Evidence map›Paper›PMID 39443371›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2024

Defining modern iatrogenic flatback syndrome: examination of segmental lordosis in short lumbar fusion patients undergoing thoracolumbar deformity correction.

Bassel G Diebo, Manjot Singh, Mariah Balmaceno-Criss, Mohammad Daher, Lawrence G Lenke, Christopher P Ames, Douglas C Burton, Stephen M Lewis, Eric O Klineberg, Renaud Lafage and 22 more

Abstract read
PubMed Publisher
In one paragraph

Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Successful execution of preoperative lumbar alignment planning: reliability of the L5-S1 anterior lumbar interbody fusion (ALIF).European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
    Article
  2. Article
  3. Redefining physiological whole-body alignment according to pelvic incidence: normative values and prediction models.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
    Article
  4. Review
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

32 authors.

Bassel G DieboDepartment of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA.
Manjot SinghDepartment of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA.
Mariah Balmaceno-CrissDepartment of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA.
Mohammad DaherDepartment of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA.
Lawrence G LenkeDepartment of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.
Christopher P AmesDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Douglas C BurtonDepartment of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA.
Stephen M LewisDepartment of Orthopedics, University of Toronto, Toronto, Canada.
Eric O KlinebergDepartment of Orthopedic Surgery, University of Texas McGovern Medical School, Houston, TX, USA.
Renaud LafageDepartment of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA.
Robert K EastlackDivision of Orthopaedic Surgery, Scripps Clinic, La Jolla, San Diego, CA, USA.
Munish C GuptaDepartment of Orthopedic Surgery, Washington University, St. Louis, MO, USA.
Gregory M MundisDivision of Orthopaedic Surgery, Scripps Clinic, La Jolla, San Diego, CA, USA.
Jeffrey L GumNorton Leatherman Spine Center, Louisville, KY, USA.
Kojo D HamiltonDepartment of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Richard HostinSouthwest Scoliosis and Spine Institute, Plano, TX, USA.
Peter G PassiasDepartment of Orthopedics, New York University Langone Orthopedic Hospital, New York, NY, USA.
Themistocles S ProtopsaltisDepartment of Orthopedics, New York University Langone Orthopedic Hospital, New York, NY, USA.
Khaled M KebaishDepartment of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Han Jo KimDepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Christopher I ShaffreyDepartment of Neurosurgery, Duke Spine Division, Durham, NC, USA.
Breton G LineDepartment of Spine Surgery, Denver International Spine Center, Denver, CO, USA.
Praveen V MummaneniDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Pierce D NunleySpine Institute of Louisiana, Shreveport, LA, USA.
Justin S SmithDepartment of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA.
Jay TurnerBarrow Brain and Spine, Phoenix, AZ, USA.
Frank J SchwabDepartment of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA.
Juan S UribeBarrow Brain and Spine, Phoenix, AZ, USA.
Shay BessDepartment of Spine Surgery, Denver International Spine Center, Denver, CO, USA.
Virginie LafageDepartment of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA.
Alan H DanielsDepartment of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA. alandanielsmd@gmail.com.ORCID 0000-0001-9597-4139
International Spine Study Group (ISSG)

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeUnderstanding the mechanism and extent of preoperative deformity in revision procedures may provide data to prevent future failures in lumbar spinal fusion patients.

methodsASD patients without prior spine surgery (PRIMARY) and with prior short (SHORT) and long (LONG) fusions were included. SHORT patients were stratified into modes of failure: implant, junctional, malalignment, and neurologic. Baseline demographics, spinopelvic alignment, offset from alignment targets, and patient-reported outcome measures (PROMs) were compared across PRIMARY and SHORT cohorts. Segmental lordosis analyses, assessing under-, match, or over-correction to segmental and global lordosis targets, were performed by SRS-Schwab coronal curve type and construct length.

resultsAmong 785 patients, 430 (55%) were PRIMARY and 355 (45%) were revisions. Revision procedures included 181 (23%) LONG and 174 (22%) SHORT corrections. SHORT modes of failure included 27% implant, 40% junctional, 73% malalignment, and/or 28% neurologic. SHORT patients were older, frailer, and had worse baseline deformity (PT, PI-LL, SVA) and PROMs (NRS, ODI, VR-12, SRS-22) compared to primary patients (p < 0.001). Segmental lordosis analysis identified 93%, 88%, and 62% undercorrected patients at LL, L1-L4, and L4-S1, respectively. SHORT patients more often underwent 3-column osteotomies (30% vs. 12%, p < 0.001) and had higher ISSG Surgical Invasiveness Score (87.8 vs. 78.3, p = 0.006).

conclusionsNearly half of adult spinal deformity surgeries were revision fusions. Revision short fusions were associated with sagittal malalignment, often due to undercorrection of segmental lordosis goals, and frequently required more invasive procedures. Further initiatives to optimize alignment in lumbar fusions are needed to avoid costly and invasive deformity corrections. LEVEL OF EVIDENCE: IV: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Indexed as

LordosisLumbar VertebraeSpinal FusionThoracic VertebraeAdultAgedFemaleHumansIatrogenic DiseaseMaleMiddle AgedReoperationAdult spinal deformityMode of failureRevisionSagittal malalignmentSegmental lordosis

Identifiers

PMID39443371

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.