{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T23:00:45Z","timestamp":1773097245173,"version":"3.50.1"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The aim of this study was to determine if spinal deformity patients with L5 sacralization should have pelvic incidence (PI) and other spinopelvic parameters measured from the L5 or S1 endplate.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This study was a multicenter retrospective comparative cohort study comprising a large database of adult spinal deformity (ASD) patients and a database of asymptomatic individuals. Linear regression modeling was used to determine normative T1 pelvic angle (TPA) and PI \u2212 lumbar lordosis (LL) mismatch (PI-LL) based on PI and age in a database of asymptomatic subjects. In an ASD database, patients with radiographic evidence of L5 sacralization had the PI, LL, and TPA measured from the superior endplate of S1 and then also from L5. The differences in TPA and PI-LL from normative were calculated in the sacralization cohort relative to L5 and S1 and correlated to the Oswestry Disability Index (ODI). Patients were grouped based on the Scoliosis Research Society (SRS)\u2013Schwab PI-LL modifier (0, +, or ++) using the L5 PI-LL and S1 PI-LL. Baseline ODI and SF-36 Physical Component Summary (PCS) scores were compared across and within groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Among 1179 ASD patients, 276 (23.4%) had transitional anatomy, 176 with sacralized L5 (14.9%) and 100 (8.48%) with lumbarization of S1. The 176 patients with sacralized L5 were analyzed. When measured using the L5 superior endplate, pelvic parameters were significantly smaller than those measured relative to S1 (PI: 24.5\u00b0 \u00b1 11.0\u00b0 vs 55.7\u00b0 \u00b1 12.0\u00b0, p = 0.001;TPA: 11.2\u00b0 \u00b1 12.0\u00b0 vs 20.3\u00b0 \u00b1 12.5\u00b0, p = 0.001; and PI-LL: 0.67\u00b0 \u00b1 21.1\u00b0 vs 11.4\u00b0 \u00b1 20.8\u00b0, p = 0.001). When measured from S1, 76 (43%), 45 (25.6%), and 55 (31.3%) patients had SRS-Schwab PI-LL modifiers of 0, +, and ++, respectively, compared with 124 (70.5%), 22 (12.5%), and 30 (17.0%), respectively, when measured from L5. There were significant differences in ODI and PCS scores as the SRS-Schwab grade increased regardless of L5 or S1 measurement. The L5 group had lower PCS functional scores for SRS-Schwab modifiers 0 and ++ relative to same grades in the S1 group. Offset from normative TPA (0.5\u00b0 \u00b1 11.1\u00b0 vs 9.6\u00b0 \u00b1 10.8\u00b0, p = 0.001) and PI-LL (4.5\u00b0 \u00b1 20.4\u00b0 vs 15.2\u00b0 \u00b1 19.3\u00b0, p = 0.001) were smaller when measuring from L5. Moreover, S1 measurements were more correlated with health status by ODI (TPA offset from normative: S1, R = 0.326 vs L5, R = 0.285; PI-LL offset from normative: S1, R = 0.318 vs L5, R = 0.274).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Measuring the PI and spinopelvic parameters at L5 in sacralized anatomy results in underestimating spinal deformity and is less correlated with health-related quality of life. Surgeons may consider measuring PI and spinopelvic parameters relative to S1 rather than at L5 in patients with a sacralized L5.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.8.spine23432","type":"journal-article","created":{"date-parts":[[2023,10,21]],"date-time":"2023-10-21T01:50:11Z","timestamp":1697853011000},"page":"92-98","source":"Crossref","is-referenced-by-count":6,"title":["Determining the best vertebra for measuring pelvic incidence and spinopelvic parameters in adult spinal deformity patients with transitional anatomy"],"prefix":"10.3171","volume":"40","author":[{"given":"Fares","family":"Ani","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, NYU Langone Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Themistocles S.","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, NYU Langone Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yesha","family":"Parekh","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalid","family":"Odeh","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, NYU Langone Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lenox Hill, Northwell Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert K.","family":"Eastlack","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Scripps Memorial Hospital, La Jolla, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence","family":"Lenke","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lenox Hill, Northwell Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory M.","family":"Mundis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Scripps Memorial Hospital, La Jolla, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munish C.