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Chiu YC, Tsai PC, Lee SH, Wu WT, Yu TC, Lee RP, Chen IH, Wang JH, Yeh KT. Research of Global Tilt and Functional Independence: Insights into Spinal Health of Older Women. Bioengineering (Basel) 2024; 11:493. [PMID: 38790360 PMCID: PMC11118819 DOI: 10.3390/bioengineering11050493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/24/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Spinal alignment intricately influences functional independence, particularly in older women with osteopenia experiencing mild neck and back pain. This study elucidates the interplay between spinal alignment, bone mineral density (BMD), and muscle strength in elderly women presenting with mild neck and back pain. Focusing on a cohort of 189 older women, we examined the associations among global tilt (GT), coronal and sagittal alignment, BMD, grip strength, and functional independence as gauged by the Barthel index. Our findings indicate significant associations between functional capacity and grip strength, bone density, GT, and pelvic tilt (PT). Elderly women with a Barthel Index above 80 demonstrated higher grip strength and better bone quality, reflected by less negative average T scores. These individuals also exhibited lower values of GT and PT, suggesting a better sagittal alignment compared to those with a Barthel index of 80 or below. The results highlight that deviations in GT and PT are significantly associated with decreased functional independence. These insights emphasize the importance of maintaining optimal spinal alignment and muscle strength to support functional independence in elderly women. This study underscores the potential for targeted interventions that improve postural stability and manage pain effectively in this vulnerable population.
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Affiliation(s)
- Yu-Chieh Chiu
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (Y.-C.C.); (P.-C.T.); (S.-H.L.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
| | - Ping-Chiao Tsai
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (Y.-C.C.); (P.-C.T.); (S.-H.L.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
| | - Ssu-Hsien Lee
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (Y.-C.C.); (P.-C.T.); (S.-H.L.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
| | - Wen-Tien Wu
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (Y.-C.C.); (P.-C.T.); (S.-H.L.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan;
| | - Tzai-Chiu Yu
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (Y.-C.C.); (P.-C.T.); (S.-H.L.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
| | - Ru-Ping Lee
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan;
| | - Ing-Ho Chen
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (Y.-C.C.); (P.-C.T.); (S.-H.L.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
| | - Kuang-Ting Yeh
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (Y.-C.C.); (P.-C.T.); (S.-H.L.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan;
- Department of Medical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970, Taiwan
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Boissiere L, Bourghli A, Kieser D, Larrieu D, Alanay A, Pellisé F, Kleinstück F, Loibl M, Pizones J, Obeid I. Fixed coronal malalignment (CM) in the lumbar spine independently impacts disability in adult spinal deformity (ASD) patients when considering the obeid-CM (O-CM) classification. Spine J 2023; 23:1900-1907. [PMID: 37633521 DOI: 10.1016/j.spinee.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/20/2023] [Accepted: 08/13/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Postoperative flatback has been described in detail for sagittal plane considerations over the past 2 decades, and its correlations with disability are now accepted. Fixed Coronal Malalignment (CM) has been less described, and some authors report no significant association with the clinical outcome. The O-CM classification analyses CM and incorporates specific modifiers for each curve type. PURPOSE This study evaluates the O-CM classification modifiers according to age, sagittal alignment, and patient-reported outcome measures (PROMs). Our hypothesis is that fixed CM correlates with PROMs independently from sagittal alignment and age. STUDY DESIGN Retrospective analysis of a large adult spinal deformity (ASD) database prospectively collected. PATIENT SAMPLE We included 747 patients from the database with long lumbar fusion (more than 3 levels), with at least two years of follow-up. Three categories of patients met the inclusion criteria (prior surgery at baseline and no revision surgery afterward, prior surgery at baseline and revision afterward, no prior surgery at baseline but fusion>3 levels and 2 years follow-up). OUTCOME MEASURES All patients completed the Oswestry Disability Index (ODI), Short Form 36 (SF36), and Scoliosis Research Society 22 scores. METHODS The patients were classified according to the six modifiers of the O-CM classification. Central Sacral Vertical Line (CSVL) above 2, 3, and 4 cm's impact on PROMs was analyzed. Multivariate analysis was performed on the relationship between PROMS and age, global tilt (GT), and CM modifiers. RESULTS After multivariate analysis using age and GT as confounding factors, we found that CM independently affects PROMs starting at 2 cm offset. Disability increases linearly with CSVL. Patients classified with 2B modifiers have the worst SRS-22 total score, social life, and self-image. CONCLUSION In a fused spine, CM independently affects disability in ASD patients. Disability increases linearly with CSVL. Despite previous reports that failed to find correlations of CM with PROMs, our study showed that fixed postoperative CM, according to O-CM classification, correlates independently from sagittal malalignment with worse PROMs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Louis Boissiere
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, Bruges, France.
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Hospital, Al Mathar Ash Shamali, Riyadh 11564, Saudi Arabia
| | - David Kieser
- School of Medicine, University of Otago, PO Box 4345, Christchurch 8140, New Zealand
| | - Daniel Larrieu
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, Bruges, France
| | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Kayışdağı Cd., 34750 Ataşehir/ Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron 119, 08035 Barcelona, Spain
| | - Frank Kleinstück
- Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | - Markus Loibl
- Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, P.º de la Castellana, 261, Madrid, Spain
| | - Ibrahim Obeid
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, Bruges, France
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Girod PP, Lener S, Kögl N, Hartmann S, Abramovic A, Krismer L, Santer M, Ortler M, Thomé C. Health-related quality of life 2 years after pedicle subtraction osteotomy for sagittal imbalance: a single-center experience of 65 patients. Acta Neurochir (Wien) 2023; 165:3521-3527. [PMID: 37715821 PMCID: PMC10624731 DOI: 10.1007/s00701-023-05787-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/30/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Pedicle subtraction osteotomy (PSO) as an invasive procedure with high reoperation and complication rates in an often elderly population has often been questioned. The purpose of our study was to evaluate the impact of PSO for sagittal imbalance (SI) on patient-reported outcomes including self-reported satisfaction and health-related quality of life 2 years postoperatively. METHODS Consecutive patients who underwent correction of their spinal deformity by thoracolumbar PSO were assessed using self-reporting questionnaires 2 years postoperatively. Outcome was measured by visual analogue scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and EQ-5D scores. Additionally, a Patient Satisfaction Index (PSI) rated in four grades (A: very satisfied to D: not satisfied), walking range, and the Timed Up and Go (TUG) Test were evaluated. RESULTS Sixty-five patients were included, and each parameter was assessed preoperatively and 24 months postoperatively. The intervention led to significant improvements in back pain (8.1 ± 1.2 vs. 2.9 ± 1.9; p < 0.001), as well as ODI scores (57.7 ± 13.9 vs. 32.6 ± 18.9; p < 0.001), walking range (589 ± 1676 m vs. 3265 ± 3405 m; p < 0.001), and TUG (19.2 s vs. 9.7 s; p < 0.05). 90.7% of patients (n = 59/65) reported a PSI grade "A" or "B" 24 months postoperatively. CONCLUSION Patient satisfaction 24 months after PSO for SI is high. Quality of life improved significantly by restoring sagittal balance.
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Affiliation(s)
- Pierre-Pascal Girod
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Nikolaus Kögl
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Anto Abramovic
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Laura Krismer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Markus Santer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Martin Ortler
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Department of Neurosurgery, Klinik Landstraße, Vienna, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Datt R, Jain G, Krishna A, Vijayakumar V, Tank S. Association of Various Spinopelvic Parameters and the Quality of Life in Those With Degenerative Lumbar Scoliosis in the Indian Population. Cureus 2023; 15:e40884. [PMID: 37492835 PMCID: PMC10364075 DOI: 10.7759/cureus.40884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/27/2023] Open
Abstract
Purpose The current study aimed to find any association between various spinopelvic parameters and the quality of life in patients with degenerative lumbar scoliosis (DLS) measured as per the Oswestry disability index (ODI) and visual analog scale (VAS) in the Indian population. Methods We included 20 DLS patients of more than 40 years with a Cobb angle of more than 10° and without any trauma, tumour, infection, or congenital scoliosis presented in our tertiary care centre in the study. The VAS and ODI were calculated for each patient. Radiological parameters were recorded for every patient, including sagittal balance, coronal balance, Cobb angle, pelvic incidence, pelvic tilt, and lumbar lordotic angle. We evaluated the results and sought any association between clinical and radiological variables for DLS. Results Patients with positive sagittal balance had significantly higher disability than those with neutral sagittal balance (p-value 0.007). Furthermore, patients with coronal imbalance had more severe pain (p-value 0.013) and disability (p-value 0.038) than those with neutral coronal balance. We also found that the ODI and VAS were not associated with any other spinopelvic parameters. Conclusion From the present study, we can conclude that in the Indian population, both positive sagittal and coronal imbalances are associated with poor functional status in patients with DLS. Therefore, while planning surgical correction for these patients, both coronal and sagittal balance are important and need to be considered.
