{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:01:30Z","timestamp":1780736490399,"version":"3.54.1"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Multiple studies in the past have developed equations to determine the ideal lumbar lordosis (ILL) in the sagittal plane. These equations differ but all look to accomplish the same goal of providing the surgeon with specific alignment targets during surgery. To date, no study has compared the different equations of ILL against each other. This study compares 5 target alignment formulas in patients with high, normal, and low pelvic incidence (PI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a retrospective chart review from January 2015 through April 2022 and reviewed available full-spine standing spine radiographs. They classified patients by their PI: high (65\u00b0\u201395\u00b0), normal (50\u00b0\u201360\u00b0), and low (30\u00b0\u201345\u00b0) and included 5 patients for each classification. They calculated ILL based on the measured PI using 5 different formulas (Global Alignment and Proportion [GAP] score [ILL = 0.62 \u00d7 PI + 29], Le Huec [ILL = 0.5 \u00d7 PI + 28], Hyun [ILL = 0.62 \u00d7 PI + 27.6], Hamamatsu University [ILL = 0.45 \u00d7 PI + 31.8], and Kelly [ILL = 0.6 \u00d7 PI + 30]). They compared the different ILL equations to determine if there were significant differences and considered any measurement \u00b1 3\u00b0 as equivalent to account for measurement variability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Fifteen patients were included in the data analysis (5 patients for each PI classification). The mean PI measurements in the patients were as follows: high, 77.8\u00b0; normal, 54.6\u00b0; and low, 37.8\u00b0. The ILL measurements using the GAP formula were high, 77.2\u00b0; normal, 62.9\u00b0; and low, 52.4\u00b0. The ILL measurements using the Le Huec formula were high, 66.9\u00b0; normal, 55.3\u00b0; and low, 46.9\u00b0. The ILL measurements using the Hyun formula were high, 75.8\u00b0; normal, 61.5\u00b0; and low, 51.0\u00b0. The ILL measurements using the Hamamatsu University formula were high, 66.8\u00b0; normal, 56.4\u00b0; and low, 48.8\u00b0. Finally, the ILL measurements using the Kelly formula were high, 76.7\u00b0; normal, 62.8\u00b0; and low, 52.7\u00b0. Two-way ANOVA using Tukey Honestly Significant Difference post hoc multiple comparisons showed that the GAP, Hyun, and Kelly formulas for calculating ILL significantly differed from Le Huec and Hamamatsu University formulas (p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Variation exists among the 5 different ILL equations, with 3 of the formulas being statistically different from the others. One must take note of these differences when considering patient-specific sagittal alignment goals. Further discussion is needed to determine which ILL equation should be widely used.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.3.focus2568","type":"journal-article","created":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T05:55:32Z","timestamp":1748757332000},"page":"E9","source":"Crossref","is-referenced-by-count":1,"title":["Differences across various ideal lumbar lordosis measurement formulas for patient-specific sagittal alignment goals"],"prefix":"10.3171","volume":"58","author":[{"given":"David W.","family":"Polly","sequence":"first","affiliation":[{"name":"Departments of Orthopedic Surgery and"},{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason J.","family":"Haselhuhn","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Keller","sequence":"additional","affiliation":[{"name":"Medical School, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul Brian O.","family":"Soriano","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Odland","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen E.","family":"Jones","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan N.","family":"Sembrano","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Incremental cost-effectiveness of adult spinal deformity surgery: observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery","volume":"36","author":"McCarthy I","year":"2014","unstructured":"McCarthy I, O\u2019Brien M, Ames C,  Incremental cost-effectiveness of adult spinal deformity surgery: observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery. Neurosurg Focus. 