ReviewSpine surgery and related research2026
Sagittal Alignment as a Determinant of Pain and Functional Recovery after Lumbar Surgery: A Systematic Review and Meta-Analysis.
Review in Spine surgery and related research, 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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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.
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Abstract
Background: Sagittal alignment is increasingly recognized as a key determinant of functional recovery after lumbar spine surgery; however, its role in degenerative lumbar disease remains variably reported. While alignment principles are well-established in adult spinal deformity, their applicability to routine degenerative procedures has not been quantitatively synthesized. Methods: A systematic review and meta-analysis of 23 original clinical studies (1,837 adults) was performed. Eligible studies reported postoperative sagittal or spinopelvic parameters-pelvic incidence (PI)-lumbar lordosis (LL) mismatch, sagittal vertical axis, LL, pelvic tilt, or segmental lordosis-and at least one validated clinical outcome (Oswestry Disability Index, visual analogue scale/numerical rating scale, 12-Item Short Form Health Survey, EuroQol Five Dimensions, Core Outcome Measures Index, Japanese Orthopaedic Association). Continuous data were converted to log-odds ratios (ORs) (Chinn method) to enable unified pooling. Random-effects models were applied for disability and pain outcomes. Subgroup analyses assessed fusion versus decompression, PI-LL versus other alignment metrics, and short-term versus long-term follow-up. Results: Eight studies contributed disability outcomes, yielding a pooled OR of 0.33 (95% confidence interval [CI] 0.16-0.65), indicating a 67% reduction in the odds of significant postoperative disability in aligned patients. Five studies contributed pain data, producing a pooled OR of 0.39 (95% CI 0.25-0.61), corresponding to a 61% lower likelihood of persistent postoperative pain. Fusion procedures demonstrated stronger alignment-associated benefit (OR 0.34) compared with decompression alone (OR 0.56). PI-LL-based studies showed consistent predictive value (OR 0.48), and the alignment effect increased with long-term follow-up (>12 months; OR ~0.28). Qualitatively, 87% of studies reported positive alignment-outcome associations. Conclusion: Restoration of physiological sagittal alignment significantly improves postoperative disability and pain across degenerative lumbar procedures. Alignment correction should be considered a central element of surgical planning in both fusion and decompression.
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