{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T15:32:37Z","timestamp":1781278357172,"version":"3.54.1"},"reference-count":45,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The main purpose of selective dorsal rhizotomy (SDR) is to reduce spasticity in the lower extremities of children diagnosed with cerebral palsy (CP) and spastic diplegia. The potential for developing spinal abnormalities and pain is a concern, especially in the aging CP population. Therefore, the aim of this study was to evaluate spinal abnormalities, level of pain, and disability (due to back or leg pain) in adults with CP, and associations with participant characteristics, more than 25 years after SDR.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This is a 9-year follow-up study with data collection conducted in 2008 and 2017. Radiographs were assessed for the degree of scoliosis, thoracic kyphosis and lumbar lordosis curvatures, and prevalence of spondylolysis and spondylolisthesis, while level of pain and disability was determined with a self-developed questionnaire and the Oswestry Disability Index (ODI) questionnaire, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Twenty-five participants were included (15 males; median age 35.9 years, IQR 34.3\u201341.5 years), with a follow-up time after SDR ranging from 25 to 35 years. No clinically relevant changes were found for spinal curvatures, spondylolysis and spondylolisthesis, perceived pain frequency, and ODI scores between 2008 and 2017. While the prevalence of spondylolysis was 44%, spondylolisthesis was found in 20% (of whom 15% were grade I and 5% grade II), lumbar hyperlordosis was found in 32%, thoracic hyperkyphosis in 4%, and scoliosis in 20%. The Cobb angle was &lt; 25\u00b0, and no patient required surgery for scoliosis. In addition, the low back was reported as the most common site of pain, with 28% of the adults with CP having daily pain. This resulted in 80% of the cohort indicating none or minimal disability due to pain based on the ODI. The only correlation found was between hyperkyphosis and female gender.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>At follow-up more than 25 years after SDR, no progression in spinal abnormalities, level of pain, and disability was found when compared with findings 15 years after SDR. The prevalence of scoliosis, thoracic hyperkyphosis, and lumbar hyperlordosis was within the range reported for adults with CP, while spondylolysis and spondylolisthesis occurred more often than would be expected. It is difficult, however, to establish the role of SDR in this finding, given the limited data on the natural history of CP. Despite the encouraging outcome of this long-term follow-up study after SDR, it is important to continue monitoring adults with CP during the aging process.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2020.6.spine20751","type":"journal-article","created":{"date-parts":[[2020,10,16]],"date-time":"2020-10-16T07:20:46Z","timestamp":1602832846000},"page":"228-235","source":"Crossref","is-referenced-by-count":11,"title":["A long-term follow-up study of spinal abnormalities and pain in adults with cerebral palsy and spastic diplegia more than 25 years after selective dorsal rhizotomy"],"prefix":"10.3171","volume":"34","author":[{"given":"Berendina E.","family":"Veerbeek","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert P.","family":"Lamberts","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Division of Orthopaedic Surgery, Stellenbosch University, Cape Town; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Graham","family":"Fieggen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ncedile","family":"Mankahla","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard V. P.","family":"de Villiers","sequence":"additional","affiliation":[{"name":"Winelands Radiology, Institute of Orthopaedics and Rheumatology, Winelands Orthopaedic Hospital, Stellenbosch, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsabe","family":"Botha","sequence":"additional","affiliation":[{"name":"Winelands Radiology, Institute of Orthopaedics and Rheumatology, Winelands Orthopaedic Hospital, Stellenbosch, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelleke G.","family":"Langerak","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"10","key":"b1","series-title":"Ont Health Technol Assess Ser","first-page":"1","article-title":"Lumbosacral dorsal rhizotomy for spastic cerebral palsy: a health technology assessment","volume":"17","author":"Ontario HQ","year":"2017","unstructured":"Ontario HQ. Lumbosacral dorsal rhizotomy for spastic cerebral palsy: a health technology assessment. Ont Health Technol Assess Ser. 2017;17(10):1\u2013186."