• Bassel G Diebo, Mariah Balmaceno-Criss, Renaud Lafage, Mohammad Daher, Manjot Singh, D Kojo Hamilton, Justin S Smith, Robert K Eastlack, Richard Fessler, Jeffrey L Gum, Munish C Gupta, Richard Hostin, Khaled M Kebaish, Stephen Lewis, Breton G Line, Pierce D Nunley, Gregory M Mundis, Peter G Passias, Themistocles S Protopsaltis, Jay Turner, Thomas Buell, Justin K Scheer, Jeffery Mullin, Alex Soroceanu, Christopher P Ames, Shay Bess, Christopher I Shaffrey, Lawrence G Lenke, Frank J Schwab, Virginie Lafage, Douglas C Burton, Alan H Daniels, and International Spine Study Group (ISSG).
• Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
• Spine. 2024 Sep 1; 49 (17): 118711941187-1194.

Study DesignRetrospective analysis of prospectively collected data.ObjectiveEvaluate the impact of correcting normative segmental lordosis values on postoperative outcomes.BackgroundRestoring lumbar lordosis magnitude is crucial in adult spinal deformity surgery, but the optimal location and segmental distribution remain unclear.Patients And MethodsPatients were grouped based on offset to normative segmental lordosis values, extracted from recent publications. Matched patients were within 10% of the cohort's mean offset, less than or over 10% were undercorrected and overcorrected. Surgical technique, patient-reported outcome measures, and surgical complications were compared across groups at baseline and two years.ResultsIn total, 510 patients with a mean age of 64.6, a mean Charlson comorbidity index 2.08, and a mean follow-up of 25 months. L4-5 was least likely to be matched (19.1%), while L4-S1 was the most likely (24.3%). More patients were overcorrected at proximal levels (T10-L2; undercorrected, U: 32.2% vs. matched, M: 21.7% vs. overcorrected, O: 46.1%) and undercorrected at distal levels (L4-S1: U: 39.0% vs. M: 24.3% vs. O: 36.8%). Postoperative Oswestry disability index was comparable across correction groups at all spinal levels except at L4-S1 and T10-L2/L4-S1, where overcorrected patients and matched were better than undercorrected (U: 32.1 vs. M: 25.4 vs. O: 26.5, P =0.005; U: 36.2 vs. M: 24.2 vs. O: 26.8, P =0.001; respectively). Patients overcorrected at T10-L2 experienced higher rates of proximal junctional failure (U: 16.0% vs. M: 15.6% vs. O: 32.8%, P <0.001) and had greater posterior inclination of the upper instrumented vertebrae (U: -9.2±9.4° vs. M: -9.6±9.1° vs. O: -12.2±10.0°, P <0.001), whereas undercorrection at these levels led to higher rates of revision for implant failure (U: 14.2% vs. M: 7.3% vs. O: 6.4%, P =0.025).ConclusionsPatients undergoing fusion for adult spinal deformity suffer higher rates of proximal junctional failure with overcorrection and increased rates of implant failure with undercorrection based on normative segmental lordosis.Level Of EvidenceLevel IV.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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