{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:05:14Z","timestamp":1772827514129,"version":"3.50.1"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,29]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The aim of this retrospective study was to investigate the relationship between postoperative Roussouly sagittal profile changes and patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>From a prospectively collected, single-center database, the authors reviewed the records of patients with adult spinal deformity (ASD) who had clinical and radiographic data from baseline to 2 years after surgery. The patients were stratified by their Roussouly curve type (current sacral slope\u2013based and \"theoretical\" pelvic incidence\u2013based types). Means comparison tests (ANOVA and chi-square) were used to assess differences among Roussouly groups. Backstep logistic regression analyses were used to analyze associations between Roussouly sagittal profile changes and patient outcomes, including minimum clinically important differences (MCIDs) in functional metrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Five hundred twenty-five patients, 79% of whom were female, were included in this study. The mean age of the cohort was 60.8 \u00b1 14.1 years, BMI was 27.2 \u00b1 5.5 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , and Charlson Comorbidity Index score was 1.72 \u00b1 1.68. According to the Roussouly classification, 8.3% of patients had a Roussouly type 1 (R1) curve, 53.6% type 2 (R2), 26.3% type 3 (R3), and 11.9% type 4 (R4). Overall, 39% of patients had a changed Roussouly shape postoperatively: 59% had R1, 58.5% R2, 48.1% R3, and 26.7% R4 (p &lt; 0.001). Forty-eight percent of patients matched the theoretical Roussouly type postoperatively (41% R1, 41.5% R2, 51.9% R3, and 73.3% R4, p &lt; 0.001). When controlling for baseline clinical and radiographic differences, the Roussouly type changes associated with a higher risk of proximal junctional kyphosis or proximal junctional failure were as follows: R1 to R2 (OR 2.5, 95% CI 1.1\u20135.6, p = 0.024), R2 to R4 (OR 2.8, 95% CI 1.1\u20137.7, p = 0.039), and R3 to R4 (OR 2.3, 95% CI 1.1\u20134.9, p = 0.033). R4 to R3 switches had the highest mechanical complication risks (OR 3.4, 95% CI 1.2\u20139.4, p = 0.016). R1 to R2 changes had the highest rate of attaining an MCID in the Oswestry Disability Index at 6 weeks (23.5%, p = 0.004). Roussouly type changes were not associated with differences in the MCID on the refined 22-item Scoliosis Research Society patient outcome questionnaire (SRS-22r) up to 2 years after surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>While a significant portion of patients matched their postoperative theoretical Roussouly type, many of those matched at baseline were prone to become unmatched postoperatively. Postoperative Roussouly shape changes influence patient outcomes and should be accounted for when planning ASD surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.4.spine241520","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:34:42Z","timestamp":1757687682000},"page":"609-615","source":"Crossref","is-referenced-by-count":0,"title":["The impact of Roussouly sagittal profile changes on postoperative outcomes"],"prefix":"10.3171","volume":"43","author":[{"given":"Oluwatobi O.","family":"Onafowokan","sequence":"first","affiliation":[{"name":"Duke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, North Carolina;"},{"name":"Division of Spinal Surgery\/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pawel P.","family":"Jankowski","sequence":"additional","affiliation":[{"name":"Hoag Neurosciences Institute, Newport Beach, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Yung","sequence":"additional","affiliation":[{"name":"Duke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max R.