Health Related Quality of Life and Spinopelvic Parameters in Sagittal Imbalance Patients: A Comparison of Multilevel SmithPetersen Osteotomy (SPO) and Pedicle Subtraction Osteotomy (PSO)

Abstract

Study Design: A multicenter, retrospective review of surgical patients with sagittal imbalance. Objective: Determine if the use of one type of osteotomy is justified instead of the other by basing on improvements in the quality of life and radiographical parameters after sagittal imbalance correction. Summary of Background Data: ASD includes broad ranges of clinical and radiographical conditions that could be associated with a decrease in quality of life of patients. SPO and PSO are the techniques most commonly used to correct sagittal imbalance. Methods: Retrospective study with patients from two hospitals who suffered from sagittal imbalance and underwent PSO/SPO with a minimum one-year follow-up. Radiographic parameters measured were Thoracic Kyphosis (TK), Lumbar Lordosis (LL), Coob Angle (Cobb), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Health Related Quality of Life was obtained by ODI, SRS-22, and VAS. Two analyses: (1) Pre-/postoperative data comparison of each technique (paired sample t-test). (2) Magnitude of change comparison between SPO and PSO (independent samples t-test). Results: 65 patients with a mean age of 67.7 (±9.59) years, 70.8% female. Two groups: SPO (48 cases with a mean of 2.13 osteotomies), PSO (17, one PSO in each). In the SPO group significant improvements were seen TK (Pre: 31.38 ± 16.92; Post: 41.37 ± 11.67, p < 0.001), LL (Pre: 31.20 ± 15.69; Post: 38.63 ± 9.62, p < 0.001), and Cobb (Pre: 25.42 ± 15.84; Post: 9.49 ± 8.60, p < 0.001), as well as in the quality of life questionnaires. In the PSO group significant improvements were determined in TK (Pre: 32.26 ± 19.48; Post: 42.51 ± 16.23, p = 0.003), LL (Pre: 20.71 ± 12.50; Post: 38.54 ± 8.62, p < 0.001), and SVA (Pre: 156.00 ± 37.79; Post: 98.65 ± 38.72, p < 0.001) and in total SRS-22 (Pre: 2.13 ± 0.42; Post: 3.10 ± 0.87, p < 0.001) and self- image subdomain (Pre: 2.06 ± 0.54; Post: 2.99 ± 0.77, p = 0.002), mental health (Pre: 2.06 ± 0.54; Post: 3.59 ± 1.08, p < 0.001), and function (Pre: 2.31 ± 0.43; Post: 2.96 ± 0.92, p = 0.010). The comparison between SPO/PSO revealed no significant improvements in both techniques. Regarding quality of life, significant better scoring was obtained in VAS-PSO group (-3.29 ± 5.77) in comparison with SPO-group (-2.73 ± 3.49), p = 0.009. However, as a whole, quality of life improves more in both osteotomies groups. Conclusions: Significant quality of life improvements are seen in patients with sagittal imbalance after being treated with SPO and PSO techniques. Differences between both techniques were not found