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Affiliation(s)
- Rameshwar Datt
- Orthopaedics, Employees' State Insurance (ESI) - Postgraduate Institute of Medical Sciences and Research (PGIMSR), New Delhi, IND
| | - Gunjar Jain
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Anant Krishna
- Orthopaedics, Maulana Azad Medical College, New Delhi, IND
| | - Vivek Vijayakumar
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Shekhar Tank
- Orthopaedics, Maulana Azad Medical College, New Delhi, IND
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Haddad S, Yasuda T, Vila-Casademunt A, Yilgor Ç, Nuñez-Pereira S, Ramirez M, Pizones J, Alanay A, Kleinstuck F, Obeid I, Pérez-Grueso FJS, Matsuyama Y, Pellisé F. Revision surgery following long lumbopelvic constructs for adult spinal deformity: prospective experience from two dedicated databases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1787-1799. [PMID: 36939889 DOI: 10.1007/s00586-023-07627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE Pan Lumbar Arthodesis (PLA) are often required for Adult Spinal Deformity (ASD) correction, reducing significantly the compensatory capacity in case of postoperative sagittal malalignment. Few papers have investigated outcomes and complications in this vulnerable subset of patients. The objective of this study was to assess revision surgery rate for PLA in ASD, its risk factors and impact on clinical outcomes. METHODS Retrospective multicenter review of prospective ASD data from 7 hospitals covering Europe and Asia. ASD patients included in two prospective databases having a posterior instrumentation spanning the whole lumbar region with more than 2-years of follow-up were reviewed. Demographic, surgical, radiographic parameters and Health-Related Quality of Life (HRQoL) scores were analyzed. Univariate and multivariate regression models analyzed risk factors for revision surgery as well as surgical outcomes. Patients with Early versus Late and PJK versus Non-PJK mechanical complications were also compared. RESULTS Out of 1359 ASD patients included in the database 589 (43%) had a PLA and 357 reached 2-years mark. They were analyzed and compared to non-PLA patients. Average age was 67 and 82% were females. 100 Patients (28.1%) needed 114 revision surgeries (75.4% for mechanical failures). Revised patients were more likely to have a nerve system disorder, higher BMI and worst immediate postoperative alignment (as measured by GAP Parameters). These risk factors were also associated with earlier mechanical complications and PJK. Deformity and HRQoL parameters were comparable at baseline. Non-revised patients had significantly better clinical outcomes at 2-years (SRS 22 scores, ODI, Back pain). Multivariate analysis could identify nerve system disorder (OR 4.8; CI 1.8-12.6; p = 0.001), postoperative sagittal alignment (GAP Score) and high BMI (OR 1.07; CI 1.01-1.13; p = 0.004) as independent risk factors for revisions. CONCLUSIONS Revision surgery due to mechanical failures is relatively common after PLA leading to worse clinical outcomes. Prevention strategies should focus on individualized restoration of sagittal alignment and better weight control to decrease stress on these rigid constructs in non-compliant spines. Nerve system disorders independently increase revision risk in PLA. LEVEL OF EVIDENCE II Prognosis.
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Affiliation(s)
- Sleiman Haddad
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain.
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
| | - Tatsuya Yasuda
- Department of Orthopedic Surgery, Iwata City Hospital, Iwata-City, Shizuoka, Japan
| | | | - Çaglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey
| | - Susana Nuñez-Pereira
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - Manuel Ramirez
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - Javier Pizones
- Spine Surgery Unit, La Paz University Hospital, Madrid, Spain
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey
| | | | - Ibrahim Obeid
- Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | | | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu-City, Shizuoka, Japan
| | - Ferran Pellisé
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
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Asahi R, Nakamura Y, Koike Y, Kanai M, Yuguchi S, Kamo T, Azami M, Ogihara H, Asano S. Sagittal alignment cut-off values for predicting future fall-related fractures in community-dwelling osteoporotic women. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023. [PMID: 36809343 DOI: 10.1007/s00586-023-07580-0[advanceonlinepublication.]] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE Determining the optimal cut-off value of sagittal alignment for detecting osteoporotic patients at high risk for fall-related fractures is essential for understanding fracture risk and informing clinicians and physical therapists. We determined the optimal cut-off value of sagittal alignment for detecting osteoporotic patients at high risk for fall-related fractures in this study. METHODS In the retrospective cohort study, we enrolled a total of 255 women aged ≥ 65 years who visited an outpatient osteoporosis clinic. We measured participants' bone mineral density and sagittal alignment, including sagittal vertical axis (SVA), pelvic tilt, thoracic kyphosis, pelvic incidence, lumbar lordosis, global tilt, and gap score at the initial visit. The cut-off value for sagittal alignment that was significantly associated with fall-related fractures was calculated after using multivariate Cox proportional hazards regression analysis. RESULTS Ultimately, 192 patients were included in the analysis. After a mean follow-up of 3.0 years, 12.0% (n = 23) had fractures due to falls. Multivariate Cox regression analysis confirmed that SVA (hazard ratio [HR] = 1.022, 95% confidence interval [CI] = 1.005-1.039) was the only independent predictor of fall-related fracture occurrence. The predictive ability of SVA for the occurrence of fall-related fractures was moderate (area under the curve [AUC] = 0.728, 95% CI = 0.623-0.834), with a cut-off value of 100 mm for SVA. SVA classified by cut-off value was also associated with an increased risk of developing fall-related fractures (HR = 17.002, 95% CI = 4.102-70.475). CONCLUSION We found that assessing the cut-off value of sagittal alignment would be useful information in understanding fracture risk in postmenopausal older women.
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Affiliation(s)
- Ryoma Asahi
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan.
| | - Yutaka Nakamura
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| | - Yoshinao Koike
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| | - Masayoshi Kanai
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| | - Satoshi Yuguchi
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan
| | - Tomohiko Kamo
- Department of Rehabilitation, Gunma Paz University, 1-7-1 Tonyamachi, Takasaki City, Gunma, 370-0006, Japan
| | - Masato Azami
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan
| | - Hirofumi Ogihara
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, 11-1, Imaihara, Kawanakajima-Machi, Nagano City, Nagano, 381-2227, Japan
| | - Satoshi Asano
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
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Sagittal alignment cut-off values for predicting future fall-related fractures in community-dwelling osteoporotic women. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1446-1454. [PMID: 36809343 DOI: 10.1007/s00586-023-07599-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/12/2023] [Accepted: 02/09/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Determining the optimal cut-off value of sagittal alignment for detecting osteoporotic patients at high risk for fall-related fractures is essential for understanding fracture risk and informing clinicians and physical therapists. We determined the optimal cut-off value of sagittal alignment for detecting osteoporotic patients at high risk for fall-related fractures in this study. METHODS In the retrospective cohort study, we enrolled a total of 255 women aged ≥ 65 years who visited an outpatient osteoporosis clinic. We measured participants' bone mineral density and sagittal alignment, including sagittal vertical axis (SVA), pelvic tilt, thoracic kyphosis, pelvic incidence, lumbar lordosis, global tilt, and gap score at the initial visit. The cut-off value for sagittal alignment that was significantly associated with fall-related fractures was calculated after using multivariate Cox proportional hazards regression analysis. RESULTS Ultimately, 192 patients were included in the analysis. After a mean follow-up of 3.0 years, 12.0% (n = 23) had fractures due to falls. Multivariate Cox regression analysis confirmed that SVA (hazard ratio [HR] = 1.022, 95% confidence interval [CI] = 1.005-1.039) was the only independent predictor of fall-related fracture occurrence. The predictive ability of SVA for the occurrence of fall-related fractures was moderate (area under the curve [AUC] = 0.728, 95% CI = 0.623-0.834), with a cut-off value of 100 mm for SVA. SVA classified by cut-off value was also associated with an increased risk of developing fall-related fractures (HR = 17.002, 95% CI = 4.102-70.475). CONCLUSION We found that assessing the cut-off value of sagittal alignment would be useful information in understanding fracture risk in postmenopausal older women.
