Abstract
PurposeTo evaluate the predictive effect of lumbar lordosis minus thoracic kyphosis (LL-TK) in the surgical outcome of adult degenerative scoliosis (ADS) patients and explore the optimum target base on it.MethodsThe preoperative and postoperative data including radiographic image and functional evaluation (Visual Analog Scale, VAS; Oswestry Disability Index, ODI; Japanese Orthopaedic Association, JOA) of 130 patients with ADS who underwent corrective surgery was retrospectively reviewed. The relationship between sagittal parameters and surgical outcome was assessed by using the Pearson correlation analysis. Receiver operating characteristic (ROC) curve was used to define the optimum cutoff value of LL-TK. Patients were divided into two groups based on LL-TK to compare the preoperative and postoperative status.ResultsLL-TK assessed soon after surgery strongly correlated with health-related quality of life (HRQOL) and sagittal vertical axis (SVA) at last follow-up. The cutoff value of LL-TK was set at 10° to determine a good clinical outcome (ODI < 20) and sagittal balance (SVA < 50 mm). Patients with LL-TK > 10° presented significantly better postoperative VAS, ODI, JOA, and SVA than patients with LL-TK < 10°.ConclusionLL-TK could effectively predict postoperative HRQOL and sagittal balance for patients with ADS. Patients with LL-TK > 10° showed a better clinical outcome and sagittal balance, so LL-TK > 10° could be the optimum corrective target for these patients.
Highlights
Owing to the degeneration of spinal motion segments, adult degenerative scoliosis (ADS) was a common type of adult spinal deformity (ASD) without history of adolescent idiopathic scoliosis (AIS) [1]
Schwab et al proposed a classification for patients with ASD based on three critical sagittal parameters including sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence minus lumbar lordosis (PI-LL), and they pointed out that corrective surgery should reach the objectives of SVA less than 50 mm, PT less than 25°, and PI-LL within 10° [9, 10], which had been widely used in clinical practice
We found that LL-thoracic kyphosis (TK) = 10° could be used as the best cut-off value accounting for both clinical outcome (AUC = 0.617, sensitivity = 0.764, specificity = 0.440) and sagittal balance (AUC = 0.631, sensitivity = 0.761, specificity = 0.492)
Summary
Owing to the degeneration of spinal motion segments, adult degenerative scoliosis (ADS) was a common type of adult spinal deformity (ASD) without history of adolescent idiopathic scoliosis (AIS) [1]. This kind of deformity could be found in approximately 30% of elderly people [2]. Schwab et al proposed a classification for patients with ASD based on three critical sagittal parameters including sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence minus lumbar lordosis (PI-LL), and they pointed out that corrective surgery should reach the objectives of SVA less than 50 mm, PT less than 25°, and PI-LL within 10° [9, 10], which had been widely used in clinical practice
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