2014;36(5):E3."},{"issue":"18","key":"b2","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 KM, Dimar JR,  The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005;30(18):2024\u20132029."},{"issue":"13","key":"b3","series-title":"Spine (Phila Pa 1976)","first-page":"E803","article-title":"Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis","volume":"38","author":"Schwab FJ","year":"2013","unstructured":"Schwab FJ, Blondel B, Bess S,  Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976). 2013;38(13):E803\u2013E812."},{"issue":"6","key":"b4","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,  Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976). 2005;30(6):682\u2013688."},{"key":"b5","series-title":"The Pediatric Spine: Principles and Practices","first-page":"479","article-title":"Three-dimensional analysis of the scoliotic deformity","author":"Dubousset J","year":"1994","unstructured":"Dubousset J. Three-dimensional analysis of the scoliotic deformity. In: , Weinstein SL, ed.The Pediatric Spine: Principles and Practices. Raven Press;1994:479-496."},{"issue":"9","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"642","article-title":"Recruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: a full-standing axis analysis of key radiographical parameters","volume":"40","author":"Diebo BG","year":"2015","unstructured":"Diebo BG, Ferrero E, Lafage R,  Recruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: a full-standing axis analysis of key radiographical parameters. Spine (Phila Pa 1976). 2015;40(9):642-649."},{"issue":"9","key":"b7","series-title":"Eur Spine J","first-page":"1889","article-title":"Sagittal balance of the spine","volume":"28","author":"Le Huec JC","year":"2019","unstructured":"Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A. Sagittal balance of the spine. Eur Spine J. 2019;28(9):1889\u20131905."},{"issue":"2","key":"b8","series-title":"Ann Transl Med","first-page":"35","article-title":"The importance of sagittal balance in adult scoliosis surgery","volume":"8","author":"Cheung JPY","year":"2020","unstructured":"Cheung JPY. The importance of sagittal balance in adult scoliosis surgery. Ann Transl Med. 2020;8(2):35."},{"issue":"6","key":"b9","series-title":"Spine J","first-page":"600","article-title":"Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis","volume":"5","author":"Hioki A","year":"2005","unstructured":"Hioki A, Miyamoto K, Kodama H,  Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis. Spine J. 2005;5(6):600\u2013607."},{"issue":"8","key":"b10","series-title":"Clin Biomech (Bristol)","first-page":"763","article-title":"The effect of sagittal alignment on adjacent joint mobility after lumbar instrumentation\u2014a biomechanical study of lumbar vertebrae in a porcine model","volume":"19","author":"Chen WJ","year":"2004","unstructured":"Chen WJ, Lai PL, Tai CL, Chen LH, Niu CC. The effect of sagittal alignment on adjacent joint mobility after lumbar instrumentation\u2014a biomechanical study of lumbar vertebrae in a porcine model. Clin Biomech (Bristol). 2004;19(8):763\u2013768."},{"issue":"17","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"1828","article-title":"Sagittal plane considerations and the pelvis in the adult patient","volume":"34","author":"Schwab F","year":"2009","unstructured":"Schwab F, Lafage V, Patel A, Farcy JP. Sagittal plane considerations and the pelvis in the adult patient. 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Eur Spine J. 2022;31(6):1573\u20131582."},{"issue":"4","key":"b16","series-title":"Eur Spine J","first-page":"415","article-title":"Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis","volume":"15","author":"Boulay C","year":"2006","unstructured":"Boulay C, Tardieu C, Hecquet J,  Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J. 2006;15(4):415\u2013422."},{"issue":"25","key":"b17","series-title":"Spine (Phila Pa 1976)","first-page":"2224","article-title":"Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery","volume":"35","author":"Schwab F","year":"2010","unstructured":"Schwab F, Patel A, Ungar B, Farcy JP, Lafage V. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? 