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Semaan K, Rachkidi R, Saad E, Massaad A, Kawkabani G, Saliby RM, Mekhael M, Abi Karam K, Fakhoury M, Jaber E, Ghanem I, Skalli W, Lafage V, Assi A. Alterations of gait kinematics depend on the deformity type in the setting of adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3069-3080. [PMID: 36028589 DOI: 10.1007/s00586-022-07348-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/13/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate 3D kinematic alterations during gait in Adult Spinal Deformity (ASD) subjects with different deformity presentations. METHODS One hundred nineteen primary ASD (51 ± 19y, 90F), age and sex-matched to 60 controls, underwent 3D gait analysis with subsequent calculation of 3D lower limb, trunk and segmental spine kinematics as well as the gait deviation index (GDI). ASD were classified into three groups: 51 with sagittal malalignment (ASD-Sag: SVA > 50 mm, PT > 25°, and/or PI-LL > 10°), 28 with only frontal deformity (ASD-Front: Cobb > 20°) and 40 with only hyperkyphosis (ASD-HyperTK: TK > 60°). Kinematics were compared between groups. RESULTS ASD-Sag had a decreased pelvic mobility compared to controls with a decreased ROM of hips (38 vs. 45°) and knees (51 vs. 61°). Furthermore, ASD-Sag exhibited a decreased walking speed (0.8 vs. 1.2 m/s) and GDI (80 vs. 95, all p < 0.05) making them more prone to falls. ASD-HyperTK showed similar patterns but in a less pronounced way. ASD-Front had normal walking patterns. GDI, knee flex/extension and walking speed were significantly associated with SVA and PT (r = 0.30-0.65). CONCLUSION Sagittal spinal malalignment seems to be the driver of gait alterations in ASD. Patients with higher GT, SVA, PT or PI-LL tended to walk slower, with shorter steps in order to maintain stability with a limited flexibility in the pelvis, hips and knees. These changes were found to a lesser extent in ASD with only hyperkyphosis but not in those with only frontal deformity. 3D gait analysis is an objective tool to evaluate functionality in ASD patients depending on their type of spinal deformity. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Karl Semaan
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Rami Rachkidi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Eddy Saad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Georges Kawkabani
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Renée Maria Saliby
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Mario Mekhael
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Krystel Abi Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Marc Fakhoury
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Elena Jaber
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts Et Métiers, Paris, France
| | | | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
- Institut de Biomécanique Humaine Georges Charpak, Arts Et Métiers, Paris, France.
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9
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Gille O, Skalli W, Mathio P, Kouyoumdjian P, Boishardy A, Gajny L, Roscop C. Sagittal Balance Using Position and Orientation of Each Vertebra in an Asymptomatic Population. Spine (Phila Pa 1976) 2022; 47:E551-E559. [PMID: 35867624 DOI: 10.1097/brs.0000000000004366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 02/26/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A monocentric, retrospective radiographic study with 99 asymptomatic volunteers. OBJECTIVE The authors performed the postural analysis commonly scheduled when evaluating sagittal balance in a vertebra-by-vertebra manner by enrolling an asymptomatic population. They measured the position and angulation of each vertebra to reveal those for which the spatial positioning could be relevant during spinal surgeries. SUMMARY OF BACKGROUND DATA Several recent publications detailed the sagittal alignment parameters and focus on global analysis parameters. Some patients with identical commonly evaluated spinal parameters have exhibited very different profiles, with notable differences in vertebral positions and orientations. Therefore, a fine segmental analysis of position of each vertebra could be interest to gain understanding of spine alignment. MATERIALS AND METHODS The authors obtained full-spine EOS x-rays of 99 volunteers in the standard free-standing position. We used a validated three-dimensional reconstruction technique to extract current spinal parameters and the positions and angulations of all vertebrae and lumbar discs. Particular attention was paid to the positions and angulations of the apical and transitional vertebrae in the general population and in subgroups according to pelvic incidence (PI). RESULTS T1 was the most common transitional cervicothoracic vertebra (in 89.9% of subjects) and was oriented downwards by an average of 22.0° (SD=7.3°, minimum=2.3°, maximum=40.1°). The thoracic apex trio of T5 (22.2%), T6 (28.3%), and T7 (36.4%) were equally found. The transitional thoracolumbar vertebrae were L1 (39.4%) and T12 (33.3%). The lumbar apex was usually the L3-L4 disc (36.4%). T1 seemed to be the transitional vertebra (90%) irrespective of the PI. For the other relevant vertebrae, the greater the PI, the more cranial the vertebra. CONCLUSIONS We performed a detailed three-dimensional assessment of overall spinal balance using positional and rotational parameters. The positions and orientations of all vertebrae were specified, particularly the apical and transitional vertebrae. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Olivier Gille
- Spine Surgery Department, University Hospital, Bordeaux, France
| | - Wafa Skalli
- Biomechanical Laboratory, ENSAM-CNRS UMR 8005, Paris, France
| | - Paul Mathio
- Spine Surgery Department, University Hospital, Bordeaux, France
| | | | - Alice Boishardy
- Spine Surgery Department, University Hospital, Bordeaux, France
| | - Laurent Gajny
- Spine Surgery Department, University Hospital, Nîmes, France
| | - Cecile Roscop
- Spine Surgery Department, University Hospital, Bordeaux, France
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10
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Charles YP, Bauduin E, Pesenti S, Ilharreborde B, Prost S, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Blondel B. Variation of Global Sagittal Alignment Parameters According to Gender, Pelvic Incidence, and Age. Clin Spine Surg 2022; 35:E610-E620. [PMID: 35383599 DOI: 10.1097/bsd.0000000000001321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE The aim was to describe existing global sagittal alignment parameters across ages and to analyze differences according to gender and pelvic incidence (PI). SUMMARY OF BACKGROUND DATA Variability with age has been reported. It remains unclear how gender and spinopelvic morphology could additionally influence global alignment parameters. MATERIALS AND METHODS Radiographs of 2599 individuals (5-93 y) were analyzed. Translation parameters were: Sagittal Vertical Axis (SVA)-C7, SVA-C2, SVA-Center Acoustic Meatus (CAM), C7/Sacrofemoral Distance (SFD) ratio. Inclination parameters were: C7-Vertical Tilt (VT), T1-VT and T9-VT, Odontoid-Hip Axis (OD-HA), OD-CAM. Pelvic compensation parameters were: T1-Pelvic Angle (TPA), Global Tilt (GT), Spino-Sacral Angle (SSA). Global sagittal alignment (GSA) was considered among formulae. The distribution of parameters was analyzed using a Bayesian inference. Correlations with spinopelvic parameters were investigated. RESULTS SVA-C7, SVA-C2, SVA-CAM were larger in males and high PI, and increased significantly after 50 years (Pr>0.9999). C7/SFD decreased during growth and was larger in low PI (Pr=0.951). There was no correlation with spinopelvic parameters. Age-related variations of inclination parameters were nonsignificant. T1-VT and T9-VT increased with PI and were significantly larger in high PI (Pr>0.95). C7-VT was significantly larger in low PI (Pr>0.9999). OD-HA and OD-CAM were constant and increased after 80 years. TPA and GT increased with PI (Pr>0.9999) and age after 35 years (Pr>0.9999). SSA decreased nonsignificantly after 50 years. TPA correlated with PI (ρ=0.6130) and pelvic tilt (PT) (ρ=0.8375). GT correlated with PI (ρ=0.5961) and PT (ρ=0.8996). SSA correlated with sacral slope (ρ=0.9026). GSA was larger in high PI (Pr>0.9999) and increased after 35 years (Pr>0.9999). GSA correlated with PT (ρ=0.7732). CONCLUSION Translation parameters increase with age, more prominently in males and high PI. Variations of inclination parameters are smaller. Pelvic compensation parameters and GSA increase with age and are closely related to PT and spinopelvic morphology. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yann P Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims
| | - Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris
| | - Federico Solla
- Service d'Orthopédie Pédiatrique, Fondation Lenval, Nice
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, Bordeaux
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris
| | - Georges N Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris
| | | | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris
| | - Jonathan Lebhar
- Institut Locomoteur de l'Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire
| | | | | | - Erik A Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille
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Kieser DC, Yuksel S, Boissiere L, Yilgor C, Cawley DT, Hayashi K, Alanay A, Kleinstueck FS, Pellise F, Perez-Grueso FJS, Jean-Marc V, Bourghli A, Acaroglu ER, Obeid I. Impact of radiologic variables on item responses of ODI, SRS22 and SF-36. in adult spinal deformity patients: differential item functioning (DIF) analysis results from a multi-center database. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1166-1173. [PMID: 35059861 DOI: 10.1007/s00586-021-07088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/24/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine if responses given to each question of the Scoliosis Research Society-22 (SRS22), Oswestry disability index (ODI) and Short Form-36 (SF-36) questionnaires are influenced by the radiological parameters. METHODS Patients enrolled in a multi-centre prospectively collected adult spinal deformity database who had complete SRS22, ODI and SF-36 data at baseline and at one-year follow-up were analysed. The presence of a differential item function of each question within each score in relation to radiological parameters was analysed using a mixed Rasch model with the radiological threshold value(s) determined. RESULTS Of those patients analysed (n = 1745; 1406 female, average age 51.0 ± 19.8 years), 944 were surgically and 801 were non-surgically treated. For the SRS22, questions (Q) 3, 5 and 18 were sensitive to almost all radiological parameters and the overall score was found sensitive to the Cobb angle. For the ODI, Q3, 6, 9 and 10 were not sensitive to any radiologic parameters whereas Q4 and 5 were sensitive to most. In contrast, only 3 of the SF-36 items were sensitive to radiological parameters. CONCLUSIONS 78% of the SRS-22, 60% of the ODI and 8% of the questions in the SF-36 are sensitive to radiological parameters. Sagittal imbalance is independently associated with a poor overall outcome, but affects mental status and function more than pain and self-image. The assembly of questions responsive to radiological parameters may be useful in establishing a connection between changes in radiologic parameters and HRQL.
