Rheumatology Division, Federal University of São Paulo/ Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil.
Diagnostic Imaging Department, Federal University of São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil; Diagnostic Imaging Department, Fleury Medicina e Saúde, São Paulo, Brazil.
Semin Arthritis Rheum. 2024 Apr;65:152415. doi: 10.1016/j.semarthrit.2024.152415. Epub 2024 Feb 7.
To assess the relationship between spinal structural damage, sagittal balance parameters and spine curvatures in patients with axial spondyloarthritis (axSpA).
In this cross-sectional study, the pelvic and sagittal balance parameters were obtained through EOS® (Biospace, Paris, France). Patients were divided into three groups according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) tertiles (G1 ≤6, n = 36; G2: 6.1-31, n = 36; G3 >31, n = 35) and pelvic and sagittal parameters were compared across them. Multivariable regression analysis was performed to analyze the impact of spinal structural damage and of other factors on sagittal vertical axis (SVA), an important sagittal balance parameter.
A total of 107 patients was included. G2 and 3 exhibited higher mean values of thoracic kyphosis T1-T12 when compared to G1 (10.5°(12.3) vs. 22.3°(17.3) vs. 35.2°(14.6), p < 0.001), and G3 demonstrated lumbar L1-S1 straightening compared to the other groups (55.7°(9) and 50.7°(19.8), G1 and G2, respectively, vs. 35.7°(13.2), p < 0.001). Mean SVA values showed an increasing gradient from G1 to G3 (21.6(25.1) vs. 41(44.3) vs. 84.3(47.2)mm, p < 0.001). In the multivariable regression, a one-unit increase in total mSASSS was associated with an average 0.8 mm higher SVA.
Our data showed that more spinal structural damage is associated with a higher SVA, reflecting poorer sagittal balance. Patients with increasing spinal damage have an important increase in thoracic kyphosis suggesting that postural modifications in patients with axSpA might have their origin in the thoracic spine.
评估强直性脊柱炎（axSpA）患者脊柱结构损伤、矢状面平衡参数与脊柱曲度之间的关系。
本横断面研究通过 EOS®（Biospace，巴黎，法国）获取骨盆和矢状面平衡参数。患者根据改良 Stoke 强直性脊柱炎脊柱评分（mSASSS）三分位数（G1≤6，n=36；G2：6.1-31，n=36；G3＞31，n=35）分为三组，比较各组间的骨盆和矢状面参数。多变量回归分析用于分析脊柱结构损伤及其他因素对重要矢状面平衡参数矢状垂直轴（SVA）的影响。
共纳入 107 例患者。与 G1 相比，G2 和 G3 的 T1-T12 胸椎后凸角平均值更高（10.5°（12.3） vs. 22.3°（17.3） vs. 35.2°（14.6），p＜0.001），且 G3 与其他两组相比腰椎 L1-S1 更直（55.7°（9）和 50.7°（19.8），G1 和 G2 分别 vs. 35.7°（13.2），p＜0.001）。SVA 的平均值呈从 G1 到 G3 的递增梯度（21.6（25.1） vs. 41（44.3） vs. 84.3（47.2）mm，p＜0.001）。在多变量回归中，mSASSS 总分每增加 1 分，SVA 平均增加 0.8mm。
我们的数据表明，脊柱结构损伤越严重，SVA 越高，反映出矢状面平衡越差。脊柱损伤越严重的患者胸椎后凸角增加明显，提示 axSpA 患者的姿势改变可能起源于胸椎。
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