{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T22:53:31Z","timestamp":1768949611912,"version":"3.49.0"},"reference-count":29,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:00:00Z","timestamp":1768694400000},"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 adult spinal deformity (ASD) surgery, appropriate rod length determination is crucial, as excessive cranial rod length can lead to skin problems, especially in thin elderly patients if proximal junctional kyphosis (PJK) develops. In adolescent idiopathic scoliosis (AIS), correction is primarily performed in the coronal plane, and rod length changes are relatively predictable. Moreover, PJK is uncommon in AIS, making excess rod length rarely a clinical concern. In contrast, ASD correction involves more complex three-dimensional realignment, including restoration of lumbar lordosis (LL), which makes it challenging to predict postoperative changes in rod trace length (RTL). Furthermore, because PJK occurs more frequently in ASD surgery, appropriate rod length selection becomes clinically important. This study aimed to quantitatively evaluate changes in RTL before and after posterior correction. Method: Thirty patients with ASD who underwent staged lateral lumbar interbody fusion (LLIF) followed by posterior corrective fusion from T9 to the pelvis were retrospectively analyzed. RTL before posterior correction (Pre-RTL) was estimated from the planned screw insertional point on axial CT after LLIF, and postoperative RTL (Post-RTL) was measured from screw head centers on post-operative CT. LL and Cobb angle were assessed before and after posterior correction. Correlations between RTL change and alignment change were evaluated. Results: Postoperative RTL was shortened in all patients, with an average reduction of approximately 16\u201317 mm. RTL shortening demonstrated significant correlations with LL correction (R = 0.51, p = 0.003) and Cobb angle correction (R = 0.70, p = 0.00001). Greater shortening of RTL was observed on the convex side in patients with preoperative Cobb angle \u2265 10\u00b0 (p = 0.04). Conclusions: Greater coronal deformity, particularly on the convex side, was associated with increased RTL shortening. These findings suggest that routine preparation of excessively long rods may be unnecessary. Consideration of anticipated RTL shortening may help avoid excessive cranial rod length and potentially reduce the risk of skin complications associated with PJK, particularly in thin elderly patients.<\/jats:p>","DOI":"10.3390\/jcm15020778","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T09:24:34Z","timestamp":1768901074000},"page":"778","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["CT-Based Analysis of Rod Trace Length Changes During Posterior Spinal Correction in Adult Spinal Deformity"],"prefix":"10.3390","volume":"15","author":[{"given":"Takumi","family":"Takeuchi","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi 181-8611, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takafumi","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Keiyu Orthopedic Hospital, 2267-1, Akouda-cho, Tatebayashi 374-0013, Gunma-ken, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaito","family":"Jinnai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi 181-8611, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yosuke","family":"Kawano","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi 181-8611, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazumasa","family":"Konishi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi 181-8611, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahito","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi 181-8611, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitoshi","family":"Kono","sequence":"additional","affiliation":[{"name":"Keiyu Orthopedic Hospital, 2267-1, Akouda-cho, Tatebayashi 374-0013, Gunma-ken, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naobumi","family":"Hosogane","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi 181-8611, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1097\/01.brs.0000179086.30449.96","article-title":"The impact of positive sagittal balance in adult spinal deformity","volume":"30","author":"Glassman","year":"2005","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1007\/s00586-012-2207-1","article-title":"Influence of lumbar kyphosis and back muscle strength on the symptoms of gastroesophageal reflux disease in middle-aged and elderly people","volume":"21","author":"Imagama","year":"2012","journal-title":"Eur. Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1007\/s00586-020-06660-9","article-title":"Sagittal imbalance and symptoms of depression in adults: Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study (LOHAS)","volume":"30","author":"Watanabe","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.jos.2020.05.006","article-title":"The complication trends of adult spinal deformity surgery in Japan\u2014The Japanese Scoliosis Society Morbidity and Mortality survey from 2012 to 2017","volume":"26","author":"Sugawara","year":"2021","journal-title":"J. Orthop. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"426","DOI":"10.22603\/ssrr.2024-0289","article-title":"Morbidity and Mortality of Adult Spinal Deformity Surgery Using the Japanese Orthopedic Association National Registry\/Japanese Society for Spine Surgery and Related Research Database (JOANR\/JSSR-DB)","volume":"9","author":"Takeuchi","year":"2025","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"E60","DOI":"10.1097\/BRS.0b013e3181eeaee2","article-title":"Incidence, risk factors and classification of proximal junctional kyphosis: Surgical outcomes review of adult idiopathic scoliosis","volume":"36","author":"Yagi","year":"2011","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1097\/BRS.0b013e31823e15e2","article-title":"Scoliosis Research Society-Schwab adult spinal deformity classification: A validation study","volume":"37","author":"Schwab","year":"2012","journal-title":"Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E211","DOI":"10.1097\/BRS.0000000000001209","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","year":"2016","journal-title":"Spine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3638","DOI":"10.1007\/s00586-016-4563-8","article-title":"Optimum