},{"issue":"10","key":"b2","series-title":"Dev Med Child Neurol","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1111\/dmcn.12246","article-title":"A systematic review of interventions for children with cerebral palsy: state of the evidence","volume":"55","author":"Novak I","year":"2013","unstructured":"Novak I, McIntyre S, Morgan C,  A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013;55(10):885\u2013910.2396235010.1111\/dmcn.12246"},{"issue":"22","key":"b3","series-title":"S Afr Med J","first-page":"849","article-title":"The neurosurgical management of spasticity","volume":"60","author":"Peacock WJ","year":"1981","unstructured":"Peacock WJ, Eastman RW. The neurosurgical management of spasticity. S Afr Med J. 1981;60(22):849\u2013850.7302758"},{"issue":"2","key":"b4","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1159\/000098382","article-title":"Selective dorsal rhizotomy and postoperative pain management. A worldwide survey","volume":"43","author":"Hesselgard K","year":"2007","unstructured":"Hesselgard K, Reinstrup P, Stromblad LG,  Selective dorsal rhizotomy and postoperative pain management. A worldwide survey. Pediatr Neurosurg. 2007;43(2):107\u2013112.10.1159\/00009838217337921"},{"issue":"1","key":"b5","series-title":"Neurotherapeutics","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s13311-018-00690-4","article-title":"The evolution of selective dorsal rhizotomy for the management of spasticity","volume":"16","author":"Enslin JMN","year":"2019","unstructured":"Enslin JMN, Langerak NG, Fieggen AG. The evolution of selective dorsal rhizotomy for the management of spasticity. Neurotherapeutics. 2019;16(1):3\u20138.10.1007\/s13311-018-00690-430460456"},{"issue":"9","key":"b6","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1007\/s00381-007-0379-5","article-title":"Selective dorsal rhizotomy for spastic cerebral palsy: a review","volume":"23","author":"Steinbok P","year":"2007","unstructured":"Steinbok P. Selective dorsal rhizotomy for spastic cerebral palsy: a review. Childs Nerv Syst. 2007;23(9):981\u2013990.1755173910.1007\/s00381-007-0379-5"},{"issue":"6","key":"b7","series-title":"J Neurosurg","first-page":"441","article-title":"Spinal deformities following selective dorsal rhizotomy","volume":"106","author":"Golan JD","year":"2007","unstructured":"Golan JD, Hall JA, O\u2019Gorman G,  Spinal deformities following selective dorsal rhizotomy. J Neurosurg. 2007;106(6)(suppl):441\u2013449.17566400"},{"issue":"5","key":"b8","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/BF00306275","article-title":"Spondylolysis and spondylolisthesis after five-level lumbosacral laminectomy for selective posterior rhizotomy in cerebral palsy","volume":"9","author":"Peter JC","year":"1993","unstructured":"Peter JC, Hoffman EB, Arens LJ. Spondylolysis and spondylolisthesis after five-level lumbosacral laminectomy for selective posterior rhizotomy in cerebral palsy. Childs Nerv Syst. 1993;9(5):285\u2013288.825252010.1007\/BF00306275"},{"issue":"1","key":"b9","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/BF00262263","article-title":"Incidence of spinal deformity in children after multiple level laminectomy for selective posterior rhizotomy","volume":"6","author":"Peter JC","year":"1990","unstructured":"Peter JC, Hoffman EB, Arens LJ, Peacock WJ. Incidence of spinal deformity in children after multiple level laminectomy for selective posterior rhizotomy. Childs Nerv Syst. 1990;6(1):30\u201332.10.1007\/BF002622632311112"},{"issue":"4","key":"b10","series-title":"J Neurosurg","first-page":"363","article-title":"Spinal deformities after selective dorsal rhizotomy for spastic cerebral palsy","volume":"102","author":"Steinbok P","year":"2005","unstructured":"Steinbok P, Hicdonmez T, Sawatzky B,  Spinal deformities after selective dorsal rhizotomy for spastic cerebral palsy. J Neurosurg. 