Mechanical Failures as Predicted by Achieving Local Versus Global T4-L1 Hip Axis Goals : A Single-center Experience.
| Title: | Mechanical Failures as Predicted by Achieving Local Versus Global T4-L1 Hip Axis Goals : A Single-center Experience. |
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| Authors: | Joseph K; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Bui TT; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Yahanda AT; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Gupta VP; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Vogl S; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Yakdan S; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Galla JT; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Ruiz-Cardozo MA; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Barot K; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Chakladar S; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Poulin ND; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Challagundla A; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Ng J; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Krishnan A; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Brehm SN; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Benedict B; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Clohisy JC Jr; Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.; Pallotta N; Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.; Gupta MC; Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.; Neuman BJ; Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.; Hills J; Department of Orthopedic Surgery, University of Texas, San Antonio, TX.; Kelly MP; Department of Orthopedic Surgery, Rady Children's Hospital, University of California, San Diego, San Diego, CA.; Hafez D; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Greenberg JK; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Ray WZ; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO.; Molina CA; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO. |
| Source: | Spine [Spine (Phila Pa 1976)] 2026 May 15; Vol. 51 (10), pp. 708-716. Date of Electronic Publication: 2025 Jul 11. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 7610646 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1159 (Electronic) Linking ISSN: 03622436 NLM ISO Abbreviation: Spine (Phila Pa 1976) Subsets: MEDLINE |
| Imprint Name(s): | Publication: Hagerstown, MD : Lippincott Williams & Wilkins; Original Publication: Hagerstown, Md., Medical Dept., Harper & Row. |
| MeSH Terms: | Lumbar Vertebrae*/surgery ; Lumbar Vertebrae*/diagnostic imaging ; Spinal Fusion*/adverse effects ; Spinal Fusion*/methods ; Thoracic Vertebrae*/surgery ; Thoracic Vertebrae*/diagnostic imaging ; Postoperative Complications*/etiology; Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Adult ; Aged |
| Abstract: | Study Design: Retrospective cohort study.; Objective: To evaluate the predictive value of T4-L1 Hip Axis Error (HAE) and L1PA Error (L1PAE) on mechanical failure following adult spinal deformity (ASD) surgery, and to assess how error directionality and fusion length influence outcomes.; Summary of Background Data: The T4-L1 Hip Axis is a novel framework for defining normative sagittal alignment by aligning thoracic and lumbar curvatures relative to the pelvis. Prior studies suggest that deviation from this axis may contribute to mechanical complications following ASD surgery. However, the impact of directionality, construct length, and specific risk factors remains underexplored.; Methods: A retrospective review was conducted of 271 ASD patients who underwent fusion from L2 or above to the pelvis between 2016 and 2024. T4PA and L1PA were measured from six-week postoperative standing radiographs. Alignment errors (HAE, L1PAE) were calculated based on the target threshold derived from prior normative studies. Multivariate logistic regression identified predictors of mechanical failures. Subgroup analyses were stratified by fusion length and error direction.; Results: HAE was a significant predictor of mechanical failure (OR=1.20 per degree, P |
| Competing Interests: | V.P.G. reported royalties from DePuy, Globus, and Innomed; consulting fees from DePuy, Globus, and Medtronic; travel fees from DePuy, Globus, Medtronic, Scoliosis Research Society, Yale, Sonntag, Columbian Spine Society, Brazilian Spine Society, and Japanese Orthopaedic Association; personal stock from J&J and SMAIO; honoraria from SMAIO, Yale, and Japanese Orthopaedic Association; and board of directors membership for Scoliosis Research Society outside the submitted work. N.P. reported consulting fees from Stryker Spine, fellowship support from Medtronic, and research support from ATEC outside the submitted work. J.H. reported personal fees from SMAIO outside the submitted work. B.J.N. reported nonfinancial support from SMAIO outside the submitted work and fellowship support from Medtronic. W.Z.R. reported personal fees from Globus and DePuy outside the submitted work. C.A.M. reported personal fees from SMAIO, NuVasive, Baxter Health, Stryker, and Augmedics outside the submitted work. The remaining authors report no conflicts of interest. |
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| Contributed Indexing: | Keywords: L1 pelvic angle; T4 pelvic angle; T4-L1 hip axis; adult spinal deformity; mechanical failure; spinal realignment; spinopelvic parameters; thoracolumbar fusion |
| Entry Date(s): | Date Created: 20250711 Date Completed: 20260422 Latest Revision: 20260422 |
| Update Code: | 20260423 |
| DOI: | 10.1097/BRS.0000000000005450 |
| PMID: | 40643908 |
| Database: | MEDLINE |
Journal Article