Baseline Patient-Reported Outcomes Correlate Weakly With Radiographic Parameters

Abstract

Study Design Prospective, cross sectional study. Objective Determine which radiographic parameters drive patient-reported outcomes (PROs) in primary presentation adult symptomatic lumbar scoliosis (ASLS). Summary of Background Data Previous literature suggests correlations between PROs and sagittal plane deformity (sagittal vertical axis [SVA], pelvic incidence-lumbar lordosis [PI-LL] mismatch, pelvic tilt [PT]). Prior work included revision and primary adult spinal deformity patients. This study addresses only primary presentation ASLS. Methods Prospective baseline data were analyzed on 286 patients enrolled in an NIH RO1 clinical trial by nine centers from 2010–2014. Inclusion criteria: 40–80 years old, lumbar Cobb (LC) ≥30° and Scoliosis Research Society-23 (SRS-23) score ≤4.0 in Pain, Function or Self-Image domains or Oswestry Disability Index (ODI) ≥20. Patients were primary presentation (no prior spinal deformity surgery) and had complete baseline data: standing coronal/sagittal 36” radiographs and PROs (ODI, SRS-23, Short Form-12). Correlation coefficients were calculated to evaluate relationships between radiographic parameters and PROs for the study population and a subset of patients with ODI ≥40. ANOVA was used to identify differences in PROs for radiographic modifier groups. Results Mean age was 60.3 years. Mean spinopelvic parameters were: LL=−39.2°; SVA=3.1cm; sacral slope (SS)=32.5°; PT=23.9°; PI-LL mismatch=16.8°. Only weak correlations (0.2–0.4) were identified between population SS, SVA and SVA modifiers and SRS Function. SVA and SVA modifiers were weakly associated with ODI. While there were more correlations in subset analysis of high-symptom patients, all were weak. ANOVA identified significant differences in ODI reported by SVA modifier groups. Conclusions In primary presentation ASLS patients and a subset of ‘high-symptom’ patients (ODI ≥40), only weak associations between baseline PROs and radiographic parameters were identified. For this patient population, these results suggest regional radiographic parameters (LC, LL, PT, PI-LL mismatch) are not drivers of PROs and cannot be used to extrapolate impact on patient-perceived pathology. Level of Evidence 2

Reliability of the balance evaluation systems test and trunk control measurement scale in adult spinal deformity

“…Furthermore, the results of this study showed that performance on BESTest had higher potential to predict health-related quality of life (HRQOL) in ASD patients than demographic and 2D radiographic spinopelvic parameters [4], which form the current cornerstone of clinical decision-making within ASD. Also, other researchers reported that the relation between 2D radiographic spinopelvic parameters and HRQOL scores is weaker than previously assumed, questioning the current classification and evaluation methods in ASD [4,17,18].…”

Current evidence for spinal X-ray use in the chiropractic profession: a narrative review

“…Some studies have reported an association between pain and variation in spinal curvatures [ 67 – 69 ], while others have not found significant association [ 70 , 71 ] or argue that the association may be coincidental or reflective of normal variability [ 72 , 73 ]. Individual study findings that associate symptomology with changes in spinal curves must be balanced by the findings from a systematic review by Christensen and Hartvigsen who found no robust evidence of association [ 74 ].…”

Loss of cervical lordosis: What is the prognosis?

“…[ 38 ] Quite quickly, many papers were published that showed how indispensable it is to recreate a certain spinal alignment to obtain maximum clinical benefit. This started with the lumbar spine, but also here limitations start to appear,[ 39 ] and is currently attempted for the cervical spine where we are, however, still far from making any particular extrapolations. Up to now, all that can be said about alignment in the cervical spine is that what seems logical in any way and most of all serves a purpose.…”