2005;102(4)(suppl):363\u2013373.15926386"},{"issue":"suppl 4","key":"b11","series-title":"Dev Med Child Neurol","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1111\/j.1469-8749.2009.03461.x","article-title":"Scoliosis in cerebral palsy","volume":"51","author":"Koop SE","year":"2009","unstructured":"Koop SE. Scoliosis in cerebral palsy. Dev Med Child Neurol. 2009;51(suppl 4):92\u201398.10.1111\/j.1469-8749.2009.03461.x19740215"},{"issue":"12","key":"b12","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"2349","DOI":"10.2106\/00004623-200312000-00012","article-title":"Correction of sagittal plane spinal deformities with unit rod instrumentation in children with cerebral palsy","volume":"85","author":"Lipton GE","year":"2003","unstructured":"Lipton GE, Letonoff EJ, Dabney KW,  Correction of sagittal plane spinal deformities with unit rod instrumentation in children with cerebral palsy. J Bone Joint Surg Am. 2003;85(12):2349\u20132357.10.2106\/00004623-200312000-0001214668504"},{"issue":"10","key":"b13","series-title":"Dev Med Child Neurol","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1111\/dmcn.13481","article-title":"Long-term impact of childhood selective dorsal rhizotomy on pain, fatigue, and function: a case-control study","volume":"59","author":"Daunter AK","year":"2017","unstructured":"Daunter AK, Kratz AL, Hurvitz EA. Long-term impact of childhood selective dorsal rhizotomy on pain, fatigue, and function: a case-control study. Dev Med Child Neurol. 2017;59(10):1089\u20131095.2861794310.1111\/dmcn.13481"},{"issue":"4","key":"b14","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"380","DOI":"10.3171\/2013.1.PEDS12311","article-title":"Functional outcomes of childhood dorsal rhizotomy in adults and adolescents with cerebral palsy","volume":"11","author":"Hurvitz EA","year":"2013","unstructured":"Hurvitz EA, Marciniak CM, Daunter AK,  Functional outcomes of childhood dorsal rhizotomy in adults and adolescents with cerebral palsy. J Neurosurg Pediatr. 2013;11(4):380\u2013388.10.3171\/2013.1.PEDS1231123394352"},{"issue":"1","key":"b15","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1097\/01241398-200401000-00007","article-title":"Spinal deformity following selective dorsal rhizotomy","volume":"24","author":"Spiegel DA","year":"2004","unstructured":"Spiegel DA, Loder RT, Alley KA,  Spinal deformity following selective dorsal rhizotomy. J Pediatr Orthop. 2004;24(1):30\u201336.10.1097\/01241398-200401000-0000714676531"},{"issue":"6","key":"b16","series-title":"Arthritis Rheum","doi-asserted-by":"publisher","first-page":"2028","DOI":"10.1002\/art.34347","article-title":"A systematic review of the global prevalence of low back pain","volume":"64","author":"Hoy D","year":"2012","unstructured":"Hoy D, Bain C, Williams G,  A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028\u20132037.2223142410.1002\/art.34347"},{"issue":"8","key":"b17","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1016\/S0003-9993(03)00263-6","article-title":"Pain in persons with cerebral palsy: extension and cross validation","volume":"84","author":"Engel JM","year":"2003","unstructured":"Engel JM, Jensen MP, Hoffman AJ, Kartin D. Pain in persons with cerebral palsy: extension and cross validation. Arch Phys Med Rehabil. 2003;84(8):1125\u20131128.10.1016\/S0003-9993(03)00263-612917849"},{"issue":"6","key":"b18","series-title":"Am J Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1097\/00002060-200406000-00006","article-title":"Natural history of chronic pain and pain treatment in adults with cerebral palsy","volume":"83","author":"Jensen MP","year":"2004","unstructured":"Jensen MP, Engel JM, Hoffman AJ, Schwartz L. Natural history of chronic pain and pain treatment in adults with cerebral palsy. Am J Phys Med Rehabil. 