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Duke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Lorentz","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery\/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Galetta","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery\/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paritash","family":"Tahmasebpour","sequence":"additional","affiliation":[{"name":"Hoag Neurosciences Institute, Newport Beach, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, New York; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Duke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, New York; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Duke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"10193","key":"b1","series-title":"Lancet (London, England)","first-page":"160","article-title":"Adult spinal deformity","volume":"394","author":"Diebo BG","year":"2019","unstructured":"Diebo BG, Shah NV, Boachie-Adjei O,  Adult spinal deformity. Lancet (London, England). 2019;394(10193):160\u2013172."},{"issue":"1","key":"b2","series-title":"Global Spine J","first-page":"51","article-title":"Current status of adult spinal deformity","volume":"3","author":"Youssef JA","year":"2013","unstructured":"Youssef JA, Orndorff DO, Patty CA,  Current status of adult spinal deformity. Global Spine J. 2013;3(1):51\u201362."},{"issue":"3","key":"b3","series-title":"Spine (Phila Pa 1976)","first-page":"346","article-title":"Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position","volume":"30","author":"Roussouly P","year":"2005","unstructured":"Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976).2005;30(3):346\u2013353."},{"issue":"8","key":"b4","series-title":"Eur Spine J","first-page":"2002","article-title":"Classification of normal sagittal spine alignment: refounding the Roussouly classification","volume":"27","author":"Laouissat F","year":"2018","unstructured":"Laouissat F, Sebaaly A, Gehrchen M, Roussouly P. Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J. 2018;27(8):2002\u20132011."},{"issue":"4","key":"b5","series-title":"Eur Spine J","first-page":"904","article-title":"Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study","volume":"29","author":"Sebaaly A","year":"2020","unstructured":"Sebaaly A, Gehrchen M, Silvestre C,  Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study. Eur Spine J. 2020;29(4):904\u2013913."},{"issue":"1","key":"b6","series-title":"Eur Spine J","first-page":"54","article-title":"Restoring the ideal Roussouly sagittal profile in adult scoliosis surgery decreases the risk of mechanical complications","volume":"29","author":"Pizones J","year":"2020","unstructured":"Pizones J, Moreno-Manzanaro L, S\u00e1nchez P\u00e9rez-Grueso FJ,  Restoring the ideal Roussouly sagittal profile in adult scoliosis surgery decreases the risk of mechanical complications. Eur Spine J. 2020;29(1):54\u201362."},{"issue":"11","key":"b7","series-title":"Bone Joint J","first-page":"1342","article-title":"Frail patients require instrumentation of a more proximal vertebra for a successful outcome after surgery for adult spine deformity","volume":"106-B","author":"Onafowokan OO","year":"2024","unstructured":"Onafowokan OO, Jankowski PP, Das A,  Frail patients require instrumentation of a more proximal vertebra for a successful outcome after surgery for adult spine deformity. Bone Joint J. 2024;106-B(11):1342\u20131347."},{"issue":"20","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"1463","article-title":"Performance of the modified Adult Spinal Deformity Frailty Index in preoperative risk assessment","volume":"47","author":"Passias PG","year":"2022","unstructured":"Passias PG, Moattari K, Pierce KE,  Performance of the modified Adult Spinal Deformity Frailty Index in preoperative risk assessment. Spine (Phila Pa 1976).2022;47(20):1463\u20131469."},{"issue":"1","key":"b9","series-title":"Acta Neurochir (Wien)","first-page":"448","article-title":"Treatment of adult spine deformity: a retrospective comparison of bone morphogenic protein and bone marrow aspirate with bone allograft","volume":"166","author":"Onafowokan OO","year":"2024","unstructured":"Onafowokan OO, Uzosike AC, Sharma A,  Treatment of adult spine deformity: a retrospective comparison of bone morphogenic protein and bone marrow aspirate with bone allograft. Acta Neurochir (Wien). 2024;166(1):448."