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Risk factors for coronal oblique take-off following adult spinal deformity surgery using lateral lumbar interbody fusion and open posterior corrective fusion



To evaluate risk factors associated with oblique take-off (OT) following lateral lumbar interbody fusion (LLIF) for adult spinal deformity.


Thirty-nine consecutive patients (mean age 67.9 years) with scoliosis of the lumbar curve (> 30°) were evaluated. Multilevel LLIF, followed by open thoraco-pelvic posterior corrective fusion after 1 week, was performed. We defined OT as a distance of > 25 mm between the C7 plumb line and the central sacral vertical line and examined risk factors by dividing the patients into the OT and non-OT groups.


OT occurred in 11 patients (28%), all showing a tilt to the convex side. The correction rate of the lumbar curve was approximately 70% range for both groups, which indicated good correction. Preoperative radiographs showed a high L1-central sacral vertical line in the standing position; high L5 tilt in the supine position; high L3, L4, and L5 tilts to the convex side in the supine-bending position; and a high L4 vertebral wedge on the convex side in OT cases. Multiple logistic regression analysis showed that an L4 tilt to the concave side in the bending position was the most effective predictor of OT (odds ratio = 1.104, P = 0.047). For a cutoff value of 16°, the sensitivity and specificity were 73% and 61%, respectively, according to the receiver operating characteristic curve analysis (area under the curve = 0.73).


OT occurred in 28% of adult scoliosis patients following LLIF. An L4 tilt > 16° to the concave side in the bending position was the most valuable risk factor.

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Availability of data and material

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.


  1. Smith JS, Klineberg E, Schwab F et al (2013) Change in classification grade by the SRS-schwab adult spinal deformity classification predicts impact on health-related quality of life measures. Spine (Phila Pa 1976) 38:1663–1671.

    Article  Google Scholar 

  2. Schwab F, Blondel B, Bess S et al (2013) Radiographical spinopelvic parameters and disability in the setting adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 38:E803–E812.

    Article  Google Scholar 

  3. Glassman SD, Berven S, Bridwell K et al (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 30:682–688.

    Article  Google Scholar 

  4. Pellisé F, Vila-Casademunt A, Ferrer M et al (2015) Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J 24:3–11.

    Article  PubMed  Google Scholar 

  5. Yoshida G, Hasegawa T, Yamato Y et al (2018) Predicting perioperative complications in adult spinal deformity surgery using a simple sliding scale. Spine (Phila Pa 1976) 43:562–570.

    Article  Google Scholar 

  6. Schwab FJ, Hawkinson N, Lafage V et al (2012) Risk factors for major perioperative complications in adult spinal deformity surgery: a multi-center review of 953 consecutive patients. Eur Spine J 21:2603–2610.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Glassman SD, Hamill CL, Bridwell KH et al (2007) The impact of perioperative complications on clinical outcome in adult deformity surgery. Spine (Phila Pa 1976) 32:2764–2770.

    Article  Google Scholar 

  8. Sansur CA, Smith JS, Coe JD et al (2011) Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine (Phila Pa 1976) 36:E593–E597.

    Article  Google Scholar 

  9. Yamato Y, Matsuyama Y, Hasegawa K et al (2017) A Japanese nationwide multicenter survey on perioperative complications of corrective fusion for elderly patients with adult spinal deformity. J Orthop Sci 22:237–242.

    Article  PubMed  Google Scholar 

  10. Carreon LY, Puno RM, Dimar JR 2nd et al (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 85:2089–2092.

    Article  PubMed  Google Scholar 

  11. Pimenta L, Diaz RC, Guerrero LG (2006) Charité lumbar artificial disc retrieval: use of a lateral minimally invasive technique. Technical note. J Neurosurg Spine 5:556–561.

    Article  PubMed  Google Scholar 

  12. Strom RG, Bae J, Mizutani J et al (2016) Lateral interbody fusion combined with open posterior surgery for adult spinal deformity. J Neurosurg Spine 25:697–705.

    Article  PubMed  Google Scholar 

  13. Tempel ZJ, Gandhoke GS, Bonfield CM et al (2014) Radiographic and clinical outcomes following combined lateral lumbar interbody fusion and posterior segmental stabilization in patients with adult degenerative scoliosis. Neurosurg Focus 36:E11.

    Article  PubMed  Google Scholar 

  14. Baghdadi YM, Larson AN, Dekutoski MB et al (2014) Sagittal balance and spinopelvic parameters after lateral lumbar interbody fusion for degenerative scoliosis: a case-control study. Spine (Phila Pa 1976) 39:E166–E173.

    Article  Google Scholar 

  15. Schwab F, Blondel B, Chay E et al (2014) The comprehensive anatomical spinal osteotomy classification. Neurosurgery 74:112–120.