2004;83(6):439\u2013445.1516668810.1097\/00002060-200406000-00006"},{"issue":"10","key":"b19","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1016\/S0003-9993(99)90023-0","article-title":"Pain in persons with cerebral palsy","volume":"80","author":"Schwartz L","year":"1999","unstructured":"Schwartz L, Engel JM, Jensen MP. Pain in persons with cerebral palsy. Arch Phys Med Rehabil. 1999;80(10):1243\u20131246.10.1016\/S0003-9993(99)90023-010527081"},{"issue":"2","key":"b20","series-title":"J Rehabil Med","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1080\/16501970310018305","article-title":"Musculoskeletal pain in adults with cerebral palsy compared with the general population","volume":"36","author":"Jahnsen R","year":"2004","unstructured":"Jahnsen R, Villien L, Aamodt G,  Musculoskeletal pain in adults with cerebral palsy compared with the general population. J Rehabil Med. 2004;36(2):78\u201384.1518022210.1080\/16501970310018305"},{"issue":"12","key":"b21","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1007\/s00381-009-0993-5","article-title":"Incidence of spinal abnormalities in patients with spastic diplegia 17 to 26 years after selective dorsal rhizotomy","volume":"25","author":"Langerak NG","year":"2009","unstructured":"Langerak NG, Vaughan CL, Hoffman EB,  Incidence of spinal abnormalities in patients with spastic diplegia 17 to 26 years after selective dorsal rhizotomy. Childs Nerv Syst. 2009;25(12):1593\u20131603.1978465710.1007\/s00381-009-0993-5"},{"issue":"10","key":"b22","series-title":"Dev Med Child Neurol","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1111\/j.1469-8749.2008.03089.x","article-title":"Content validity of the expanded and revised Gross Motor Function Classification System","volume":"50","author":"Palisano RJ","year":"2008","unstructured":"Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol. 2008;50(10):744\u2013750.1883438710.1111\/j.1469-8749.2008.03089.x"},{"issue":"4","key":"b23","series-title":"S Afr Med J","first-page":"119","article-title":"Selective posterior rhizotomy for the relief of spasticity in cerebral palsy","volume":"62","author":"Peacock WJ","year":"1982","unstructured":"Peacock WJ, Arens LJ. Selective posterior rhizotomy for the relief of spasticity in cerebral palsy. S Afr Med J. 1982;62(4):119\u2013124.7089801"},{"issue":"6","key":"b24","series-title":"Ann Hum Biol","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1080\/03014460701730024","article-title":"Early life and current determinants of bone in South African children of mixed ancestral origin","volume":"34","author":"Micklesfield LK","year":"2007","unstructured":"Micklesfield LK, Levitt NS, Carstens MT,  Early life and current determinants of bone in South African children of mixed ancestral origin. Ann Hum Biol. 2007;34(6):647\u2013655.10.1080\/0301446070173002418092208"},{"issue":"8","key":"b25","series-title":"S Afr Med J","doi-asserted-by":"publisher","first-page":"767","DOI":"10.7196\/SAMJ.2020.v110i8.14472","article-title":"A narrative review on spinal deformities in people with cerebral palsy: Measurement, norm values, incidence, risk factors and treatment","volume":"110","author":"Britz E","year":"2020","unstructured":"Britz E, Langerak NG, Lamberts RP. A narrative review on spinal deformities in people with cerebral palsy: Measurement, norm values, incidence, risk factors and treatment. S Afr Med J. 2020;110(8):767\u2013776.3288030510.7196\/SAMJ.2020.v110i8.14472"},{"issue":"7","key":"b26","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1097\/00007632-198907000-00012","article-title":"Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction","volume":"14","author":"Bernhardt M","year":"1989","unstructured":"Bernhardt M, Bridwell KH. Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine (Phila Pa 1976). 1989;14(7):717\u2013721.10.1097\/00007632-198907000-000122772721"},{"issue":"1","key":"b27","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1097\/01241398-200001000-00021","article-title":"The risk of spinal deformity after selective dorsal rhizotomy","volume":"20","author":"Turi M","year":"2000","unstructured":"Turi M, Kalen V. The risk of spinal deformity after selective dorsal rhizotomy. J Pediatr Orthop. 