},{"issue":"1","key":"b10","series-title":"Asian Spine J","first-page":"35","article-title":"Minimum clinically important differences in Oswestry Disability Index domains and their impact on adult spinal deformity surgery","volume":"13","author":"Yoshida G","year":"2019","unstructured":"Yoshida G, Hasegawa T, Yamato Y,  Minimum clinically important differences in Oswestry Disability Index domains and their impact on adult spinal deformity surgery. Asian Spine J. 2019;13(1):35\u201344."},{"issue":"6","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"377","article-title":"The minimum clinically important difference in SRS-22R total score, appearance, activity and pain domains after surgical treatment of adult spinal deformity","volume":"40","author":"Crawford CH III","year":"2015","unstructured":"Crawford CH III, Glassman SD, Bridwell KH, Berven SH, Carreon LY. The minimum clinically important difference in SRS-22R total score, appearance, activity and pain domains after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976).2015;40(6):377\u2013381."},{"issue":"7","key":"b12","series-title":"Global Spine J","first-page":"1978","article-title":"The influence of multilevel spinal deformity surgery on the EuroQol 5 Dimensions\u2019 (EQ-5D) Questionnaire and residential status in the elderly: a prospective, observational, multicenter study","volume":"14","author":"Jentzsch T","year":"2024","unstructured":"Jentzsch T, Lewis SJ, Oitment C,  The influence of multilevel spinal deformity surgery on the EuroQol 5 Dimensions\u2019 (EQ-5D) Questionnaire and residential status in the elderly: a prospective, observational, multicenter study. Global Spine J. 2024;14(7):1978\u20131989."},{"issue":"3","key":"b13","series-title":"Article in French. 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":"b14","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."},{"key":"b15","article-title":"Spinal Deformity Study Group Radiographic Measurement Manual","author":"O\u2019Brien MF","year":"2008","unstructured":"O\u2019Brien MF, Kuklo TR, Blanke KM, Lenke LG. Spinal Deformity Study Group Radiographic Measurement Manual. Medtronic Sofamor Danek USA, Inc;2008.Accessed May 22, 2025.https:\/\/www.srs.org\/Files\/Research\/Manuals-and-Publications\/sdsg-radiographic-measuremnt-manual.pdf"},{"issue":"2","key":"b16","series-title":"Eur Spine J","first-page":"489","article-title":"Description of the sagittal alignment of the degenerative human spine","volume":"27","author":"Sebaaly A","year":"2018","unstructured":"Sebaaly A, Grobost P, Mallam L, Roussouly P. Description of the sagittal alignment of the degenerative human spine. Eur Spine J. 2018;27(2):489\u2013496."},{"issue":"1","key":"b17","series-title":"J Orthop Traumatol","first-page":"2","article-title":"Validation of Roussouly classification in predicting the occurrence of adjacent segment disease after short-level lumbar fusion surgery","volume":"25","author":"Wang M","year":"2024","unstructured":"Wang M, Wang X, Wang H,  Validation of Roussouly classification in predicting the occurrence of adjacent segment disease after short-level lumbar fusion surgery. J Orthop Traumatol. 2024;25(1):2."},{"issue":"4","key":"b18","series-title":"Spine (Phila Pa 1976)","first-page":"270","article-title":"Impact of adult scoliosis on Roussouly sagittal shape classification","volume":"44","author":"Pizones J","year":"2019","unstructured":"Pizones J, Martin MB, Perez-Grueso FJS,  Impact of adult scoliosis on Roussouly sagittal shape classification. Spine (Phila Pa 1976).2019;44(4):270\u2013279."},{"issue":"10","key":"b19","series-title":"Spine (Phila Pa 1976)","first-page":"884","article-title":"Does a long-fusion \"T3-sacrum\" portend a worse outcome than a short-fusion \"T10-sacrum\" in primary surgery for adult scoliosis?","volume":"37","author":"O\u02bcShaughnessy BA","year":"2012","unstructured":"O\u02bcShaughnessy BA, Bridwell KH, Lenke LG,  Does a long-fusion \"T3-sacrum\" portend a worse outcome than a short-fusion \"T10-sacrum\" in primary surgery for adult scoliosis? Spine (Phila Pa 1976). 2012;37(10):884-890."},{"issue":"6","key":"b20","series-title":"Neurosurgery","first-page":"899","article-title":"Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle","volume":"72","author":"Bridwell KH","year":"2013","unstructured":"Bridwell KH, Lenke LG, Cho SK,  Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle. Neurosurgery. 