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PMID- 28894683
OWN - NLM
STAT- PubMed-not-MEDLINE
DA  - 20170912
LR  - 20170914
IS  - 2192-5682 (Print)
IS  - 2192-5682 (Linking)
VI  - 7
IP  - 6
DP  - 2017 Sep
TI  - Beyond Pelvic Incidence-Lumbar Lordosis Mismatch: The Importance of Assessing the
      Entire Spine to Achieve Global Sagittal Alignment.
PG  - 536-542
LID - 10.1177/2192568217699405 [doi]
AB  - STUDY DESIGN: Retrospective case series. OBJECTIVE: To investigate which sagittal
      parameters contribute to a normal sagittal vertical axis (SVA) when there is a
      pelvic incidence-lumbar lordosis (PI-LL) mismatch >10 degrees following adult
      spinal deformity (ASD) correction. METHODS: We performed a retrospective review
      of ASD patients with >5 levels fused. Sagittal measurements between cohorts of
      postoperative PI-LL >10 degrees and PI-LL<10 degrees were compared. We correlated
      SVA to pelvic tilt (PT), thoracic kyphosis (TK), PI-LL, cervical lordosis (CL),
      and correlated the pre- to postoperative change in SVA to change in PT, change in
      TK, change in PI-LL, and change in CL. We also correlated SVA and the change in
      SVA to combined parameters of ((PI-LL) - PT + TK). RESULTS: We analyzed 52
      patients with a mean age of 59 +/- 16 years. In patients with a postoperative SVA
      <5cm, a smaller TK was seen when PI-LL >10 degrees than when PI-LL<10 degrees
      (15.45 degrees vs 33.04 degrees , P = .0004). Additionally, PT was larger when
      PI-LL >10 degrees than when PI-LL <10 degrees (25.73 degrees vs 19.07 degrees , P
      = .006). SVA correlated better with ((PI-LL) - PT + TK) (R2 = 0.51) than with
      PI-LL alone (R2 = 0.33). Lastly, there was no significant correlation between
      change in pre- to postoperative SVA with change in TK for all cases (P = .73),
      but in cases where change in PI-LL was <10 degrees , there was a significant
      correlation between change in TK and change in SVA (P = .009). CONCLUSION: Our
      results demonstrate that PT and TK, and not just PI-LL, play an important role in
      maintaining sagittal balance when there is a PI-LL mismatch >10 degrees .
FAU - Merrill, Robert K
AU  - Merrill RK
AD  - Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New
      York, NY, USA.
FAU - Kim, Jun S
AU  - Kim JS
AD  - Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New
      York, NY, USA.
FAU - Leven, Dante M
AU  - Leven DM
AD  - Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New
      York, NY, USA.
FAU - Kim, Joung Heon
AU  - Kim JH
AD  - Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New
      York, NY, USA.
FAU - Cho, Samuel K
AU  - Cho SK
AD  - Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New
      York, NY, USA.
LA  - eng
PT  - Journal Article
DEP - 20170420
PL  - England
TA  - Global Spine J
JT  - Global spine journal
JID - 101596156
PMC - PMC5582711
OTO - NOTNLM
OT  - PI-LL
OT  - compensatory mechanisms
OT  - pelvic incidence
OT  - pelvic tilt
OT  - sagittal balance
OT  - thoracic kyphosis
COI - Declaration of Conflicting Interests: The author(s) declared no potential
      conflicts of interest with respect to the research, authorship, and/or
      publication of this article.
EDAT- 2017/09/13 06:00
MHDA- 2017/09/13 06:01
CRDT- 2017/09/13 06:00
AID - 10.1177/2192568217699405 [doi]
AID - 10.1177_2192568217699405 [pii]
PST - ppublish
SO  - Global Spine J. 2017 Sep;7(6):536-542. doi: 10.1177/2192568217699405. Epub 2017
      Apr 20.