[Impact of hyperlordosis on orthopedic correction outcomes in severe neuromuscular scoliosis].

<b>Objective:</b> To evaluate and compare surgical outcomes of orthopedic correction in neuromuscular scoliosis (NMS) patients with or without excessive lumbar lordosis, and to analyze the impact of excessive lumbar lordosis on treatment efficacy. <b>Methods:</b> The case data of 102 patients with severe NMS were retrospectively analyzed, there were 34 males and 68 females. The patients underwent surgical treatment at Nanjing Gulou Hospital from April 2008 to June 2022; the age <i>M</i>(<i>Q</i>₁, <i>Q</i>₃) was 18(12, 26) years. There were 25 cases of cerebral palsy, 7 cases of spinal cord bulge, 28 cases of myopathy, 12 cases of post-traumatic paraplegia, and 30 cases of poliomyelitis. The patients were divided into 2 groups according to the degree of preoperative lumbar lordosis: 62 patients with lumbar lordosis<70° (non-hyperlordotic group) and 40 patients with lumbar lordosis≥70° (hyperlordotic group). Radiographic parameters were evaluated preoperatively, postoperatively, and at final follow-up, including scoliosis Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), pelvic obliquity (PO), and SVA. Postoperative complications and follow-up outcomes were compared between groups. The Scoliosis Research Society-22 (SRS-22) questionnaire was administered preoperatively and at final follow-up to assess clinical outcomes in both groups. <b>Results:</b> No statistically significant differences were observed in age and gender distribution between the hyperlordotic and non-hyperlordotic groups (all <i>P</i>>0.05). The hyperlordotic group demonstrated greater preoperative Cobb angles and lumbar lordosis compared to the non-hyperlordotic group (all <i>P</i><0.01). Operative time was significantly longer in the hyperlordotic group (374±59) min compared to the non-hyperlordotic group (295±42)min (<i>P</i><0.001), with intraoperative blood loss of (2 018±978) ml and (1 603±805) ml, respectively (<i>P</i>=0.028).Significant postoperative correction was obtained in both coronal and sagittal planes in both groups, and there was a significant difference in coronal Cobb angle and sagittal LL at the last follow-up compared with the immediate postoperative period in both groups (both <i>P</i><0.05). Complications in the hyperlordotic group included seven cases of malpositioned screws, one postoperative hematoma, two deep surgical site infections, and one case of major intraoperative hemorrhage. The non-hyperlordotic group experienced four cases of screw malposition, two dural tears, and two cases of proximal junctional kyphosis (PJK). The incidence rate of complications in the hyperlordotic group and non-hyperlordotic group was 32.50% (13/40) and 9.68% (6/62), respectively (<i>P</i>=0.004). Preoperative SRS-22 total scores were lower in the hyperlordotic group compared to the non-hyperlordotic group (1.84±0.25 vs 2.65±0.26, <i>P</i><0.001). Both groups showed significant improvement postoperatively (3.54±0.20 vs 3.45±0.45), with no statistically significant difference between groups (<i>P</i>=0.287). <b>Conclusions:</b> Compared with patients without lumbar hyperlordosis, orthopedic surgical treatment of NMS patients with hyperlordosis is more difficult than orthopedic treatment of patients with normal lumbar lordosis, greater intraoperative blood loss, and higher complication rates. Nevertheless, spinal corrective surgery effectively improved quality of life in NMS patients with hyperlordosis.