2013;72(6):899\u2013906."},{"issue":"23","key":"b21","series-title":"Spine (Phila Pa 1976)","first-page":"E1469","article-title":"Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity","volume":"38","author":"Maruo K","year":"2013","unstructured":"Maruo K, Ha Y, Inoue S,  Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity. Spine (Phila Pa 1976).2013;38(23):E1469\u2013E1476."},{"issue":"9","key":"b22","series-title":"Spine J","first-page":"S126","article-title":"258. The pelvic tilt response to ASD correction depends on PI, age and alignment","volume":"19","author":"Protopsaltis T","year":"2019","unstructured":"Protopsaltis T, Ayres E, Soroceanu A,  258. The pelvic tilt response to ASD correction depends on PI, age and alignment. Spine J. 2019;19(9):S126."},{"issue":"9","key":"b23","series-title":"Spine (Phila Pa 1976)","first-page":"645","article-title":"Pelvic nonresponse following treatment of adult spinal deformity: influence of realignment strategies on occurrence","volume":"48","author":"Passias PG","year":"2023","unstructured":"Passias PG, Pierce KE, Williamson TK,  Pelvic nonresponse following treatment of adult spinal deformity: influence of realignment strategies on occurrence. Spine (Phila Pa 1976).2023;48(9):645\u2013652."},{"issue":"3","key":"b24","series-title":"Int J Spine Surg","first-page":"530","article-title":"Improved surgical correction relative to patient-specific ideal spinopelvic alignment reduces pelvic nonresponse for severely malaligned adult spinal deformity patients","volume":"16","author":"Passias PG","year":"2022","unstructured":"Passias PG, Bortz C, Alas H,  Improved surgical correction relative to patient-specific ideal spinopelvic alignment reduces pelvic nonresponse for severely malaligned adult spinal deformity patients. Int J Spine Surg. 2022;16(3):530\u2013539."},{"issue":"18","key":"b25","first-page":"1258","article-title":"Does matching Roussouly spinal shape and improvement in SRS-Schwab modifier contribute to improved patient-reported outcomes? Spine (Phila Pa 1976)","volume":"46","author":"Passias PG","year":"2021","unstructured":"Passias PG, Pierce KE, Raman T,  Does matching Roussouly spinal shape and improvement in SRS-Schwab modifier contribute to improved patient-reported outcomes? Spine (Phila Pa 1976). 2021;46(18):1258\u20131263."},{"issue":"6","key":"b26","series-title":"Spine (Phila Pa 1976)","first-page":"455","article-title":"Comparing and contrasting the clinical utility of sagittal spine alignment classification frameworks: Roussouly versus SRS-Schwab","volume":"47","author":"Passias PG","year":"2022","unstructured":"Passias PG, Bortz C, Pierce KE,  Comparing and contrasting the clinical utility of sagittal spine alignment classification frameworks: Roussouly versus SRS-Schwab. Spine (Phila Pa 1976).2022;47(6):455\u2013462."},{"issue":"3","key":"b27","series-title":"Quant Imaging Med Surg","first-page":"1375","article-title":"The change of Roussouly classification after posterior lumbar fusion surgery","volume":"13","author":"Tu Z","year":"2023","unstructured":"Tu Z, Xie F, Huang P,  The change of Roussouly classification after posterior lumbar fusion surgery. Quant Imaging Med Surg. 2023;13(3):1375\u20131383."},{"issue":"S2","key":"b28","series-title":"Int J Spine Surg","first-page":"S4","article-title":"Defining clinically relevant proximal junctional kyphosis","volume":"17","author":"Hills J","year":"2023","unstructured":"Hills J, Kelly MP. Defining clinically relevant proximal junctional kyphosis. Int J Spine Surg. 2023;17(S2):S4\u2013S8."},{"issue":"2","key":"b29","series-title":"Eur Spine J","first-page":"741","article-title":"The predictive power of the Roussouly classification on mechanical complications after surgery for adult spinal deformity: systematic review and meta-analysis","volume":"34","author":"Aoun M","year":"2025","unstructured":"Aoun M, Daher M, Daniels AH, Kreichati G, Kharrat K, Sebaaly A. The predictive power of the Roussouly classification on mechanical complications after surgery for adult spinal deformity: systematic review and meta-analysis. Eur Spine J. 2025;34(2):741\u2013747."