Fixed Sagittal Plane Deformity: Causes, Prevention, and Treatment Options

Sagittal plane deformity describes the loss of normal lumbar lordosis. This deformity is usually iatrogenic and often follows lumbar fusion, thoracolumbar fusion, and (in some cases) lumbar decompressive procedures. Nonsurgical causes include ankylosing spondylitis, degenerative changes, or adult presentation of adolescent idiopathic scoliosis. The deformity may lead to neurogenic radicular symptoms secondary to stenosis, paraspinal muscular fatigue, and low back pain. Nonoperative treatment options fail for most patients. Surgical interventions are aimed at restoring lumbar lordosis, which is typically accomplished with revision decompression, fusion, and various osteotomies.