{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:28:01Z","timestamp":1791829681423,"version":"4.3.4"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The subtraction of lumbar lordosis (LL) from the pelvic incidence (PI) offers an estimate of the LL required for a given PI value. Relative LL (RLL) and the lordosis distribution index (LDI) are PI-based individualized measures. RLL quantifies the magnitude of lordosis relative to the ideal lordosis as defined by the magnitude of PI. LDI defines the magnitude of lower arc lordosis in proportion to total lordosis. The aim of this study was to compare RLL and PI \u2212 LL for their ability to predict postoperative complications and their correlations with health-related quality of life (HRQOL) scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Inclusion criteria were \u2265 4 levels of fusion and \u2265 2 years of follow-up. Mechanical complications were proximal junctional kyphosis\/proximal junctional failure, distal junctional kyphosis\/distal junctional failure, rod breakage, and implant-related complications. Correlations between PI \u2212 LL, RLL, PI, and HRQOL were analyzed using the Pearson correlation coefficient. Mechanical complication rates in PI \u2212 LL, RLL, LDI, RLL, and LDI interpreted together, and RLL subgroups for each PI \u2212 LL category were compared using chi-square tests and the exact test. Predictive models for mechanical complications with RLL and PI \u2212 LL were analyzed using binomial logistic regressions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Two hundred twenty-two patients (168 women, 54 men) were included. The mean age was 52.2 \u00b1 19.3 years (range 18\u201384 years). The mean follow-up was 28.8 \u00b1 8.2 months (range 24\u201362 months). There was a significant correlation between PI \u2212 LL and PI (r = 0.441, p &lt; 0.001), threatening the use of PI \u2212 LL to quantify spinopelvic mismatch for different PI values. RLL was not correlated with PI (r = \u22120.093, p &gt; 0.05); therefore, it was able to quantify divergence from ideal lordosis for all PI values. Compared with PI \u2212 LL, RLL had stronger correlations with HRQOL scores (p &lt; 0.05). Discrimination performance was better for the model with RLL than for PI \u2212 LL. The agreement between RLL and PI \u2212 LL was high (\u03ba = 0.943, p &lt; 0.001), moderate (\u03ba = 0.455, p &lt; 0.001), and poor (\u03ba = \u22120.154, p = 0.343), respectively, for large, average, and small PI sizes. When analyzed by RLL, each PI \u2212 LL category was further divided into distinct groups of patients who had different mechanical complication rates (p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Using the formula of PI \u2212 LL may be insufficient to quantify normolordosis for the whole spectrum of PI values when applied as an absolute numeric value in conjunction with previously reported population-based average thresholds of 10\u00b0 and 20\u00b0. Schwab PI \u2212 LL groups were found to constitute an inhomogeneous group of patients. RLL offers an individualized quantification of LL for all PI sizes. Compared with PI \u2212 LL, RLL showed a greater association with both mechanical complications and HRQOL. The use of RLL and LDI together, instead of PI \u2212 LL, for surgical planning may result in lower mechanical complication rates and better long-term HRQOL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2017.8.focus17498","type":"journal-article","created":{"date-parts":[[2017,12,1]],"date-time":"2017-12-01T03:36:31Z","timestamp":1512099391000},"page":"E5","source":"Crossref","is-referenced-by-count":108,"title":["Relative lumbar lordosis and lordosis distribution index: individualized pelvic incidence\u2013based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis"],"prefix":"10.3171","volume":"43","author":[{"given":"Caglar","family":"Yilgor","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuray","family":"Sogunmez","sequence":"additional","affiliation":[{"name":"Comprehensive Spine Center, Acibadem Maslak Hospital, Istanbul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasemin","family":"Yavuz","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Ankara University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadir","family":"Abul","sequence":"additional","affiliation":[{"name":"Comprehensive Spine Center, Acibadem Maslak Hospital, Istanbul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Boissi\u00e9re","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sleiman","family":"Haddad","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, Hospital Universitari Vall d\u2019Hebron, Barcelona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Obeid","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Kleinst\u00fcck","sequence":"additional","affiliation":[{"name":"Departments of Orthopedics and Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Javier","family":"S\u00e1nchez P\u00e9rez-Grueso","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain; Spine Center Division,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emre","family":"Acaro\u011flu","sequence":"additional","affiliation":[{"name":"Ankara ARTES Spine Center, Ankara, Turkey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne F.","family":"Mannion","sequence":"additional","affiliation":[{"name":"Research and Development, Schulthess Klinik, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferran","family":"Pellise","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, Hospital Universitari Vall d\u2019Hebron, Barcelona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Alanay","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"2381","article-title":"Further development and validation of the Scoliosis Research Society (SRS) outcomes instrument","volume":"25","author":"Asher MA","year":"2000","unstructured":"Asher MA, Min Lai S, Burton DC: Further development and validation of the Scoliosis Research Society (SRS) outcomes instrument. 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