Impact of cephalad versus caudal lumbar lordosis correction on spinal shape and outcomes of complex deformity spine surgery.
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2025-10
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Abstract
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To compare the impact of lumbar lordosis correction achieved by cephalad versus caudal distribution on radiographic alignment and surgical outcomes among adult spinal deformity (ASD) patients.Methods
Patients who underwent ASD surgery with uppermost instrumented vertebrae (UIV) at or above L1, had preoperative pelvic incidence-lumbar lordosis (PI-LL) > 10°, and had full-body radiographs available were included. Eligible patients were categorized by the focus of lordosis correction: caudal (L4-S1 lordosis between 35 and 45°) and cephalad lordosis-based correction. Patient demographics, preoperative and 2 years spinopelvic alignment and PROMs, and 2 years postoperative surgical complications were compared.Results
In total, 187 (111 caudal and 76 cephalad) patients were included, with mean age of 66.2 years, 78.6% female, and mean frailty score of 3.6. Caudally-restored patients often had an upper thoracic UIV, sacrum/ilium LIV, longer length of fusion, and no lateral lumbar interbody fusion (LLIF) while cephaladly-restored patients had two or more LLIFs above L4 (p < 0.001). Preoperatively, there were no significant differences in radiographic alignment and PROMs between the two groups (p > 0.02). Two years postoperatively, caudally-restored patients had higher L1-S1 LL (p = 0.015) and L4-S1 LL (p < 0.001), and lower PI-LL (p = 0.039) and SVA (p = 0.001). In addition, they had higher SRS-22 activity (p = 0.045), pain (p = 0.047), appearance (p = 0.046), and total (p = 0.016) scores. Finally, they had lower rates of sensory deficits (p < 0.001), motor deficits (p = 0.003), implant failure (p = 0.092), and reoperation (p = 0.020).Conclusion
Caudal lordosis-based correction of spinal deformity patients was associated with higher PROMs and lower rates of neurologic deficits, implant failure, and revisions at 2 years. These findings, while subject to unmeasured confounding, indicate that great caution should be taken when considering cephalad-based correction of ASD.Type
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Diebo, Bassel G, Manjot Singh, Renaud Lafage, Lawrence G Lenke, Stephen M Lewis, Eric O Klineberg, Robert K Eastlack, Gregory M Mundis, et al. (2025). Impact of cephalad versus caudal lumbar lordosis correction on spinal shape and outcomes of complex deformity spine surgery. Spine deformity. 10.1007/s43390-025-01199-5 Retrieved from https://hdl.handle.net/10161/33470.
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Peter Passias
Throughout my medical career, I have remained dedicated to improving my patients' quality of life. As a specialist in adult cervical and spinal deformity surgery, I understand the significant impact our interventions have on individuals suffering from debilitating pain and physical and mental health challenges. Spinal deformity surgery merges the complexities of spinal biomechanics with the needs of an aging population. My research focuses on spinal alignment, biomechanics, innovative surgical techniques, and health economics to ensure value-based care that enhances patient outcomes.
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