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Purpose <p>To evaluate the&#xa0;early postoperative relationship&#xa0;between changes in distal and proximal lumbar lordosis and the L1–pelvic angle in adult spinal deformity surgery.</p> Methods <p>A retrospective review was performed of 120 adult spinal deformity patients undergoing ≥ 6-level thoracolumbar fusion to the pelvis with a UIV at T10 or higher. Spinopelvic parameters were assessed preoperatively and at an early postoperative window (minimum 6&#xa0;months to maximum 1&#xa0;year) to isolate initial alignment mechanics, ideal L1–pelvic angle was defined as (0.5 × pelvic incidence − 19) ± 2, and uni- and multivariable regression analyses examined associations between changes in lumbar lordosis components and L1–pelvic angle, with stratification by postoperative L1–pelvic angle deviation.</p> Results <p>The cohort (mean age 65.7&#xa0;years; 64.1% female) had a mean pelvic incidence of 55.2°. L1–pelvic angle improved from 13.7° preoperatively (deviation 5.1°) to 9.2° postoperatively (deviation 0.1°), with increases in distal and proximal lumbar lordosis of 10.5° and 9.5°, respectively. Change in distal lumbar lordosis strongly correlated with change in L1–pelvic angle (ΔL1PA =  − 0.5ΔDLL + 0.4; <i>r</i> =  − 0.80; <i>p</i> &lt; 0.001). Patients with postoperative L1–pelvic angle increase had greater preoperative thoracic kyphosis, thoracolumbar kyphosis, and L4–S1 lordosis (all <i>p</i> ≤ 0.017).</p> Conclusion <p>Distal lumbar lordosis change is strongly associated with early postoperative L1–pelvic angle alignment in adult spinal deformity, with each 1° of L4–S1 correction producing a 0.5° L1–pelvic angle reduction. This relationship provides a descriptive framework for understanding early lumbopelvic behavior after major reconstruction, while the lack of association with proximal lordosis and ideal preoperative L1–pelvic angle suggests sagittal deformity drivers beyond the distal lumbar spine.</p>

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The relationship between distal lumbar lordosis correction and early postoperative L1–pelvic angle changes in adult spinal deformity surgery

  • 期刊论文

  • 发表日期：

    2026年6月15日

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  • Rafael Garcia de Oliveira,
  • Takeshi Fujii,
  • Iyan Younus,
  • Aiyush Bansal,
  • Kenneth T. Nguyen,
  • Kento Yamanouchi,
  • Philip K. Louie,
  • Rajiv K. Sethi,
  • Jean-Christophe Leveque,
  • Venu M. Nemani

摘要

Purpose

To evaluate the early postoperative relationship between changes in distal and proximal lumbar lordosis and the L1–pelvic angle in adult spinal deformity surgery.

Methods

A retrospective review was performed of 120 adult spinal deformity patients undergoing ≥ 6-level thoracolumbar fusion to the pelvis with a UIV at T10 or higher. Spinopelvic parameters were assessed preoperatively and at an early postoperative window (minimum 6 months to maximum 1 year) to isolate initial alignment mechanics, ideal L1–pelvic angle was defined as (0.5 × pelvic incidence − 19) ± 2, and uni- and multivariable regression analyses examined associations between changes in lumbar lordosis components and L1–pelvic angle, with stratification by postoperative L1–pelvic angle deviation.

Results

The cohort (mean age 65.7 years; 64.1% female) had a mean pelvic incidence of 55.2°. L1–pelvic angle improved from 13.7° preoperatively (deviation 5.1°) to 9.2° postoperatively (deviation 0.1°), with increases in distal and proximal lumbar lordosis of 10.5° and 9.5°, respectively. Change in distal lumbar lordosis strongly correlated with change in L1–pelvic angle (ΔL1PA =  − 0.5ΔDLL + 0.4; r =  − 0.80; p < 0.001). Patients with postoperative L1–pelvic angle increase had greater preoperative thoracic kyphosis, thoracolumbar kyphosis, and L4–S1 lordosis (all p ≤ 0.017).

Conclusion

Distal lumbar lordosis change is strongly associated with early postoperative L1–pelvic angle alignment in adult spinal deformity, with each 1° of L4–S1 correction producing a 0.5° L1–pelvic angle reduction. This relationship provides a descriptive framework for understanding early lumbopelvic behavior after major reconstruction, while the lack of association with proximal lordosis and ideal preoperative L1–pelvic angle suggests sagittal deformity drivers beyond the distal lumbar spine.