Sagittal malalignment has a significant association with postoperative leg pain in adult spinal deformity patients

Takemoto, Mitsuru; Boissière, Louis; Novoa, Felipe; Vital, Jean-Marc; Pellisé, Ferràn; Pérez-Grueso, Francisco Javier Sánchez; Kleinstück, Frank; Acaroğlu, Emre; Alanay, Ahmet; Obeid, Ibrahim

doi:10.1007/s00586-016-4616-z

Cited by 18 publications

(8 citation statements)

References 31 publications

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“…The prospective and long-term nature of the current study represent 2 important strengths. While many multicenter studies of ASD surgery exist from large, collaborative registries, 33 - 35 the majority of these studies are retrospective. Furthermore, the threshold for complex ASD surgery is defined differently throughout the literature, yet our current inclusion was fairly strict, evidenced by nearly 3 in 4 patients undergoing 3CO.…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Outcomes After Complex Adult Spinal Deformity Surgery: 5-Year Results of the Scoli-Risk-1 Study

Zuckerman

Cerpa

Lenke

et al. 2021

Global Spine Journal

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Study Design: Prospective cohort. Objective: To prospectively evaluate PROs up to 5-years after complex ASD surgery. Methods: The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers. Inclusion criteria was Cobb angle of >80°, corrective osteotomy for congenital or revision deformity, and/or 3-column osteotomy. The following PROs were measured prospectively at intervals up to 5-years postoperative: ODI, SF36-PCS/MCS, SRS-22, NRS back/leg. Among patients with 5-year follow-up, comparisons were made from both baseline and 2-years postoperative to 5-years postoperative. PROs were analyzed using mixed models for repeated measures. Results: Seventy-seven patients (28.3%) had 5-year follow-up data. Comparing baseline to 5-year data among these 77 patients, significant improvement was seen in all PROs: ODI (45.2 vs. 29.3, P < 0.001), SF36-PCS (31.5 vs. 38.8, P < 0.001), SF36-MCS (44.9 vs. 49.1, P = 0.009), SRS-22-total (2.78 vs. 3.61, P < 0.001), NRS-back pain (5.70 vs. 2.95, P < 0.001) and NRS leg pain (3.64 vs. 2.62, P = 0.017). In the 2 to 5-year follow-up period, no significant changes were seen in any PROs. The percentage of patients achieving MCID from baseline to 5-years were: ODI (62.0%) and the SRS-22r domains of function (70.4%), pain (63.0%), mental health (37.5%), self-image (60.3%), and total (60.3%). Surprisingly, mean values ( P > 0.05) and proportion achieving MCID did not differ significantly in patients with major surgery-related complications compared to those without. Conclusions: After complex ASD surgery, significant improvement in PROs were seen at 5-years postoperative in ODI, SF36-PCS/MCS, SRS-22r, and NRS-back/leg pain. No significant changes in PROs occurred during the 2 to 5-year postoperative period. Those with major surgery-related complications had similar PROs and proportion of patients achieving MCID as those without these complications.

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Section: Discussionmentioning

confidence: 99%

Patient-Reported Outcomes After Complex Adult Spinal Deformity Surgery: 5-Year Results of the Scoli-Risk-1 Study

Zuckerman

Cerpa

Lenke

et al. 2021

Global Spine Journal

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“…Our results showed that LL was less related to PT/PI or PT but more related to SS; the spine adjusted TK for the adaptation of pelvic changes. TK and PT were recognized as compensatory mechanisms in patients with ASD, and the cascade was also reported (26). In asymptomatic individuals, the thoracic spine has adequate compensatory capacity (27); thus, sagittal alignment could be maintained in those with a small PT/PI (subgroup 1), although they may have a higher risk of sagittal malalignment once the capacity for thoracic compensation is exhausted due to the pelvic retroversion being limited.…”

Section: Discussionmentioning

confidence: 99%

An analysis of the interactions between the spine, pelvis, and lower limbs in asymptomatic adults with limited pelvic compensation

