Department of Orthopedic Surgery, Liaocheng People's Hospital, Liaocheng, Shandong, People's Republic of China.
Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China.
Arch Orthop Trauma Surg. 2023 Jul;143(7):3975-3984. doi: 10.1007/s00402-022-04667-z. Epub 2022 Nov 8.
Surgery is still an effective treatment option for adult degenerative scoliosis (ADS), but how to predict patients' significant amount of the improvement in quality of life remains unclear. The previous studies included an inhomogeneous population. This study aimed to report the results about concentrating on the amount of immediate changes in spinopelvic radiographic parameters to predict the amount of mid-term improvement in quality of life in ADS patients.
Pre-operative and immediately post-operative radiographic parameters included Cobb angle, coronal vertical axis (CVA), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI) and LL/PI matching (PI-LL). Quality of life scores were evaluated pre-operatively and at the final follow-up using Oswestry Disability Index (ODI) and visual analogue scale (VAS). The amount of immediate changes in spinopelvic radiographic parameters (Δ) and the amount of mid-term improvement in quality of life (Δ) were defined, respectively.
Patients showed significant change in radiographic parameters, ODI and VAS pre- and post-surgery, except CVA and PI. Univariate analysis showed a significant correlation between ΔTK, ΔLL, ΔCVA and the amount of mid-term improvement in quality of life, but multivariate analysis did not get a significant result. Univariate and multivariate analyses showed that ΔSVA was still a significant predictor of ΔVAS and ΔODI. The changes in the other radiographic parameters were not significant. The equations were developed by linear regression: ΔODI = 0.162 × ΔSVA - 21.592, ΔVAS = 0.034 × ΔSVA - 2.828. In the ROC curve for ΔSVA in the detection of a strong ΔODI or ΔVAS, the cut-off value of ΔSVA was - 19.855 mm and - 15.405 mm, respectively.
This study shows that ΔSVA can predict the amount of mid-term improvement in quality of life in ADS patients. The changes in the other radiographic parameters were not significant. Two equations were yielded to estimate ΔODI and ΔVAS. ΔSVA has respective cut-off value to predict ΔODI and ΔVAS.
手术仍然是成人退行性脊柱侧凸（ADS）的有效治疗选择，但如何预测患者生活质量的显著改善量仍不清楚。以前的研究包括一个异质人群。本研究旨在报告集中于脊柱骨盆影像学参数的即刻变化量以预测 ADS 患者中期生活质量改善量的结果。
术前和即刻术后影像学参数包括 Cobb 角、冠状垂直轴（CVA）、矢状垂直轴（SVA）、腰椎前凸（LL）、胸椎后凸（TK）、骨盆倾斜度（PT）、骶骨倾斜度（SS）、骨盆入射角（PI）和 LL/PI 匹配（PI-LL）。使用 Oswestry 残疾指数（ODI）和视觉模拟评分（VAS）分别在术前和最终随访时评估生活质量评分。定义了脊柱骨盆影像学参数的即刻变化量（Δ）和生活质量的中期改善量（Δ）。
患者在术前和术后的影像学参数、ODI 和 VAS 均显示出显著变化，除了 CVA 和 PI。单因素分析显示，ΔTK、ΔLL、ΔCVA 与生活质量的中期改善量之间存在显著相关性，但多因素分析未得到显著结果。单因素和多因素分析均显示，ΔSVA 仍然是 ΔVAS 和 ΔODI 的显著预测因子。其他影像学参数的变化不显著。通过线性回归建立了方程：ΔODI=0.162×ΔSVA-21.592，ΔVAS=0.034×ΔSVA-2.828。在用于检测强 ΔODI 或 ΔVAS 的 ΔSVA 的 ROC 曲线中，ΔSVA 的截断值分别为-19.855mm 和-15.405mm。
本研究表明，ΔSVA 可以预测 ADS 患者生活质量的中期改善量。其他影像学参数的变化不显著。得出了两个方程来估计 ΔODI 和 ΔVAS。ΔSVA 有各自的截断值来预测 ΔODI 和 ΔVAS。
