The Impact of Surgical Correction of Adult Spine Deformity on Radiological Parameters and Its Correlation With Clinical Outcomes
Abstract
To evaluate the correlations between changes in radiological parameters and clinical outcomes following adult spinal deformity (ASD) surgery. Radiological assessments are necessary for evaluation of deformity magnitude and choosing the appropriate surgical approach. Some studies have demonstrated the correlation between radiological parameters and pain and disability among patients. However, few studies have evaluated changes in both coronal and sagittal radiological parameters following the surgical treatment of ASD and its correlation with clinical outcomes. Radiological parameters include: pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and PI minus LL (PI-LL), and Cobb’s angle and three clinical outcome measures include: visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 health survey (SF-36), were assessed at baseline and 6 and 12 months after surgery. A total of 95 patients were included. Mean VAS scores and ODI significantly improved from 7.09±2.1 and 61.07±13.6 to 2.64±1.6 and 31.8±16.1 respectively, after surgery (both P<0.001). All items of the SF-36 survey, as well as all radiologic measures, improved significantly following surgery (both P<0.001). We found a significant negative correlation between pre-operative SS and VAS scores (r= -0.307, P=0.002). Energy (r= -0.262, P=0.010) and social functioning (r= -0.248, P=0.015) scales of SF-36. PI-LL was positively associated with ODI (r=0.223, P=0.030) before surgery and energy scale (r= -0.262, P=0.010) of SF-36 after surgery. Surgical treatment of patients with ASD improves clinical outcomes, and in line with previous studies, restoration of sagittal alignment has a more important role in the enhancement of patients’ function and quality of life.
2. Smith JS, Shaffrey CI, Fu KM, et al. Clinical and radiographic evaluation of the adult spinal deformity patient. Neurosurgery clinics of North America 2013;24:143-56.
3. Ailon T, Smith JS, Shaffrey CI, et al. Degenerative Spinal Deformity. Neurosurgery 2015;77 Suppl 4:S75-91.
4. Schwab FJ, Smith VA, Biserni M, et al. Adult scoliosis: a quantitative radiographic and clinical analysis. Spine 2002;27:387-92.
5. Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine 2005;30:2024-9.
6. Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 2005;30:682-8.
7. Simon J, Longis PM, Passuti N. Correlation between radiographic parameters and functional scores in degenerative lumbar and thoracolumbar scoliosis. Orthopaedics & traumatology, surgery & research : OTSR 2017;103:285-90.
8. Schwab F, Patel A, Ungar B, et al. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 2010;35:2224-31.
9. Inami S, Moridaira H, Takeuchi D, et al. Optimum pelvic incidence minus lumbar lordosis value can be determined by individual pelvic incidence. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2016;25:3638-43.
10. Jackson RP, Simmons EH, Stripinis D. Coronal and sagittal plane spinal deformities correlating with back pain and pulmonary function in adult idiopathic scoliosis. Spine 1989;14:1391-7.
11. Cho KJ, Suk SI, Park SR, et al. Risk factors of sagittal decompensation after long posterior instrumentation and fusion for degenerative lumbar scoliosis. Spine 2010;35:1595-601.
12. Ploumis A, Liu H, Mehbod AA, et al. A correlation of radiographic and functional measurements in adult degenerative scoliosis. Spine 2009;34:1581-4.
13. Vaz G, Roussouly P, Berthonnaud E, et al. Sagittal morphology and equilibrium of pelvis and spine. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2002;11:80-7.
14. Ogon M, Krismer M, Sollner W, et al. Chronic low back pain measurement with visual analogue scales in different settings. Pain 1996;64:425-8.
15. Fairbank JC, Couper J, Davies JB, et al. The Oswestry low back pain disability questionnaire. Spine 2000;25:2940-52.
16. Schwab F, Dubey A, Pagala M, et al. Adult scoliosis: a health assessment analysis by SF-36. Spine 2003;28:602-6.
17. Yadla S, Maltenfort MG, Ratliff JK, et al. Adult scoliosis surgery outcomes: a systematic review. Neurosurgical focus 2010;28:E3.
18. Ghandhari H, Ameri Mahabadi M, Nikouei F, et al. The Role of Spinopelvic Parameters in Clinical Outcomes of Spinal Osteotomies in Patients with Sagittal Imbalance. The Archives of Bone and Joint Surgery 2018;6:324-30.
19. Lee CH, Chung CK, Jang JS, et al. Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance: a meta-analysis. Journal of neurosurgery. Spine 2017;27:540-51.
20. Soroceanu A, Diebo BG, Burton D, et al. Radiographical and Implant-Related Complications in Adult Spinal Deformity Surgery: Incidence, Patient Risk Factors, and Impact on Health-Related Quality of Life. Spine 2015;40:1414-21.
21. Pull ter Gunne AF, van Laarhoven CJHM, Cohen DB. Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk. European Spine Journal 2010;19:982-8.
22. Soroceanu A, Burton DC, Diebo BG, et al. Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery. Journal of Neurosurgery: Spine 2015;23:656-64.
23. Daubs MD, Lenke LG, Bridwell KH, et al. Does Correction of Preoperative Coronal Imbalance Make a Difference in Outcomes of Adult Patients With Deformity? Spine 2013;38:476-83.
24. Mac-Thiong JM, Transfeldt EE, Mehbod AA, et al. Can c7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine 2009;34:E519-27.
25. Smith JS, Bess S, Shaffrey CI, et al. Dynamic changes of the pelvis and spine are key to predicting postoperative sagittal alignment after pedicle subtraction osteotomy: a critical analysis of preoperative planning techniques. Spine 2012;37:845-53.
26. Vaz G, Roussouly P, Berthonnaud E, et al. Sagittal morphology and equilibrium of pelvis and spine. European Spine Journal 2002;11:80-7.
27. Duval-Beaupere G, Schmidt C, Cosson P. A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Annals of biomedical engineering 1992;20:451-62.
28. Legaye J, Duval-Beaupere G, Hecquet J, et al. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 1998;7:99-103.
29. Kim Y-C, Lenke LG, Lee S-J, et al. The cranial sagittal vertical axis (CrSVA) is a better radiographic measure to predict clinical outcomes in adult spinal deformity surgery than the C7 SVA: a monocentric study. European Spine Journal 2017;26:2167-75.
30. Schwab FJ, Blondel B, Bess S, et al. Radiographical Spinopelvic Parameters and Disability in the Setting of Adult Spinal Deformity: A Prospective Multicenter Analysis. Spine 2013;38:E803-E12.
| Files | ||
| Issue | Vol 58, No 4 (2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v58i4.3924 | |
| Keywords | ||
| Adult spine deformity Spine deformity Spine surgery Sagittal balance Coronal balance | ||
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