},{"issue":"2","key":"b30","series-title":"J Orthop Sci","first-page":"302","article-title":"Pelvic incidence is a risk factor for lower instrumented vertebra failure in adult spinal deformity patients who underwent corrective fusion terminating at the L5 vertebra","volume":"28","author":"Ushio S","year":"2023","unstructured":"Ushio S, Yoshii T, Otani K,  Pelvic incidence is a risk factor for lower instrumented vertebra failure in adult spinal deformity patients who underwent corrective fusion terminating at the L5 vertebra. J Orthop Sci. 2023;28(2):302\u2013307."},{"issue":"1","key":"b31","series-title":"Eur Spine J","first-page":"80","article-title":"Sagittal morphology and equilibrium of pelvis and spine","volume":"11","author":"Vaz G","year":"2002","unstructured":"Vaz G, Roussouly P, Berthonnaud E, Dimnet J. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J. 2002;11(1):80\u201387."},{"issue":"25","key":"b32","series-title":"Spine (Phila Pa 1976)","first-page":"E959","article-title":"Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position","volume":"31","author":"Schwab F","year":"2006","unstructured":"Schwab F, Lafage V, Boyce R, Skalli W, Farcy JP. Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine (Phila Pa 1976).2006;31(25):E959\u2013E967."},{"key":"b33","series-title":"World Neurosurg","first-page":"e565","article-title":"Association between Roussouly classification and characteristics of lumbar degeneration","volume":"163","author":"Zhao B","year":"2022","unstructured":"Zhao B, Huang W, Lu X,  Association between Roussouly classification and characteristics of lumbar degeneration. World Neurosurg. 2022;163:e565\u2013e572."},{"key":"b34","series-title":"Spine (Phila Pa 1976)","first-page":"2940","article-title":"Pynsent PB. The Oswestry Disability Index","volume":"25","author":"Fairbank JC","year":"2000","unstructured":"Fairbank JC. Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976).2000;25:2940\u20132952."},{"issue":"10193","key":"b1","series-title":"Lancet (London, England)","first-page":"160","article-title":"Adult spinal deformity","volume":"394","author":"Diebo BG","year":"2019","unstructured":"Diebo BG, Shah NV, Boachie-Adjei O,  Adult spinal deformity. Lancet (London, England). 2019;394(10193):160\u2013172."},{"issue":"1","key":"b2","series-title":"Global Spine J","first-page":"51","article-title":"Current status of adult spinal deformity","volume":"3","author":"Youssef JA","year":"2013","unstructured":"Youssef JA, Orndorff DO, Patty CA,  Current status of adult spinal deformity. Global Spine J. 2013;3(1):51\u201362."},{"issue":"3","key":"b3","series-title":"Spine (Phila Pa 1976)","first-page":"346","article-title":"Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position","volume":"30","author":"Roussouly P","year":"2005","unstructured":"Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976).2005;30(3):346\u2013353."},{"issue":"8","key":"b4","series-title":"Eur Spine J","first-page":"2002","article-title":"Classification of normal sagittal spine alignment: refounding the Roussouly classification","volume":"27","author":"Laouissat F","year":"2018","unstructured":"Laouissat F, Sebaaly A, Gehrchen M, Roussouly P. Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J. 2018;27(8):2002\u20132011."},{"issue":"4","key":"b5","series-title":"Eur Spine J","first-page":"904","article-title":"Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study","volume":"29","author":"Sebaaly A","year":"2020","unstructured":"Sebaaly A, Gehrchen M, Silvestre C,  Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study. Eur Spine J. 2020;29(4):904\u2013913."},{"issue":"1","key":"b6","series-title":"Eur Spine J","first-page":"54","article-title":"Restoring the ideal Roussouly sagittal profile in adult scoliosis surgery decreases the risk of mechanical complications","volume":"29","author":"Pizones J","year":"2020","unstructured":"Pizones J, Moreno-Manzanaro L, S\u00e1nchez P\u00e9rez-Grueso FJ,  Restoring the ideal Roussouly sagittal profile in adult scoliosis surgery decreases the risk of mechanical complications. Eur Spine J. 2020;29(1):54\u201362."