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Ryan C. Hofler, Muturi G. Muriuki, Robert M. Havey, Kenneth R. Blank, Joseph N. Frazzetta, Avinash G. Patwardhan and G. Alexander Jones

1 tilt angle increased above nominal, and a T1 tilt angle reduced below nominal. Measurements We defined a zero (or lowest-magnitude) T1 flexion-extension moment as the neutral CSVA. This serves as a criterion by which to understand postural consequences, as this simulates the head and neck position requiring the least muscle contraction to maintain. The CSVA at which the T1 flexion-extension moment was zero (or at a minimum value) was determined for each of the 3 CSVA tests conducted. The lordosis angles and foraminal heights at these lowest energy states were

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Calvin C. Kuo, Audrey Martin, Connor Telles, Jeremi Leasure, Alex Iezza, Christopher Ames and Dimitriy Kondrashov

R estoration of sagittal balance is one of the most important considerations in adult spinal reconstructive surgery. Positive sagittal balance has been identified as the radiographic parameter that is most correlated with adverse health status outcomes in spinal deformity patients. 6 Restoration of optimal lumbar lordosis and secure lumbosacral fixation are necessary, especially in patients with preoperative sagittal imbalance and high pelvic incidence, in order to prevent sagittal decompensation after surgery. 3 Furthermore, restoration of lower lumbar

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Juan S. Uribe, Donald A. Smith, Elias Dakwar, Ali A. Baaj, Gregory M. Mundis, Alexander W. L. Turner, G. Bryan Cornwall and Behrooz A. Akbarnia

column resection is both an anterior and posterior excision. 11 Although effective, these maneuvers typically require wide exposure of the spinal anatomy and are associated with high blood loss and morbidity. 3 , 9 , 13 , 16 , 31 , 38 The minimally invasive lateral transpsoas approach to the lumbar spine represents an alternative method for lumbar interbody fusion and spinal deformity correction. 5 , 6 , 17 , 23 , 32 , 34 , 37 , 42 , 44 The contribution to global lumbar lordosis provided by the minimally invasive lateral approach, or XLIF, however, has not been

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Darryl Lau, Anthony M. DiGiorgio, Andrew K. Chan, Cecilia L. Dalle Ore, Michael S. Virk, Dean Chou, Erica F. Bisson and Praveen V. Mummaneni

(defined as an NDI improvement < 15 points). 39 Similarly, in a series by Lanman et al., 5.6% of patients did not experience an improvement in neck pain, and 9.6% of patients did not experience improvement in arm pain. 20 Identifying factors predictive of functional outcomes following ACDF can assist in both patient selection and operative planning. In thoracolumbar deformity correction, spinal parameters such as sagittal vertical axis (SVA) and the relationship between pelvic incidence and lumbar lordosis have been shown to significantly correlate with health

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Caglar Yilgor, Nuray Sogunmez, Yasemin Yavuz, Kadir Abul, Louis Boissiére, Sleiman Haddad, Ibrahim Obeid, Frank Kleinstück, Francisco Javier Sánchez Pérez-Grueso, Emre Acaroğlu, Anne F. Mannion, Ferran Pellise, Ahmet Alanay and the European Spine Study Group

T o allow the human trunk to adopt an erect posture, the spine has developed successive, opposing curves, which differ from the C-shaped spine of bipedal primates. No other species has spinal alignment that includes a lumbar lordosis (LL). 4 , 29 This upright bipedalism provided notable modifications in the morphology of the skeleton. 13 Sitting upon the femoral heads, the pelvis has rotated vertically to act as the foundation for the vertebral column. 14 Reported normal values for LL in asymptomatic adults vary widely. 5 , 9 , 19 , 30 , 31 After the

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Francis C. Lovecchio, Avani S. Vaishnav, Michael E. Steinhaus, Yahya A. Othman, Catherine Himo Gang, Sravisht Iyer, Steven J. McAnany, Todd J. Albert and Sheeraz A. Qureshi

T he maintenance or restoration of sagittal alignment during lumbar fusion surgery is critical to achieve optimal mechanical and patient-reported outcomes. This relationship has been demonstrated regardless of the indication for surgery or the surgical approach. 1 , 2 Specifically, in minimally invasive surgery (MIS) techniques performed for degenerative lumbar conditions, the interbody cage being used is often the sole driver of postoperative lordosis. 3 , 4 Despite the reported advantages of interbody devices in MIS fusion surgery (increased surface area for

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Blake N. Staub, Renaud Lafage, Han Jo Kim, Christopher I. Shaffrey, Gregory M. Mundis Jr., Richard Hostin, Douglas Burton, Lawrence Lenke, Munish C. Gupta, Christopher Ames, Eric Klineberg, Shay Bess, Frank Schwab, Virginie Lafage and the International Spine Study Group

lordosis when operating on the cervical spine. The problem with this, however, is that there is no uniform normal cervical lordosis. Nearly 34% of asymptomatic subjects in one study were found to have a baseline cervical kyphosis, which indicates that cervical kyphosis can, in fact, be a normal physiological parameter. 19 Reliance on cSVA or simple cervical alignment parameters without a predicted ideal cervical lordosis (CL) makes cervical deformity correction difficult and less exact, leading to either residual deformity or the creation of iatrogenic deformity where

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Lee A. Tan, David C. Straus and Vincent C. Traynelis

lordosis or even kyphosis—especially when multiple levels are treated. The literature addressing this topic is limited to a single publication. In Goel and Shah's series of 36 patients, mild loss of lordosis was noted following surgery; however, all of their postoperative patients were found to have cervical lordosis within the normal range and none developed kyphosis. 3 To our knowledge, there are no other published data addressing the effect of CIS on sagittal alignment. This retrospective case review was performed to test the hypothesis that CISs are associated with

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Jae Hyup Lee, Ji-Ho Lee, Kang-Sup Yoon, Seung-Baik Kang and Chris H. Jo

O ver the past few years, interbody fusion procedures have been widely used for arthrodesis in the treatment of degenerative disorders of the lumbar spine. There are many reports showing that the sagittal and coronal alignment of the spine are very important, 5 , 6 and the preservation of lordosis during instrumented lumbar fusion for degenerative lumbar disease is crucial. Most positioning devices used for lumbar surgery allow the abdomen to hang free to minimize epidural bleeding. Depending on the degree of hip flexion, lordosis may or may not be

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Carolyn J. Sparrey, Jeannie F. Bailey, Michael Safaee, Aaron J. Clark, Virginie Lafage, Frank Schwab, Justin S. Smith and Christopher P. Ames

L umbar lordosis is unique to the human spine and is necessary to facilitate our upright posture. However, decreased lumbar lordosis and increased thoracic kyphosis are hallmarks of an aging human spinal column. 75 , 143 Degeneration of the sagittal spine curvature leads to loss of sagittal alignment, which is implicated in a broad range of adverse health outcomes. 67 Significant postural degeneration often requires surgical intervention to alleviate pain and facilitate upright posture and ambulation. However, surgical interventions to correct postural