{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:37:24Z","timestamp":1792805844076,"version":"4.5.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Changes to segmental lordosis at a single level may affect adjacent-level biomechanics and overall spinal alignment with an iatrogenic domino effect commonly seen in adult spinal deformity. This study investigated the effects of different segmental angles of single-level lumbar fixation on stability and principal strain across the surface of the adjacent-level disc.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Seven human cadaveric L3\u2013S1 specimens were instrumented at L4\u20135 and tested in 3 conditions: 1) neutral native angle (\"neutral\"), 2) increasing angle by 5\u00b0 of lordosis (\"lordosis\"), and 3) decreasing angle by 5\u00b0 of kyphosis (\"kyphosis\"). Pure moment loads (7.5 Nm) were applied in flexion, extension, lateral bending, and axial rotation, followed by 400 N of axial compression alone and together with pure moments. Range of motion (ROM), principal maximum strain (E1), and principal minimum strain (E2) across different surface subregions of the upper adjacent-level disc (L3\u20134) were optically assessed. Larger magnitudes of either E1 or E2 indicate larger tissue deformations and represent indirect measures of increased stress.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>At the superior adjacent level, a significant increase in ROM was observed in kyphosis and lordosis versus neutral in flexion (p \u2264 0.001) and extension (p \u2264 0.02). ROM was increased in lordosis versus neutral (p = 0.03) and kyphosis (p = 0.004) during compression. ROM increased in kyphosis versus neutral and lordosis (both p = 0.03) in compression plus extension. Lordosis resulted in increased E1 across the midposterior subregion of the disc (Q3) versus neutral during right lateral bending (p = 0.04); lordosis and kyphosis resulted in decreased E1 in Q3 versus neutral with compression (p \u2264 0.03). Lordosis decreased E1 in Q3 versus neutral during compression plus flexion (p = 0.01), whereas kyphosis increased E1 in all quartiles and increased E2 in the midanterior subregion versus lordosis in compression plus flexion (p \u2264 0.047). Kyphosis decreased E1 in Q3 (p = 0.02) and E2 in the anterior-most subregion of the disc (Q1) (p = 0.006) versus neutral, whereas lordosis decreased E1 in Q3 (p = 0.008) versus neutral in compression plus extension.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Lumbar spine monosegmental fixation with 5\u00b0 offset from the neutral individual segmental angle altered the motion and principal strain magnitudes at the upper adjacent disc, with induced kyphosis resulting in larger principal strains compared with lordosis. Segmental alignment of single-level fusion influences adjacent-segment biomechanics, and suboptimal alignment may play a role in the clinical development of adjacent-segment disease.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.3.spine211221","type":"journal-article","created":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T07:20:31Z","timestamp":1653636031000},"page":"525-534","source":"Crossref","is-referenced-by-count":4,"title":["Subtle segmental angle changes of single-level lumbar fusions and adjacent-level biomechanics: cadaveric study of optically measured disc strain"],"prefix":"10.3171","volume":"37","author":[{"given":"Bernardo","family":"de Andrada Pereira","sequence":"first","affiliation":[{"name":"Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piyanat","family":"Wangsawatwong","sequence":"additional","affiliation":[{"name":"Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer N.","family":"Lehrman","sequence":"additional","affiliation":[{"name":"Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna G. 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