Radiographical Spinopelvic Parameters and Disability in the Setting of Adult Spinal Deformity

Schwab, Frank J.; Blondel, Benjamin; Bess, Shay; Hostin, Richard A.; Shaffrey, Christopher I.; Smith, Justin S.; Boachie-Adjei, Oheneba; Burton, Douglas C.; Akbarnia, Behrooz A.; Mundis, Gregory M.; Ames, Christopher P.; Kebaish, Khaled M.; Hart, Robert A.; Farcy, Jean-Pierre; Lafage, Virginie

doi:10.1097/brs.0b013e318292b7b9

Cited by 886 publications

(680 citation statements)

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“…[24][25][26] More recently, there has been an increase in the number of studies demonstrating that there is also an important correlation between the postoperative outcomes of spine interventions and sagittal parameters. 15,20,27 However, studies that correlate cervical sagittal parameters with quality of life indicators in patients who were not submitted to surgical treatment are extremely rare.…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Cervical Sagittal Alignment and Functional Capacity in Cervical Spondylosis

2017

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Objective: To correlate the radiographic parameters of sagittal cervical alignment with quality of life and functional capacity in patients with cervical spondylosis under conservative treatment. Methods: This is an observational and prospective study in patients with cervical spondylosis under conservative treatment and without indication for surgery. The 52 patients included were divided into three groups: axial pain, radiculopathy, and cervical myelopathy. The radiographic parameters considered were cervical lordosis (CL), cervical sagittal vertical axis (CSVA), T1 slope (TS) and the discrepancy between TS and CL (TS-CL). Quality of life and functional capacity were evaluated by the Neck Disability Index (NDI) questionnaire. Pain was assessed by the Visual Analogue Scale (VAS). The correlation between the radiographic parameters and the clinical scores was evaluated by the Pearson correlations coefficient. Results: There was no difference in cervical radiographic parameters between the three groups. In the total of the sample, the mean value of the CSVA was 17.8 o (±8.3 o ), CL, 22.4° (± 8.8°); TS, 29.3° (±6.6°), and TS-CL, 7.0° (±7.4°). Significant inverse correlation (r= -0.3, p=0.039) was observed between NDI and CL, but there was no significant correlation between CL and VAS. CSVA (p=0.541), TS (p=0.287) and TS-CL (p=0.287) had no significantly correlated with NDI or VAS. Conclusion: Considering patients with cervical spondylosis not candidates for surgery, the only sagittal parameter that correlated with functional capacity was LC. In these patients, the correlation between cervical alignment and quality of life needs to be better characterized.Keywords: Spondylosis; Neck pain; Lordosis; Postural balance; Quality of life. (± 8,3°); de LC,22,4° (± 8,8 °); del AIT1,29,3° (± 6,7,0° (± 7,4°). Se observó una correlación inversa significativa (r = -0,3, p = 0,039) entre NDI y LC, pero no hubo correlación significativa entre LC y EVA. EVSC (p = 0,541), AIT1 (p = 0,287) RESUMO

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Section: Discussionmentioning

confidence: 99%

Correlation Between Cervical Sagittal Alignment and Functional Capacity in Cervical Spondylosis

2017

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“…In addition to PT, the LL-PI relationship has been analyzed, and an LL-PI mismatch of less than 11° has been proposed to positively influence outcomes. 19 Based on these and other studies, it has been suggested that the ideal radiographic parameters consist of an SVA less than 50 mm, PT less than 20°, and an LL-PI mismatch of less than 10°.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two minimally invasive surgery strategies to treat adult spinal deformity

Park

Wang

Lafage

et al. 2015

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OBJECT Minimally invasive surgery (MIS) techniques are becoming a more common means of treating adult spinal deformity (ASD). The aim of this study was to compare the hybrid (HYB) surgical approach, involving minimally invasive lateral interbody fusion with open posterior instrumented fusion, to the circumferential MIS (cMIS) approach to treat ASD. METHODS The authors performed a retrospective, multicenter study utilizing data collected in 105 patients with ASD who were treated via MIS techniques. Criteria for inclusion were age older than 45 years, coronal Cobb angle greater than 20°, and a minimum of 1 year of follow-up. Patients were stratified into 2 groups: HYB (n = 62) and cMIS (n = 43). RESULTS The mean age was 60.7 years in the HYB group and 61.0 years in the cMIS group (p = 0.910). A mean of 3.6 interbody fusions were performed in the HYB group compared with a mean of 4.0 interbody fusions in the cMIS group (p = 0.086). Posterior fusion involved a mean of 6.9 levels in the HYB group and a mean of 5.1 levels in the cMIS group (p = 0.003). The mean follow-up was 31.3 months for the HYB group and 38.3 months for the cMIS group. The mean Oswestry Disability Index (ODI) score improved by 30.6 and 25.7, and the mean visual analog scale (VAS) scores for back/leg pain improved by 2.4/2.5 and 3.8/4.2 for the HYB and cMIS groups, respectively. There was no significant difference between groups with regard to ODI or VAS scores. For the HYB group, the lumbar coronal Cobb angle decreased by 13.5°, lumbar lordosis (LL) increased by 8.2°, sagittal vertical axis (SVA) decreased by 2.2 mm, and LL–pelvic incidence (LL-PI) mismatch decreased by 8.6°. For the cMIS group, the lumbar coronal Cobb angle decreased by 10.3°, LL improved by 3.0°, SVA increased by 2.1 mm, and LL-PI decreased by 2.2°. There were no significant differences in these radiographic parameters between groups. The complication rate, however, was higher in the HYB group (55%) than in the cMIS group (33%) (p = 0.024). CONCLUSIONS Both HYB and cMIS approaches resulted in clinical improvement, as evidenced by decreased ODI and VAS pain scores. While there was no significant difference in degree of radiographic correction between groups, the HYB group had greater absolute improvement in degree of lumbar coronal Cobb angle correction, increased LL, decreased SVA, and decreased LL-PI. The complication rate, however, was higher with the HYB approach than with the cMIS approach.