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University in St. Louis, Missouri;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric O.","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California, Davis, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lenox Hill, Northwell Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Swedish Medical Center, Seattle, Washington;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Duke Health, Durham, North Carolina; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Denver International Spine Center, Denver, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"10","key":"b1","series-title":"AJNR Am J Neuroradiol","first-page":"1778","article-title":"Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance","volume":"31","author":"Konin GP","year":"2010","unstructured":"Konin GP, Walz DM. Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. AJNR Am J Neuroradiol. 2010;31(10):1778\u20131786."},{"issue":"12","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"813","article-title":"Variability in assessing spinopelvic parameters with lumbosacral transitional vertebrae: inter- and intraobserver reliability among spine surgeons","volume":"43","author":"Khalsa AS","year":"2018","unstructured":"Khalsa AS, Mundis GM Jr, Yagi M,  Variability in assessing spinopelvic parameters with lumbosacral transitional vertebrae: inter- and intraobserver reliability among spine surgeons. Spine (Phila Pa 1976). 2018;43(12):813\u2013816."},{"issue":"suppl 1","key":"b3","series-title":"Int J Spine Surg","first-page":"14","article-title":"Sacral dysmorphism and lumbosacral transitional vertebrae (LSTV) review","volume":"14","author":"Matson DM","year":"2020","unstructured":"Matson DM, Maccormick LM, Sembrano JN, Polly DW. Sacral dysmorphism and lumbosacral transitional vertebrae (LSTV) review. Int J Spine Surg. 2020;14(suppl 1):14\u201319."},{"issue":"9","key":"b4","series-title":"Spine J","first-page":"858","article-title":"The prevalence of transitional vertebrae in the lumbar spine","volume":"11","author":"Apazidis A","year":"2011","unstructured":"Apazidis A, Ricart PA, Diefenbach CM, Spivak JM. The prevalence of transitional vertebrae in the lumbar spine. Spine J. 2011;11(9):858\u2013862."},{"issue":"22","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"E1176","article-title":"Does lumbosacral transitional vertebra have any influence on sacral tilt?","volume":"40","author":"Benlidayi IC","year":"2015","unstructured":"Benlidayi IC, Coskun NC, Basaran S. Does lumbosacral transitional vertebra have any influence on sacral tilt? Spine (Phila Pa 1976). 2015;40(22):E1176\u2013E1179."},{"issue":"5","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"493","article-title":"Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects","volume":"9","author":"Castellvi AE","year":"1984","unstructured":"Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976). 1984;9(5):493\u2013495."},{"issue":"1","key":"b7","series-title":"Pain Physician","first-page":"53","article-title":"Lumbosacral transitional vertebrae: incidence in a consecutive patient series","volume":"9","author":"Delport EG","year":"2006","unstructured":"Delport EG, Cucuzzella TR, Kim N, Marley J, Pruitt C, Delport AG. Lumbosacral transitional vertebrae: incidence in a consecutive patient series. Pain Physician. 2006;9(1):53\u201356."},{"issue":"17","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"1852","article-title":"Determining the lumbar vertebral segments on magnetic resonance imaging","volume":"24","author":"Peh WC","year":"1999","unstructured":"Peh WC, Siu TH, Chan JH. Determining the lumbar vertebral segments on magnetic resonance imaging. Spine (Phila Pa 1976). 1999;24(17):1852\u20131855."},{"issue":"2","key":"b9","series-title":"Spine (Phila Pa 1976)","first-page":"200","article-title":"Lumbosacral transitional vertebra: relation to disc degeneration and low back pain","volume":"29","author":"Luoma K","year":"2004","unstructured":"Luoma K, Vehmas T, Raininko R, Luukkonen R, Riihim\u00e4ki H. Lumbosacral transitional vertebra: relation to disc degeneration and low back pain. Spine (Phila Pa 1976). 2004;29(2):200\u2013205."