},{"issue":"11","key":"b7","series-title":"Bone Joint J","first-page":"1342","article-title":"Frail patients require instrumentation of a more proximal vertebra for a successful outcome after surgery for adult spine deformity","volume":"106-B","author":"Onafowokan OO","year":"2024","unstructured":"Onafowokan OO, Jankowski PP, Das A,  Frail patients require instrumentation of a more proximal vertebra for a successful outcome after surgery for adult spine deformity. Bone Joint J. 2024;106-B(11):1342\u20131347."},{"issue":"20","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"1463","article-title":"Performance of the modified Adult Spinal Deformity Frailty Index in preoperative risk assessment","volume":"47","author":"Passias PG","year":"2022","unstructured":"Passias PG, Moattari K, Pierce KE,  Performance of the modified Adult Spinal Deformity Frailty Index in preoperative risk assessment. Spine (Phila Pa 1976).2022;47(20):1463\u20131469."},{"issue":"1","key":"b9","series-title":"Acta Neurochir (Wien)","first-page":"448","article-title":"Treatment of adult spine deformity: a retrospective comparison of bone morphogenic protein and bone marrow aspirate with bone allograft","volume":"166","author":"Onafowokan OO","year":"2024","unstructured":"Onafowokan OO, Uzosike AC, Sharma A,  Treatment of adult spine deformity: a retrospective comparison of bone morphogenic protein and bone marrow aspirate with bone allograft. Acta Neurochir (Wien). 2024;166(1):448."},{"issue":"1","key":"b10","series-title":"Asian Spine J","first-page":"35","article-title":"Minimum clinically important differences in Oswestry Disability Index domains and their impact on adult spinal deformity surgery","volume":"13","author":"Yoshida G","year":"2019","unstructured":"Yoshida G, Hasegawa T, Yamato Y,  Minimum clinically important differences in Oswestry Disability Index domains and their impact on adult spinal deformity surgery. Asian Spine J. 2019;13(1):35\u201344."},{"issue":"6","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"377","article-title":"The minimum clinically important difference in SRS-22R total score, appearance, activity and pain domains after surgical treatment of adult spinal deformity","volume":"40","author":"Crawford CH III","year":"2015","unstructured":"Crawford CH III, Glassman SD, Bridwell KH, Berven SH, Carreon LY. The minimum clinically important difference in SRS-22R total score, appearance, activity and pain domains after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976).2015;40(6):377\u2013381."},{"issue":"7","key":"b12","series-title":"Global Spine J","first-page":"1978","article-title":"The influence of multilevel spinal deformity surgery on the EuroQol 5 Dimensions\u2019 (EQ-5D) Questionnaire and residential status in the elderly: a prospective, observational, multicenter study","volume":"14","author":"Jentzsch T","year":"2024","unstructured":"Jentzsch T, Lewis SJ, Oitment C,  The influence of multilevel spinal deformity surgery on the EuroQol 5 Dimensions\u2019 (EQ-5D) Questionnaire and residential status in the elderly: a prospective, observational, multicenter study. Global Spine J. 2024;14(7):1978\u20131989."},{"issue":"3","key":"b13","series-title":"Article in French. 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":"b14","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."},{"key":"b15","article-title":"Spinal Deformity Study Group Radiographic Measurement Manual","author":"O\u2019Brien MF","year":"2008","unstructured":"O\u2019Brien MF, Kuklo TR, Blanke KM, Lenke LG. Spinal Deformity Study Group Radiographic Measurement Manual. Medtronic Sofamor Danek USA, Inc;2008.Accessed May 22, 2025.https:\/\/www.srs.org\/Files\/Research\/Manuals-and-Publications\/sdsg-radiographic-measuremnt-manual.pdf"},{"issue":"2","key":"b16","series-title":"Eur Spine J","first-page":"489","article-title":"Description of the sagittal alignment of the degenerative human spine","volume":"27","author":"Sebaaly A","year":"2018","unstructured":"Sebaaly A, Grobost P, Mallam L, Roussouly P. Description of the sagittal alignment of the degenerative human spine. Eur Spine J. 2018;27(2):489\u2013496."