Objective To quantify the effect of different hip positions on lumbar lordosis (LL) and spinopelvic parameters in the right lateral decubitus position (RLDP) and identify the configuration that most closely replicates physiologic standing alignment during lateral lumbar interbody fusion in minimally invasive spinal surgery.
Methods Thirty healthy volunteers (15 males, 15 females; mean age, 27.8±8.6 years) underwent lateral lumbar radiographs in standing position and 5 RLDP configurations: neutral hips (NN), 30° flexion of both hips (30FF), 30° flexion of the right hip with left hip neutral (30FN), 60° flexion of both hips (60FF), and 60° flexion of the right hip with left hip neutral (60FN). LL, pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI) were measured. Each position was compared to standing using paired t-tests. Intra- and interobserver reliability were evaluated using intraclass correlation coefficients (ICCs).
Results LL decreased significantly in all RLDP positions compared with standing (51.1°±3.8°). The 30FN position showed the smallest change (ΔLL=-4.9°, p<0.001), whereas 60FF showed the greatest (ΔLL=-15.0°, p<0.001). In 30FN, PT decreased (p=0.013) and SS increased (p=0.003), indicating mild anterior pelvic rotation. PI showed minimal variation across positions. Intra- and interobserver ICCs ranged from 0.92 to 0.99, confirming high measurement reliability.
Conclusion Hip position significantly influences lumbar and pelvic alignment in RLDP. Among tested configurations, the 30FN position (right hip flexed 30°, left neutral) showed the smallest numerical deviation from standing alignment and spinopelvic harmony relative to standing in RLDP.
Objective Based on spinopelvic parameters and biomechanical principles, the pedicle-facet joint (PFJ) morphological characteristics of isthmic and degenerative spondylolisthesis were analyzed, and the mechanism of their onset and progression was discussed.
Methods This retrospective cross-sectional study included 194 patients with L5 spondylolysis or L5–S1 low-grade isthmic spondylolisthesis (IS group), 172 patients with L4–5 degenerative spondylolisthesis (DS group), and 366 patients with nonlumbar spondylolysis (NL group). The spinopelvic parameters and PFJ morphological parameters of the patients were measured, the differences in these parameters among and within the 3 groups were compared, and the correlations were analyzed.
Results Sacral slope (SS) and lumbar lordosis (LL) were the highest in the IS group, the second highest in the DS group, and the lowest in the NL group. Among the 3 groups, the L4 facet joint angle (FJA) was the largest in the IS group, the second largest in the NL group, and the smallest in the DS group. The L4 pedicle-facet joint angle (PFA) was the largest in the DS group, the second largest in the IS group, and the smallest in the NL group. Pearson correlation analysis showed that within each group, SS and LL were negatively correlated with FJA and positively correlated with PFA.
Conclusion This study found a correlation between the PFJ morphological characteristics of patients with lumbar spondylolisthesis and spinopelvic parameters, suggesting that the morphological characteristics of PFJs may be caused by varying stresses under different spinopelvic morphologies.
Objective The effect on fat infiltration (FI) of paraspinal muscles in degenerative lumbar spinal diseases has been demonstrated except for spinopelvic parameters. The present study is to identify the effect of spinopelvic parameters on FI of paraspinal muscle (PSM) and psoas major muscle (PMM) in patients with degenerative lumbar spondylolisthesis.
Methods A single-center, retrospective cross-sectional study of 160 patients with degenerative lumbar spondylolisthesis (DLS) and lumbar stenosis (LSS) who had lateral full-spine x-ray and lumbar spine magnetic resonance imaging was conducted. PSM and PMM FIs were defined as the ratio of fat to its muscle cross-sectional area. The FIs were compared among patients with different pelvic tilt (PT) and pelvic incidence (PI), respectively.
