Multicenter retrospective study of 752 adult spinal deformity patients, 352 with positive sagittal balance. Correlates C7 plumb line deviation and regional sagittal Cobb angles with validated outcomes (SF-12, SRS-29, ODI). Asks: within patients who already have positive sagittal balance, which radiographic parameters best predict clinical disability?
When you measure a standing 36-inch lateral on an adult spinal deformity patient, the C7 plumb line number is not binary — every millimeter of anterior deviation carries measurable clinical cost, confirmed across three independent outcome instruments.
Prioritize lumbar lordosis restoration above all other regional targets. Lumbar kyphosis worsens pain and function independently of how far forward the C7 plumb line sits. A patient with modest global imbalance but a flat or kyphotic lumbar spine can be just as disabled as one with severe global decompensation.
Do not over-correct the upper thoracic spine. High thoracic kyphosis is actually associated with less disability in this population. Aggressive T2–T5 correction is not warranted and may be counterproductive.
This paper is foundational to modern adult spinal deformity planning. It provided the evidence base for lumbar lordosis restoration as the primary surgical objective, directly enabling the SRS-Schwab classification and the pelvic incidence minus lumbar lordosis mismatch correction targets used today.
Multicenter retrospective study of 752 adult spinal deformity patients, 352 with positive sagittal balance. Correlates C7 plumb line deviation and regional sagittal Cobb angles with validated outcomes (SF-12, SRS-29, ODI). Asks: within patients who already have positive sagittal balance, which radiographic parameters best predict clinical disability?
When you measure a standing 36-inch lateral on an adult spinal deformity patient, the C7 plumb line number is not binary — every millimeter of anterior deviation carries measurable clinical cost, confirmed across three independent outcome instruments.
Prioritize lumbar lordosis restoration above all other regional targets. Lumbar kyphosis worsens pain and function independently of how far forward the C7 plumb line sits. A patient with modest global imbalance but a flat or kyphotic lumbar spine can be just as disabled as one with severe global decompensation.
Do not over-correct the upper thoracic spine. High thoracic kyphosis is actually associated with less disability in this population. Aggressive T2–T5 correction is not warranted and may be counterproductive.
This paper is foundational to modern adult spinal deformity planning. It provided the evidence base for lumbar lordosis restoration as the primary surgical objective, directly enabling the SRS-Schwab classification and the pelvic incidence minus lumbar lordosis mismatch correction targets used today.