• Ki Young Lee, Jung-Hee Lee, and Sang-Kyu Im.
• Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, Korea.
• Spine. 2021 Dec 1; 46 (23): E1246E1253E1246-E1253.

Study DesignA retrospective study.ObjectivesThe purpose of this study was to evaluate optimal and ideal target values of the spine balance correction in elderly patients with adult spinal deformity who were over the age of 60 years.Summary Of Background DataThe target values of the Scoliosis Research Society -Schwab classification to obtain satisfactory alignment and favorable outcomes are used in many spinal reconstruction surgeries. However, uniformly applying the Scoliosis Research Society-Schwab classification to all elderly patients aged 60 years or older showing sagittal malalignment may lead to several inconsistencies.MethodsThis study included 121 patients (average age 70.5 yr and a minimum 2-yr follow-up) with adult spinal deformity who underwent long-segment fusion from T10 to sacrum. We used Pearson's correlation coefficient to analyze the relationship between clinical and radiographic parameters, and multilinear regression analysis and multivariate logistic regression model (backward elimination method) were conducted using the correlation factors of postoperative (Post) and last follow-up (Last) sagittal vertical axis to find the risk factors of Post sagittal imbalance.ResultsLogistic regression analysis with the correlation factors of Post and Last sagittal vertical axis led to risk factors of Post sagittal imbalance, and after confirming the significance of each path, it was confirmed that the effects of pelvic incidence (PI)- lumbar lordosis (LL) and Post pelvic tilt ratio (PTr) were valid (P < 0.05). After using ROC curve, target value of PI-LL was 1.33, and that of PTr was 25.95%.ConclusionThrough our study, the risk factors of Post sagittal imbalance were the Post value of PI-LL and that of PTr, and target value of PI-LL was <1.33 and that of PTr was <25.95%. These target values can be effective guidelines for spine surgeons who perform spine reconstruction surgeries for elderly patients with a pure sagittal imbalance based on Schwab's formula.Level of Evidence: 4.Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

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