Results The PSM FI correlated significantly with pelvic parameters in DLS patients, but not in LSS patients. The PSM FI in pelvic retroversion (PT > 25°) was 0.54 ± 0.13, which was significantly higher in DLS patients than in normal pelvis (0.41 ± 0.14) and pelvic anteversion (PT < 5°) (0.34 ± 0.12). The PSM FI of DLS patients with large PI ( > 60°) was 0.50 ± 0.13, which was higher than those with small ( < 45°) and normal PI (0.37 ± 0.11 and 0.36 ± 0.13). However, the PSM FI of LSS patients didn’t change significantly with PT or PI. Moreover, the PMM FI was about 0.10–0.15, which was significantly lower than the PSM FI, and changed with PT and PI in a similar way of PSM FI with much less in magnitude.
Conclusion FI of the PSMs increased with greater pelvic retroversion or larger pelvic incidence in DLS patients, but not in LSS patients.
Citations
Citations to this article as recorded by
A local and systemic path in L4 degenerative spondylolisthesis: independent roles of paraspinal muscle fat infiltration and dyslipidemia Yilong Zhang, Wenbin Wu, Bu Yang, Feng Feng, Yuefei Guo, Sijin Cheng, Jiajun Deng, Yuejian Sun, Da An, Jian Mo, Limin Rong, Peigen Xie European Spine Journal.2026;[Epub] CrossRef
Lumbar spine fusion in elderly patients: risk factors for failure in achieving favorable outcomes Peng Cui, Qingyang Huang, Peng Wang, Xiaolong Chen, Chao Kong, Shibao Lu European Spine Journal.2025; 34(5): 1771. CrossRef
Correlation between the severity of lumbar spinal stenosis and lumbar paraspinal muscle atrophy Xiaoyu Mu American Journal of Translational Research.2025; 17(6): 4247. CrossRef
Different Degeneration Patterns of Paraspinal Muscles Between Double-Level and Single-Level Lumbar Spondylolisthesis: An Magnetic Resonance Imaging Analysis of 140 Patients Yi Li, Ruiling Wang, Junjun Li, Linfeng Wang, Yong Shen Neurospine.2024; 21(3): 1029. CrossRef
Development and validation of a nomogram to predict the unfavorable outcomes in elderly patients undergoing lumbar fusion surgery for degenerative disease Peng Cui, Shuaikang Wang, Haojie Zhang, Peng Wang, Xiaolong Chen, Chao Kong, Shibao Lu BMC Surgery.2024;[Epub] CrossRef
Objective Spinopelvic parameters play important roles in clinical outcomes and disability after short-segment fusion surgery for degenerative spine disease. This study aimed to investigate the relationship between preoperative or postoperative spinopelvic parameters and symptomatic adjacent segment degeneration (ASD) after single-level anterior lumbar interbody fusion (ALIF) surgery at the L4–5 segments.
Methods All patients who underwent single-level ALIF at the L4–5 level from January 2010 to December 2013 and were followed up for 5 years were analyzed. We collected the degree of degeneration at adjacent segments and preoperative and postoperative spinopelvic parameters. We compared the preoperative and postoperative parameters between patients with and without symptomatic ASD.
Results Sixty-one patients were included in our study, and 30 patients had symptomatic ASD. Degeneration at adjacent segments and preoperative spinopelvic parameters did not affect the occurrence of symptomatic ASD. Patients with symptomatic ASD had higher postoperative pelvic tilt (PT) and a mismatch between lumbar lordosis (LL) and pelvic incidence (PI) compared to those without. Postoperative PT > 15° and PI–LL mismatch > 10° were significant risk factors for symptomatic ASD.
Conclusion High PT and PI–LL mismatch were significant risk factors for symptomatic ASD after single-level ALIF surgery. Spine surgeons should consider achieving proper LL to insert the cage at the appropriate angle and prevent a PI–LL mismatch value > 10° after single-level fusion surgery.
