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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Christopher Ignatius Shaffrey
I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.
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