},{"issue":"1","key":"b17","series-title":"J Orthop Traumatol","first-page":"2","article-title":"Validation of Roussouly classification in predicting the occurrence of adjacent segment disease after short-level lumbar fusion surgery","volume":"25","author":"Wang M","year":"2024","unstructured":"Wang M, Wang X, Wang H,  Validation of Roussouly classification in predicting the occurrence of adjacent segment disease after short-level lumbar fusion surgery. J Orthop Traumatol. 2024;25(1):2."},{"issue":"4","key":"b18","series-title":"Spine (Phila Pa 1976)","first-page":"270","article-title":"Impact of adult scoliosis on Roussouly sagittal shape classification","volume":"44","author":"Pizones J","year":"2019","unstructured":"Pizones J, Martin MB, Perez-Grueso FJS,  Impact of adult scoliosis on Roussouly sagittal shape classification. Spine (Phila Pa 1976).2019;44(4):270\u2013279."},{"issue":"10","key":"b19","series-title":"Spine (Phila Pa 1976)","first-page":"884","article-title":"Does a long-fusion \"T3-sacrum\" portend a worse outcome than a short-fusion \"T10-sacrum\" in primary surgery for adult scoliosis?","volume":"37","author":"O\u02bcShaughnessy BA","year":"2012","unstructured":"O\u02bcShaughnessy BA, Bridwell KH, Lenke LG,  Does a long-fusion \"T3-sacrum\" portend a worse outcome than a short-fusion \"T10-sacrum\" in primary surgery for adult scoliosis? Spine (Phila Pa 1976). 2012;37(10):884-890."},{"issue":"6","key":"b20","series-title":"Neurosurgery","first-page":"899","article-title":"Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle","volume":"72","author":"Bridwell KH","year":"2013","unstructured":"Bridwell KH, Lenke LG, Cho SK,  Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle. Neurosurgery. 2013;72(6):899\u2013906."},{"issue":"23","key":"b21","series-title":"Spine (Phila Pa 1976)","first-page":"E1469","article-title":"Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity","volume":"38","author":"Maruo K","year":"2013","unstructured":"Maruo K, Ha Y, Inoue S,  Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity. Spine (Phila Pa 1976).2013;38(23):E1469\u2013E1476."},{"issue":"9","key":"b22","series-title":"Spine J","first-page":"S126","article-title":"258. The pelvic tilt response to ASD correction depends on PI, age and alignment","volume":"19","author":"Protopsaltis T","year":"2019","unstructured":"Protopsaltis T, Ayres E, Soroceanu A,  258. The pelvic tilt response to ASD correction depends on PI, age and alignment. Spine J. 2019;19(9):S126."},{"issue":"9","key":"b23","series-title":"Spine (Phila Pa 1976)","first-page":"645","article-title":"Pelvic nonresponse following treatment of adult spinal deformity: influence of realignment strategies on occurrence","volume":"48","author":"Passias PG","year":"2023","unstructured":"Passias PG, Pierce KE, Williamson TK,  Pelvic nonresponse following treatment of adult spinal deformity: influence of realignment strategies on occurrence. Spine (Phila Pa 1976).2023;48(9):645\u2013652."},{"issue":"3","key":"b24","series-title":"Int J Spine Surg","first-page":"530","article-title":"Improved surgical correction relative to patient-specific ideal spinopelvic alignment reduces pelvic nonresponse for severely malaligned adult spinal deformity patients","volume":"16","author":"Passias PG","year":"2022","unstructured":"Passias PG, Bortz C, Alas H,  Improved surgical correction relative to patient-specific ideal spinopelvic alignment reduces pelvic nonresponse for severely malaligned adult spinal deformity patients. Int J Spine Surg. 2022;16(3):530\u2013539."},{"issue":"18","key":"b25","first-page":"1258","article-title":"Does matching Roussouly spinal shape and improvement in SRS-Schwab modifier contribute to improved patient-reported outcomes? Spine (Phila Pa 1976)","volume":"46","author":"Passias PG","year":"2021","unstructured":"Passias PG, Pierce KE, Raman T,  Does matching Roussouly spinal shape and improvement in SRS-Schwab modifier contribute to improved patient-reported outcomes? Spine (Phila Pa 1976). 2021;46(18):1258\u20131263."