Impact of Lordosis Distribution Index on Proximal Junctional Kyphosis and Clinical Outcomes in Patients Undergoing Thoracolumbar Fusion for Degenerative Flatback Syndrome

LDI correction alone did not affect PJK occurrence, but in conjunction with age-adjusted PI-LL overcorrection, LDI overcorrection significantly increased the risk of PJK. Clinical outcomes were affected by age-adjusted PI-LL correction with best outcomes in matched correction group but not by the LDI correction status. This lack of association between LDI and clinical outcomes may be attributable to the fact that LDI alone did not have a significant effect on determining spinopelvic alignment.