European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
Full versus partial correction of pelvic incidence-lumbar lordosis mismatch in lumbar fusion: a systematic review and meta-analysis.
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Bour Daniel, Wang Kevin Jieyi, Sahi Gurjovan, Singh Jaskaran, Ghimire Nischal, Koucheki Robert, Lewis Stephen, Kim Han Jo, Toor Jay, Abbas Aazad
Аннотация
PURPOSE: Restoration of sagittal balance, specifically the mismatch between pelvic incidence and lumbar lordosis (PI-LL), is an important objective in lumbar fusion, particularly for degenerative deformity correction. While a postoperative PI-LL of ≤ 10° is generally considered optimal, the clinical necessity of achieving this threshold versus partial correction (PI-LL > 10°) remains uncertain. This study aimed to systematically review the differences in disability outcomes and mechanical complications between "full" (≤ 10°) versus "partial" (> 10°) PI-LL correction.
METHODS: Ovid Embase, Ovid MEDLINE, PubMed, Scopus, and Cochrane CENTRAL were searched from database inception to May 9, 2025. Studies were included if they compared full and partial PI-LL correction in adults undergoing lumbar fusion due to degenerative spinal conditions. Correction status was defined by a fixed PI-LL threshold only; the full SRS-Schwab classification was not applied. Using random-effects models, continuous outcomes were pooled as mean differences (MD) in pre-post change and dichotomous outcomes as odds ratios (ORs), both with 95% CIs. Risk of bias was assessed using ROBINS-I.
RESULTS: Twenty-seven studies involving 3,682 patients met the inclusion criteria. Patients who achieved full correction had a modestly greater ODI improvement than patients with partial correction (MD - 2.21; 95% CI [- 4.21, - 0.21]; I2 = 69.3%; p = 0.033). Full correction was also associated with lower odds of developing ASD than partial correction (OR 0.19; 95% CI [0.08, 0.47]; I2 = 81.5%; p = 0.003). There was no significant difference in VAS improvement between correction groups (p = 0.298).
CONCLUSIONS: Postoperative PI-LL ≤ 10° ("full" correction) is associated with a small improvement in ODI that falls below established minimal clinically important difference thresholds. In short-segment degenerative cohorts, full correction is associated with reduced odds of ASD. However, these findings are associational, and PI-LL should be treated as an important guidepost within an individualized alignment strategy that accounts for patient-specific factors and global sagittal balance, rather than as a universal numeric target.
METHODS: Ovid Embase, Ovid MEDLINE, PubMed, Scopus, and Cochrane CENTRAL were searched from database inception to May 9, 2025. Studies were included if they compared full and partial PI-LL correction in adults undergoing lumbar fusion due to degenerative spinal conditions. Correction status was defined by a fixed PI-LL threshold only; the full SRS-Schwab classification was not applied. Using random-effects models, continuous outcomes were pooled as mean differences (MD) in pre-post change and dichotomous outcomes as odds ratios (ORs), both with 95% CIs. Risk of bias was assessed using ROBINS-I.
RESULTS: Twenty-seven studies involving 3,682 patients met the inclusion criteria. Patients who achieved full correction had a modestly greater ODI improvement than patients with partial correction (MD - 2.21; 95% CI [- 4.21, - 0.21]; I2 = 69.3%; p = 0.033). Full correction was also associated with lower odds of developing ASD than partial correction (OR 0.19; 95% CI [0.08, 0.47]; I2 = 81.5%; p = 0.003). There was no significant difference in VAS improvement between correction groups (p = 0.298).
CONCLUSIONS: Postoperative PI-LL ≤ 10° ("full" correction) is associated with a small improvement in ODI that falls below established minimal clinically important difference thresholds. In short-segment degenerative cohorts, full correction is associated with reduced odds of ASD. However, these findings are associational, and PI-LL should be treated as an important guidepost within an individualized alignment strategy that accounts for patient-specific factors and global sagittal balance, rather than as a universal numeric target.