Abstract
Increased sagittal vertical axis (SVA) correlates strongly with pain and disability in adult spinal deformity (ASD). However, increased SVA is caused by failure of physiological compensatory mechanisms to maintain upright posture, with resultant sagittal decompensation. A subset of patients with sagittal spinopelvic malalignment (SSM) have flat back deformity (pelvic incidence-lumbar lordosis mismatch; PI-LL >10°) but remain sagittally compensated with normal SVA. Few data exist for SSM patients with flat back deformity and normal SVA.
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