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Does alignment with Roussouly classification improve outcomes in well-aligned adult spinal deformity patients?
Aydin Kaghazchi1, Janesh Karnati1, Ahmed Ashraf1
1Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States.
Surgical Neurology International
|June 3, 2026
Summary
Roussouly classification matching did not reduce mechanical complications in adult spinal deformity patients already achieving good sagittal alignment. Surgical planning should focus on key alignment targets, as Roussouly matching offers no additional benefit in these cases.
Area of Science:
- Spine Surgery
- Orthopedics
- Biomechanical Engineering
Background:
- Adult spinal deformity (ASD) correction aims to reduce mechanical complications.
- Established classification systems (Roussouly, SRS-Schwab, GAP score) guide surgical planning.
- The added benefit of combining these frameworks for ASD correction remains unclear.
Purpose of the Study:
- To evaluate if Roussouly classification matching provides additional reduction in mechanical complications for ASD patients undergoing corrective surgery.
- To determine if Roussouly matching offers benefits within subgroups defined by sagittal alignment parameters.
Main Methods:
- Retrospective study of 174 ASD patients undergoing corrective surgery (2018-2023).
- Patients classified as Roussouly 'Match' or 'Mismatch' based on concordance with theoretical type.
- Well-aligned subgroups defined by sagittal vertical axis (SVA ≤5 cm), pelvic incidence-lumbar lordosis (PI-LL ≤10°), or GAP score (≤6).
- Primary outcome: mechanical complications.
Main Results:
- No significant difference in mechanical complications between Roussouly-matched and mismatched patients overall.
- No significant differences observed within matched/mismatched subgroups based on alignment parameters.
- Findings remained consistent after adjusting for demographic and comorbidity factors.
Conclusions:
- Roussouly classification matching does not offer additional mechanical complication reduction in well-aligned ASD patients.
- Surgical planning can prioritize established sagittal alignment targets.
- Future research should explore alignment strategies impacting broader patient outcomes.
