{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T02:09:28Z","timestamp":1793239768669,"version":"4.5.0"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Adequate correction of sagittal spinal malalignment is crucial in adult spinal deformity (ASD) surgery. Although the age-adjusted pelvic incidence (PI)\u2013lumbar lordosis (LL) scheme has been widely used for ideal sagittal correction, its association with long-term surgical outcomes is not well documented. Therefore, the authors aimed to evaluate the association of age-adjusted PI-LL correction with long-term radiographic and clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors included patients who underwent \u2265 5-level fusion including the sacrum for ASD between 2012 and 2023. The patients were categorized into three groups according to the correction status relative to the age-adjusted PI-LL target, as follows: undercorrection, matched correction, and overcorrection. The proximal junctional kyphosis\/failure (PJK\/F) rates, radiographic results, and clinical outcomes, including visual analog scale for back pain, Oswestry Disability Index (ODI), and Scoliosis Research Society (SRS)\u201322 scores, were compared between the PI-LL correction groups. To investigate the influence of PJK\/F on the outcomes, patients with and without PJK\/F were analyzed separately.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Altogether, 384 patients were included in the study (mean age 69.0 years, mean total fused levels 7.9 levels, and mean follow-up duration 43.1 months). At 6 weeks postoperatively, all sagittal parameters were significantly more pertinently corrected in the overcorrection group than in the undercorrection and matched correction groups. PJK\/F developed more frequently in the overcorrection group than in the undercorrection and matched correction groups. Final correction status, except the sacral slope, was more robust in the overcorrection group than in the undercorrection and matched correction groups. In the overall study cohort, the final ODI and SRS-22 scores were significantly better in the matched correction group than in the undercorrection and overcorrection groups. In the subgroup analysis, the clinical outcomes were comparable between the matched correction and overcorrection groups even with the exclusion of PJK\/F.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Overcorrection relative to the age-adjusted PI-LL was associated with an increased risk of PJK\/F. Clinical outcomes, such as ODI and SRS-22 scores, at the final follow-up were significantly better in the matched correction group than in the other correction groups. Even in the subgroup analysis excluding PJK\/F, overcorrection did not provide any additional clinical benefit compared to matched correction.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.3.spine241155","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:34:13Z","timestamp":1757687653000},"page":"396-404","source":"Crossref","is-referenced-by-count":4,"title":["Association of age-adjusted pelvic incidence minus lumbar lordosis correction with long-term radiographic and clinical outcomes in adult spinal deformity surgery"],"prefix":"10.3171","volume":"43","author":[{"given":"Se-Jun","family":"Park","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Sung","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Ho","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyunghun","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minwook","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong-Suh","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","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. 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Neurosurg Focus. 2014;36(5):E9."},{"issue":"6","key":"b35","series-title":"Clin Orthop Surg","first-page":"975","article-title":"Proximal junctional failure after corrective surgery: focusing on elderly patients with severe sagittal imbalance","volume":"15","author":"Park SJ","year":"2023","unstructured":"Park SJ, Park JS, Lee CS, Proximal junctional failure after corrective surgery: focusing on elderly patients with severe sagittal imbalance. Clin Orthop Surg. 2023;15(6):975\u2013982."},{"issue":"6","key":"b1","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."},{"issue":"25","key":"b2","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, 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):2224-2231."