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Study Design:   Retrospective single-center study.Objective:   Investigate the effect of posterior instrumentation on the relationship between lordosis and kyphosis.Methods:   Surgically treated patients with a minimum of 6 months of follow-up were analyzed. Asymptomatic volunteers served to show the normal anatomical relationship between thoracic and lumbar curves. Patients were stratified based on postoperative instrumentation: “Thoracic Fusion” = complete fusion of thoracic spine; “Lumbar Fusion” = complete fusion of lumbar spine; and “Complete Fusion” = fusion from sacrum to at least T5. Bivariate correlations and regression analysis were used to evaluate the relationship between change in thoracic kyphosis (ΔTK) and change in spinopelvic mismatch (ΔPI-LL; pelvic incidence-lumbar lordosis) before and after fusion. Analyses were repeated in “Lumbar Fusion” patients with flexible preoperative thoracic spines.Results:   For asymptomatic volunteers, the natural anatomical relationship between TK and LL was found to be TK = 41% of LL ( r = 0.425, P &lt; .001). A total of 153 of 167 adult spinal deformity patients were included (62 years old, 26.7 kg/m 2 , 78% female). Mean follow-up was 11.5 ± 6.8 months. “Thoracic Fusion” group showed no alteration in the natural relationship between TK and LL (ΔTK = 39% ΔPI-LL), whereas “Lumbar Fusion” group had a reduction in reciprocal change (ΔTK = 34% ΔPI-LL) although a subanalysis of patients in the “Lumbar Fusion” group with flexible thoracic spines showed a marked compensation in reciprocal change with (ΔTK = 58% ΔPI-LL).Conclusion:   The relationship between ΔTK and ΔPI-LL is dependent on level instrumented. “Thoracic Fusion” drives change in LL while this relationship is affected by TK’s natural stiffness in “Lumbar Fusion” patients.

In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which?