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Morphological features of lower lumbar degenerative kyphosis

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Kyphosis in the lower lumbar spine (L4-S1) significantly affects sagittal alignment. However, the characteristics of the spinopelvic parameters and compensatory mechanisms in patients with lower lumbar degenerative kyphosis (LLDK) have not been described in detail. The objective of this retrospective study was to analyze the morphological characteristics in patients with sagittal imbalance due to LLDK.


In this retrospective study, we reviewed the clinical records of consecutive patients who underwent corrective surgery for adult spinal deformity (ASD) at a single institution. We defined LLDK as (i) kyphotic deformity in lower lumbar spine (L4-S1) or (ii) inappropriate distribution of lordosis (lordosis distribution index < 40%) in the lower lumbar spine. Global spine parameters of ASD patients and MRI findings were compared between those with LLDK (LLDK group) and without LLDK (control group).


A total of 95 patients were enrolled in this study, of which the LLDK group included 14 patients (14.7%). Compared to the control, LLDK presented significantly higher pelvic incidence (62.1° vs 52.6°) and pelvic tilt (40.0° vs 33.4°), larger lordosis at the thoracolumbar junction (12.0° vs -19.6°), and smaller thoracic kyphosis (9.3° vs 26.0°). In LLDK, there was significantly less disc degeneration at L2/3 and L3/4.


LLDK patients had high pelvic incidence, large pelvic tilt, and a long compensatory curve at the thoracolumbar junction and thoracic spine region.

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  1. Diebo BG, Shah NV, Boachie-Adjei O, Zhu F, Rothenfluh DA, Paulino CB, Schwab FJ, Lafage V (2019) Adult spinal deformity. Lancet 394:160–172.

    Article  PubMed  Google Scholar 

  2. Kim HJ, Yang JH, Chang DG, Lenke LG, Suh SW, Nam Y, Park SC, Suk SI (2022) Adult spinal deformity: a comprehensive review of current advances and future directions. Asian Spine J 16:776–788.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Good CR, Auerbach JD, O’Leary PT, Schuler TC (2011) Adult spine deformity. Curr Rev Musculoskelet Med 4:159–167.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Roussouly P, Pinheiro-Franco JL (2011) Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J 20(Suppl 5):609–618.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Roussouly P, Pinheiro-Franco JL (2011) Sagittal parameters of the spine: biomechanical approach. Eur Spine J 20(Suppl 5):578–585.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y (1988) Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine 13:1317–1326

    Article  CAS  PubMed  Google Scholar 

  7. Ding JZ, Kong C, Li XY, Sun XY, Lu SB, Zhao GG (2022) Different degeneration patterns of paraspinal muscles in degenerative lumbar diseases: a MRI analysis of 154 patients. Eur Spine J 31:764–773.

    Article  PubMed  Google Scholar 

  8. Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A (2019) Sagittal balance of the spine. Eur Spine J 28:1889–1905.

    Article  PubMed  Google Scholar 

  9. Yilgor C, Sogunmez N, Boissiere L, Yavuz Y, Obeid I, Kleinstück F, Pérez-Grueso FJS, Acaroglu E, Haddad S, Mannion AF, Pellise F (2017) Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. JBJS 99(19):1661–1672.

    Article  Google Scholar 

  10. Boissiere L, Bourghli A, Vital JM, Gille O, Obeid I (2013) The lumbar lordosis index: a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery. Eur Spine J 22:1339–1345.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ushirozako H, Hasegawa T, Yamato Y, Yoshida G, Yasuda T, Banno T, Arima H, Oe S, Mihara Y, Yamada T, Ide K, Watanabe Y, Nakai K, Matsuyama Y (2020) L5 pedicle subtraction osteotomy maintains good radiological and clinical outcomes in elderly patients with a rigid kyphosis deformity: a more than 2-year follow-up report. Eur Spine J 29:3018–3027.

    Article  PubMed  Google Scholar 

  12. Funao H, Kebaish FN, Skolasky RL, Kebaish KM (2020) Clinical results and functional outcomes after three-column osteotomy at L5 or the sacrum in adult spinal deformity. Eur Spine J 29:821–830.

    Article  PubMed  Google Scholar 

  13. Alzakri A, Boissiere L, Cawley DT, Bourghli A, Pointillart V, Gille O, Vital JM, Obeid I (2018) L5 pedicle subtraction osteotomy: indication, surgical technique and specificities. Eur Spine J 27:644–651.

    Article  PubMed  Google Scholar 

  14. Lee GY, Lee JW, Choi HS, Oh KJ, Kang HS (2011) A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal Radiol 40:1033–1039.