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Affiliation(s)
- D C Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, 2 Riccarton Avenue, 8011, Christchurch, New Zealand.
| | - S Yuksel
- School of Medicine Ankara, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - L Boissiere
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - C Yilgor
- Mater Private Hospital, Dublin, Ireland
| | - D T Cawley
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France.,Mater Private Hospital, Dublin, Ireland
| | - K Hayashi
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - A Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | | | - F Pellise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Vital Jean-Marc
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - A Bourghli
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | | | - I Obeid
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
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12
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Cirillo Totera JI, Fleiderman Valenzuela JG, Garrido Arancibia JA, Pantoja Contreras ST, Beaulieu Lalanne L, Alvarez-Lemos FL. Sagittal balance: from theory to clinical practice. EFORT Open Rev 2021; 6:1193-1202. [PMID: 35839102 PMCID: PMC8693232 DOI: 10.1302/2058-5241.6.210062] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Adequate sagittal balance (SB) is essential to maintain an upright, efficient, and painless posture. It has been shown that sagittal profile alterations affect quality of life of patients with a similar or even greater impact than chronic disease. Evaluation of the SB has gained much relevance in recent years, with recognition of its importance in the evaluation of spinal pathology. This review summarizes the basic principles of SB, aiming to obtain a practical, simple and understandable evaluation of the sagittal profile of a patient. SB is a dynamic process that involves a varying degree of energy expenditure. Distinguishing between a balanced, compensated imbalance or decompensated imbalanced patient, is relevant to diagnosis and therapeutic decision-making.
Cite this article: EFORT Open Rev 2021;6:1193-1202. DOI: 10.1302/2058-5241.6.210062
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Affiliation(s)
- Juan I. Cirillo Totera
- Clínica Universidad de los Andes, Santiago, Chile
- Hospital del Trabajador, Santiago, Chile
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13
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Lee KY, Lee JH, Im SK. Optimal Lumbar Lordosis Correction for Adult Spinal Deformity with Severe Sagittal Imbalance in Patients Over Age 60: Role of Pelvic Tilt and Pelvic Tilt Ratio. Spine (Phila Pa 1976) 2021; 46:E1246-E1253. [PMID: 33907085 PMCID: PMC8565504 DOI: 10.1097/brs.0000000000004068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/26/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES The purpose of this study was to evaluate optimal and ideal target values of the spine balance correction in elderly patients with adult spinal deformity who were over the age of 60 years. SUMMARY OF BACKGROUND DATA The target values of the Scoliosis Research Society -Schwab classification to obtain satisfactory alignment and favorable outcomes are used in many spinal reconstruction surgeries. However, uniformly applying the Scoliosis Research Society-Schwab classification to all elderly patients aged 60 years or older showing sagittal malalignment may lead to several inconsistencies. METHODS This study included 121 patients (average age 70.5 yr and a minimum 2-yr follow-up) with adult spinal deformity who underwent long-segment fusion from T10 to sacrum. We used Pearson's correlation coefficient to analyze the relationship between clinical and radiographic parameters, and multilinear regression analysis and multivariate logistic regression model (backward elimination method) were conducted using the correlation factors of postoperative (Post) and last follow-up (Last) sagittal vertical axis to find the risk factors of Post sagittal imbalance. RESULTS Logistic regression analysis with the correlation factors of Post and Last sagittal vertical axis led to risk factors of Post sagittal imbalance, and after confirming the significance of each path, it was confirmed that the effects of pelvic incidence (PI)- lumbar lordosis (LL) and Post pelvic tilt ratio (PTr) were valid (P < 0.05). After using ROC curve, target value of PI-LL was 1.33, and that of PTr was 25.95%. CONCLUSION Through our study, the risk factors of Post sagittal imbalance were the Post value of PI-LL and that of PTr, and target value of PI-LL was <1.33 and that of PTr was <25.95%. These target values can be effective guidelines for spine surgeons who perform spine reconstruction surgeries for elderly patients with a pure sagittal imbalance based on Schwab's formula.Level of Evidence: 4.
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Affiliation(s)
- Ki Young Lee
- Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, Korea
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14
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Roscop C, Mathio P, Gajny L, Kouyoumdjian P, Skalli W, Gille O. Analysis of apex and transitional vertebra of the spine according to pelvic incidence using orientation and position parameters. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2514-2519. [PMID: 34236504 DOI: 10.1007/s00586-021-06908-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/03/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the different apex and transitional vertebra according to the shape of the pelvis of individuals despite their difference in sagittal alignment using our measurement system. METHODS Full-spine X-rays using EOS in standard stand-position of 99 volunteers were selected (47 women, 52 men, mean age 31 years old). Validated 3D reconstruction technique allows extraction of spinopelvic parameters, and position and rotation of each vertebra and lumbar disks. Subjects were divided into three groups: low PI (lowPI, n = 37), moderate PI (midPI, n = 52), high PI (highPI, n = 10), with, respectively, a PI below 45°, between 45° and 60° and above 60°. Occurrence of specific position and rotation values of apex and transitional vertebra were assessed in each group. RESULTS Frequency curves tend to move cranially when the incidence increases except in cervicothoracic where T1 is a constant for all shapes of spine with occurrence approaching 90%. Angulation value of relevant vertebra and lumbar lordosis are significantly positively correlated for the whole population. CONCLUSIONS Our study allowed the assessment of the distribution of spine curvatures according to the pelvic incidence. It describes the occurrence of localization of the apex and transitional vertebrae according to pelvic incidence. These results should be taken into account during the analysis of the sagittal balance, especially when planning deformity surgery in adults.
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Affiliation(s)
- C Roscop
- Spine Surgery Department, University Hospital, Bordeaux, France.
| | - P Mathio
- Spine Surgery Department, University Hospital, Bordeaux, France
| | - L Gajny
- Laboratoire de Biomécanique, Ecole Nationale Supérieure D'Arts Et Métiers (ENSAM), Paris, France
| | - P Kouyoumdjian
- Spine Surgery Department, University Hospital, Nîmes, France
| | - W Skalli
- Laboratoire de Biomécanique, Ecole Nationale Supérieure D'Arts Et Métiers (ENSAM), Paris, France
| | - O Gille
- Spine Surgery Department, University Hospital, Bordeaux, France
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15
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Girod PP, Kögl N, Molliqaj G, Lener S, Hartmann S, Thomé C. Flexing a standard hinge-powered operating table for lumbosacral three-column osteotomy (3-CO) site closure in 84 consecutive patients. Neurosurg Rev 2021; 45:517-524. [PMID: 33963469 DOI: 10.1007/s10143-021-01559-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
Three-column osteotomy (3-CO) is a powerful technique in adult deformity surgery, and pedicle subtraction osteotomy (PSO) is the workhorse to correct severe kyphotic spinal deformities. Aging of the population, increasing cases of iatrogenic flat back deformities and understanding the importance of sagittal balance have led to a dramatic increase of this surgical technique. Surgery, however, is demanding and associated with high complication rates so that every step of the procedure requires meticulous technique. Particularly, osteotomy closure is associated with risks like secondary fracture, translation, or iatrogenic stenosis. This step is traditionally performed by compression or a cantilever maneuver with sometimes excessive forces on the screws or instrumentation. Implant loosening or abrupt subluxation resulting in construct failure and/or neurological deficits can result. The aim of this prospective registry study was to assess the efficacy and safety of our surgical PSO technique as well as the osteotomy closure by flexing a hinge-powered OR table. In a series of 84 consecutive lumbosacral 3-CO, a standardized surgical technique with special focus on closure of the osteotomy was prospectively evaluated. The surgical steps with the patients positioned prone on a soft frame are detailed. Osteotomy closure was achieved by remote controlled bending of a standard OR table without compressive or cantilever forces in all 84 cases. This technique carries a number of advantages, particularly the reversibility and the slow speed of closure with minimum force. There was not a single mechanical intraoperative complication such as vertebral body fracture, subluxation, or adjacent implant loosening during osteotomy closure, compared to external cohorts using the cantilever technique (p = 0.130). The feasibility of controlled 3-CO closure by flexing a standard OR table is demonstrated. This technique enables a safe, gentle closure of the osteotomy site with minimal risk of implant failure or accidental neurological injury.