pelvic incidence minus lumbar lordosis value can be determined by individual pelvic incidence","volume":"25","author":"Inami","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3675","DOI":"10.1007\/s00586-016-4702-2","article-title":"Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects","volume":"25","author":"Hasegawa","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E280","DOI":"10.1097\/BRS.0000000000001883","article-title":"Mismatch Between Proximal Rod Contouring and Proximal Junctional Angle: A Predisposed Risk Factor for Proximal Junctional Kyphosis in Degenerative Scoliosis","volume":"42","author":"Yan","year":"2017","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1007\/s00586-021-06761-z","article-title":"Rod contour and overcorrection are risk factors of proximal junctional kyphosis after adult spinal deformity correction surgery","volume":"30","author":"Ishihara","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"123741","DOI":"10.1016\/j.wneu.2025.123741","article-title":"Impact of Adjacent Muscular Anatomic Preservation on Proximal Junctional Kyphosis and Failure","volume":"195","author":"Patel","year":"2025","journal-title":"World Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E166","DOI":"10.1097\/BSD.0000000000001099","article-title":"Utility of a Computer-assisted Rod Bending System to Avoid Pull-out and Loosening of Percutaneous Pedicle Screws","volume":"34","author":"Ohba","year":"2021","journal-title":"Clin. Spine Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1007\/s43390-023-00698-7","article-title":"Evaluation of intraoperative coronal alignment using a computer-assisted rod bending system (CARBS) without intraoperative radiation exposure in adult spinal deformity surgery: A technical note and preliminary results","volume":"11","author":"Takeuchi","year":"2023","journal-title":"Spine Deform."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Pham, M.H., Hernandez, N.S., and Stone, L.E. (2024). Preoperative Robotics Planning Facilitates Complex Construct Design in Robot-Assisted Minimally Invasive Adult Spinal Deformity Surgery-A Preliminary Experience. J. Clin. Med., 13.","DOI":"10.3390\/jcm13071829"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"20","DOI":"10.14245\/ns.2347138.569","article-title":"Spinal Robotics in Adult Spinal Deformity Surgery: A Systematic Review","volume":"21","author":"Khalifeh","year":"2024","journal-title":"Neurospine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy-to-use software \u2018EZR\u2019 for medical statistics","volume":"48","author":"Kanda","year":"2013","journal-title":"Bone Marrow Transplant."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/BRS.0000000000003249","article-title":"Effective Prevention of Proximal Junctional Failure in Adult Spinal Deformity Surgery Requires a Combination of Surgical Implant Prophylaxis and Avoidance of Sagittal Alignment Overcorrection","volume":"45","author":"Line","year":"2020","journal-title":"Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1227\/NEU.0000000000001240","article-title":"Different Risk Factors of Proximal Junctional Kyphosis and Proximal Junctional Failure Following Long Instrumented Fusion to the Sacrum for Adult Spinal Deformity: Survivorship Analysis of 160 Patients","volume":"80","author":"Park","year":"2017","journal-title":"Neurosurgery"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1097\/BRS.0000000000000627","article-title":"Proximal junctional kyphosis and failure after spinal deformity surgery: A systematic review of the literature as a background to classification development","volume":"39","author":"Lau","year":"2014","journal-title":"Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2376","DOI":"10.1007\/s00586-016-4534-0","article-title":"Incidence and risk factors for proximal junctional kyphosis: A meta-analysis","volume":"25","author":"Liu","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.2106\/JBJS.16.01594","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","year":"2017","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"E80","DOI":"10.1097\/BRS.0000000000003738","article-title":"Predictive Probability of the Global Alignment and Proportion Score for the Development of Mechanical Failure Following Adult Spinal Deformity Surgery in Asian Patients","volume":"46","author":"Yagi","year":"2021","journal-title":"Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3286","DOI":"10.1007\/s00586-022-07386-6","article-title":"GAP score potential in predicting post-operative spinal mechanical complications: A systematic review of the literature","volume":"31","author":"Quarto","year":"2022","journal-title":"Eur. Spine J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1097\/BRS.0000000000004414","article-title":"The T4-L1-Hip Axis: Defining a Normal Sagittal Spinal Alignment","volume":"47","author":"Hills","year":"2022","journal-title":"Spine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e48","DOI":"10.2106\/JBJS.23.00372","article-title":"The T4-L1-Hip Axis: Sagittal Spinal Realignment Targets in Long-Construct Adult Spinal Deformity Surgery: Early Impact","volume":"106","author":"Hills","year":"2024","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1097\/BRS.0000000000002974","article-title":"Artificial Intelligence Based Hierarchical Clustering of Patient Types and Intervention Categories in Adult Spinal Deformity Surgery: Towards a New Classification Scheme that Predicts Quality and Value","volume":"44","author":"Ames","year":"2019","journal-title":"Spine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s43390-023-00805-8","article-title":"Patient-specific rods in adult spinal deformity: A systematic review","volume":"12","author":"Picton","year":"2024","journal-title":"Spine Deform."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/778\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T09:46:11Z","timestamp":1768902371000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,18]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020778"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020778","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,18]]}}}