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. 2024 Jan 30;49(21):E355–E360. doi: 10.1097/BRS.0000000000004918

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© 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

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The flow of the participants and their Sagittal Plane Shear Index (SPSI) metric and surgical planning results. * These cases explain why the sample sizes in the “Final surgical plan” boxes decreased. The spine surgeons’ reasons reported for not implementing a change to the surgical plan in cases where the SPSI metric suggested a change should be considered were: ^a the decision to perform decompression with fusion despite a SPSI of exactly 2 which was suggesting spinal stability (n=2); ^b concerns about the invasiveness of fusion surgery in a participant at risk of complications (n=1); ^c doubts about the presence of instability based on the radiographic images despite a SPSI of 4.1 (n=1); ^d the decision to perform a decompression with fusion at two levels (n=1); and ^e the refusal of a participant to undergo fusion surgery (n=1). MRI indicates magnetic resonance imaging.