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Affiliation(s)
- Pierre-Pascal Girod
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria.
| | - Nikolaus Kögl
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria
| | - Granit Molliqaj
- Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria
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16
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Cawley DT, Takemoto M, Boissiere L, Larrieu D, Kieser DC, Fujishiro T, Hayashi K, Bourghli A, Yilgor C, Alanay A, Perez Grueso FJ, Pelisse F, Kleinstück F, Vital JM, Obeid I. The Impact of Corrective Surgery on Health-Related Quality of Life Subclasses in Adult Scoliosis: Will Degree of Correction Prognosticate Degree of Improvement? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2033-2039. [PMID: 33900475 DOI: 10.1007/s00586-021-06786-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/15/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Objectives in scoliosis corrective surgery include restoration of normal sagittal and coronal parameters to achieve patient satisfaction. HRQLs improvements remain limited after corrective surgery. The aim of this study was to evaluate the HRQL subclass variability specific to the sagittal and coronal correction in adult scoliosis surgery. METHODS This multi-centre prospective analysis of consecutive adult spinal deformity (ASD) patients, from five European centres, only included multilevel instrumentation for scoliosis. d-(delta) values for each parameter represented pre to post-operative changes. Parameters included demographics, baseline, 1- and 2-year. HRQL outcomes (Oswestry disability index (ODI), Scoliosis Research Society (SRS)-22 and Short Form (SF36)), sagittal correction including relative spinopelvic alignment (dRSA) and coronal correction including major Cobb (dCobb) angles. RESULTS A total of 353 patients reached 1-year and 2-year follow up. All HRQL total scores significantly improved postoperatively, including ODI, SRS-22 and SF36. HRQL subclasses which displayed persistent improvements correlated to dRSA included sex-life, self-image, fatigue, vitality, social functioning. The only HRQL subclass improvement that correlated with dCobb was self-image. CONCLUSION Adult scoliosis surgery improves overall HRQL, having a minimal effect on each variable. Importantly, greater coronal deformity correction affects only greater self-image scores, whereas with greater sagittal correction there are many greater HRQL sub-class impacts. Correction and restoration of coronal balance is one of the surgical goals in adult scoliosis but the degree to which Cobb angle is corrected, apart from self-image, does not correlate with gains in sub-classes of HRQL. These results need to be taken into account when planning surgery.
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Affiliation(s)
- D T Cawley
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France.
- Mater Private Hospital, Dublin 1, Ireland.
| | | | - L Boissiere
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - D Larrieu
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - D C Kieser
- Christchurch School of Medicine, University of Otago, Dunedin, New Zealand
| | - T Fujishiro
- Osaka Medical College, Takatsuki-shi, Osaka, Japan
| | - K Hayashi
- Osaka City University Graduate School of Medicine, Juso Hospital, Osaka, Japan
| | | | - C Yilgor
- Acibadem University School of Medicine, Istanbul, Turkey
| | - A Alanay
- Acibadem University School of Medicine, Istanbul, Turkey
| | | | - F Pelisse
- Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - J M Vital
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - I Obeid
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
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17
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Yeh YC, Weng CH, Huang YJ, Fu CJ, Tsai TT, Yeh CY. Deep learning approach for automatic landmark detection and alignment analysis in whole-spine lateral radiographs. Sci Rep 2021; 11:7618. [PMID: 33828159 PMCID: PMC8027006 DOI: 10.1038/s41598-021-87141-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/18/2021] [Indexed: 12/21/2022] Open
Abstract
Human spinal balance assessment relies considerably on sagittal radiographic parameter measurement. Deep learning could be applied for automatic landmark detection and alignment analysis, with mild to moderate standard errors and favourable correlations with manual measurement. In this study, based on 2210 annotated images of various spinal disease aetiologies, we developed deep learning models capable of automatically locating 45 anatomic landmarks and subsequently generating 18 radiographic parameters on a whole-spine lateral radiograph. In the assessment of model performance, the localisation accuracy and learning speed were the highest for landmarks in the cervical area, followed by those in the lumbosacral, thoracic, and femoral areas. All the predicted radiographic parameters were significantly correlated with ground truth values (all p < 0.001). The human and artificial intelligence comparison revealed that the deep learning model was capable of matching the reliability of doctors for 15/18 of the parameters. The proposed automatic alignment analysis system was able to localise spinal anatomic landmarks with high accuracy and to generate various radiographic parameters with favourable correlations with manual measurements.
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Affiliation(s)
- Yu-Cheng Yeh
- Department of Orthopaedic Surgery, Spine Division, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Chi-Hung Weng
- aetherAI Co., Ltd., 9F., No.3-2, Yuanqu St., Nangang Dist., Taipei City, 115, Taiwan, ROC
| | - Yu-Jui Huang
- Department of Orthopaedic Surgery, Spine Division, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Chen-Ju Fu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Division, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Chao-Yuan Yeh
- aetherAI Co., Ltd., 9F., No.3-2, Yuanqu St., Nangang Dist., Taipei City, 115, Taiwan, ROC.
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Kieser DC, Bourghli A, Larrieu D, Cawley DT, Hayashi K, Jakinapally S, Pizones J, Boissiere L, Obeid I. Impact of COVID-19 on the pain and disability of patients with adult spinal deformity. Spine Deform 2021; 9:1073-1076. [PMID: 33651340 PMCID: PMC7923403 DOI: 10.1007/s43390-021-00315-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/16/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the pain and functional effect of the COVID-19 pandemic on patients with ASD reflected by their response to SRS-22, ODI, and SF-36 questionnaires. METHODS Patients who had stable pain and functional outcome scores over the preceding 2 years were enrolled in a local prospectively collected adult spinal deformity (ASD) database. A reanalysis of their SRS22, ODI and SF-36 data 14 days into confinement were compared to their last pre-confinement scores. RESULTS 89 patients were included in this study (average age 60.7 years, 91% female) with an average time from last FU until confinement of 9.6 months. The ODI total score worsened by 5 points post-confinement with no difference seen in personal care, walking and social life. In contrast, the SRS-22 score showed small improvements in function/activity and satisfaction, but no significant differences for the other domains. Similarly, the SF-36 showed small improvements in physical function, physical and emotional role, vitality and PCS. CONCLUSION The global COVID-19 pandemic and ensuing confinement had variable overall effects on ASD patients, without the expected marked worsening. In addition, this study illustrates that the SRS-22 questionnaire is less influenced by environmental and psychological factors than the ODI supporting its objectivity and accuracy in the evaluation of the QoL of ASD patients.
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Affiliation(s)
- D. C. Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, 2 Riccarton Avenue, Christchurch, 8011 New Zealand
| | - A. Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O. Box 84400, Riyadh, 11671 Saudi Arabia
| | - D. Larrieu
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, 33076 Bordeaux, France
| | | | - K. Hayashi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - S. Jakinapally
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, 33076 Bordeaux, France
| | - J. Pizones
- Spine Unit, Hospital La Paz, Madrid, Spain
| | - L. Boissiere
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, 33076 Bordeaux, France ,ELSAN, Polyclinique Jean Villar, Avenue Maryse Bastie, 33520 Bruges, France
| | - I. Obeid
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, 33076 Bordeaux, France ,ELSAN, Polyclinique Jean Villar, Avenue Maryse Bastie, 33520 Bruges, France
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Revisiting thoracic kyphosis: a normative description of the thoracic sagittal curve in an asymptomatic population. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:1184-1189. [PMID: 33222002 DOI: 10.1007/s00586-020-06670-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Thoracic kyphosis (TK) remained in the shadow of lumbar lordosis. Based on Berthonnaud and Roussouly segmentation, TK is divided into two arches: upper TK (UTK) and lower TK (LTK). The purpose of this study is to propose a normative description of the TK arches in an asymptomatic adults' population and their correlation with spinal and pelvic parameters. METHODS This is an observational study performed on asymptomatic healthy Caucasians volunteers aged between 18 and 45 years. Each patient had a standardized standing biplanar full spine X-rays. Using KEOPS®, sacropelvic parameters and global spinal parameters (LL, TK) as well as the inflexion point location were measured. The upper lumbar lordosis angle (ULL) as well as LTK and UTK was calculated. Patients were classified according to Roussouly morphotypes of normal spine. RESULTS A total of 373 adults (F/M = 1.4/1) were enrolled with mean age of 27 years. Mean UTK averaged 25.8°, while mean LTK averaged 19.8° (p < 0.001). UTK angle values were statistically the same in the five different Roussouly spinal shapes (p > 0.05), while LTK values were variable among different Roussouly spine subtypes (p < 0.05). Finally, TK showed the highest correlation with the LL mainly with the ULL (Pearson = 0.66). CONCLUSION In asymptomatic young adults, thoracic kyphosis is composed by two unequal arches, a stable UTK and a variable LTK, with an apex around T8 and T9 vertebra, depending on the spinal morphotype according to Roussouly classification. This should be taken into consideration when analyzing spine sagittal compensation and preparing corrections to minimize risk of mechanical complications.