Shu¹,

Hu²,

Bao³

et al. 2020

Quant Imaging Med Surg

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Background: The interactions between the spine, pelvis, and lower limbs are dynamic based on the "cone of economy" concept; thus, different global radiographic parameters could be regarded as reflections of different centers of gravity. We conducted this retrospective study to evaluate the offsets of different centers of gravity in asymptomatic populations and to investigate how the global sagittal alignment is supported. Methods:The following parameters were measured: cervical lordosis, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), the ratio between PT and PI (PT/PI), sacral slope, PI minus LL (PI-LL), the sagittal vertical axis (SVA), cranial SVA to ankle center (Cr-A), CrSVA to the femoral head center (Cr-FH), C2SVA to the femoral head center (C2-FH), pelvic translation (P. Shift), and knee angle (KA). Participants were divided into subgroups based on the PT/PI ratio. Mean values were compared using the t-test, and correlations were assessed using Pearson's coefficient.Results: A total of 82 asymptomatic adults were enrolled. The average PT/PI in subgroup 1 was the smallest, showing that individuals in this group may have limited pelvic retroversion. No significant differences in Cr-FH, Cr-A, or C2-FH were found between subgroups (all P>0.1), implying that global alignment was well supported in each group. Specifically, C2-FH showed minor changes between subgroups (P=0.998), showing that C2-FH may be a target for sagittal compensation. There were positive correlations between PT/PI and both P. Shift and SVA (r=0.930 and r=0.606, respectively). However, Cr-FH, Cr-A, and C2-FH were not significantly correlated with P. Shift or PT/PI (all P>0.05). Weak correlations existed between Cr-A, Cr-FH, and age (all P>0.2).Conclusions: This study revealed that the Cr-FH and C2-FH offsets are stable across the population and could be maintained by regulating only the sagittal spinal curvature when pelvic compensation is limited. Cr-FH is not affected by age in the asymptomatic population. Thus, the stable Cr-FH and C2-FH could provide references for surgeons during the surgical decision-making process in patients with adult spinal deformity with sagittal malalignment.

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“…The impact of sagittal vertebral alignment on the treatment of spinal disorders is of critical importance. The principles of sagittal balance are vital to achieve optimum outcomes when treating spinal disorders, since a failure to recognize malalignment in this plane can have significant consequences for the patient in terms of pain and deformity [27]. Normally, the spine is known to have a lordotic curves in the cervical and lumbar regions and a kyphotic curve in the thoracic region.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of low back pain and the relationship with sagittal vertebral alignment in Tanzania

Tatsumi

Mkoba

Suzuki

et al. 2019

BMC Musculoskelet Disord

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BackgroundLBP is a common and serious problem affecting vast populations of the world. However, only few studies on LBP in sub-Saharan Africa have been conducted. Studies report that LBP and pelvic angle are interrelated, and African residents have a high pelvic tilt. The strategy to prevent LBP should focus on activities that promote holistic health. For that purpose, it is important to grasp the state of LBP and how it affects people’s lifestyle in Tanzania to clarify the direction of implementation of physiotherapy treatment and reduce the incidences of LBP among adults. This study aimed to investigate the prevalence and presentation of low back pain (LBP) and the relationship between anthropometric measurements and LBP among people in Moshi city, Kilimanjaro region Tanzania.MethodsFollowing signing consent forms, participants were given questionnaires regarding LBP and then grouped accordingly into either asymptomatic or symptomatic cohorts. Anthropometric measurements of participants’ height, weight, curvature of the spine, and pelvic angle were obtained.ResultsA Mann-Whitney U test analysis showed a significant difference in pelvic angle, body mass index (BMI), and thoracic kyphosis angle between the asymptomatic group and the symptomatic group. No significant differences in lumbar lordosis angle or abdominal muscle strength were found between the two groups.ConclusionsA person with symptomatic LBP in Tanzania has a large anteversion of the pelvic tilt and a thoracic kyphotic posture. This study shows a relationship between sagittal spinal alignment and LBP in Tanzania, which could allow for prospective identification of subjects prone to developing LBP in the future.

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Sagittal malalignment has a significant association with postoperative leg pain in adult spinal deformity patients

Cited by 18 publications

References 31 publications

Patient-Reported Outcomes After Complex Adult Spinal Deformity Surgery: 5-Year Results of the Scoli-Risk-1 Study

Patient-Reported Outcomes After Complex Adult Spinal Deformity Surgery: 5-Year Results of the Scoli-Risk-1 Study

An analysis of the interactions between the spine, pelvis, and lower limbs in asymptomatic adults with limited pelvic compensation

Risk factors of low back pain and the relationship with sagittal vertebral alignment in Tanzania

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