Ohba T, et al. - A total of 128 consecutive patients treated with spinal correction surgery who had a minimum 2-year follow-up were involved in a retrospective observational study to ascertain the association between clinical and radiographic outcomes and Global Alignment and Proportion (GAP) score, and to determine which preoperative parameters predominantly impacted the risk for poor GAP score. On the basis of the total GAP score, 32 patients were classified into proportioned, 50 into moderately disproportioned, and 44 into severely disproportioned spinopelvic alignment. A significantly positive association between Oswestry Disability Index, increased proximal junctional angle 2 years following surgery, and total GAP score was noted. Uni and multivariate regression analysis revealed that a large global tilt was a risk factor for a poor GAP score and that the risk for a poor GAP score enhanced with aging. Therefore, since the GAP score associated with the Oswestry Disability Index and increased proximal junctional angle 2 years following surgery, the GAP score might determine targets for sagittal spinopelvic alignment for favorable outcomes of corrective spinal surgery. A large preoperative global tilt is a potential prognosticator of poor postoperative GAP score.