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Spine (Phila Pa 1976). 2016;41(1):62\u201368."},{"key":"b19","series-title":"World Neurosurg","first-page":"e114","article-title":"Effect of lumbar lordosis on the adjacent segment in transforaminal lumbar interbody fusion: a finite element analysis","volume":"114","author":"Zhao X","year":"2018","unstructured":"Zhao X, Du L, Xie Y,  Effect of lumbar lordosis on the adjacent segment in transforaminal lumbar interbody fusion: a finite element analysis. World Neurosurg. 2018;114:e114\u2013e120."},{"issue":"13","key":"b20","series-title":"Spine (Phila Pa 1976)","first-page":"1617","article-title":"The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments","volume":"25","author":"Umehara S","year":"2000","unstructured":"Umehara S, Zindrick MR, Patwardhan AG,  The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine (Phila Pa 1976). 2000;25(13):1617\u20131624."},{"issue":"1","key":"b21","series-title":"J Neurosurg Spine","first-page":"4","article-title":"Improvement of sagittal balance and lumbar lordosis following less invasive adult spinal deformity surgery with expandable cages and percutaneous instrumentation: Clinical article","volume":"18","author":"Wang MY","year":"2013","unstructured":"Wang MY. Improvement of sagittal balance and lumbar lordosis following less invasive adult spinal deformity surgery with expandable cages and percutaneous instrumentation: Clinical article. J Neurosurg Spine. 2013;18(1):4\u201312."},{"issue":"5","key":"b22","series-title":"Oper Neurosurg (Hagerstown)","first-page":"533","article-title":"The effects of global alignment and proportionality scores on postoperative outcomes after adult spinal deformity correction","volume":"24","author":"Passias PG","year":"2023","unstructured":"Passias PG, Krol O, Owusu-Sarpong S,  The effects of global alignment and proportionality scores on postoperative outcomes after adult spinal deformity correction. Oper Neurosurg (Hagerstown). 2023;24(5):533-541"},{"issue":"6","key":"b23","series-title":"J Neurosurg Spine","first-page":"653","article-title":"Crossing the cervicothoracic junction: an evaluation of radiographic alignment, functional outcomes, and patient-reported outcomes","volume":"38","author":"Aflatooni J","year":"2023","unstructured":"Aflatooni J, Mohanty S, Angelov I,  Crossing the cervicothoracic junction: an evaluation of radiographic alignment, functional outcomes, and patient-reported outcomes. J Neurosurg Spine. 2023;38(6):653\u2013661."},{"issue":"3","key":"b24","series-title":"Neurospine","first-page":"837","article-title":"Outcomes of surgical treatment for patients with mild scoliosis and age-appropriate sagittal alignment with minimum 2-year follow-up","volume":"20","author":"Scheer JK","year":"2023","unstructured":"Scheer JK, Smith JS, Passias PG,  Outcomes of surgical treatment for patients with mild scoliosis and age-appropriate sagittal alignment with minimum 2-year follow-up. Neurospine. 2023;20(3):837\u2013848."},{"issue":"1","key":"b25","series-title":"BMC Musculoskelet Disord","first-page":"192","article-title":"Increasing pelvic incidence is associated with more global sagittal imbalance in ankylosing spondylitis with thoracolumbar kyphosis: an observational retrospective study of 94 cases","volume":"21","author":"Song D","year":"2020","unstructured":"Song D, Zheng G, Wang T, Qi D, Wang Y. Increasing pelvic incidence is associated with more global sagittal imbalance in ankylosing spondylitis with thoracolumbar kyphosis: an observational retrospective study of 94 cases. BMC Musculoskelet Disord. 2020;21(1):192."},{"issue":"8","key":"b26","series-title":"Global Spine J","first-page":"1821","article-title":"The pelvic incidence stratified sagittal spinopelvic alignment in asymptomatic Chinese population with different age groups","volume":"12","author":"Zhou S","year":"2022","unstructured":"Zhou S, Sun Z, Li W, Zou D, Li W. The pelvic incidence stratified sagittal spinopelvic alignment in asymptomatic Chinese population with different age groups. Global Spine J. 2022;12(8):1821\u20131826."