El Rachkidi Rami, Massaad Abir, Saad Eddy, Kawkabani Georges, Semaan Karl, Abi Nahed Julien, Ghanem Ismat, Lafage Virginie, Skalli Wafa, Assi Ayman
Department of Orthopedics and Traumatology, Hôtel-Dieu de France Hospital, Beirut, LBN.
Laboratory of Biomechanics and Medical Imaging, University of Saint Joseph, Beirut, LBN.
Cureus. 2022 Aug 17;14(8):e28113. doi: 10.7759/cureus.28113. eCollection 2022 Aug.
Purpose To describe spinopelvic adaptations in the standing and sitting positions in patients with adult spinal deformity (ASD). Methods Ninety-five patients with ASD and 32 controls completed health-related quality of life (HRQOL) questionnaires: short form 36 (SF36), Oswestry Disability Index (ODI), and visual analog scale (VAS) for pain. They underwent biplanar radiography in both standing and sitting positions. Patients with ASD were divided into ASD-front (frontal deformity Cobb > 20°, n = 24), ASD-sag (sagittal vertical axis (SVA) > 50 mm, pelvic tilt (PT) > 25°, or pelvic incidence (PI)-lumbar lordosis (LL) > 10°, n = 40), and ASD-hyper thoracic kyphosis (TK >60°, n = 31) groups. Flexibility was defined as the difference (Δ) in radiographic parameters between the standing and sitting positions. The radiographic parameters were compared between the groups. Correlations between HRQOL scores were evaluated. Results All participants increased their SVA from standing to sitting (ΔSVA<0), except for patients with ASD-sag, who tended to decrease their SVA (78-62 mm) and maximize their pelvic retroversion (27-40° vs 10-34° in controls, p<0.001). They also showed reduced thoracic and lumbar flexibility (ΔLL = 3.4 vs 37.1°; ΔTK = -1.7 vs 9.4° in controls, p<0.001). ASD-hyperTK showed a decreased PT while sitting (28.9 vs 34.4° in controls, p<0.001); they tended to decrease their LL and TK but could not reach values for controls (ΔLL = 22.8 vs 37.1° and ΔTK = 5.2 vs 9.4°, p<0.001). The ASD-front had normal standing and sitting postures. ΔSVA and ΔLL were negatively correlated with the physical component scale (PCS of SF36) and ODI (r = -0.39 and r = -0.46, respectively). Conclusion Patients with ASD present with different spinopelvic postures and adaptations from standing to sitting positions, with those having sagittal malalignment most affected. In addition, changes in standing and sitting postures were related to HRQOL outcomes. Therefore, surgeons should consider patient sitting adaptations in surgical planning and spinal fusion. Future studies on ASD should evaluate whether physical therapy or spinal surgery can improve sitting posture and QOL, especially for those with high SVA or PT.
目的 描述成人脊柱畸形（ASD）患者站立位和坐位时的脊柱骨盆适应性变化。方法 95例ASD患者和32例对照者完成了与健康相关的生活质量（HRQOL）问卷：简短健康调查问卷（SF36）、Oswestry功能障碍指数（ODI）和疼痛视觉模拟量表（VAS）。他们在站立位和坐位时均接受了双平面X线摄影。ASD患者被分为ASD-前路组（额状面畸形Cobb角>20°，n = 24）、ASD-矢状面组（矢状垂直轴（SVA）>50 mm、骨盆倾斜（PT）>25°或骨盆入射角（PI）-腰椎前凸（LL）>10°，n = 40）和ASD-胸椎后凸增加组（TK>60°，n = 31）。灵活性定义为站立位和坐位时影像学参数的差值（Δ）。比较了各组之间的影像学参数。评估了HRQOL评分之间的相关性。结果 除ASD-矢状面组患者外，所有参与者从站立位到坐位时SVA均增加（ΔSVA<0），ASD-矢状面组患者的SVA有降低趋势（78 - 62 mm），且骨盆后倾最大化（对照组为10 - 34°，该组为27 - 40°，p<0.001）。他们还表现出胸腰椎灵活性降低（对照组ΔLL = 37.1°，该组为3.4°；对照组ΔTK = 9.4°，该组为 - 1.7°，p<0.001）。ASD-胸椎后凸增加组坐位时PT降低（对照组为34.4°，该组为28.9°，p<0.001）；他们的LL和TK有降低趋势，但未达到对照组水平（ΔLL = 37.1°，该组为22.8°；ΔTK = 9.4°，该组为5.2°，p<0.001）。ASD-前路组站立位和坐位姿势正常。ΔSVA和ΔLL与身体成分量表（SF36的PCS）和ODI呈负相关（r分别为 - 0.39和 - 0.46）。结论 ASD患者在站立位和坐位时呈现不同的脊柱骨盆姿势及适应性变化，矢状面排列不齐的患者受影响最大。此外，站立位和坐位姿势的变化与HRQOL结果相关。因此，外科医生在手术规划和脊柱融合时应考虑患者的坐位适应性。未来关于ASD的研究应评估物理治疗或脊柱手术是否能改善坐位姿势和生活质量，尤其是对于高SVA或PT患者。