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Abstract
Pelvic motion acting as a hinge between the spine and hips is essential to maintain proper balance during bipedalism. Pelvic rotation is recruited as a compensation mechanism when spinal malalignment occurs.This pelvic rotation can affect functional acetabular orientation, and consequently functional cup positioning if a total hip arthroplasty (THA) is needed. Pelvic retroversion, frequently associated with degenerative spinal changes, implies an increase of acetabular version.Patients with flexible lumbar spines (spine users) protect the hip joint. Patients with stiff, degenerated or fused lumbar spines (hip users) demand higher hip mobility, placing the THA at risk.Pelvises in retroversion place the THA at risk for anterior dislocation when standing. In contrast, pelvises in anteversion or with low pelvic incidence (PI) can place THA at risk for posterior dislocation when sitting.Try to set the cup in an anatomic position. However, bear in mind that low PI pelvises may need more acetabular ante-inclination, and high PI pelvises more acetabular retroversion.If surgery is needed, start first by addressing the hip, except in patients with compensation (high pelvic retroversion), who may need spine surgery first to place the pelvis, and consequently the acetabulum, in a proper position. Cite this article: EFORT Open Rev 2020;5:522-533. DOI: 10.1302/2058-5241.5.200032.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Eduardo García-Rey
- Hip Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Madrid, Spain
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Identification of Predictive Factors for Mechanical Complications After Adult Spinal Deformity Surgery: A Multi-Institutional Retrospective Study. Spine (Phila Pa 1976) 2020; 45:1185-1192. [PMID: 32205686 DOI: 10.1097/brs.0000000000003500] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective multicenter observational study. OBJECTIVE To investigate correction surgeries that were performed in relatively aged patients in terms of mechanical complications (MCs) and their predictive factors. SUMMARY OF BACKGROUND DATA The risk factors associated with MCs have not yet been well examined, especially in aged populations. METHODS We retrospectively reviewed 230 surgically treated ASD patients with an average age of 72.2 years. Twenty-eight patients with ASD caused by vertebral fractures were excluded. The minimum follow-up was 2 years. Postoperative MCs were defined as proximal junction kyphosis, distal junction kyphosis, pseudoarthrosis, rod breakage, and vertebral fractures. We divided all the ASD patients into two groups: patients with MC (the MC (+) group) and patients without MC (the MC (-) group). Radiographic parameters were evaluated before and immediately after surgery. The SRS-Schwab ASD classification and global alignment and proportion (GAP) score were also evaluated. RESULTS Of the 202 patients, 91 (45.0%) had MCs. The age at surgery was significantly higher in the MC (+) group than in the MC (-) group. Regarding radiographic parameters, postoperative global tilt (GT), pre- and postoperative thoracolumbar kyphosis (TLK), and postoperative thoracic kyphosis were significantly higher in the MC (+) group than in the MC (-) group. Other parameters, such as the proposed ideal alignment target of PI-LL<10, did not significantly affect MC rates. The GAP score was high in both groups and not significantly related to a higher rate of MC. Forward stepwise logistic regression indicated that the age at surgery, postoperative GT, and preoperative TLK were significant risk factors for MCs. CONCLUSION Older age, higher postoperative GT, and higher pre and postoperative TLK can be risk factors for MCs. The GAP score was high in both groups and not significantly related to a higher rate of MC. LEVEL OF EVIDENCE 4.
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Wang XD, Ma L, Wang DH, Yan JT. Relationships among the lumbar lordosis index, sacral horizontal angle, and chronic low back pain in the elderly aged 60-69 years: A cross-sectional study. J Back Musculoskelet Rehabil 2020; 33:29-33. [PMID: 31282399 DOI: 10.3233/bmr-181382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Spinal sagittal imbalance caused by degenerative changes or iatrogenic factors in the elderly can cause symptoms such as anteversion and low back pain (LBP). There are different and conflicting opinions about the relationship between the degree of lumbar lordosis and functional status of patients with chronic low back pain (CLBP). OBJECTIVE This study aimed to determine the relationships among the lumbar lordosis index, sacral horizontal angle, and CLBP in the elderly. METHODS Subject data were collected from Lishui City, Zhejiang Province, China, using cluster sampling according to the background information provided by national physical fitness monitoring. The 207 subjects were urban and rural individuals, 60-69 years old. Radiographs were evaluated according to a standardized protocol. The lumbar lordosis index and sacral horizontal angle were recorded. Data on the prevalence and functional status of CLBP were collected through field investigations. Statistical correlations between the radiographic parameters and the prevalence and functional status of CLBP measurements were evaluated. RESULTS No significant difference was observed in the sacral horizontal angles among the subjects with and without CLBP; however, the lumbar lordosis index of CLBP subjects was significantly higher than that of those without CLBP (P= 0.028) and showed a significant association with CLBP (P= 0.013). Neither the sacral horizontal angle nor the lumbar lordosis index showed significant correlations with the Oswestry Disability Index in CLBP subjects. CONCLUSIONS The lumbar lordosis index, but not the sacral horizontal angle, was significantly associated with CLBP in the subjects.
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Affiliation(s)
- Xiao-Dong Wang
- Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China.,Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Li Ma
- Hangzhou Normal University Affiliated Hospital, Hangzhou, Zhejiang 310015, China.,Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - De-Hong Wang
- Lishui Vocational and Technical College, Lishui, Zhejiang 323000, China
| | - Jun-Tao Yan
- Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
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Severijns P, Overbergh T, Thauvoye A, Baudewijns J, Monari D, Moke L, Desloovere K, Scheys L. A subject-specific method to measure dynamic spinal alignment in adult spinal deformity. Spine J 2020; 20:934-946. [PMID: 32058084 DOI: 10.1016/j.spinee.2020.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/19/2019] [Accepted: 02/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Two-dimensional static radiography currently forms the golden standard in spinal alignment measurement in adult spinal deformity (ASD). However, these static measurements offer no information on dynamic spinal behavior. To fully understand the functionality and compensation strategies of ASD patients, tools to assess dynamic spinal alignment are needed. PURPOSE Therefore, the aim of this study was to introduce, validate and assess the reliability of a new kinematic model to measure dynamic spinal parameters in ASD based on a polynomial function, taking into account the subject-specific anatomy. STUDY DESIGN Validation and reliability study OUTCOME MEASURES: Radiographic parameters, spinal kinematics and range of motion (ROM), Scoliosis Research Society Outcome Questionnaire (SRS-22), Core Outcome Measures Index (COMI). METHODS Spinal alignment of 23 ASD patients and 18 controls was measured using both x-rays and motion capture. Marker positions were corrected to the underlying anatomy and a polynomial function was fitted through these corrected marker positions. By comparing the polynomial method to x-ray measurements concurrent validity was assessed. Test-retest, inter- and intrarater reliability during standing and sit-to-stand (STS) were assessed on a subsample of eight ASD patients and eight controls. RESULTS The results showed good to excellent correlations (r>0.75) between almost all x-ray and anatomy-corrected polynomial parameters. Anatomy correction consistently led to better correlations than no correction. Intraclass correlation coefficients for the polynomial method were good to excellent (>0.75) between sessions and between and within raters and comparable or even better than radiographic measurements. Also, during STS reliability was excellent. Fair to moderate correlations were found between spinal ROM during STS and quality of life, measured with SRS-22 and COMI. CONCLUSIONS The results of this study indicate the polynomial method, with subject-specific anatomy correction, can measure spinal alignment in a valid and reliable way using motion capture in both healthy and deformed spines. This method makes it possible to extend evaluation in ASD from mainly static, by means of x-ray measurements, to dynamic and functional assessments. CLINICAL SIGNIFICANCE Eventually, this newly obtained dynamic spinal alignment information might lead to new insights in clinical decision-making and new treatment strategies, based and oriented on dynamic parameters and functionality.
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Affiliation(s)
- Pieter Severijns
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium.
| | - Thomas Overbergh
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium
| | - Anaïsse Thauvoye
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jana Baudewijns
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Davide Monari
- Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium; Department of Mechanical Engineering, Faculty of Engineering, KU Leuven, Leuven, Belgium
| | - Lieven Moke
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium; Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium; Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
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Kieser DC, Wyatt MC, Boissiere L, Hayashi K, Cawley DT, Yilgor C, Larrieu D, Fujishiro T, Alanay A, Acaroglu E, Kleinstueck F, Pellisé F, Perez-Grueso FJS, Bourghli A, Vital JM, Gille O, Obeid I. The effect of increasing body mass index on the pain and function of patients with adult spinal deformity. JOURNAL OF SPINE SURGERY 2020; 5:535-540. [PMID: 32043004 DOI: 10.21037/jss.2019.11.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Both adult spinal deformity (ASD) and obesity are growing concerns internationally. This study therefore aims to determine the effect of increasing body mass index (BMI) on the pain and function of patients with ASD. Methods A retrospective review of prospectively collected data from a multicentre European database was undertaken. Initially a univariate analysis was performed on the effect of BMI on the initial presentation of functional scores in patients with ASD. The functional scores included the Numerical Rating Scale (NRS) back and leg score, Core Outcome Measures Index (COMI) back score, SRS22 total score, Short Form 36 (SF-36) [general health, physical component score (PCS) and mental component score (MCS)] and Oswestry Disability Index (ODI) score (including all domains). Subsequently a multivariate analysis controlling for age, sex, comorbidities, employment status, smoking status and radiological parameters [coronal cobb, coronal balance, sagittal balance, global tilt, and pelvic incidence minus lumbar lordosis (PI - LL) mismatch] was performed. Results A total of 1,004 patients were included in this study (166 male, 838 female). On univariate analysis a statistically significant (P<0.05) moderate correlation between NRS leg pain, ODI (walking, standing, sex life, social life and total score), SF-36 (physical component), sagittal balance, global tilt and age were recognised (P<0.05). A statistically significant low correlation was identified for all other outcomes, except coronal balance (P=0.640). On multivariate analysis BMI remained significantly related to all functional outcomes except ODI-pain and ODI-travelling (P>0.05). Conclusions Increasing BMI has a significant adverse effect on the pain and functioning of patients with ASD. Clinicians should recognise this association and treat patients accordingly.
