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. 2025 May 6;17(5):e83612.
doi: 10.7759/cureus.83612. eCollection 2025 May.

Impact of Global Sagittal Spinal Alignment on Degenerative Lumbar Scoliosis

Hideya Yamauchi  1 , Kenji Endo  1 , Yasunobu Sawaji  1 , Hirosuke Nishimura  1 , Kengo Yamamoto  1
Affiliations

Impact of Global Sagittal Spinal Alignment on Degenerative Lumbar Scoliosis

Hideya Yamauchi et al. Cureus. .

Abstract

Background: In spine surgery, understanding the balance between sagittal and coronal planes, taking both spinal alignment and pelvic orientation into account, is crucial. The purpose of this study was to clarify the influence of pelvic incidence (PI) on spinopelvic parameters in patients with degenerative lumbar scoliosis (DLS) by comparing them to those without DLS.

Method: The subjects were 259 patients (146 men and 113 women, mean age 69.4 years) who underwent surgery in our department between January 2010 and August 2018. The nonscoliosis group (N group, Cobb angle: 0°-9°; n = 161) and the scoliosis group (S group, Cobb angle: 10°-29°; n = 98) were used to compare their spinal alignments.

Result: Regarding the parameters of sagittal spinal alignment, lumbar lordosis (LL) (N group 35.3 ± 12.5°; S group 31.6 ± 14.9°) was significantly smaller (p < 0.05) and PI (N group 46.6 ± 11.6°; S group 52.3 ± 12.1°) and PI-LL (N group 11.8 ± 14.3°; S group 21.0 ± 17.5°) were significantly larger (p < 0.001) in the S group than in the N group. Positive correlations were observed between Cobb angle and sagittal vertical axis (SVA), pelvic tilt (PT), PI, and PI-LL, and a negative correlation was observed between Cobb angle and LL.

Conclusion: The incidence of DLS in middle-aged and older patients is related to PI, and the coronal Cobb angle is positively correlated with PI and PI-LL and is negatively correlated with LL. Coronal deformity could be affected by both pelvic orientation and sagittal spine alignment.

Keywords: coronal spine alignment; degenerative lumbar scoliosis; diagnosis; lumbar spinal canal stenosis; pelvic incidence; sagittal spine alignment.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Tokyo Medical University, Institutional Review Board issued approval T2020-0410. Tokyo Medical University, Institutional Review Board, hereby gives notice of its decision regarding the application detailed below: Approval number: T2020-0410 Research topic: Spinal Alignment for Spinal Disease and Lower Extremity Joint Disease Decision: Approved Keisuke MYIAZAVA. M.D., Ph.D. President Tokyo Medical University. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Measurements of radiological parameters
Lateral (A) and anteroposterior (B) standing radiographs SVA: sagittal vertical axis; TK: thoracic kyphosis angle; LL: lumbar lordosis; SS: sacral slope; PT: pelvic tilt; PI: pelvic incidence; Cobb angle: between the inferior endplates of L1 and L5
Figure 2
Figure 2. Visual representation of the regression models superimposed on raw data
(A) ROC curve. (B) Linear regression. A positive correlation was observed between Cobb angle and PI-LL. AUC = 0.64 (95%CI 0.57-0.71). The cut-off values of PI-LL of the ROC curve and linear regression between the scoliosis group and nonscoliosis group were 11° (ROC curve) and 17° (Linear regression), respectively. ROC: receiver operating characteristic, PI: pelvic incidence, LL: lumbar lordosis
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