Spine Division, Hospital for Joint Diseases, New York University, New York, New York 10003, USA.
Neurosurgery. 2012 Aug;71(2):341-8; discussion 348. doi: 10.1227/NEU.0b013e31825d20c0.
Sagittal plane malalignment has been established as the main radiographic driver of disability in adult spinal deformity (ASD).
To evaluate the amount of sagittal correction needed for a patient to perceive improvement (minimal clinically important difference, MCID) in health-related quality of life (HRQOL) scores.
This was a multicenter, retrospective analysis of prospectively consecutively enrolled ASD patients. Inclusion criterion was a sagittal vertical axis (SVA) >80 mm. Demographic, radiographic, and HRQOL preoperative and 2-year postsurgery data were collected. Surgical treatment was categorized based on SVA correction: <60 mm, 60 mm to 120 mm, and >120 mm. Changes in parameters were analyzed using paired t test, 1-way analysis of variance, and χ2 test.
Seventy-six patients (preoperative SVA = 140 mm) were analyzed; each subgroup revealed significant HRQOL improvements following surgery. Compared with the <60 mm correction group, the likelihood of reaching MCID was significantly improved for the >120 mm group (Oswestry Disability Index) but not for the 60 mm to 120 mm group. A significantly greater likelihood of reaching MCID thresholds was observed for corrections above 66% of preoperative SVA.
Best HRQOL outcomes for ASD patients with severe sagittal plane deformity were obtained with a correction >120 mm for SVA and at least 66% of correction. Although lesser amounts of SVA correction yielded clinical improvement, the rate of MCID threshold improvement was not significantly different for mild or modest corrections. These results underline the need for complete sagittal plane deformity correction if high rates of HRQOL benefit are sought for patients with marked sagittal plane deformity.
矢状面失平衡已被确定为成人脊柱畸形（ASD）导致残疾的主要影像学因素。
评估患者感知健康相关生活质量（HRQOL）评分改善所需的矢状面矫正量（最小临床重要差异，MCID）。
这是一项多中心、回顾性分析，对前瞻性连续入组的 ASD 患者进行分析。纳入标准为矢状垂直轴（SVA）>80mm。收集术前和术后 2 年的人口统计学、影像学和 HRQOL 数据。根据 SVA 矫正情况对手术治疗进行分类：<60mm、60mm 至 120mm 和>120mm。使用配对 t 检验、单因素方差分析和 χ2 检验分析参数变化。
共分析 76 例患者（术前 SVA=140mm）；每个亚组在手术后 HRQOL 均显著改善。与<60mm 矫正组相比，>120mm 矫正组达到 MCID 的可能性显著提高（Oswestry 残疾指数），但 60mm 至 120mm 矫正组并非如此。对于 SVA 术前矫正超过 66%的患者，达到 MCID 阈值的可能性显著提高。
对于严重矢状面畸形的 ASD 患者，获得最佳 HRQOL 结果的方法是矫正 SVA>120mm，且矫正程度至少为 66%。虽然 SVA 矫正量较小也能带来临床改善，但对于轻度或中度矫正，达到 MCID 阈值的改善率并无显著差异。这些结果强调了如果要为有明显矢状面畸形的患者获得更高的 HRQOL 益处，就需要完全矫正矢状面畸形。
