{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:35:08Z","timestamp":1788568508381,"version":"build-2803163510"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The aim of this study was to discern whether patients with a cranial sagittal vertical axis to the hip (CrSVA-H) &gt; 2 cm at 2 years postoperatively exhibit significantly worse patient-reported outcomes (PROs) and clinical outcomes compared with patients with CrSVA-H &lt; 2 cm.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This was a retrospective, 1:1 propensity score\u2013matched (PSM) study of patients who underwent posterior spinal fusion for adult spinal deformity. All patients had a baseline sagittal imbalance of CrSVA-H &gt; 30 mm. Two-year patient-reported and clinical outcomes were assessed in unmatched and PSM cohorts, including Scoliosis Research Society\u201322r (SRS-22r) and Oswestry Disability Index scores as well as reoperation rates. The study compared two cohorts based on 2-year alignment: CrSVA-H &lt; 20 mm (aligned cohort) vs CrSVA-H &gt; 20 mm (malaligned cohort). For the matched cohorts, binary outcome comparisons were carried out using the McNemar test, while continuous outcomes used the Wilcoxon rank-sum test. For unmatched cohorts, categorical variables were compared using chi-square\/Fisher\u2019s tests, while continuous outcomes were compared using Welch\u2019s t-test.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 156 patients with mean age of 63.7 (SEM 1.09) years underwent posterior spinal fusion spanning a mean of 13.5 (0.32) levels. At baseline, the mean pelvic incidence minus lumbar lordosis mismatch was 19.1\u00b0 (2.01\u00b0), the T1 pelvic angle was 26.6\u00b0 (1.20\u00b0), and the CrSVA-H was 74.9 (4.33) mm. The mean CrSVA-H improved from 74.9 mm to 29.2 mm (p &lt; 0.0001). At the 2-year follow-up, 129 (78%) of 164 patients achieved CrSVA-H &lt; 2 cm (aligned cohort). Patients who had CrSVA-H &gt; 2 cm (malaligned cohort) at the 2-year follow-up had worse preoperative CrSVA-H (p &lt; 0.0001). After performing PSM, 27 matched pairs were generated. In the PSM cohort, the aligned and malaligned cohorts demonstrated comparable preoperative patient-reported outcomes (PROs). However, at the 2-year postoperative follow-up, the malaligned cohort reported worse outcomes in SRS-22r function (p = 0.0275), pain (p = 0.0012), and mean total score (p = 0.0109). Moreover, when patients were stratified based on their magnitude of improvement in CrSVA-H (&lt; 50% vs &gt; 50%), patients with &gt; 50% improvement in CrSVA-H had superior outcomes in SRS-22r function (p = 0.0336), pain (p = 0.0446), and mean total score (p = 0.0416). Finally, patients in the malaligned cohort had a higher 2-year reoperation rate (22% vs 7%; p = 0.0412) compared with patients in the aligned cohort.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Among patients who present with forward sagittal imbalance (CrSVA-H &gt; 30 mm), patients with CrSVA-H exceeding 20 mm at the 2-year postoperative follow-up have inferior PROs and higher reoperation rates.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.4.spine23303","type":"journal-article","created":{"date-parts":[[2023,6,3]],"date-time":"2023-06-03T16:53:03Z","timestamp":1685811183000},"page":"301-310","source":"Crossref","is-referenced-by-count":8,"title":["Outcomes and reoperation rates of adult spinal deformity patients with baseline sagittal malalignment based on the cranial axis to the hip at 2 years postoperatively"],"prefix":"10.3171","volume":"39","author":[{"given":"Sarthak","family":"Mohanty","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"},{"name":"Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Mikhail","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Greisberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fthimnir M.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen R.","family":"Stephan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeeshan M.","family":"Sardar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald A.","family":"Lehman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence G.","family":"Lenke","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Spine Deform","first-page":"310","article-title":"Adult spinal deformity: epidemiology, health impact, evaluation, and management","volume":"4","author":"Ames CP","year":"2016","unstructured":"Ames CP, Scheer JK, Lafage V,  Adult spinal deformity: epidemiology, health impact, evaluation, and management. 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Bone Jt Open. 2020;1(3):19\u201328."},{"issue":"1","key":"b4","series-title":"Eur Spine J","first-page":"3","article-title":"Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions","volume":"24","author":"Pellis\u00e9 F","year":"2015","unstructured":"Pellis\u00e9 F, Vila-Casademunt A, Ferrer M,  Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J. 2015;24(1):3\u201311."},{"issue":"7","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"776","article-title":"Outcome and complications of long fusions to the sacrum in adult spine deformity: Luque-Galveston, combined iliac and sacral screws, and sacral fixation","volume":"27","author":"Emami A","year":"2002","unstructured":"Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS. Outcome and complications of long fusions to the sacrum in adult spine deformity: Luque-Galveston, combined iliac and sacral screws, and sacral fixation. Spine (Phila Pa 1976). 2002;27(7):776\u2013786."},{"issue":"6","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"682","article-title":"Correlation of radiographic parameters and clinical symptoms in adult scoliosis","volume":"30","author":"Glassman SD","year":"2005","unstructured":"Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976). 2005;30(6):682\u2013688."},{"issue":"18","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"2024","article-title":"The impact of positive sagittal balance in adult spinal deformity","volume":"30","author":"Glassman SD","year":"2005","unstructured":"Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005;30(18):2024\u20132029."},{"issue":"11","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"E320","article-title":"The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers","volume":"31","author":"Roussouly P","year":"2006","unstructured":"Roussouly P, Gollogly S, Noseda O, Berthonnaud E, Dimnet J. The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. 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Eur Spine J. 2017;26(8):2167\u20132175."},{"issue":"1","key":"b11","series-title":"BMC Musculoskelet Disord","first-page":"696","article-title":"The differences in whole-body sagittal alignment between different postures in young, healthy adults","volume":"21","author":"Xue R","year":"2020","unstructured":"Xue R, Liu D, Shen Y. The differences in whole-body sagittal alignment between different postures in young, healthy adults. BMC Musculoskelet Disord. 2020;21(1):696."},{"issue":"1","key":"b12","series-title":"Clin Spine Surg","first-page":"E32","article-title":"Is the cranial sagittal vertical axis (Cr-SVA) a better midterm predictor of clinical results than C7-SVA in adult patients operated on spinal deformity after a minimum 2-year follow-up?","volume":"34","author":"Gomez-Rice A","year":"2021","unstructured":"Gomez-Rice A, Madrid C, Izquierdo E, Marco-Mart\u00ednez F, Tresguerres JAF, Sanchez-Mariscal F. 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