Spine Division, NYU Hospital for Joint Diseases, New York, NY, USA.
Spine (Phila Pa 1976). 2013 Jun 1;38(13):E803-12. doi: 10.1097/BRS.0b013e318292b7b9.
Prospective multicenter study evaluating operative (OP) versus nonoperative (NONOP) treatment for adult spinal deformity (ASD).
Evaluate correlations between spinopelvic parameters and health-related quality of life (HRQOL) scores in patients with ASD.
Sagittal spinal deformity is commonly defined by an increased sagittal vertical axis (SVA); however, SVA alone may underestimate the severity of the deformity. Spinopelvic parameters provide a more complete assessment of the sagittal plane but only limited data are available that correlate spinopelvic parameters with disability. METHODS.: Baseline demographic, radiographical, and HRQOL data were obtained for all patients enrolled in a multicenter consecutive database. Inclusion criteria were: age more than 18 years and radiographical diagnosis of ASD. Radiographical evaluation was conducted on the frontal and lateral planes and HRQOL questionnaires (Oswestry Disability Index [ODI], Scoliosis Research Society-22r and Short Form [SF]-12) were completed. Radiographical parameters demonstrating highest correlation with HRQOL values were evaluated to determine thresholds predictive of ODI more than 40.
Four hundred ninety-two consecutive patients with ASD (mean age, 51.9 yr) were enrolled. Patients from the OP group (n = 178) were older (55 vs. 50.1 yr, P < 0.05), had greater SVA (5.5 vs. 1.7 cm, P < 0.05), greater pelvic tilt (PT; 22° vs. 11°, P < 0.05), and greater pelvic incidence/lumbar lordosis PI/LL mismatch (PI-LL; 12.2 vs. 4.3; P < 0.05) than NONOP group (n = 314). OP group demonstrated greater disability on all HRQOL measures compared with NONOP group (ODI = 41.4 vs. 23.9, P < 0.05; Scoliosis Research Society score total = 2.9 vs. 3.5, P < 0.05). Pearson analysis demonstrated that among all parameters, PT, SVA, and PI-LL correlated most strongly with disability for both OP and NONOP groups (P < 0.001). Linear regression models demonstrated threshold radiographical spinopelvic parameters for ODI more than 40 to be: PT 22° or more (r = 0.38), SVA 47 mm or more (r = 0.47), PI - LL 11° or more (r = 0.45).
ASD is a disabling condition. Prospective analysis of consecutively enrolled patients with ASD demonstrated that PT and PI-LL combined with SVA can predict patient disability and provide a guide for patient assessment for appropriate therapeutic decision making. Threshold values for severe disability (ODI > 40) included: PT 22° or more, SVA 47 mm or more, and PI - LL 11° or more.
前瞻性多中心研究，评估成人脊柱畸形（ASD）的手术（OP）与非手术（NONOP）治疗。
评估 ASD 患者脊柱骨盆参数与健康相关生活质量（HRQOL）评分之间的相关性。
矢状位脊柱畸形通常通过增加矢状垂直轴（SVA）来定义；然而，SVA 本身可能低估了畸形的严重程度。脊柱骨盆参数提供了对矢状面更全面的评估，但仅有有限的数据表明脊柱骨盆参数与残疾相关。
所有入组多中心连续数据库的患者均获得基线人口统计学、影像学和 HRQOL 数据。纳入标准为：年龄大于 18 岁，影像学诊断为 ASD。进行正面和侧面的影像学评估，并完成 HRQOL 问卷（Oswestry 残疾指数[ODI]、脊柱侧凸研究协会-22r 和简短表格[SF]-12）。评估与 HRQOL 值相关性最高的影像学参数，以确定预测 ODI 大于 40 的阈值。
共纳入 492 例 ASD 连续患者（平均年龄 51.9 岁）。手术组（n = 178）患者年龄较大（55 岁比 50.1 岁，P < 0.05），SVA 较大（5.5 厘米比 1.7 厘米，P < 0.05），骨盆倾斜度（PT；22°比 11°，P < 0.05）和骨盆入射角/腰椎前凸 PI/LL 不匹配（PI-LL；12.2 比 4.3，P < 0.05）大于非手术组（n = 314）。与非手术组相比，手术组在所有 HRQOL 测量中均表现出更大的残疾（ODI = 41.4 比 23.9，P < 0.05；脊柱侧凸研究协会评分总分 = 2.9 比 3.5，P < 0.05）。Pearson 分析表明，在所有参数中，PT、SVA 和 PI-LL 与 OP 和 NONOP 组的残疾相关性最强（P < 0.001）。线性回归模型表明，预测 ODI 大于 40 的影像学脊柱骨盆参数阈值为：PT 22°或更大（r = 0.38），SVA 47 毫米或更大（r = 0.47），PI-LL 11°或更大（r = 0.45）。
ASD 是一种致残疾病。对连续入组 ASD 患者的前瞻性分析表明，PT 和 PI-LL 与 SVA 相结合可以预测患者的残疾情况，并为患者评估提供指导，以做出适当的治疗决策。严重残疾（ODI > 40）的阈值包括：PT 22°或更大，SVA 47 毫米或更大，PI-LL 11°或更大。