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“…As reported previously, 24 we used standard measurements to assess thoracolumbar and lumbar Cobb angles, coronal balance (C7-CSVL), sagittal balance (sagittal vertical axis [SVA]), lumbar lordosis (T12-S1), thoracic kyphosis (T5-12), thoracolumbar kyphosis (T10-L2), pelvic incidence, pelvic tilt, and sacral slope. The first author (T.H), who was not the primary surgeon, conducted the radiological measurements.…”

Section: Radiological Parametersmentioning

confidence: 99%

“…23 Schwab et al demonstrated an SVA threshold of 47 mm or more for disability. 24 Therefore, we grouped patients according to preoperative SVA values < 50 mm (Group A) or ≥ 50 mm (Group B) and postoperative SVA values < 50 mm (Group C) or ≥ 50 mm (Group D). Radiological parameters, clinical outcomes, and HRQOL outcomes were compared statistically among these groups.…”

Section: Radiological Parametersmentioning

confidence: 99%

Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance

Hikata¹,

Watanabe²,

Fujita³

et al. 2015

SPI

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OBJECT The object of this study was to investigate correlations between sagittal spinopelvic alignment and improvements in clinical and quality-of-life (QOL) outcomes after lumbar decompression surgery for lumbar spinal canal stenosis (LCS) without coronal imbalance. METHODS The authors retrospectively reviewed data from consecutive patients treated for LCS with decompression surgery in the period from 2009 through 2011. They examined correlations between preoperative or postoperative sagittal vertical axis (SVA) and radiological parameters, clinical outcomes, and health-related (HR)QOL scores in patients divided according to SVA. Clinical outcomes were assessed according to Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores. Health-related QOL was evaluated using the Roland-Morris Disability Questionnaire (RMDQ) and the JOA Back Pain Evaluation Questionnaire (JOABPEQ). RESULTS One hundred nine patients were eligible for inclusion in the study. Compared to patients with normal sagittal alignment prior to surgery (Group A: SVA < 50 mm), those with preoperative sagittal imbalance (Group B: SVA ≥ 50 mm) had significantly smaller lumbar lordosis and thoracic kyphosis angles and larger pelvic tilt. In Group B, there was a significant decrease in postoperative SVA compared with the preoperative SVA (76.3 ± 29.7 mm vs 54.3 ± 39.8 mm, p = 0.004). The patients in Group B with severe preoperative sagittal imbalance (SVA > 80 mm) had residual sagittal imbalance after surgery (82.8 ± 41.6 mm). There were no significant differences in clinical and HRQOL outcomes between Groups A and B. Compared to patients with normal postoperative SVA (Group C: SVA < 50 mm), patients with a postoperative SVA ≥ 50 mm (Group D) had significantly lower JOABPEQ scores, both preoperative and postoperative, for walking ability (preop: 36.6 ± 26.3 vs 22.7 ± 26.0, p = 0.038, respectively; postop: 71.1 ± 30.4 vs 42.5 ± 29.6, p < 0.001) and social functioning (preop: 38.7 ± 18.5 vs 30.2 ± 16.7, p = 0.045; postop: 67.0 ± 25.8 vs 49.6 ± 20.0, p = 0.001), as well as significantly higher postoperative RMDQ (4.9 ± 5.2 vs 7.9 ± 5.7, p = 0.015) and VAS scores for low-back pain (2.68 ± 2.69 vs 3.94 ± 2.59, p = 0.039). CONCLUSIONS Preoperative sagittal balance was not significantly correlated with clinical or HRQOL outcomes after decompression surgery in LCS patients without coronal imbalance. Decompression surgery improved the SVA value in patients with preoperative sagittal imbalance; however, the patients with severe preoperative sagittal imbalance (SVA > 80 mm) had residual imbalance after decompression surgery. Both clinical and HRQOL outcomes were negatively affected by postoperative residual sagittal imbalance.

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Radiographical Spinopelvic Parameters and Disability in the Setting of Adult Spinal Deformity

Cited by 886 publications

References 25 publications

Correlation Between Cervical Sagittal Alignment and Functional Capacity in Cervical Spondylosis

Correlation Between Cervical Sagittal Alignment and Functional Capacity in Cervical Spondylosis

Comparison of two minimally invasive surgery strategies to treat adult spinal deformity

Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance

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