2000;20(1):104\u2013107.1064169810.1097\/01241398-200001000-00021"},{"key":"b28","series-title":"Surg Gynecol Obstet","first-page":"371","article-title":"Spondyloptosis","volume":"54","author":"Meyerding HW","year":"1932","unstructured":"Meyerding HW. Spondyloptosis. Surg Gynecol Obstet. 1932;54: 371\u2013377."},{"issue":"22","key":"b29","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2940","DOI":"10.1097\/00007632-200011150-00017","article-title":"The Oswestry Disability Index","volume":"25","author":"Fairbank JC","year":"2000","unstructured":"Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25(22):2940\u20132952.10.1097\/00007632-200011150-0001711074683"},{"key":"b30","series-title":"Statistical Power Analysis for Behavioral Science","author":"Cohen J.","year":"1998","unstructured":"Cohen J. Statistical Power Analysis for Behavioral Science. Lawrence Earlbaum Associates; 1998."},{"issue":"5","key":"b31","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1097\/01241398-200409000-00013","article-title":"Spinal deformity after selective dorsal rhizotomy in ambulatory patients with cerebral palsy","volume":"24","author":"Johnson MB","year":"2004","unstructured":"Johnson MB, Goldstein L, Thomas SS,  Spinal deformity after selective dorsal rhizotomy in ambulatory patients with cerebral palsy. J Pediatr Orthop. 2004;24(5):529\u2013536.10.1097\/01241398-200409000-0001315308903"},{"issue":"7","key":"b32","series-title":"J Child Neurol","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1177\/0883073817701047","article-title":"Risk factors for developing scoliosis in cerebral palsy: a cross-sectional descriptive study","volume":"32","author":"Bertoncelli CM","year":"2017","unstructured":"Bertoncelli CM, Solla F, Loughenbury PR,  Risk factors for developing scoliosis in cerebral palsy: a cross-sectional descriptive study. J Child Neurol. 2017;32(7):657\u2013662.2839557310.1177\/0883073817701047"},{"issue":"4","key":"b33","series-title":"Acta Orthop","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1080\/17453674.2018.1450091","article-title":"Incidence of scoliosis in cerebral palsy","volume":"89","author":"H\u00e4gglund G","year":"2018","unstructured":"H\u00e4gglund G, Pettersson K, Czuba T,  Incidence of scoliosis in cerebral palsy. Acta Orthop. 2018;89(4):443\u2013447.10.1080\/17453674.2018.145009129537343"},{"issue":"9117","key":"b34","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1016\/S0140-6736(98)01302-6","article-title":"Natural history of scoliosis in spastic cerebral palsy","volume":"351","author":"Saito N","year":"1998","unstructured":"Saito N, Ebara S, Ohotsuka K,  Natural history of scoliosis in spastic cerebral palsy. Lancet. 1998;351(9117):1687\u20131692.973488510.1016\/S0140-6736(98)01302-6"},{"issue":"6","key":"b35","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1097\/00007632-198111000-00009","article-title":"Scoliosis in the institutionalized cerebral palsy population","volume":"6","author":"Madigan RR","year":"1981","unstructured":"Madigan RR, Wallace SL. Scoliosis in the institutionalized cerebral palsy population. Spine (Phila Pa 1976). 1981;6(6):583\u2013590.10.1097\/00007632-198111000-000097336281"},{"issue":"6","key":"b36","series-title":"J Orthop Sports Phys Ther","doi-asserted-by":"publisher","first-page":"352","DOI":"10.2519\/jospt.2010.3099","article-title":"Age-related hyperkyphosis: its causes, consequences, and management","volume":"40","author":"Katzman WB","year":"2010","unstructured":"Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE. Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther. 2010;40(6):352\u2013360.10.2519\/jospt.2010.309920511692"},{"issue":"5","key":"b37","series-title":"AJR Am J Roentgenol","doi-asserted-by":"publisher","first-page":"979","DOI":"10.2214\/ajr.134.5.979","article-title":"Thoracic kyphosis: range in normal subjects","volume":"134","author":"Fon GT","year":"1980","unstructured":"Fon GT, Pitt MJ, Thies AC Jr. Thoracic kyphosis: range in normal subjects. AJR Am J Roentgenol. 