    Article  PubMed  Google Scholar 

  15. Griffith JF, Wang YX, Antonio GE, Choi KC, Yu A, Ahuja AT, Leung PC (2007) Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine 32:E708-712.

    Article  PubMed  Google Scholar 

  16. Lee SH, Kim KT, Suk KS, Lee JH, Seo EM, Huh DS (2011) Sagittal decompensation after corrective osteotomy for lumbar degenerative kyphosis: classification and risk factors. Spine 36:E538-544.

    Article  PubMed  Google Scholar 

  17. Lee CH, Chung CK, Jang JS, Kim SM, Chin DK, Lee JK (2017) “Lumbar degenerative kyphosis” is not byword for degenerative sagittal imbalance: time to replace a misconception. J Korean Neurosurg Soc 60:125–129.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jang JS, Lee SH, Min JH, Han KM (2007) Lumbar degenerative kyphosis: radiologic analysis and classifications. Spine 32:2694–2699.

    Article  PubMed  Google Scholar 

  19. Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 16:1459–1467.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Barrey C, Roussouly P, Le Huec JC, D’Acunzi G, Perrin G (2013) Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 22(Suppl 6):S834-841.

    Article  PubMed  Google Scholar 

  21. Lee CS, Lee CK, Kim YT, Hong YM, Yoo JH (2001) Dynamic sagittal imbalance of the spine in degenerative flat back: significance of pelvic tilt in surgical treatment. Spine 26:2029–2035.

    Article  CAS  PubMed  Google Scholar 

  22. Jang JS, Lee SH, Min JH, Maeng DH (2009) Influence of lumbar lordosis restoration on thoracic curve and sagittal position in lumbar degenerative kyphosis patients. Spine 34:280–284.

    Article  PubMed  Google Scholar 

  23. Bae JS, Jang JS, Lee SH, Kim JU (2012) Radiological analysis of lumbar degenerative kyphosis in relation to pelvic incidence. Spine J 12:1045–1051.

    Article  PubMed  Google Scholar 

  24. Laouissat F, Sebaaly A, Gehrchen M, Roussouly P (2018) Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J 27:2002–2011.

    Article  PubMed  Google Scholar 

  25. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353.

    Article  PubMed  Google Scholar 

  26. Roussouly P, Nnadi C (2010) Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 19:1824–1836.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Pesenti S, Lafage R, Stein D, Elysee JC, Lenke LG, Schwab FJ, Kim HJ, Lafage V (2018) The amount of proximal lumbar lordosis is related to pelvic incidence. Clin Orthop Relat Res 476:1603–1611.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lee JH, Kim KT, Suk KS, Lee SH, Jeong BO, Kim JS, Eoh JH, Kim YJ (2010) Analysis of spinopelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine 35:E1386-1391.

    Article  PubMed  Google Scholar 

  29. Bao H, Liabaud B, Varghese J, Lafage R, Diebo BG, Jalai C, Ramchandran S, Poorman G, Errico T, Zhu F, Protopsaltis T, Passias P, Buckland A, Schwab F, Lafage V (2018) Lumbosacral stress and age may contribute to increased pelvic incidence: an analysis of 1625 adults. Eur Spine J 27:482–488.

    Article  PubMed  Google Scholar 

  30. Jean L (2014) Influence of age and sagittal balance of the spine on the value of the pelvic incidence. Eur Spine J 23:1394–1399.

    Article  PubMed  Google Scholar 

  31. Ohya J, Kawamura N, Takasawa E, Onishi Y, Ohtomo N, Miyahara J, Hayakawa C, Kunogi J (2021) Pelvic incidence change on the operating table. Eur Spine J 30:2473–2479.

    Article  PubMed  Google Scholar 

  32. Place HM, Hayes AM, Huebner SB, Hayden AM, Israel H, Brechbuhler JL (2017) Pelvic incidence: a fixed value or can you change it? Spine J 17:1565–1569.

    Article  PubMed  Google Scholar 

  33. Pizones J, Martin MB, Perez-Grueso FJS, Yilgor C, Vila-Casademunt A, Serra-Burriel M, Obeid I, Alanay A, Acaroglu ER, Pellise F, Group EESS (2019) Impact of adult scoliosis on roussouly sagittal shape classification. Spine 44:270–279.

    Article  PubMed  Google Scholar 

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Correspondence to Mitsuhiro Nishizawa.

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Nishizawa, M., Ohya, J., Ishikawa, Y. et al. Morphological features of lower lumbar degenerative kyphosis. Eur Spine J (2024).

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