Defining a Critical Partition Zone for Sagittal Alignment in Lumbar Spine Fusion Surgery: A Systematic Review.

Abstract

Background: Sagittal alignment in the lumbar spine is essential for spinal stability and functionality, with significant implications in surgical planning for spinal deformity correction. However, standardized lumbar partitioning, particularly identifying a critical sagittal alignment zone, remains underdefined. This study aims to establish a reliable lumbar partition to guide surgical decisions and optimize clinical outcomes.

Methods: A systematic review of four major biomedical databases yielded 32 studies, of which 4 met the inclusion criteria. Studies on asymptomatic adults with segmental lordosis data stratified by pelvic incidence were analyzed. Lumbar lordosis values were converted to percentages, allowing for cross-study comparison. Sensitivity analysis and bias assessment were performed to ensure methodological rigor.

Results: The findings identified the L3-L5 interval, especially around the L4 vertebra, as a critical biomechanical zone across various populations and pelvic incidence groups. Individuals with higher pelvic incidence had concentrated lordosis in lower segments, while those with lower pelvic incidence had greater lordosis in upper segments, underscoring the L3-L5 region's stability as a surgical reference.

Conclusions: The L3-L5 interval serves as a key partition zone for sagittal alignment, providing a stable reference for lumbar spine fusion. These findings offer a foundational clinical reference, potentially improving alignment outcomes and reducing postoperative complications.