1980;134(5):979\u2013983.10.2214\/ajr.134.5.9796768276"},{"issue":"4","key":"b38","series-title":"Int Orthop","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1007\/s00264-006-0218-4","article-title":"Lumbar hyperlordosis of neuromuscular origin: pathophysiology and surgical strategy for correction","volume":"31","author":"Vialle R","year":"2007","unstructured":"Vialle R, Khouri N, Glorion C,  Lumbar hyperlordosis of neuromuscular origin: pathophysiology and surgical strategy for correction. Int Orthop. 2007;31(4):513\u2013523.10.1007\/s00264-006-0218-416967278"},{"issue":"4","key":"b39","series-title":"J Bone Joint Surg Br","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1302\/0301-620X.75B4.8331105","article-title":"The lumbar spine in spastic diplegia. A radiographic study","volume":"75","author":"Harada T","year":"1993","unstructured":"Harada T, Ebara S, Anwar MM,  The lumbar spine in spastic diplegia. A radiographic study. J Bone Joint Surg Br. 1993;75(4):534\u2013537.833110510.1302\/0301-620X.75B4.8331105"},{"issue":"4","key":"b40","series-title":"J Chiropr Med","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/S0899-3467(07)60153-0","article-title":"Spondylolysis and spondylolisthesis: a narrative review of etiology, diagnosis, and conservative management","volume":"4","author":"Haun DW","year":"2005","unstructured":"Haun DW, Kettner NW. Spondylolysis and spondylolisthesis: a narrative review of etiology, diagnosis, and conservative management. J Chiropr Med. 2005;4(4):206\u2013217.1967466410.1016\/S0899-3467(07)60153-0"},{"issue":"1","key":"b41","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1148\/radiology.151.1.6701343","article-title":"Oblique lumbar spine radiographs: importance in young patients","volume":"151","author":"Libson E","year":"1984","unstructured":"Libson E, Bloom RA, Dinari G, Robin GC. Oblique lumbar spine radiographs: importance in young patients. Radiology. 1984;151(1):89\u201390.10.1148\/radiology.151.1.67013436701343"},{"issue":"2","key":"b42","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1097\/BRS.0b013e31818edcfd","article-title":"Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population","volume":"34","author":"Kalichman L","year":"2009","unstructured":"Kalichman L, Kim DH, Li L,  Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976). 2009;34(2):199\u2013205.10.1097\/BRS.0b013e31818edcfd19139672"},{"issue":"8","key":"b43","series-title":"PLoS One","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0133685","article-title":"The lumbar lordosis in males and females, revisited","volume":"10","author":"Hay O","year":"2015","unstructured":"Hay O, Dar G, Abbas J,  The lumbar lordosis in males and females, revisited. PLoS One. 2015;10(8):e0133685.10.1371\/journal.pone.013368526301782"},{"issue":"5","key":"b44","series-title":"Ortop Traumatol Rehabil","first-page":"652","article-title":"Computed tomorgaphy diagnostic of lumbar spondylolysis","volume":"6","author":"Krupski W","year":"2004","unstructured":"Krupski W, Majcher P, Tatara MR. Computed tomorgaphy diagnostic of lumbar spondylolysis. Ortop Traumatol Rehabil. 2004;6(5):652\u2013657.17618216"},{"issue":"3","key":"b45","series-title":"J Neurosci Rural Pract","doi-asserted-by":"publisher","first-page":"298","DOI":"10.4103\/jnrp.jnrp_508_17","article-title":"Comparison of four radiographic angular measures of lumbar lordosis","volume":"9","author":"Okpala FO","year":"2018","unstructured":"Okpala FO. Comparison of four radiographic angular measures of lumbar lordosis. J Neurosci Rural Pract. 2018;9(3):298\u201330410.4103\/jnrp.jnrp_508_1730069082"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/34\/2\/article-p228.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/34\/2\/article-p228.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/34\/2\/article-p228.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T01:01:59Z","timestamp":1751072519000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/34\/2\/article-p228.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2]]},"references-count":45,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2020.6.spine20751","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2021,2]]}}}