Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis.

Abstract

Little information is available on the relationship between cervical sagittal alignment and health-related quality of life (HRQOL) in adolescent idiopathic scoliosis (AIS) patients. The aim of this study was to identify relationships between postoperative cervical sagittal alignment and HRQOL in AIS. The study and control groups comprised 67 AIS patients (51 girls and 16 boys). All underwent anteroposterior and lateral plain radiography and completed clinical questionnaires. The radiographic parameters investigated were pre- and postoperative C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), T1 slope, T1 slope minus C2-C7 lordosis (TS-CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI). The Korean version of the SRS-22 questionnaire and the previously validated Short Form-36 (SF-36) outcome questionnaire were administered to evaluate HRQOL at last follow-up visits. Statistical analysis was performed to determine the significances of differences between preoperative and last follow-up radiological findings. In addition, correlations between radiological parameters and clinical questionnaire scores were sought. Radiological sagittal parameters were found to be significantly increased after surgical correction in terms of C2-C7 lordosis (3.5±11.4), C2-C7 SVA (1.5±6.0), T1 slope (3.5±6.1), and TK (6.0±8.1). However, no significant difference was observed for TS-CL, LL, PT, SS, and PI (P>0.05). Correlation analysis revealed significant relationships between radiographic parameters and questionnaire scores. Multiple regression analysis was performed to identify predictors of HRQOL, and the results obtained revealed that postoperative T1 slope significantly predicted SRS, PCS, and MCS scores and that postoperative C2-C7 SVA predicted SRS scores. Changes in cervical sagittal parameters were significant after deformity correction in AIS patients. Correlation analysis revealed significant relationships between postoperative radiographic parameters and HRQOL. In particular, T1 slope and C2-C7 SVA were found to be significant predictors of HRQOL in AIS patient.