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Affiliation(s)
- David Christopher Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | - Michael Charles Wyatt
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | - Louis Boissiere
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Kazunori Hayashi
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | | | - Caglar Yilgor
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Daniel Larrieu
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Takashi Fujishiro
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Ahmet Alanay
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Emre Acaroglu
- Spine Surgery Unit, Ankara Acibadem ARTES Spine Center, Ankara, Turkey
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Jean-Marc Vital
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Olivier Gille
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Ibrahim Obeid
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
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The Transverse Gravitational Deviation Index, a Novel Gravity Line-Related Spinal Parameter, Relates to Balance Control and Health-Related Quality of Life in Adults With Spinal Deformity. Spine (Phila Pa 1976) 2020; 45:E25-E36. [PMID: 31842109 DOI: 10.1097/brs.0000000000003301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cross-sectional case-control study design. OBJECTIVE This study aims to analyze the relation between balance control as well as health-related quality of life (HRQOL) in patients with adult spinal deformity (ASD), with a novel gravity line (GL)-related 3D spinal alignment parameter, the transverse gravitational deviation index (TGDI), defined to quantify the transverse plane position of any vertebra with respect to the GL. SUMMARY OF BACKGROUND DATA Demographic data and balance control have both been identified as important determinants of HRQOL in ASD patients during a preoperative setting. Therefore, a better understanding of the relation between spinal alignment and balance is required. METHODS After informed consent, 15 asymptomatic healthy volunteers (mean age 60.1 ± 11.6 years old) and 55 ASD patients (mean age 63.5 ± 10.1 years old) were included. Relation between performance on BESTest as well as core outcome measures index (COMI) with spinopelvic alignment was explored using General Linear Modeling (GLM). A P-value ≤0.05 was considered statistically significant. RESULTS The L3 TGDI was identified to relate to balance control in the total ASD population after correction for confounding demographic factors (P = 0.001; adjusted R = 0.500) and explained 19% of the observed variance in balance performance. In addition, COMI is related to L3 TGDI in a subgroup of ASD patients with combined coronal and sagittal malalignment of L3 (P = 0.027; slope B = 0.047), despite significant influence of age (P = 0.020). CONCLUSION In ASD patients with a combined coronal and sagittal malalignment of the L3 vertebra, both the level of balance impairment as well as HRQOL are related to the distance component of the L3 TGDI, that is, the offset between the center of the L3 vertebral body and the GL in the transverse plane. LEVEL OF EVIDENCE 2.
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Mental health status and sagittal spinopelvic alignment correlate with self-image in patients with adult spinal deformity before and after corrective surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:63-72. [DOI: 10.1007/s00586-019-06200-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/13/2019] [Accepted: 10/20/2019] [Indexed: 02/07/2023]
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Hayashi K, Boissière L, Guevara-Villazón F, Larrieu D, Núñez-Pereira S, Bourghli A, Gille O, Vital JM, Pellisé F, Sánchez Pérez-Grueso FJ, Kleinstück F, Acaroğlu E, Alanay A, Obeid I. Factors influencing patient satisfaction after adult scoliosis and spinal deformity surgery. J Neurosurg Spine 2019; 31:408-417. [PMID: 31075761 DOI: 10.3171/2019.2.spine181486] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/19/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Achieving high patient satisfaction with management is often one of the goals after adult spinal deformity (ASD) surgery. However, literature on associated factors and their correlations with patient satisfaction is limited. The aim of this study was to determine the clinical and radiographic factors independently correlated with patient satisfaction in terms of management at 2 years after surgery. METHODS A multicenter prospective database of ASD surgery was retrospectively reviewed. The demographics, complications, health-related quality of life (HRQOL) subdomains, and radiographic parameters were examined to determine their correlation coefficients with the Scoliosis Research Society-22 questionnaire (SRS-22R) satisfaction scores at 2 years (Sat-2y score). Subsequently, factors determined to be independently associated with low satisfaction (Sat-2y score ≤ 4.0) were used to construct 2 types of multivariate models: one with 2-year data and the other with improvement (score at 2 years - score at baseline) data. RESULTS A total of 422 patients who underwent ASD surgery (mean age 53.1 years) were enrolled. All HRQOL subdomains and several coronal and sagittal radiographic parameters had significantly improved 2 years after surgery. The Sat-2y score was strongly correlated with the SRS-22R self-image (SI)/appearance subdomain (r = 0.64), followed by moderate correlation with subdomains related to standing (r = 0.53), body pain (r = 0.49-0.55), and function (r = 0.41-0.55) at 2 years. Conversely, the correlation between radiographic or demographic parameters with Sat-2y score was weak (r < 0.4). Multivariate analysis to eliminate confounding factors revealed that a worse Oswestry Disability Index (ODI) score for standing (≥ 2 points; OR 4.48) and pain intensity (≥ 2 points; OR 2.07), SRS-22R SI/appearance subdomain (< 3 points; OR 2.70) at 2 years, and a greater sagittal vertical axis (SVA) (> 5 cm; OR 2.68) at 2 years were independent related factors for low satisfaction. According to the other model, a lower improvement in ODI for standing (< 30%; OR 2.68), SRS-22R pain (< 50%; OR 3.25) and SI/appearance (< 50%; OR 2.18) subdomains, and an inadequate restoration of the SVA from baseline (< 2 cm; OR 3.16) were associated with low satisfaction. CONCLUSIONS Self-image, pain, standing difficulty, and sagittal alignment restoration may be useful goals in improving patient satisfaction with management at 2 years after ASD surgery. Surgeons and other medical providers have to take care of these factors to prevent low satisfaction.
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Affiliation(s)
- Kazunori Hayashi
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- 2Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Louis Boissière
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- 3ELSAN, Polyclinique Jean Villar, Bruges, France
| | | | - Daniel Larrieu
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | | | - Anouar Bourghli
- 5Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Olivier Gille
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Jean-Marc Vital
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Ferran Pellisé
- 4Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | | | | | | | - Ahmet Alanay
- 9Comprehensive Spine Center, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ibrahim Obeid
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- 3ELSAN, Polyclinique Jean Villar, Bruges, France
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Severijns P, Overbergh T, Scheys L, Moke L, Desloovere K. Reliability of the balance evaluation systems test and trunk control measurement scale in adult spinal deformity. PLoS One 2019; 14:e0221489. [PMID: 31449540 PMCID: PMC6709918 DOI: 10.1371/journal.pone.0221489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/07/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To test the reliability of the Balance Evaluation Systems Test (BESTest) and Trunk Control Measurement Scale (TCMS) between sessions and raters in the adult spinal deformity (ASD) population. SUMMARY OF BACKGROUND DATA Up to now evaluation in ASD was mainly based on static radiographic parameters. Recently literature showed that dynamic balance was a better predictor of health-related quality of life than radiographic parameters, stressing the importance of balance assessment. However, to the best of our knowledge, reliability of balance assessment tools has not yet been investigated in the ASD population. METHODS Twenty ASD patients participated in this study. Ten patients were included in the test-retest study, including repeated measurements. Ten patients were measured once, simultaneously but independently by three raters. Each participant performed two balance scales, namely the BESTest and the TCMS. Statistical analysis consisted of intra class correlations (ICC) on scale- and subscale level, and kappa scores on item-level. Cronbach's alpha on total scores, standard errors of measurement (SEM), smallest detectable differences and percentages of agreement were also calculated. Bland-altman plots were created to investigate systematic bias. RESULTS ICC scores between sessions and raters for TCMS (0.76 and 0.88) and BESTest (0.90 and 0.94) total scores were good to excellent. SEM's between sessions and raters were also low for total scores on TCMS (1.66 and 2.35) and BESTest (2.99 and 2.32). However, on subscale- and item-level reliability decreased and ceiling effects were observed. No systematic bias was observed between sessions and raters. CONCLUSION BESTest and TCMS showed to be reliable tools to measure balance in ASD on scale-level. However, on subscale- and item-level reliability decreased and ceiling effects were observed. Therefore, the question arises if there is need for an ASD-specific balance scale.
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Affiliation(s)
- Pieter Severijns
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium
| | - Thomas Overbergh
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Lennart Scheys
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Lieven Moke
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium
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Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A. Sagittal balance of the spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1889-1905. [DOI: 10.1007/s00586-019-06083-1] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 11/24/2022]
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Diebo BG, Shah NV, Boachie-Adjei O, Zhu F, Rothenfluh DA, Paulino CB, Schwab FJ, Lafage V. Adult spinal deformity. Lancet 2019; 394:160-172. [PMID: 31305254 DOI: 10.1016/s0140-6736(19)31125-0] [Citation(s) in RCA: 238] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022]
Abstract
Adult spinal deformity affects the thoracic or thoracolumbar spine throughout the ageing process. Although adolescent spinal deformities taken into adulthood are not uncommon, the most usual causes of spinal deformity in adults are iatrogenic flatback and degenerative scoliosis. Given its prevalence in the expanding portion of the global population aged older than 65 years, the disorder is of growing interest in health care. Physical examination, with a focus on gait and posture, along with radiographical assessment are primarily used and integrated with risk stratification indices to establish optimal treatment planning. Although non-operative treatment is regarded as the first-line response, surgical outcomes are considerably favourable. Global disparities exist in both the assessment and treatment of adults with spinal deformity across countries of varying incomes, which represents an area requiring further investigation. This Seminar presents evidence and knowledge that represent the evolution of data related to spinal deformity in adults over the past several decades.
