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How coronal malalignment affects the surgical outcome in corrective spine surgery for adult symptomatic lumbar deformity

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The importance of coronal alignment is unclear, while the importance of sagittal alignment in the treatment of adult patients with spinal deformities is well described. This study sought to elucidate the impact of global coronal malalignment (GCMA) in surgically treated adult symptomatic lumbar deformity (ASLD) patients.


A multicentre retrospective analysis of a prospective ASD database. GCMA was defined as GCA (C7PL-CSVL) ≥ 3 cm. GCMA is categorized based on the Obeid-Coronal Malalignment Classification (O-CM). Demographic, surgical, radiographic, HRQOL, and complication data were analysed. The risk for postoperative GCMA was analysed by univariate and multivariate analyses.


Of 230 surgically treated ASLD patients, 96 patients showed GCMA preoperatively and baseline GCA was correlated with the baseline SRS-22 pain domain score (r = − 30). Postoperatively, 62 patients (27%, O-CM type 1: 41[18%], type 2: 21[9%]) developed GCMA. The multivariate risk analysis indicated dementia (OR 20.1[1.2–304.4]), diabetes (OR 5.9[1.3–27.3]), and baseline O-CM type 2 (OR 2.1[1.3–3.4]) as independent risk factors for postoperative GCMA. The 2-year SRS-22 score was not different between the 2 groups, while 4 GCMA patients required revision surgery within 1 year after surgery due to coronal decompensation (GCMA+ vs. GCMA- function: 3.6 ± 0.6 vs. 3.7 ± 0.7, pain: 3.7 ± 0.8 vs. 3.8 ± 0.8, self-image: 3.6 ± 0.8 vs. 3.6 ± 0.8, mental health: 3.7 ± 0.8 vs. 3.8 ± 0.9, satisfaction: 3.9 ± 0.9 vs. 3.9 ± 0.8, total: 3.7 ± 0.7 vs. 3.7 ± 0.7). Additionally, the comparisons of 2-yr SRS-22 between GCMA ± showed no difference in any UIV and LIV level or O-CM type.


In ASLD patients with corrective spine surgery, GCMA at 2 years did not affect HRQOL or major complications at any spinal fusion extent or O-CM type of malalignment, whereas GCA correlated with pain intensity before surgery. These findings may warrant further study of the impact of GCMA on HRQOL in the surgical treatment of ASLD patients.

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Authors and Affiliations




Conception of work: MY, YY, MM, and NM. Design of the work: MY and KW. Acquisition of data: TS. Analysis of data: TS, MY. Interpretation of data: SS, YT, MO, OY and NN. Drafted the work or revised it critically for important intellectual content: TS, MY, MO, NN, YY, MM, NM and KW. Approved the version to be published: TS, MY, SS, YT, MO, OT, NN, YY, MM, NM, and KW. Agree 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: TS, MY, SS, YT, MO, OT, NN, YY, MM, NM, and KW.

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Correspondence to Mitsuru Yagi.

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Conflict of interest

Tomohisa Tabata, Satoshi Suzuki, Yohei Takahashi, Masahiro Ozaki, Osahiko Tsuji, Narihito Nagoshi, Masaya Nakamura, and Kowa Watanabe have no conflicts of interest. Mitsuru Yagi reports receiving grants from Medtronic and DePuy Synthes that are outside the scope of the submitted work. Morio Matsumoto reports receiving grants from Medtronic and NuVasive that are outside the scope of the submitted work.

Ethical approval

This study was approved by the appropriate institutional review board. The study approval was obtained from the ethics committee of Keio University School of Medicine. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in this study.

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Shimizu, T., Yagi, M., Suzuki, S. et al. How coronal malalignment affects the surgical outcome in corrective spine surgery for adult symptomatic lumbar deformity. Spine Deform (2023).

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