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
Quantifying apex mismatch: a new method to assess spinal and rod apex position in sagittal realignment.
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.
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Abstract
purposeThe objective of this study was to develop and validate a radiographic method to quantify the lumbar apex on calibrated EOS imaging, to compare the anatomical lumbar apex with the rod apex, and to evaluate the impact of pedicle subtraction osteotomy (PSO) on apex location.
methodsThis retrospective cohort included 53 patients (mean age 52 ± 16 years) with a 2-year follow-up who underwent L4 or L5 PSO with sacral fixation using 40°, 65°, or 90° pre-bent rods. Pre- and immediate postoperative EOS images were assessed to measure spinopelvic parameters and spinal lordosis ratio (SLR). Differences between the lumbar and rod apices (ΔApex
resultsThe lumbar apex was on average 6.1 mm (p < 0.001) higher than the rod apex. PSO induced a significant distal migration of the spinal apex of - 28.6 mm (p < 0.001). SLR increased by 92.7% postoperatively (p = 0.05). No significant subgroup differences for both ΔApex were found. Both ΔApex values correlated significantly with preoperative pelvic incidence, pelvic tilt, lumbar lordosis, and SLR. Reproducibility was excellent, with ICC values over 0.87.
conclusionsThe spinal apex lies on average higher than the rod apex, and PSO induces a marked distal migration of the anatomical apex. Combined with SLR, apex analysis refines the description of early postoperative sagittal construct geometry. Clinically meaningful thresholds and associations with longer-term outcomes (mechanical events, radiographic maintenance, and PROMs) remain unknown and require longitudinal validation. STUDY
designRetrospective, single-center observational cohort study, Level of evidence IV.
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