    Article  PubMed  Google Scholar 

  16. Lafage V, Schwab F, Patel A et al (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 34:E599–E606.

    Article  Google Scholar 

  17. Daubs MD, Lenke LG, Bridwell KH et al (2013) Does correction of preoperative coronal imbalance make a difference in outcomes of adult patients with deformity? Spine (Phila Pa 1976) 38:476–483.

    Article  Google Scholar 

  18. Schwab FJ, Smith VA, Biserni M et al (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976) 27:387–392.

    Article  Google Scholar 

  19. Faraj SA, Kleuver MD, Vila-Casademunt AV et al (2018) Sagittal radiographic parameters demonstrate weak correlations with pretreatment patient-reported health-related quality of life measures in symptomatic de novo degenerative lumbar scoliosis: a European multicenter analysis. J Neurosurg Spine 28:573–580.

    Article  PubMed  Google Scholar 

  20. Matsumura A, Namikawa T, Kato M et al (2021) Factors related to postoperative coronal imbalance in adult lumbar scoliosis. J Neurosurg Spine 34:66–72.

    Article  Google Scholar 

  21. Theologis AA, Lertudomphonwanit T, Lenke LG et al (2021) The role of the fractional lumbosacral curve in persistent coronal malalignment following adult thoracolumbar deformity surgery: a radiographic analysis. Spine Deformity 9:721–731.

    Article  PubMed  Google Scholar 

  22. Bao H, Yan P, Qiu Y et al (2016) Coronal imbalance in degenerative lumbar scoliosis: prevalence and influence on surgical decision-making for spinal osteotomy. Bone Joint J 98-B:1227–1233.

    Article  CAS  PubMed  Google Scholar 

  23. Yang C, Zhao Y, Zhai X et al (2017) Coronal balance in idiopathic scoliosis: a radiograph study after posterior fusion of thoracolumbar/lumbar curves (Lenke 5 or 6). Eur Spine J 26:1775–1781.

    Article  PubMed  Google Scholar 

  24. Thompson JP, Transfeldt EE, Bradford DS et al (1990) Decompensation after Cotrel-Dubousset instrumentation of idiopathic scoliosis. Spine (Phila Pa 1976) 15:927–931.

    Article  CAS  Google Scholar 

  25. Lenke LG, Edwards CC 2nd, Bridwell KH (2003) The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine (Phila Pa 1976) 28:S199–S207.

    Article  Google Scholar 

  26. Ploumis A, Simpson AK, Cha TD et al (2015) Coronal spinal balance in adult spine deformity patients with long spinal fusions. a minimum 2- to 5-year follow-up study. J Spinal Discord Tech 28:341–347.

    Article  Google Scholar 

  27. Lewis SJ, Keshen SG, Kato S et al (2018) Risk factors for postoperative coronal balance in adult spinal deformity surgery. Global Spine J 8:690–697.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Obeid I, Berjano P, Lamartina C et al (2019) Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline. Eur Spine J 28:94–113.

    Article  PubMed  Google Scholar 

  29. Tanaka N, Ebata S, Oda K et al (2020) Predictors and clinical importance of postoperative coronal malalignment after surgery to correct adult spinal deformity. Clin Spine Surg 33:E337–E341.

    Article  PubMed  Google Scholar 

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The authors express their appreciation for the help provided by Daisuke Togawa, Sho Kobayashi, Tatsuya Yasuda, and Hiroki Ushirozako regarding case collections or manuscript discussions. The authors also thank Editage for English language editing.


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Authors and Affiliations



Conception or design of the work: KN, YY, TH, GY, TB, HA, SO, YMi, TY, KI, YW, KK, YMa. Acquisition of data for the work: KN, YY. Analysis of data for the work: KN, YY. Interpretation of data for the work: KN, YY. Drafting the work or revising it critically for important intellectual content: KN, YY, TH, GY, TB, HA, SO, YMi, TY, KI, YW, KK, YMa. Final approval of the version to be published: KN, YY, TH, GY, TB, HA, SO, YMi, TY, KI, YW, KK, YMa. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: KN, YY, TH, GY, TB, HA, SO, YMi, TY, KI, YW, KK, YMa.

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Correspondence to Keiichi Nakai.

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Conflict of interest

Dr. Yamato and Dr. Oe work for a donation-funded laboratory called the Division of Geriatric Musculoskeletal Health. Donations to this laboratory were received from Medtronic Sofamor Danek, Inc., Japan Medical Dynamic Marketing, Inc., and Meitoku Medical Institution Jyuzen Memorial Hospital. The other authors declare no conflicts of interest.

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Institutional review board approval was obtained from Hamamatsu University School of Medicine.

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Nakai, K., Yamato, Y., Hasegawa, T. et al. Risk factors for coronal oblique take-off following adult spinal deformity surgery using lateral lumbar interbody fusion and open posterior corrective fusion. Spine Deform 10, 647–656 (2022).

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