},{"issue":"3","key":"b10","series-title":"Neurosurg Clin N Am","first-page":"323","article-title":"Spinopelvic parameters: lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope: what does a spine surgeon need to know to plan a lumbar deformity correction?","volume":"29","author":"Celestre PC","year":"2018","unstructured":"Celestre PC, Dimar JR II, Glassman SD. Spinopelvic parameters: lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope: what does a spine surgeon need to know to plan a lumbar deformity correction? Neurosurg Clin N Am. 2018;29(3):323\u2013329."},{"issue":"5","key":"b11","series-title":"Spine Deform","first-page":"587","article-title":"Interpretation of spinal radiographic parameters in patients with transitional lumbosacral vertebrae","volume":"6","author":"Zhou PL","year":"2018","unstructured":"Zhou PL, Moon JY, Tishelman JC,  Interpretation of spinal radiographic parameters in patients with transitional lumbosacral vertebrae. Spine Deform. 2018;6(5):587\u2013592."},{"issue":"3","key":"b12","series-title":"Rev Chir Orthop Reparatrice Appar Mot","first-page":"218","article-title":"Validation of a tool to measure pelvic and spinal parameters of sagittal balance","volume":"89","author":"Rillardon L","year":"2003","unstructured":"Rillardon L, Levassor N, Guigui P,  Validation of a tool to measure pelvic and spinal parameters of sagittal balance. Article in French. Rev Chir Orthop Reparatrice Appar Mot. 2003;89(3):218\u2013227."},{"issue":"6","key":"b13","series-title":"Eur Spine J","first-page":"982","article-title":"Validation of new clinical quantitative analysis software applicable in spine orthopaedic studies","volume":"15","author":"Champain S","year":"2006","unstructured":"Champain S, Benchikh K, Nogier A, Mazel C, Guise JD, Skalli W. Validation of new clinical quantitative analysis software applicable in spine orthopaedic studies. Eur Spine J. 2006;15(6):982\u2013991."},{"issue":"9","key":"b14","series-title":"Eur J Radiol","first-page":"1679","article-title":"Lumbosacral transitional vertebra in a population-based study of 5860 individuals: prevalence and relationship to low back pain","volume":"83","author":"Tang M","year":"2014","unstructured":"Tang M, Yang XF, Yang SW,  Lumbosacral transitional vertebra in a population-based study of 5860 individuals: prevalence and relationship to low back pain. Eur J Radiol. 2014;83(9):1679\u20131682."},{"issue":"3","key":"b15","series-title":"Asian Spine J","first-page":"407","article-title":"Lumbosacral transitional vertebra-related low back pain: resolving the controversy","volume":"12","author":"Gopalan B","year":"2018","unstructured":"Gopalan B, Yerramshetty JS. Lumbosacral transitional vertebra-related low back pain: resolving the controversy. Asian Spine J. 2018;12(3):407\u2013415."},{"issue":"6","key":"b16","series-title":"Spine J","first-page":"1210","article-title":"Associations between lumbosacral transitional anatomy types and degeneration at the transitional and adjacent segments","volume":"15","author":"Farshad-Amacker NA","year":"2015","unstructured":"Farshad-Amacker NA, Herzog RJ, Hughes AP, Aichmair A, Farshad M. Associations between lumbosacral transitional anatomy types and degeneration at the transitional and adjacent segments. Spine J. 2015;15(6):1210\u20131216."},{"issue":"4","key":"b17","series-title":"Neurosurgery","first-page":"559","article-title":"The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort","volume":"73","author":"Terran J","year":"2013","unstructured":"Terran J, Schwab F, Shaffrey CI,  The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery. 2013;73(4):559\u2013568."},{"issue":"16","key":"b18","series-title":"Spine (Phila Pa 1976)","first-page":"1105","article-title":"Does achieving global spinal alignment lead to higher patient satisfaction and lower disability in adult spinal deformity?","volume":"46","author":"Sheikh Alshabab B","year":"2021","unstructured":"Sheikh Alshabab B, Gupta MC, Lafage R,  Does achieving global spinal alignment lead to higher patient satisfaction and lower disability in adult spinal deformity? Spine (Phila Pa 1976). 2021;46(16):1105\u20131110."},{"issue":"4","key":"b19","series-title":"J Neurosurg Spine","first-page":"607","article-title":"Outcomes of operative treatment for adult spinal deformity: a prospective multicenter assessment with mean 4-year follow-up","volume":"37","author":"Elias E","year":"2022","unstructured":"Elias E, Bess S, Line B,  Outcomes of operative treatment for adult spinal deformity: a prospective multicenter assessment with mean 4-year follow-up. J Neurosurg Spine. 2022;37(4):607\u2013616."