},{"issue":"5","key":"b27","series-title":"J Neurosurg Spine","first-page":"572","article-title":"Should pelvic incidence influence realignment strategy? A detailed analysis in adult spinal deformity: presented at the 2024 AANS\/CNS Joint Section on Disorders of the Spine and Peripheral Nerves","volume":"41","author":"Williamson TK","year":"2024","unstructured":"Williamson TK, Onafowokan OO, Schoenfeld AJ,  Should pelvic incidence influence realignment strategy? A detailed analysis in adult spinal deformity: presented at the 2024 AANS\/CNS Joint Section on Disorders of the Spine and Peripheral Nerves. J Neurosurg Spine. 2024;41(5):572\u2013578."},{"issue":"5","key":"b1","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Incremental cost-effectiveness of adult spinal deformity surgery: observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery","volume":"36","author":"McCarthy I","year":"2014","unstructured":"McCarthy I, O\u2019Brien M, Ames C,  Incremental cost-effectiveness of adult spinal deformity surgery: observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery. Neurosurg Focus. 2014;36(5):E3."},{"issue":"18","key":"b2","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 KM, Dimar JR,  The impact of positive sagittal balance in adult spinal deformity. 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Spine (Phila Pa 1976). 2005;30(6):682\u2013688."},{"key":"b5","series-title":"The Pediatric Spine: Principles and Practices","first-page":"479","article-title":"Three-dimensional analysis of the scoliotic deformity","author":"Dubousset J","year":"1994","unstructured":"Dubousset J. Three-dimensional analysis of the scoliotic deformity. In: , Weinstein SL, ed.The Pediatric Spine: Principles and Practices. Raven Press;1994:479-496."},{"issue":"9","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"642","article-title":"Recruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: a full-standing axis analysis of key radiographical parameters","volume":"40","author":"Diebo BG","year":"2015","unstructured":"Diebo BG, Ferrero E, Lafage R,  Recruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: a full-standing axis analysis of key radiographical parameters. Spine (Phila Pa 1976). 2015;40(9):642-649."},{"issue":"9","key":"b7","series-title":"Eur Spine J","first-page":"1889","article-title":"Sagittal balance of the spine","volume":"28","author":"Le Huec JC","year":"2019","unstructured":"Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A. Sagittal balance of the spine. Eur Spine J. 2019;28(9):1889\u20131905."},{"issue":"2","key":"b8","series-title":"Ann Transl Med","first-page":"35","article-title":"The importance of sagittal balance in adult scoliosis surgery","volume":"8","author":"Cheung JPY","year":"2020","unstructured":"Cheung JPY. The importance of sagittal balance in adult scoliosis surgery. Ann Transl Med. 2020;8(2):35."},{"issue":"6","key":"b9","series-title":"Spine J","first-page":"600","article-title":"Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis","volume":"5","author":"Hioki A","year":"2005","unstructured":"Hioki A, Miyamoto K, Kodama H,  Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis. Spine J. 2005;5(6):600\u2013607."},{"issue":"8","key":"b10","series-title":"Clin Biomech (Bristol)","first-page":"763","article-title":"The effect of sagittal alignment on adjacent joint mobility after lumbar instrumentation\u2014a biomechanical study of lumbar vertebrae in a porcine model","volume":"19","author":"Chen WJ","year":"2004","unstructured":"Chen WJ, Lai PL, Tai CL, Chen LH, Niu CC. The effect of sagittal alignment on adjacent joint mobility after lumbar instrumentation\u2014a biomechanical study of lumbar vertebrae in a porcine model. Clin Biomech (Bristol). 2004;19(8):763\u2013768."},{"issue":"17","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"1828","article-title":"Sagittal plane considerations and the pelvis in the adult patient","volume":"34","author":"Schwab F","year":"2009","unstructured":"Schwab F, Lafage V, Patel A, Farcy JP. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976). 2009;34(17):1828\u20131833."},{"issue":"4","key":"b12","series-title":"Spine (Phila Pa 1976)","first-page":"E211","article-title":"Calculation of the target lumbar lordosis angle for restoring an optimal pelvic tilt in elderly patients with adult spinal deformity","volume":"41","author":"Yamato Y","year":"2016","unstructured":"Yamato Y, Hasegawa T, Kobayashi S,  Calculation of the target lumbar lordosis angle for restoring an optimal pelvic tilt in elderly patients with adult spinal deformity. Spine (Phila Pa 1976). 