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The Sloping-Type Adult Spinal Deformity.

Yuki Mihara1,2, Tomohiko Hasegawa3, Yu Yamato2

  • 1Department of Orthopedic Surgery, Iwata City Hospital, Iwata, Japan.

Spine Surgery and Related Research
|December 15, 2025
PubMed
Summary

Adults with spinal deformities may have a sloping spine, characterized by poor alignment and reduced quality of life. This condition is linked to higher pelvic incidence and lower thoracic kyphosis.

Keywords:
adult spinal deformitycohort studylumbar anteriolisthesislumbar lordosispelvic incidencesagittal vertical axisspinopelvic parameterwhole-spine radiograph

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Area of Science:

  • Spine surgery
  • Orthopedics
  • Radiography

Background:

  • Some adult spinal deformities present as a sloping spine, not kyphosis, with significant malalignment.
  • This malalignment is associated with a decline in patient-reported outcome measures (PROMs).

Purpose of the Study:

  • To define sloping-type spinal deformities using radiographic parameters.
  • To correlate these radiographic findings with PROMs.

Main Methods:

  • Included participants with sagittal vertical axis (SVA) >40 mm from a health screening program.
  • Defined sloping-type deformity (S group) based on posterior vertebral wall alignment relative to a vertical sacral line.
  • Measured radiographic parameters (SVA, TK, LL, L4-S angle, PI, PT) and Oswestry Disability Index (ODI).

Main Results:

  • 50 of 348 participants (14.4%) had sloping-type deformities (S group).
  • The S group exhibited significantly higher SVA, PI, PT, PI-LL, and lower TK and L4-S angle compared to the non-S group.
  • The S group reported significantly worse ODI scores, indicating poorer outcomes.

Conclusions:

  • Sloping-type deformities are associated with increased pelvic incidence (PI), poorer spinopelvic alignment, and worse patient-reported outcomes.
  • Higher PI, lumbar anteriolisthesis, and lower TK and L4-S angle are significant factors contributing to sloping-type deformities.