Evidence map›Paper›PMID 41555093›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 Society2026

Lower limb compensation in adult spinal deformity: can we identify different patterns?

Marc Khalife, Renaud Lafage, Alan H Daniels, Bassel G Diebo, Jonathan Elysee, Christopher P Ames, Shay R Bess, Douglas C Burton, Robert K Eastlack, Munish C Gupta and 17 more

Abstract readMulticenter Study
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, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing 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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

27 authors.

Marc KhalifeHôpital Européen Georges-Pompidou, Paris, France. marc.khalife@aphp.fr.
Renaud LafageLenox Hill Hospital, New York, USA.
Alan H DanielsUniversity Orthopedics Center, State College, USA.
Bassel G DieboUniversity Orthopedics Center, State College, USA.
Jonathan ElyseeLenox Hill Hospital, New York, USA.
Christopher P AmesUniversity of California, San Francisco, San Francisco, USA.
Shay R BessDenver International Spine Center, Denver, USA.
Douglas C BurtonUniversity of Kansas Medical Center, Kansas City, USA.
Robert K EastlackScripps Clinic, La Jolla, USA.
Munish C GuptaWashington University in St. Louis, St Louis, USA.
Richard A HostinSouthwest Scoliosis Institute, Fort Worth, USA.
Khaled KebaishJohns Hopkins Medicine, Baltimore, USA.
Han Jo KimHospital for Special Surgery, New York, USA.
Eric O KlinebergThe University of Texas Health Science Center at Houston, Houston, USA.
Gregory M MundisScripps Clinic, La Jolla, USA.
David O OkonkwoUniversity of Pittsburgh Medical Center, Pittsburgh, USA.
Olivier GilleHôpital Pellegrin, Bordeaux, France.
Pierre GuiguiHôpital Européen Georges-Pompidou, Paris, France.
Emmanuelle FerreroHôpital Européen Georges-Pompidou, Paris, France.
Wafa SkalliInstitut de Biomécanique Humaine Georges Charpak, Paris, France.
Ayman AssiSaint Joseph University, Beirut, Lebanon.
Claudio VergariInstitut de Biomécanique Humaine Georges Charpak, Paris, France.
Christopher I ShaffreyDuke Medical Center, Durham, USA.
Justin S SmithUniversity of Virginia Medical Center, Charlottesville, USA.
Frank J SchwabLenox Hill Hospital, New York, USA.
Virginie LafageLenox Hill Hospital, New York, USA.
International Spine Study GroupInternational Spine Study Group, Denver, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveLower limbs can play a major compensating role for sagittal malalignment; however, little is known about the different types of compensation. This study aimed to identify different patterns of lower limb compensation and to determine which parameters may affect the recruitment of knee flexion versus hip extension.

methodsThis study included adult spinal deformity (ASD) patients with full-body X-rays in erect position from a multicentric prospective database. All parameters were measured at baseline: demographics, clinical scores and radiographic parameters: pelvic parameters, pelvic incidence-lumbar lordosis (PI-LL) mismatch, T1 pelvic angle (TPA), sacro-femoral angle (SFA), knee flexion angle (KA), ankle dorsi-flexion angle (AA), pelvic shift (PSh), hip and knee osteoarthritis (OA) grade. A K-means cluster analysis was conducted to identify patterns of lower limb compensation based on SFA and KA. The optimal number of clusters was determined using the silhouette score. The different parameters were then compared across clusters.

results871 ASD patients were included, of whom 66.9% were females. Mean age was 62.3±14.6 years, mean BMI was 27.7±5.5 kg.m

conclusionsCluster analysis determined four types of lower limb compensation:"Recliners" using only hip extension, "Squatters" using only knee flexion,"Mixed compensators" and "No compensators". Lower limb compensatory mechanisms recruitment is multifactorial and varies with age, sex, BMI, frailty, knee and hip OA, pelvic incidence, and spinal alignment.

Indexed as

Lower ExtremitySpinal CurvaturesAgedFemaleHumansMaleMiddle AgedProspective StudiesRadiographyAdult spinal deformityCompensatory mechanismLower limbPelvic retroversionSagittal alignmentSagittal malalignment

Identifiers

PMID41555093

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.