},{"issue":"6","key":"b26","series-title":"Spine (Phila Pa 1976)","first-page":"455","article-title":"Comparing and contrasting the clinical utility of sagittal spine alignment classification frameworks: Roussouly versus SRS-Schwab","volume":"47","author":"Passias PG","year":"2022","unstructured":"Passias PG, Bortz C, Pierce KE,  Comparing and contrasting the clinical utility of sagittal spine alignment classification frameworks: Roussouly versus SRS-Schwab. Spine (Phila Pa 1976).2022;47(6):455\u2013462."},{"issue":"3","key":"b27","series-title":"Quant Imaging Med Surg","first-page":"1375","article-title":"The change of Roussouly classification after posterior lumbar fusion surgery","volume":"13","author":"Tu Z","year":"2023","unstructured":"Tu Z, Xie F, Huang P,  The change of Roussouly classification after posterior lumbar fusion surgery. Quant Imaging Med Surg. 2023;13(3):1375\u20131383."},{"issue":"S2","key":"b28","series-title":"Int J Spine Surg","first-page":"S4","article-title":"Defining clinically relevant proximal junctional kyphosis","volume":"17","author":"Hills J","year":"2023","unstructured":"Hills J, Kelly MP. Defining clinically relevant proximal junctional kyphosis. Int J Spine Surg. 2023;17(S2):S4\u2013S8."},{"issue":"2","key":"b29","series-title":"Eur Spine J","first-page":"741","article-title":"The predictive power of the Roussouly classification on mechanical complications after surgery for adult spinal deformity: systematic review and meta-analysis","volume":"34","author":"Aoun M","year":"2025","unstructured":"Aoun M, Daher M, Daniels AH, Kreichati G, Kharrat K, Sebaaly A. The predictive power of the Roussouly classification on mechanical complications after surgery for adult spinal deformity: systematic review and meta-analysis. Eur Spine J. 2025;34(2):741\u2013747."},{"issue":"2","key":"b30","series-title":"J Orthop Sci","first-page":"302","article-title":"Pelvic incidence is a risk factor for lower instrumented vertebra failure in adult spinal deformity patients who underwent corrective fusion terminating at the L5 vertebra","volume":"28","author":"Ushio S","year":"2023","unstructured":"Ushio S, Yoshii T, Otani K,  Pelvic incidence is a risk factor for lower instrumented vertebra failure in adult spinal deformity patients who underwent corrective fusion terminating at the L5 vertebra. J Orthop Sci. 2023;28(2):302\u2013307."},{"issue":"1","key":"b31","series-title":"Eur Spine J","first-page":"80","article-title":"Sagittal morphology and equilibrium of pelvis and spine","volume":"11","author":"Vaz G","year":"2002","unstructured":"Vaz G, Roussouly P, Berthonnaud E, Dimnet J. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J. 2002;11(1):80\u201387."},{"issue":"25","key":"b32","series-title":"Spine (Phila Pa 1976)","first-page":"E959","article-title":"Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position","volume":"31","author":"Schwab F","year":"2006","unstructured":"Schwab F, Lafage V, Boyce R, Skalli W, Farcy JP. Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine (Phila Pa 1976).2006;31(25):E959\u2013E967."},{"key":"b33","series-title":"World Neurosurg","first-page":"e565","article-title":"Association between Roussouly classification and characteristics of lumbar degeneration","volume":"163","author":"Zhao B","year":"2022","unstructured":"Zhao B, Huang W, Lu X,  Association between Roussouly classification and characteristics of lumbar degeneration. World Neurosurg. 2022;163:e565\u2013e572."},{"key":"b34","series-title":"Spine (Phila Pa 1976)","first-page":"2940","article-title":"Pynsent PB. The Oswestry Disability Index","volume":"25","author":"Fairbank JC","year":"2000","unstructured":"Fairbank JC. Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976).2000;25:2940\u20132952."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/43\/6\/article-p609.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/43\/6\/article-p609.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/43\/6\/article-p609.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:45:24Z","timestamp":1772804724000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/43\/6\/article-p609.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":68,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2025.4.spine241520","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2025,8,29]]}}}