• Mitsuhiro Nishizawa, Junichi Ohya, Yuki Ishikawa, Hiroyasu Kodama, Yuki Onishi, Francisco Gomez Alvarado, Junichi Kunogi, and Naohiro Kawamura.
• Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. nmitu2438@gmail.com.
• Eur Spine J. 2024 Dec 1; 33 (12): 459145974591-4597.

PurposeKyphosis in the lower lumbar spine (L4-S1) significantly affects sagittal alignment. However, the characteristics of the spinopelvic parameters and compensatory mechanisms in patients with lower lumbar degenerative kyphosis (LLDK) have not been described in detail. The objective of this retrospective study was to analyze the morphological characteristics in patients with sagittal imbalance due to LLDK.MethodsIn this retrospective study, we reviewed the clinical records of consecutive patients who underwent corrective surgery for adult spinal deformity (ASD) at a single institution. We defined LLDK as (i) kyphotic deformity in lower lumbar spine (L4-S1) or (ii) inappropriate distribution of lordosis (lordosis distribution index < 40%) in the lower lumbar spine. Global spine parameters of ASD patients and MRI findings were compared between those with LLDK (LLDK group) and without LLDK (control group).ResultsA total of 95 patients were enrolled in this study, of which the LLDK group included 14 patients (14.7%). Compared to the control, LLDK presented significantly higher pelvic incidence (62.1° vs 52.6°) and pelvic tilt (40.0° vs 33.4°), larger lordosis at the thoracolumbar junction (12.0° vs -19.6°), and smaller thoracic kyphosis (9.3° vs 26.0°). In LLDK, there was significantly less disc degeneration at L2/3 and L3/4.ConclusionLLDK patients had high pelvic incidence, large pelvic tilt, and a long compensatory curve at the thoracolumbar junction and thoracic spine region.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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