Evidence map›Paper›PMID 42472392›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

How changes in segmental lordosis impact L1-pelvic-angle after adult spinal deformity surgery: Which lumbar levels matter most?

Harsh Jain, Advith Sarikonda, Tyler Zeoli, Omar Zakieh, Anthony Bishay, Jeremia Williams, Austin Montgomery, Walter Navid, Alan Tang, Keyan Peterson and 10 more

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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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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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No citing paper in PubMed yet.

4 · The record

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5 · Who and what money

Authors and funding

20 authors.

Harsh JainVanderbilt University Medical Center, Nashville, USA. harsh.jain@vumc.org.
Advith SarikondaVanderbilt University Medical Center, Nashville, USA.
Tyler ZeoliVanderbilt University Medical Center, Nashville, USA.
Omar ZakiehVanderbilt University Medical Center, Nashville, USA.
Anthony BishayVanderbilt University School of Medine, Nashville, USA.
Jeremia WilliamsVanderbilt University School of Medine, Nashville, USA.
Austin MontgomeryVanderbilt University Medical Center, Nashville, USA.
Walter NavidVanderbilt University Medical Center, Nashville, USA.
Alan TangVanderbilt University Medical Center, Nashville, USA.
Keyan PetersonVanderbilt University Medical Center, Nashville, USA.
Iyan YounusVanderbilt University Medical Center, Nashville, USA.
Ranbir AhluwaliaVanderbilt University Medical Center, Nashville, USA.
Soren JonzzonVanderbilt University Medical Center, Nashville, USA.
Hani ChanbourVanderbilt University Medical Center, Nashville, USA.
Hui NianVanderbilt University Medical Center, Nashville, USA.
Adam WegnerOrthoVirginia, Arlington, USA.
Julian Lugo-PicoVanderbilt University Medical Center, Nashville, USA.
Amir AbtahiVanderbilt University Medical Center, Nashville, USA.
Byron StephensVanderbilt University Medical Center, Nashville, USA.
Scott ZuckermanVanderbilt University Medical Center, Nashville, USA. scott.zuckerman@vumc.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAchieving target L1-pelvic-angle (L1PA) is heavily influenced by segmental lordosis changes during adult spinal deformity (ASD) surgery. Understanding the effect of changing each lordotic segmental level on L1PA will aid in preoperative planning and intraoperative alignment assessment in ASD. In patients undergoing ASD surgery, we aimed to evaluate the impact of segmental lordosis changes on postoperative L1PA.

methodsA retrospective cohort study (2009-24) was performed for ASD surgery patients. Inclusion criteria were: ≥5-level fusion and sagittal/coronal deformity. Primary exposure variable was change in segmental lordosis at each lumbar level. Primary outcome was the change in L1PA. Multivariable regression controlling for preoperative and change in segmental lordosis at each level was performed.

resultsOf 180 patients (mean age:59 ± 19 years, 32% males), mean preoperative/postoperative L1PA were 14 ± 11° and 12 ± 9°, respectively. L1/2: Mean change in lordosis was 7 ± 6°. For a 10° increase in L1/2 lordosis, the L1PA increased by 0.33° (β = -0.03, p = 0.684). L2/3: Mean change in lordosis was 8 ± 8°. For a 10° increase in L2/3 lordosis, the L1PA decreased by 0.01° (β = 0.00, p = 0.991). L3/4: Mean change in lordosis was 9 ± 8°. For a 10° increase in L3/4 lordosis, the L1PA decreased by 1.05° (β = 0.10, p = 0.086). L4/5: Mean change in lordosis was 9 ± 8°. For a 10° increase in L4/5 lordosis, the L1PA decreased by 1.78° (β = 0.18, p = 0.001). L5/S1: Mean change in lordosis was 11 ± 12°. For a 10° increase in L5/S1 lordosis, the L1PA decreased by 1.41° (β = 0.14, p = 0.002).

conclusionChanges in segmental lordosis at the L4/5 level were associated with greatest decrease in L1PA following ASD surgery, followed by L5/S1 and L3/4. Changes at L5/S1 influenced the L1PA slightly less than L4/5. These findings suggest that focusing on adding lordosis at the L4/5 and L5/S1 level will result in the greatest improvement in L1PA.

Indexed as

L1-Pelvic angleLumbar lordosisSagittal alignmentSegmental lordosis

Identifiers

PMID42472392

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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.