{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:23:47Z","timestamp":1790652227752,"version":"4.1.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"\nOBJECTIVE<\/jats:title>\nBoth the Global Alignment and Proportion (GAP) score and Roussouly classification account for the lordosis distribution index (LDI), but the LDI of the GAP score (G-LDI) is typically set to 50%\u201380%, while the LDI of the Roussouly classification (R-LDI) varies depending on the degree of pelvic incidence (PI). The objective of this study was to validate the ability of the G-LDI to predict mechanical complications and compare it with the predictive probability of R-LDI in patients with long-level fusion surgery.<\/jats:p>\n<\/jats:sec>\n\nMETHODS<\/jats:title>\nA total of 171 patients were divided into two groups: 93 in the nonmechanical complication group (non-MC group) and 78 in the mechanical complication group (MC group). The mean age of the participants was 66.79 \u00b1 8.56 years (range 34\u201383 years), and the mean follow-up period was 45.49 \u00b1 16.20 months (range 24\u201362 months). The inclusion criteria for the study were patients who underwent > 4 levels of fusion and had > 2 years of follow-up. The predictive models for mechanical complications using the G-LDI and R-LDI were analyzed using binomial logistic regression and receiver operating characteristic analyses.<\/jats:p>\n<\/jats:sec>\n\nRESULTS<\/jats:title>\nThere was a significant correlation between R-LDI and PI (r = \u22120.561, p < 0.001), while there was no correlation between G-LDI and PI (r = 0.132, p = 0.495). In reference to G-LDI, most patients in the non-MC group were classified as having alignment (72, 77.4%), while the MC group had an inhomogeneous composition (aligned: 34, 43.6%; hyperlordosis: 37, 47.4%). The agreement between the G-LDI and R-LDI was moderate (\u03ba = 0.536, p < 0.001) to fair (\u03ba = 0.383, p = 0.011) for patients with average or large PI, but poor (\u03ba = \u22120.255, p = 0.245) for those with small PI. The areas under the curve for the G-LDI and R-LDI were 0.674 (95% CI, 0.592\u20130.757) and 0.745 (95% CI, 0.671\u20130.820), respectively.<\/jats:p>\n<\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nThe R-LDI, which uses a PI-based proportional parameter, enables individual quantification of LL for all PI sizes and has been shown to have a higher accuracy in classifying cases and a stronger correlation with the risk of mechanical complications compared with G-LDI.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.11.spine23725","type":"journal-article","created":{"date-parts":[[2024,1,27]],"date-time":"2024-01-27T01:44:45Z","timestamp":1706319885000},"page":"593-601","source":"Crossref","is-referenced-by-count":7,"title":["Lordosis distribution index for predicting mechanical complications after long-level fusion surgery: comparison of Global Alignment and Proportion score and Roussouly classification"],"prefix":"10.3171","volume":"40","author":[{"given":"Min-Hyeong","family":"Moon","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myung-Hoon","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Chan","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doo-Yong","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong-Tae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","article-title":"The Pediatric Spine: Principles and Practice","author":"D\u2019Andrea JD","year":"2001","unstructured":"D\u2019Andrea JD. 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