Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea.
Department of Neurosurgery, Champodonamu Hospital, Seoul, Korea.
Spine (Phila Pa 1976). 2019 Dec 15;44(24):1723-1730. doi: 10.1097/BRS.0000000000003170.
Retrospective analysis of prospective observational cohort OBJECTIVE.: This study assessed the difference in health-related quality of life (HRQOL) between participants with a mild to moderate adult sagittal deformity (ASD) (sagittal vertical axis [SVA] ≤9.5 cm) and those with a marked deformity (SVA >9.5 cm). We also evaluated predisposing factors for a marked deformity.
Sagittal imbalance is closely associated with HRQOL for the patient. However, how the effect changes depending on the degree of imbalance has not been fully evaluated. The understanding of the predisposing factor associated with marked deformity also lacks.
A total of 124 elderly persons with a stooping posture were enrolled. Questionnaires related to HRQOL were administered. Sagittal alignment parameters and pelvic parameters were measured with a whole spine x-ray. Lumbar spine magnetic resonance imaging was used to assess the presence of pathologic conditions, muscle quality and quantity. Multivariate logistic regression analysis was conducted to analyze potential risk factors.
Marked ASD was associated with female sex, lower height and weight, and osteoporosis (P < 0.05). Back pain (assessed by a visual analogue scale) and the Oswestry Disability Index were significantly higher in the marked deformity group (P = 0.012, 0.002, respectively). Multivariate logistic regression analysis showed significant relationships between the following parameters and marked deformity: preexisting compression fracture (odds ratio [OR] = 7.793; 95% confidence interval [CI], 1.527-39.768), severe L5/S1 Pfirrmann disc degeneration grade (OR = 1.916; 95% CI, 1.086-3.382), and lower quantities of multifidus and psoas muscles (OR = 0.994, 0.997; 95% CI, 0.991-0.998, 0.994-0.999, respectively).
Participants with a marked ASD showed different features from those with a mild to moderate ASD. This study also implies that anatomical factors, including the vertebrae, intervertebral discs, and paraspinal muscles, synergistically contribute to progression into marked deformity.
前瞻性观察队列的回顾性分析
目的：本研究评估了轻度至中度成人矢状面畸形（ASD）（矢状垂直轴[SVA]≤9.5cm）患者与明显畸形（SVA＞9.5cm）患者之间健康相关生活质量（HRQOL）的差异。我们还评估了导致明显畸形的易感因素。
背景资料概要：矢状面失衡与患者的 HRQOL 密切相关。然而，失衡程度如何变化的影响尚未得到充分评估。对与明显畸形相关的易感因素的了解也不足。
方法：共纳入 124 名有弯腰姿势的老年人。进行了与 HRQOL 相关的问卷调查。使用全脊柱 X 线片测量矢状面排列参数和骨盆参数。腰椎磁共振成像用于评估病理性疾病、肌肉质量和数量。进行多元逻辑回归分析以分析潜在的危险因素。
结果：明显的 ASD 与女性、较低的身高和体重以及骨质疏松症相关（P＜0.05）。明显畸形组的腰痛（视觉模拟评分）和 Oswestry 残疾指数明显更高（P=0.012，0.002）。多元逻辑回归分析显示以下参数与明显畸形之间存在显著关系：先前存在的压缩性骨折（比值比[OR]＝7.793；95%置信区间[CI]，1.527-39.768）、严重 L5/S1 Pfirrmann 椎间盘退变分级（OR＝1.916；95%CI，1.086-3.382）和多裂肌和腰大肌数量减少（OR＝0.994，0.997；95%CI，0.991-0.998，0.994-0.999）。
结论：明显 ASD 患者与轻度至中度 ASD 患者表现出不同的特征。本研究还表明，包括椎体、椎间盘和脊柱旁肌肉在内的解剖因素协同导致畸形进展为明显畸形。
证据水平：3 级。