2016;41(4):E211\u2013E217."},{"issue":"19","key":"b13","series-title":"J Bone Joint Surg Am","first-page":"1661","article-title":"Global Alignment and Proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery","volume":"99","author":"Yilgor C","year":"2017","unstructured":"Yilgor C, Sogunmez N, Boissiere L,  Global Alignment and Proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am. 2017;99(19):1661\u20131672."},{"issue":"9","key":"b14","series-title":"Eur Spine J","first-page":"1906","article-title":"Predictive formula of ideal lumbar lordosis and lower lumbar lordosis determined by individual pelvic incidence in asymptomatic elderly population","volume":"28","author":"Hyun SJ","year":"2019","unstructured":"Hyun SJ, Han S, Kim YB,  Predictive formula of ideal lumbar lordosis and lower lumbar lordosis determined by individual pelvic incidence in asymptomatic elderly population. Eur Spine J. 2019;28(9):1906\u20131913."},{"issue":"6","key":"b15","series-title":"Eur Spine J","first-page":"1573","article-title":"The impact of lumbar alignment targets on mechanical complications after adult lumbar scoliosis surgery","volume":"31","author":"Dial BL","year":"2022","unstructured":"Dial BL, Hills JM, Smith JS,  The impact of lumbar alignment targets on mechanical complications after adult lumbar scoliosis surgery. Eur Spine J. 2022;31(6):1573\u20131582."},{"issue":"4","key":"b16","series-title":"Eur Spine J","first-page":"415","article-title":"Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis","volume":"15","author":"Boulay C","year":"2006","unstructured":"Boulay C, Tardieu C, Hecquet J,  Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J. 2006;15(4):415\u2013422."},{"issue":"25","key":"b17","series-title":"Spine (Phila Pa 1976)","first-page":"2224","article-title":"Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery","volume":"35","author":"Schwab F","year":"2010","unstructured":"Schwab F, Patel A, Ungar B, Farcy JP, Lafage V. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976). 2010;35(25):2224\u20132231."},{"issue":"1","key":"b18","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."},{"key":"b19","series-title":"World Neurosurg","first-page":"e114","article-title":"Effect of lumbar lordosis on the adjacent segment in transforaminal lumbar interbody fusion: a finite element analysis","volume":"114","author":"Zhao X","year":"2018","unstructured":"Zhao X, Du L, Xie Y,  Effect of lumbar lordosis on the adjacent segment in transforaminal lumbar interbody fusion: a finite element analysis. World Neurosurg. 2018;114:e114\u2013e120."},{"issue":"13","key":"b20","series-title":"Spine (Phila Pa 1976)","first-page":"1617","article-title":"The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments","volume":"25","author":"Umehara S","year":"2000","unstructured":"Umehara S, Zindrick MR, Patwardhan AG,  The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine (Phila Pa 1976). 2000;25(13):1617\u20131624."},{"issue":"1","key":"b21","series-title":"J Neurosurg Spine","first-page":"4","article-title":"Improvement of sagittal balance and lumbar lordosis following less invasive adult spinal deformity surgery with expandable cages and percutaneous instrumentation: Clinical article","volume":"18","author":"Wang MY","year":"2013","unstructured":"Wang MY. Improvement of sagittal balance and lumbar lordosis following less invasive adult spinal deformity surgery with expandable cages and percutaneous instrumentation: Clinical article. J Neurosurg Spine. 2013;18(1):4\u201312."},{"issue":"5","key":"b22","series-title":"Oper Neurosurg (Hagerstown)","first-page":"533","article-title":"The effects of global alignment and proportionality scores on postoperative outcomes after adult spinal deformity correction","volume":"24","author":"Passias PG","year":"2023","unstructured":"Passias PG, Krol O, Owusu-Sarpong S,  The effects of global alignment and proportionality scores on postoperative outcomes after adult spinal deformity correction. 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