{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:42:00Z","timestamp":1788176520296,"version":"build-2803163510"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2019,6,24]],"date-time":"2019-06-24T00:00:00Z","timestamp":1561334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Traditional correction for flat back syndrome is performed with a posterior-based surgery or combined approaches in revision cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To evaluate outcome from anterior surgery with the use of hyperlordotic cages (HLCs) in patients with flat back syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>All patients operated with or without prior posterior lumbar surgery were studied. Pre- to postoperative sagittal alignment was analyzed. Radiographic parameters were analyzed including T1 pelvic angle (T1PA), sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), pelvic incidence and lumbar lordosis (PI-LL), and T4-12TK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      All 50 patients (mean age of 58 yr, 72% female with mean body mass index of 28) demonstrated significant radiographic alignment difference in their spinopelvic and global parameters from pre- to postoperative standing: LL (\u201337.04\u00b0 vs \u201359.55\u00b0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001), SS (35.12 vs 41.13,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001), PI-LL (23.55 vs 6.46), T4-12 TK (30.59 vs 41.67), PT (28.22 vs 22.13), SVA in mm (80.94 vs 37.39), and T1PA (28.70\u00b0 vs 18.43\u00b0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). Using linear regression analysis, predicted pre- to postoperative change in standing LL corresponded to a pre- to postoperative changes in standing PI-LL mismatch, T1PA, TK, SS, PT, and SVA (R\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00.59, 0.38, 0.25, 0.16, 0.12, and 0.17, respectively). Five degrees of pre- to postoperative change in T1PA translates to \u20134.15\u00b0 change in LL.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Anterior surgery with HLCs followed by posterior instrumentation is an effective technique to treat flat back syndrome. HLCs are effective to maximize LL up to 30\u00b0, which is equivalent in magnitude to a pedicle subtraction osteotomy, but associated with less blood loss, quicker recovery, lower complications, and good surgical outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opz141","type":"journal-article","created":{"date-parts":[[2019,6,23]],"date-time":"2019-06-23T23:00:53Z","timestamp":1561330853000},"page":"261-270","source":"Crossref","is-referenced-by-count":14,"title":["Surgical Treatment of Flat Back Syndrome With Anterior Hyperlordotic Cages"],"prefix":"10.1227","volume":"18","author":[{"given":"M Burhan","family":"Janjua","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania"},{"name":"Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali K","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nissim","family":"Ackshota","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan J","family":"McShane","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Comron","family":"Saifi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William C","family":"Welch","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Arlet","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania"},{"name":"Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,3]]},"reference":[{"issue":"4","key":"bib1-20231016","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s12178-011-9101-z","article-title":"Adult spine deformity","volume":"4","author":"Good","year":"2011","journal-title":"Curr Rev Musculoskelet 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