Citations
Citations to this article as recorded by
Sagittal Alignment and Clinical Outcomes After Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using a Single Expandable Cage: One Year Follow-up Sub-Ri Park, Namhoo Kim, Ji-Won Kwon, Kyung-Soo Suk, Hak-Sun Kim, Seong-Hwan Moon, Si-Young Park, Byung Ho Lee, Jae-Won Shin, Jin-Oh Park World Neurosurgery.2026; 205: 124698. CrossRef
Individuals Over 75 Year Old Experience Greater Revisions Following Transforaminal Lumbar Interbody Fusion (TLIF): A Propensity Matched Study Gregory Snigur, Alejandro Perez-Albela, Puru Sadh, Ishan Shah, Maria Jensen, Kaitlyn Crow, Timothy Jeng, Bassel G. Diebo, Alan H. Daniels, Bryce A. Basques Global Spine Journal.2026;[Epub] CrossRef
Research Progress of Adjacent Segment Degeneration after Lumbar Fusion 健威 吴 Advances in Clinical Medicine.2026; 16(02): 265. CrossRef
Sarcopenia Predicts the Development of Early Adjacent Segment Disease After Transforaminal Lumbar Interbody Fusion Brandon M. Wilkinson, Brendan Maloney, Jian Li, Hanish Polavarapu, Dan Draytsel, Ali Hazama Neurosurgery.2025; 96(5): 1044. CrossRef
Revision surgery rates following transforaminal lumbar interbody fusion in patients with and without osteoporosis Ashley Knebel, Manjot Singh, Michael J. Farias, Brian McCrae, Lauren Fisher, Joseph E. Nassar, Bassel G. Diebo, Alan H. Daniels The Spine Journal.2025; 25(8): 1582. CrossRef
Safety and Utility of Bilateral-contralateral Decompression for Adjacent Segment Stenosis After Lumbar Interbody Fusion Using Unilateral Biportal Endoscopy Dong Hyun Lee, Choon Keun Park, Jae-Won Jang, Dong-Geun Lee Clinical Spine Surgery.2025; 38(10): E488. CrossRef
The relationship between spinopelvic alignment and knee osteoarthritis in female patients: A cross-sectional study Öykü Tomay Aksoy, Bülent Bütün Journal of Back and Musculoskeletal Rehabilitation.2025; 38(5): 995. CrossRef
Influence of pelvic incidence–lumbar lordosis mismatch on surgical outcomes of total hip arthroplasty: a retrospective cohort study Hisatoshi Ishikura, Toru Nishiwaki, Maaya Kudo, Shunsuke Minoji, Takeyuki Tanaka, Sakae Tanaka European Journal of Orthopaedic Surgery & Traumatology.2025;[Epub] CrossRef
Letter to the editor concerning “ALIF vs. posterior fusion for lumbar degenerative disease: comparable efficacy but elevated risk of severe complications-a systematic review and meta-analysis” by FJ Onishi, et al. (Eur spine J [2025]; doi: 10.1007/s00586- Aécio Rubens Dias Pereira Filho, Francisco Cialdine Frota Carneiro Júnior, Vinicius de Meldau Benites European Spine Journal.2025; 34(10): 4833. CrossRef
Principles of Level Selection for Instrumentation in Adult Thoracolumbar Spinal Deformity Surgery Zeeshan M. Sardar, Josephine R. Coury, Katherine Dong, Anson G. Bautista, Lawrence G. Lenke, Justin L. Reyes Journal of Bone and Joint Surgery.2025; 107(20): 2322. CrossRef
Correlation Between Spinopelvic Sagittal Alignment Parameters and Low Back Pain Muhammad Bilal, Faizan Ali Janjua, Abdullah Jan, Asif Ali Jatoi, Muhammad Asad Qureshi, Ejaz Aslam Pakistan Journal of Health Sciences.2025; : 20. CrossRef
Spino-pelvic parameters and back pain in patients without coronal deformity or history of spinal surgery: A cross-sectional analysis Fernando Moreno-Mateo, Silvia Santiago Maniega, Almudena Llorente Peris, Rubén Hernádez Ramajo, David César Noriega González Journal of Back and Musculoskeletal Rehabilitation.2024; 37(5): 1171. CrossRef
Segmental Sagittal Alignment in Lumbar Spinal Fusion: A Review of Evidence-Based Evaluation of Preoperative Measurement, Surgical Planning, Intraoperative Execution, and Postoperative Evaluation Alan H. Daniels, Mariah Balmaceno-Criss, Christopher L. McDonald, Manjot Singh, Ashley Knebel, Michael J. Kuharski, Mohammad Daher, Daniel Alsoof, Renaud Lafage, Virginie Lafage, Bassel G. Diebo Operative Neurosurgery.2024; 27(5): 533. CrossRef
Re-Evaluating the Long-Term Efficacy of Semi-Rigid Fixation Using a Nitinol Spring Rod in Lumbar Surgery: A Retrospective Study on an Effective Alternative for Reducing Adjacent Segment Disease Hyun-Jun Jang, Bong-Ju Moon, Dong-Kyu Chin Applied Sciences.2024; 14(11): 4574. CrossRef
Relationships Between Skeletal Muscle Mass, Lumbar Lordosis, and Chronic Low Back Pain in the Elderly Myung Woo Park, Sang Jun Park, Sun Gun Chung Neurospine.2023; 20(3): 959. CrossRef
Objective To compare the outcomes of S1 foraminal hooks and iliac screws regarding fusion rate at the lumbosacral junction and protective effects on S1 screws.
