{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:13:52Z","timestamp":1791386032838,"version":"4.3.3"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The purpose of this study was to investigate the influence of sagittal alignment according to age-adjusted pelvic incidence minus lumbar lordosis (PI-LL) and lordosis distribution index (LDI) on the occurrence of adjacent-segment disease (ASD) after lumbar fusion surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This study retrospectively reviewed 234 consecutive patients with lumbar degenerative diseases who underwent 1- or 2-level lumbar fusion surgery. Demographic and radiographic (preoperative and 3-month postoperative) data were collected and compared between ASD and non-ASD groups. Binary logistic regression analysis was performed to evaluate adjusted associations between potential variables and ASD development. A subanalysis was further conducted to assess their relationships in the range of different PI values.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>With a mean follow-up duration of 70.6 months (range 60\u2013121 months), 118 patients (50.4%) were diagnosed as having cranial radiological ASD. Univariate analyses showed that older age, 2-level fusion, worse preoperative pelvic tilt and LL, lower pre- and postoperative LDI, and more improvement in sagittal vertical axis were significantly correlated with the occurrence of ASD. No significant differences in the PI-LL and age-adjusted PI-LL (offset) were detected between ASD and non-ASD groups. Multivariate analysis identified postoperative LDI (OR 0.971, 95% CI 0.953\u20130.989, p = 0.002); 2-level fusion (OR 3.477, 95% CI 1.964\u20136.157, p &lt; 0.001); and improvement of sagittal vertical axis (OR 0.992, 95% CI 0.985\u20130.998, p = 0.039) as the independent variables for predicting the occurrence of ASD. When stratified by PI, LDI was identified as an independent risk factor in the groups with low and average PI. Lower segmental lordosis (OR 0.841, 95% CI 0.742\u20130.954, p = 0.007) could significantly increase the incidence of ASD in the patients with high LDI.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Age-adjusted PI-LL may have limited ability to predict the development of ASD. LDI could exert an important effect on diagnosing the occurrence of ASD in the cases with low and average PI, but segmental lordosis was a more significant risk factor than LDI in individuals with high PI.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.8.spine23393","type":"journal-article","created":{"date-parts":[[2023,11,11]],"date-time":"2023-11-11T01:56:46Z","timestamp":1699667806000},"page":"143-151","source":"Crossref","is-referenced-by-count":8,"title":["Validation of age-adjusted pelvic incidence minus lumbar lordosis and lordosis distribution index for assessing adjacent-segment disease after short-level lumbar fusion surgery: minimum 5 years of follow-up"],"prefix":"10.3171","volume":"40","author":[{"given":"Muyi","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Orthopedics, The Affiliated Changzhou Second People\u2019s Hospital of Nanjing Medical University, Changzhou;"},{"name":"Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruikai","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Affiliated Changzhou Second People\u2019s Hospital of Nanjing Medical University, Changzhou;"},{"name":"Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Affiliated Changzhou Second People\u2019s Hospital of Nanjing Medical University, Changzhou;"},{"name":"Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingbin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Affiliated Changzhou Second People\u2019s Hospital of Nanjing Medical University, Changzhou;"},{"name":"Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifei","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Affiliated Changzhou Second People\u2019s Hospital of Nanjing Medical University, Changzhou;"},{"name":"Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Division of Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Division of Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Affiliated Changzhou Second People\u2019s Hospital of Nanjing Medical University, Changzhou;"},{"name":"Department of Orthopedics, Changzhou No. 6 People\u2019s Hospital, Changzhou; and"},{"name":"Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"World Neurosurg","first-page":"e293","article-title":"Higher improvement in patient-reported outcomes can be achieved after transforaminal lumbar interbody fusion for clinical and radiographic degenerative spondylolisthesis classification type D degenerative lumbar spondylolisthesis","volume":"114","author":"Chen X","year":"2018","unstructured":"Chen X, Xu L, Qiu Y,  Higher improvement in patient-reported outcomes can be achieved after transforaminal lumbar interbody fusion for clinical and radiographic degenerative spondylolisthesis classification type D degenerative lumbar spondylolisthesis. 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Clin Neurol Neurosurg. 2018;173:96\u2013100."},{"key":"b21","series-title":"World Neurosurg","first-page":"e507","article-title":"Comparative utility of dynamic and static imaging in the management of lumbar spondylolisthesis","volume":"117","author":"Viswanathan VK","year":"2018","unstructured":"Viswanathan VK, Hatef J, Aghili-Mehrizi S, Minnema AJ, Farhadi HF. Comparative utility of dynamic and static imaging in the management of lumbar spondylolisthesis. 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