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Affiliation(s)
- Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA.
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | | | - Feng Zhu
- Department of Orthopaedic and Traumatology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dominique A Rothenfluh
- Division of Spinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | - Frank J Schwab
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, USA
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31
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Le Huec JC, Gille O, Fabre T. Sagittal balance and spine-pelvis relation: A French speciality? Orthop Traumatol Surg Res 2018; 104:551-554. [PMID: 29906521 DOI: 10.1016/j.otsr.2018.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Jean-Charles Le Huec
- Service orthopédie traumatologie 1, 2, 3, pôle chirurgie, CHU Pellegrin-Tripode, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Ollivier Gille
- Service orthopédie traumatologie 1, 2, 3, pôle chirurgie, CHU Pellegrin-Tripode, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Thierry Fabre
- Service orthopédie traumatologie 1, 2, 3, pôle chirurgie, CHU Pellegrin-Tripode, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Passias PG, Horn SR, Oh C, Ramchandran S, Burton DC, Lafage V, Lafage R, Poorman GW, Steinmetz L, Segreto FA, Bortz CA, Smith JS, Ames C, Shaffrey CI, Kim HJ, Soroceanu A, Klineberg EO. Evaluating cervical deformity corrective surgery outcomes at 1-year using current patient-derived and functional measures: are they adequate? JOURNAL OF SPINE SURGERY 2018; 4:295-303. [PMID: 30069521 DOI: 10.21037/jss.2018.05.29] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Current health-related quality of life (HRQL) metrics used to assess patient outcomes following surgical correction of cervical deformity (CD) are not deformity-specific and thus cannot capture all aspects of a patient's deformity and outcomes. The purpose of this study is to evaluate the sensitivity of different HRQL outcome measures in assessing CD patients' outcomes 1-year post-operatively. Methods Retrospective review of prospective multi-center database. Inclusion criteria: CD patients ≥18 yrs with pre- and 1-year post-operative radiographs and HRQLs [modified Japanese Orthopaedic Association (mJOA), EuroQol five-dimensions (EQ-5D), neck disability index (NDI)]. Associations between changes in EQ5D and NDI with improvement at 1-year in mJOA scores were assessed by whether or not the patient met the minimum clinically important difference (MCID) as well as whether or not they improved by one or more categories (i.e., change from moderate to mild). Odds ratios reported with 95% confidence intervals. Results Sixty-three CD patients were included (mean 62 y, 55.6% F). Average baseline NDI scores were 46.75, mJOA was 13.68, and EQ-5D 0.74. Overall baseline myelopathy breakdown: none-9.5%, mild-30.2%, moderate-42.9%, high-17.5%. At 1-year, 46% of patients improved in mJOA, 71.4% NDI, and 65.1% EQ-5D. 19% of patients met mJOA MCID, 44.4% NDI MCID, 19% EQ-5D MCID. One-point improvement in NDI increased the odds of mJOA improvement and reaching mJOA MCID (improvement: OR, 1.06, CI: 1.01-1.10, P=0.01; MCID: OR, 1.06, CI: 1.02-1.11, P=0.006). Improvement in EQ-5D by 0.1 increased the odds of improving in mJOA and reaching mJOA MCID at 1-year (improvement: OR, 3.85, CI: 1.51-9.76, P=0.005; MCID: OR, 3.88, CI: 1.52-9.88, P=0.005). While correlations exist between outcome measures, when modeling these outcomes while controlling for confounders including cSVA change, surgical invasiveness, age and CCI, these HRQLs were not strongly correlated. Conclusions Improvements in functional outcomes, as defined by mJOA score, were correlated with changes in neck based disability and general health state, defined by NDI and EQ-5D respectively. In an adjusted model, however, these direct relationships were not maintained. A CD-specific HRQL might be more useful for surgeons in assessing patient outcomes using a single metric.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Samantha R Horn
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Cheongeun Oh
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | | | - Douglas C Burton
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Virginie Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Gregory W Poorman
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Leah Steinmetz
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Frank A Segreto
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Cole A Bortz
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Han Jo Kim
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | | | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
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Performance on Balance Evaluation Systems Test (BESTest) Impacts Health-Related Quality of Life in Adult Spinal Deformity Patients. Spine (Phila Pa 1976) 2018; 43:637-646. [PMID: 28858190 DOI: 10.1097/brs.0000000000002390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective single-center study. OBJECTIVE Study investigates how dynamic balance performance complements 2D static radiographic measurements and demographics in terms of understanding health-related quality of life in adult spinal deformity (ASD) patients. SUMMARY OF BACKGROUND DATA Recent insights suggest that demographic variables have a stronger impact on health-related quality of life than 2D radiographic spinopelvic parameters in ASD patients. METHODS Nine healthy volunteers and 36 ASD patients following inclusion criteria were recruited. Demographics, Scoliosis Research Society Score-22r (SRS-22r), Oswestry Disability Index (ODI), Core Outcome Measures Index (COMI), 2D radiographic spinopelvic measurements, and performance on Balance Evaluation Systems Test (BESTest), and Trunk Control Measurement Scale (TCMS) were determined for each subject. Nonparametric tests, Spearman correlations, univariate, and stepwise-like linear multivariate regression analysis were performed. RESULTS BESTest and TCMS had significant lower values in the ASD group versus the control group (P = 0.000). In the ASD group, Cumulative Illness Rating Scale (CIRS) correlated fair to ODI, COMI (0.441 ≥ r ≥ 0.383, P < 0.021) and to SRS-22-r (r = -0.335, P = 0.046), Mini Mental State Examination correlated fair to COMI (r = -0.352, P = 0.035), "Pelvic Incidence minus Lumbar Lordosis" correlated fair to ODI (r = 0.361, P = 0.031), BESTest correlated moderate to ODI and COMI (r ≤ -0.505; P ≤ 0.002), TCMS correlated fair to ODI (r = -0.356; P = 0.033). CIRS and BESTest were significant predictive variables for COMI based on univariate analysis in ASD patients. Multivariate regression analysis including demographics, 2D static radiographic parameters, and dynamic balance scales identified BESTest as single independent variable (P = 0.000) to predict COMI (adjusted R = 0.285) in ASD patients. CONCLUSION BESTest has a higher potential than demographic and 2D radiographic spinopelvic parameters to predict quality of life in ASD patients. Further research is necessary to identify the impact of ASD on quality of life. LEVEL OF EVIDENCE 3.
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Fujishiro T, Boissière L, Cawley DT, Larrieu D, Gille O, Vital JM, Pellisé F, Pérez-Grueso FJS, Kleinstück F, Acaroglu E, Alanay A, Obeid I. Decision-making factors in the treatment of adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2312-2321. [PMID: 29603012 DOI: 10.1007/s00586-018-5572-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/19/2018] [Accepted: 03/27/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE We aimed to elucidate the factors for the decision-making process in the treatment of adult spinal deformity (ASD), including sagittal parameters, that impact health-related quality of life (HRQOL). METHODS A multicenter prospective ASD database was retrospectively reviewed. The demographic data, HRQOL, and radiographic measures were analyzed using multivariate analyses in younger (≤ 50 years) and older (> 50 years) age groups. RESULTS This study included 414 patients (134 surgical and 280 nonsurgical; mean age 30.7 years) in the younger age group and 575 patients (323 surgical and 252 nonsurgical; mean age 65.8 years) in the older age group. Worse HRQOL measures drove surgical treatment, both in younger and older patients. The SRS-22 self-image score was the most differentiating domain, both in the younger and older age groups, and an additional significant factor in the older age group was pain and disability. Coronal deformity drove surgical treatment for the younger age group; however, older surgical patients were less likely to have coronal malalignment. Sagittal parameters were associated with the decision-making process. Greater pelvic incidence minus lumbar lordosis mismatch in the younger age group and smaller lumbar lordosis index in the older age group were most correlated with the decision to undergo surgery. CONCLUSIONS Aside from the HRQOL measures and coronal deformity, sagittal parameters were identified as significant factors for the decision-making process in the ASD population, and the lack of lumbar lordosis in relation to pelvic incidence was a strong driver to pursue surgical treatment. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Takashi Fujishiro
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France. .,Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan.
| | - Louis Boissière
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Derek Thomas Cawley
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Daniel Larrieu
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Olivier Gille
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Jean-Marc Vital
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | | | | | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ibrahim Obeid
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
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