{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T23:09:52Z","timestamp":1789168192804,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,4,26]],"date-time":"2021-04-26T00:00:00Z","timestamp":1619395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: In surgical correction of adult spinal deformity (ASD), pelvic incidence (PI)-lumbar lordosis (LL) plays a key role to restore normal sagittal alignment. Recently, it has been found that postoperative lordosis morphology act as an important factor in preventing mechanical complications. However, there have been no studies on the effect of postoperative lordosis morphology on the restoration of sagittal alignment. The primary objective of this study was to evaluate the effect of postoperative lordosis morphology on achievement of optimal sagittal alignment. The secondary objective was to find out which radiographic or morphologic parameter affects sagittal alignment in surgical correction of ASD. Methods: 228 consecutive patients with lumbar degenerative kyphosis who underwent deformity correction and long-segment fixation from T10 to S1 with sacropelvic fixation and follow-up over 2 years were enrolled. Patients were divided according to whether optimal alignment was achieved (balanced group) or not (non-balanced group) at last follow-up. We analyzed the differences of postoperative radiographic parameters and morphologic parameters between two groups. Correlation analysis and stepwise multiple linear regression analysis was performed to predict the effect of PI-LL and morphologic parameters on the sagittal vertical axis (SVA). Results: Of 228 patients, 195 (85.5%) achieved optimal alignment at last follow-up. Two groups significantly differed in postoperative and last follow-up LL (p &lt; 0.001 and p = 0.028, respectively) and postoperative and last follow-up PI-LL (p &lt; 0.001 and p = 0.001, respectively). Morphologic parameters did not significantly differ between the two groups except lower lordosis arc angle (=postoperative sacral slope). In correlation analysis and stepwise multiple linear regression analysis, postoperative PI-LL was the only parameter which had significant association with last follow-up SVA (R2 = 0.134, p &lt; 0.001). Morphologic parameters did not have any association with last follow-up SVA. Conclusions: When planning spine reconstruction surgery, although considering postoperative lordosis morphology is necessary, it is still very important considering proportional lordosis correction based on individual spinopelvic alignment (PI-LL) to achieve optimal sagittal alignment.<\/jats:p>","DOI":"10.3390\/jcm10091867","type":"journal-article","created":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T02:31:43Z","timestamp":1619490703000},"page":"1867","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Optimized Surgical Strategy for Adult Spinal Deformity: Quantitative Lordosis Correction versus Lordosis Morphology"],"prefix":"10.3390","volume":"10","author":[{"given":"Sang-Kyu","family":"Im","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul 02447, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul 02447, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hae Seong","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul 02447, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3337-0983","authenticated-orcid":false,"given":"Dong Uk","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul 02447, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1755-526X","authenticated-orcid":false,"given":"Jung-Hee","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul 02447, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2452","DOI":"10.1097\/00007632-199710150-00025","article-title":"Management of flatback and related kyphotic decompensation syndromes","volume":"22","author":"Farcy","year":"1997","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1097\/00007632-199908150-00013","article-title":"Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance)","volume":"24","author":"Booth","year":"1999","journal-title":"Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1097\/01.brs.0000155425.04536.f7","article-title":"Correlation of radiographic parameters and clinical symptoms in adult scoliosis","volume":"30","author":"Glassman","year":"2005","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2343","DOI":"10.1097\/01.brs.0000238970.67552.f5","article-title":"An analysis of sagittal spinal alignment following long adult lumbar instrumentation and fusion to L5 or S1: Can we predict ideal lumbar lordosis?","volume":"31","author":"Kim","year":"2006","journal-title":"Spine"},{"key":"ref_5","unstructured":"Weinstein, S.L. 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