Restoring the Curve: Segmental Lordosis and Its Ripple Effect on Adjacent Segment Disease
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Restoring the Curve: Segmental Lordosis and Its Ripple Effect on Adjacent Segment Disease: #MostCited:
Restoring alignment is an important consideration in spinal fusions. Failure to correct to level-specific alignment goals could promote the development of adjacent segment disease (ASD). Singh et al. explored the consequences of inadequate L4–S1 lordosis correction during short lumbar fusions. The findings are sobering: failure to restore segmental alignment within the optimal 35°–45° range significantly increases the risk of ASD and revision surgery within two years.
Among 168 patients with 1–3 level TLIF and two-year follow-up, 32.7% developed ASD and 19.6% required revision. When stratified by adequacy of L4–S1 lordosis restoration, those with optimal correction had markedly lower ASD (6.7% vs. 33.3%) and revision (5.7% vs. 25.9%) rates. Notably, ASD patients had higher implant-related complications (36.8% vs. 8.0%) and were more likely to undergo subsequent revision (61.1% vs. 8.7%).
Hence, sagittal alignment isn’t just aesthetic—it’s biomechanical insurance. In degenerative spine fusion, restoring segmental lordosis may be the difference between durable outcomes and downstream complications