Methods From January 2017 to December 2019, consecutive patients who underwent long fusions (uppermost instrumented vertebra at or above L1) to the sacrum for adult spinal deformity were enrolled. Patients were divided into S1 foraminal hook group and iliac screw group. Radiographic parameters and the incidence of pseudarthrosis and instrument failure at the lumbosacral junction were compared between the groups.
Results Twenty-nine patients (male:female = 1:28) with a mean age of 73.6 ± 6.8 years were evaluated. Sixteen patients (55.2%) had S1 foraminal hook fixation and 13 patients (44.8%) had iliac screw fixation. Lumbar lordosis, sacral slope, and sagittal vertical axis did not differ between the groups preoperatively and postoperatively. The rate of L5/S1 pseudarthrosis was significantly higher in S1 foraminal hook group (5 of 16, 31.3%), compared to iliac screw group (0 of 13, 0%; p = 0.048). Instrument failure at the lumbosacral junction trended toward a higher rate in S1 foraminal hook group (6 of 16, 37.5%) than in iliac screw group (1 of 13, 7.7%), without statistical significance (p = 0.09). Proximal junctional kyphosis/failure occurred less often in S1 foraminal hook group (2 of 16, 12.5%) than in iliac screw group (3 of 13, 30.8%) without statistical significance (p = 0.36).
Conclusion Treatment with S1 foraminal hooks achieved equivalent satisfactory sagittal correction with proportioned alignment compared to that with iliac screws. However, S1 foraminal hooks did not provide enough structural support to the lumbosacral junction in long fusions to the sacrum.
Citations
Citations to this article as recorded by
Trans-sacral interbody fixation in long fusions to the sacrum for adult spinal deformity: complications and fusion rates at minimum two years follow-up Honglei Yi, Hu Chen, Peirong Lian, Xinran Ji, Matthew E. Cunningham, Oheneba Boachie-Adjei, Han jo Kim, Thomas Ross, Venu M. Nemani, Hong Xia International Orthopaedics.2024; 48(1): 193. CrossRef
Distal Junctional Failure After Fusion Stopping at L5 in Patients With Adult Spinal Deformity: Incidence, Risk Factors, and Radiographic Criteria Sung Ho Do, Sungsoo Bae, Dae Jean Jo, Ho Yong Choi Neurospine.2024; 21(3): 856. CrossRef
Proximal junctional kyphosis: What we didn't know, what we think we know, and what we need to know Austin C. Kaidi, Justin S. Smith, Han Jo Kim Seminars in Spine Surgery.2023; 35(4): 101065. CrossRef
Objective Low back pain is the most common reason for physician visit in Western population. It’s one of the factors that affect health-related quality of life. Intervertebral disc degeneration is one of the leading factors for low back pain and disc degeneration needs serious attention. In this article, we try to summarize biomechanical factors on the degenerative process.
Methods Patients with low back pain in Neurosurgery Department between January 2012 and June 2019 are searched for this study. The patients were gathered under 2 groups; surgical intervention and conservative treatment groups. Intervertebral disc degeneration was assessed by Pfirrmann grading system. All spinopelvic parameters were measured by using standardized lateral plain standing lumbar radiographs.
