22(Suppl 2):S203\u2013S215. https:\/\/doi.org\/10.1007\/s00586-012-2571-x","journal-title":"Eur Spine J"},{"issue":"12","key":"1545_CR19","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1097\/BRS.0b013e318059321d","volume":"32","author":"VV Upasani","year":"1976","unstructured":"Upasani VV, Tis J, Bastrom T et al (1976) Analysis of sagittal alignment in thoracic and thoracolumbar curves in adolescent idiopathic scoliosis: how do these two curve types differ? Spine (Phila Pa 1976) 32(12):1355\u20131359. https:\/\/doi.org\/10.1097\/BRS.0b013e318059321d","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"1545_CR20","doi-asserted-by":"publisher","DOI":"10.1186\/s40001-024-02052-7","volume":"29","author":"M Pishnamaz","year":"2024","unstructured":"Pishnamaz M, Migliorini F, Blume C et al (2024) Long-term outcomes of spinal fusion in adolescent idiopathic scoliosis: a literature review. Eur J Med Res 29(1):534. https:\/\/doi.org\/10.1186\/s40001-024-02052-7","journal-title":"Eur J Med Res"},{"key":"1545_CR21","doi-asserted-by":"publisher","unstructured":"Fletcher ND, Hopkins J, McClung A, Browne R, Sucato DJ (2012) Residual thoracic hypokyphosis after posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis: risk factors and clinical ramifications.\u00a0Spine (Phila Pa 1976). 37(3):200\u2013206. https:\/\/doi.org\/10.1097\/BRS.0b013e318216106c","DOI":"10.1097\/BRS.0b013e318216106c"},{"issue":"14","key":"1545_CR22","doi-asserted-by":"publisher","first-page":"e957","DOI":"10.5435\/JAAOS-D-21-01060","volume":"30","author":"TF Ritzman","year":"2022","unstructured":"Ritzman TF, Floccari LV (2022) The sagittal plane in spinal fusion for adolescent idiopathic scoliosis. J Am Acad Orthop Surg 30(14):e957\u2013e967. https:\/\/doi.org\/10.5435\/JAAOS-D-21-01060","journal-title":"J Am Acad Orthop Surg"},{"key":"1545_CR23","doi-asserted-by":"publisher","DOI":"10.1186\/s40634-019-0191-7","volume":"6","author":"M Brockmeyer","year":"2019","unstructured":"Brockmeyer M, Lott S, Stroeder J et al (2019) Simple mechanical devices did not improve pelvis positioning in AP pelvis radiographs for reliable assessment of the acetabular orientation. J Exp Orthop 6:20. https:\/\/doi.org\/10.1186\/s40634-019-0191-7","journal-title":"J Exp Orthop"},{"issue":"S2","key":"1545_CR24","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.14444\/8516","volume":"17","author":"J Hills","year":"2023","unstructured":"Hills J, Kelly MP (2023) Defining clinically relevant proximal junctional kyphosis. Int J Spine Surg 17(S2):S4\u2013S8. https:\/\/doi.org\/10.14444\/8516","journal-title":"Int J Spine Surg"}],"container-title":["Spine Deformity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-026-01545-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s43390-026-01545-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-026-01545-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T16:06:25Z","timestamp":1789401985000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s43390-026-01545-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":24,"alternative-id":["1545"],"URL":"https:\/\/doi.org\/10.1007\/s43390-026-01545-1","relation":{},"ISSN":["2212-134X","2212-1358"],"issn-type":[{"value":"2212-134X","type":"print"},{"value":"2212-1358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]},"assertion":[{"value":"29 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This article does not contain any studies with human participants or animals performed by any of the authors.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}