},{"issue":"4","key":"b20","series-title":"Spine Deform","first-page":"875","article-title":"Sagittal radiographic parameters in the presence of lumbosacral transitional vertebra (LSTV): relationships between measurements using the upper vs lower transitional vertebra","volume":"9","author":"Homer CJ","year":"2021","unstructured":"Homer CJ, Sembrano JN. Sagittal radiographic parameters in the presence of lumbosacral transitional vertebra (LSTV): relationships between measurements using the upper vs lower transitional vertebra. Spine Deform. 2021;9(4):875\u2013881."},{"issue":"5","key":"b21","series-title":"Int J Spine Surg","first-page":"868","article-title":"Optimum vertebral level of Castellvi type III or higher lumbosacral transitional vertebrae when measuring spinopelvic parameters","volume":"16","author":"Tatara Y","year":"2022","unstructured":"Tatara Y, Niimura T, Sakaguchi A, Katayama H, Mihara H. Optimum vertebral level of Castellvi type III or higher lumbosacral transitional vertebrae when measuring spinopelvic parameters. Int J Spine Surg. 2022;16(5):868\u2013874."},{"issue":"4","key":"b22","series-title":"Spine (Phila Pa 1976)","first-page":"250","article-title":"Should sagittal spinal alignment targets for adult spinal deformity correction depend on pelvic incidence and age?","volume":"45","author":"Protopsaltis TS","year":"2020","unstructured":"Protopsaltis TS, Soroceanu A, Tishelman JC,  Should sagittal spinal alignment targets for adult spinal deformity correction depend on pelvic incidence and age? Spine (Phila Pa 1976). 2020;45(4):250\u2013257."},{"issue":"1","key":"b23","series-title":"Spine (Phila Pa 1976)","first-page":"62","article-title":"Defining spino-pelvic alignment thresholds should operative goals in adult spinal deformity surgery account for age?","volume":"41","author":"Lafage R","year":"2016","unstructured":"Lafage R, Schwab F, Challier V,  Defining spino-pelvic alignment thresholds should operative goals in adult spinal deformity surgery account for age? Spine (Phila Pa 1976). 2016;41(1):62\u201368."},{"issue":"1","key":"b24","series-title":"J Neurosurg Spine","first-page":"57","article-title":"Change in sagittal alignment after decompression alone in patients with lumbar spinal stenosis without significant deformity: a prospective cohort study","volume":"37","author":"Bouknaitir JB","year":"2022","unstructured":"Bouknaitir JB, Carreon LY, Brorson S, Andersen M\u00d8. Change in sagittal alignment after decompression alone in patients with lumbar spinal stenosis without significant deformity: a prospective cohort study. J Neurosurg Spine. 2022;37(1):57\u201363."},{"issue":"2","key":"b25","series-title":"J Neurosurg Spine","first-page":"154","article-title":"Validation of a simple computerized tool for measuring spinal and pelvic parameters","volume":"16","author":"Kim CH","year":"2012","unstructured":"Kim CH, Chung CK, Hong HS, Kim EH, Kim MJ, Park BJ. Validation of a simple computerized tool for measuring spinal and pelvic parameters. J Neurosurg Spine. 2012;16(2):154\u2013162."},{"issue":"12","key":"b26","series-title":"Spine J","first-page":"2493","article-title":"Validation of a new computer-assisted tool to measure spino-pelvic parameters","volume":"15","author":"Lafage R","year":"2015","unstructured":"Lafage R, Ferrero E, Henry JK,  Validation of a new computer-assisted tool to measure spino-pelvic parameters. Spine J. 2015;15(12):2493\u20132502."},{"issue":"1","key":"b27","series-title":"Spine (Phila Pa 1976)","first-page":"E22","article-title":"Dedicated spine measurement software quantifies key spino-pelvic parameters more reliably than traditional picture archiving and communication systems tools","volume":"41","author":"Gupta M","year":"2016","unstructured":"Gupta M, Henry JK, Schwab F,  Dedicated spine measurement software quantifies key spino-pelvic parameters more reliably than traditional picture archiving and communication systems tools. Spine (Phila Pa 1976). 2016;41(1):E22\u2013E27."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/40\/1\/article-p92.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/40\/1\/article-p92.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/40\/1\/article-p92.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:17:34Z","timestamp":1733491054000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/40\/1\/article-p92.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,1]]},"references-count":27,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2023.8.spine23432","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2024,1,1]]}}}