Results There were 165 patients in the surgical group (60 females, 105 males) and 84 patients in the conservative group (57 females, 27 males) after randomization. One hundred fifty patients had microdiscectomy and 15 patients had spinal instrumentation with transforaminal lumbar interbody fusion. There was not a statistically significant difference between surgical intervention and conservative treatment groups when comparing disc degeneration status. There was a statistically significant difference in parameters lumbar lordosis (LL), L4–S1, and pelvic incidence-LL (PI–LL) between the 2 treatment groups. In the surgical group when we further analyze the spinopelvic parameters in between the 2 different surgical techniques; L4–S1, pelvic tilt, and PI–LL showed a statistically significant difference.
Conclusion Degenerative disc disease is related with multiple factors which can be detailed under the mechanic components and the genetic components. Of these factors, spinopelvic parameters seem highly penetrating to patients’ surgery needs with degenerative disc disease independently.
Citations
Citations to this article as recorded by
SPP1-CD44 signaling contributes to the mechanisms and therapeutic implications in intervertebral disc degeneration Qiuwei Li, Kaida Bo, Cailiang Shen Biochemical and Biophysical Research Communications.2026; 797: 153213. CrossRef
Intervertebral disc creep behaviour through viscoelastic models: an in-vitro study Vincenza Sciortino, Jan Ulrich Jansen, Donatella Cerniglia, Tommaso Ingrassia, Hans-Joachim Wilke Discover Applied Sciences.2024;[Epub] CrossRef
Effect of Preoperative Severity and Location of Lumbar Intervertebral Disc Vacuum Phenomenon on Surgical Outcomes After Single-Level Transforaminal Lumbar Interbody Fusion Shuhei Ohyama, Yasuchika Aoki, Masahiro Inoue, Takayuki Nakajima, Yusuke Sato, Masashi Sato, Satoshi Yoh, Hiroshi Takahashi, Arata Nakajima, Toshiaki Kotani, Yawara Eguchi, Sumihisa Orita, Kazuhide Inage, Yasuhiro Shiga, Koichi Nakagawa, Seiji Ohtori World Neurosurgery.2023; 173: e727. CrossRef
Narrative Review of Pathophysiology and Endoscopic Management of Basivertebral and Sinuvertebral Neuropathy for Chronic Back Pain Hyeun Sung Kim, Pang Hung Wu, Il-Tae Jang Journal of Korean Neurosurgical Society.2023; 66(4): 344. CrossRef
A novel neural network method using radial basis function for effective assessment of stiffness index on lumbar disc degenerative subjects C. K. Sreeja, V. N. Meena Devi, M. K. Aneesh Automatika.2023; 64(4): 964. CrossRef
Biomechanical Effects of Different Sitting Postures and Physiologic Movements on the Lumbar Spine: A Finite Element Study Mingoo Cho, Jun-Sang Han, Sungwook Kang, Chang-Hwan Ahn, Dong-Hee Kim, Chul-Hyun Kim, Kyoung-Tae Kim, Ae-Ryoung Kim, Jong-Moon Hwang Bioengineering.2023; 10(9): 1051. CrossRef
A protocol for recruiting and analyzing the disease-oriented Russian disc degeneration study (RuDDS) biobank for functional omics studies of lumbar disc degeneration Olga N. Leonova, Elizaveta E. Elgaeva, Tatiana S. Golubeva, Alexey V. Peleganchuk, Aleksandr V. Krutko, Yurii S. Aulchenko, Yakov A. Tsepilov, Walid Kamal Abdelbasset PLOS ONE.2022; 17(5): e0267384. CrossRef
Genetic Odyssey to Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Systematic Review Young Il Won, Chang-Hyun Lee, Woon Tak Yuh, Shin Won Kwon, Chi Heon Kim, Chun Kee Chung Neurospine.2022; 19(2): 299. CrossRef
Using Natural Language Processing to Identify Low Back Pain in Imaging Reports Yeji Kim, Chanyoung Song, Gyuseon Song, Sol Bi Kim, Hyun-Wook Han, Inbo Han Applied Sciences.2022; 12(24): 12521. CrossRef
Dural leakage due to ipsilateral needle placement for spinal level localization in unilateral decompression surgery: A case report Lukas Andereggen, Markus M. Luedi Surgical Neurology International.2021; 12: 205. CrossRef
First
Prev
