Sagittal radiographic parameters demonstrate weak correlations with pretreatment patient-reported health-related quality of life measures in symptomatic de novo degenerative lumbar scoliosis: a European multicenter analysis

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Previous studies have demonstrated that among patients with adult spinal deformity (ASD), sagittal plane malalignment is poorly tolerated and correlates with suboptimal patient-reported health-related quality of life (HRQOL). These studies included a broad range of radiographic abnormalities and various types of ASD. However, the clinical and radiographic characteristics of de novo degenerative lumbar scoliosis (DNDLS), a subtype of ASD, may influence previously reported correlation strengths. The aim of this study was to correlate sagittal radiographic parameters with pretreatment HRQOL in patients with symptomatic DNDLS.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>In this multicenter retrospective study of prospectively collected data, 74 patients with symptomatic DNDLS were enrolled based on anteroposterior and lateral 36-inch standing radiographs. Measurements included Cobb angle, coronal imbalance, pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), thoracic kyphosis, pelvic incidence minus lumbar lordosis (PI−LL), T1-pelvic angle, and global tilt. HRQOL questionnaires included the Oswestry Disability Index (ODI), Scoliosis Research Society (SRS-22r), 36-item Short-Form Health Survey, and numeric rating scale (NRS) for back and leg pain. Correlations between radiographic parameters and HRQOL were assessed. Finally, HRQOL and increasing severity of sagittal modifiers (SVA, PI−LL, and PT) were evaluated.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Weak correlations were found between SVA and ODI (r = 0.296, p &lt; 0.05) and PT with NRS back pain and the SRS pain domain (r = −0.260, p &lt; 0.05, and r = 0.282, p &lt; 0.05, respectively). Other sagittal radiographic parameters did not show any significant correlation with HRQOL. No significant differences in HRQOL were found concerning the increasing severity of PT, PI−LL, and SVA.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>While DNDLS is a severe disabling condition, no noteworthy association between clinical and sagittal radiographic parameters was found through this study, demonstrating that sagittal radiographic parameters should not be considered the unique predictor of pretreatment suboptimal health status in this specific group of patients. Future studies addressing classification and treatment algorithms will have to take into account the existing subgroups of ASD.</jats:p></jats:sec>

Association Between Radiographic Spinopelvic Parameters and Health-related Quality of Life in De Novo Degenerative Lumbar Scoliosis and Concomitant Lumbar Spinal Stenosis

“…Although no significant difference of HRQOL in PI-LL modifier was validated in previous study, 9 Ha et al 12 reported that a higher ODI was observed in the “Very Positive” PI-LL modifier group than in the “Positive” group. Both the ODI and JOA scores were statistically significant with “Neutral” and “Very Positive” PI-LL modifier groups, and “Positive” and “Very Positive” PI-LL modifier groups.…”

“…However, only weak correlations were found between SVA with the ODI ( r = 0.296) and PT; the numeric rating scale (NRS) for back pain was ( r = −0.260) and SRS pain domain was ( r = 0.282). 9 Similarly, very weak correlations between the ODI with T1PA ( r = 0.137) and PI-LL ( r = 0.137) were demonstrated in another study. 12 Although the results of a Japanese study suggested weak correlation between LL with lumbar function ( r = 0.285), and moderate correlation between LL with VAS score for leg pain ( r = 0.328).…”

“…No significant difference of HRQOL in all SRS-Schwab classification modifiers (SVA, PT, and PI-LL) was found by Faraj et al 12 in DNDLS patients. 9 Conversely, Ha et al reported that a significant difference in the ODI was only found between the “Neutral” and “Very Positive” groups. A significant difference in JOA scores was also observed between the “Neutral” and “Very Positive” groups in our study.…”

“…Although multiple studies have focused on the relationship between spinopelvic parameters and health-related quality of life (HRQOL) in ASD patients, a general consensus has not been reached. 7 , 9 , 10 We speculated that the possible cause of the controversy was inclusion of the various subtypes of ASD in these previous studies. Thus, we have limited this study to pretreatment DNDLS with concomitant LSS patients; we also investigated the association between spinopelvic parameters and the HRQOL in these patients.…”

<p>Lumbar Muscle Fat Content Has More Correlations with Living Quality than Sagittal Vertical Axis in Elderly Patients with Degenerative Lumbar Disorders</p>

“…However, recent studies do not always show a direct correlation between sagittal imbalance and living quality.- 6,7 Faraj et al 6 conducted a multicenter retrospective study including 74 patients with symptomatic de novo degenerative lumbar scoliosis to investigate the influence of sagittal radiographic parameters on preoperative HRQoL. They found a weak correlation between SVA and the Oswestry Disability Index (ODI) scores (r=0.296, P<0.05).…”