},{"issue":"2","key":"b3","series-title":"Asian Spine J","first-page":"241","article-title":"Compensatory pelvic retro-rotation associated with a decreased quality of life in patients with normal sagittal balance","volume":"16","author":"Shimokawa T","year":"2022","unstructured":"Shimokawa T, Miyamoto K, Hioki A, Compensatory pelvic retro-rotation associated with a decreased quality of life in patients with normal sagittal balance. Asian Spine J. 2022;16(2):241\u2013247."},{"issue":"1","key":"b4","series-title":"Asian Spine J","first-page":"50","article-title":"Erector spinae atrophy correlates with global sagittal imbalance and postoperative proximal junctional kyphosis incidence in lumbar degenerative kyphosis","volume":"18","author":"Wang G","year":"2024","unstructured":"Wang G, Li Y, Zhang C, Erector spinae atrophy correlates with global sagittal imbalance and postoperative proximal junctional kyphosis incidence in lumbar degenerative kyphosis. Asian Spine J. 2024;18(1):50\u201357."},{"issue":"12","key":"b5","first-page":"1077","article-title":"Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study","volume":"37","author":"Schwab F","year":"2012","unstructured":"Schwab F, Ungar B, Blondel B, Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976).2012;37(12):1077\u20131082."},{"issue":"17","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"1275","article-title":"Age-adjusted alignment goals have the potential to reduce PJK","volume":"42","author":"Lafage R","year":"2017","unstructured":"Lafage R, Schwab F, Glassman S, Age-adjusted alignment goals have the potential to reduce PJK. Spine (Phila Pa 1976). 2017;42(17):1275\u20131282."},{"issue":"1","key":"b7","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":"19","key":"b8","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":"3","key":"b9","series-title":"Neurosurgery","first-page":"706","article-title":"A validation study of four preoperative surgical planning tools for adult spinal deformity surgery in proximal junctional kyphosis and clinical outcomes","volume":"93","author":"Park SJ","year":"2023","unstructured":"Park SJ, Lee CS, Park JS, A validation study of four preoperative surgical planning tools for adult spinal deformity surgery in proximal junctional kyphosis and clinical outcomes. Neurosurgery. 2023;93(3):706\u2013716."},{"issue":"24","key":"b10","first-page":"1737","article-title":"Validation of age-adjusted ideal sagittal alignment in terms of proximal junctional failure and clinical outcomes in adult spinal deformity","volume":"47","author":"Park SJ","year":"2022","unstructured":"Park SJ, Lee CS, Kang BJ, Validation of age-adjusted ideal sagittal alignment in terms of proximal junctional failure and clinical outcomes in adult spinal deformity. Spine (Phila Pa 1976).2022;47(24):1737\u20131745."},{"issue":"4","key":"b11","series-title":"Spine J","first-page":"635","article-title":"Effect of overcorrection on proximal junctional kyphosis in adult spinal deformity: analysis by age-adjusted ideal sagittal alignment","volume":"22","author":"Byun CW","year":"2022","unstructured":"Byun CW, Cho JH, Lee CS, Effect of overcorrection on proximal junctional kyphosis in adult spinal deformity: analysis by age-adjusted ideal sagittal alignment. Spine J. 2022;22(4):635\u2013645."},{"issue":"1","key":"b12","series-title":"Spine Deform","first-page":"121","article-title":"Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications","volume":"10","author":"Lafage R","year":"2022","unstructured":"Lafage R, Smith JS, Elysee J, Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications. Spine Deform. 2022;10(1):121\u2013131."},{"issue":"2","key":"b13","series-title":"Int J Spine Surg","first-page":"205","article-title":"Full-body radiographic analysis of postoperative deviations from age-adjusted alignment goals in adult spinal deformity correction and related compensatory recruitment","volume":"13","author":"Passias PG","year":"2019","unstructured":"Passias PG, Jalai CM, Diebo BG, Full-body radiographic analysis of postoperative deviations from age-adjusted alignment goals in adult spinal deformity correction and related compensatory recruitment. Int J Spine Surg. 2019;13(2):205\u2013214."},{"issue":"3","key":"b14","series-title":"J Neurosurg Spine","first-page":"311","article-title":"Calibration of a comprehensive predictive model for the development of proximal junctional kyphosis and failure in adult spinal deformity patients with consideration of contemporary goals and techniques","volume":"39","author":"Tretiakov PS","year":"2023","unstructured":"Tretiakov PS, Lafage R, Smith JS, Calibration of a comprehensive predictive model for the development of proximal junctional kyphosis and failure in adult spinal deformity patients with consideration of contemporary goals and techniques. 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