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Abstract
BackgroundStudies on characteristic spinal deformities in Japanese patients with ankylosing spondylitis (AS) and data demonstrating a relationship between health-related quality of life (HRQOL) and spinopelvic alignment in these patients are lacking.MethodsIn this cross-sectional study, 50 patients with AS and without a surgical history, vertebral body fracture, or scoliosis as well as 30 control patients with degenerative lumbar kyphoscoliosis (DLKS) were included. Data collected included patient sex, age, spinopelvic parameters on sagittal full-spine standing radiographs, and HRQOL questionnaire responses. Student’s t-test was used to compare the characteristics of spinopelvic parameters between the groups. A multiple regression analysis was performed to analyze correlations between spinopelvic parameters and HRQOL in the AS group.ResultsGlobal kyphosis (GK; T1–12 angle) was significantly greater in the AS group than in the DLKS group (P < 0.001), whereas the pelvic tilt (PT; posterior PT angle) was smaller in the AS group (P = 0.006). Radiographic parameters correlated with HRQOL in the AS group. Multiple regression analysis identified the sagittal vertical axis (SVA) and sacral slope (SS) as factors influencing the SRS-22 total score and SVA and GK as factors influencing Japanese Orthopaedic Association Back Pain Evaluation Questionnaire mental health (subdomain).ConclusionsPatients with AS did not use lumbar lordosis or posterior PT to compensate for their large thoracic kyphosis due to spinopelvic ankylosis. These patients showed a unique compensation pattern. The correlation/regression analysis revealed a correlation between radiographic parameters and HRQOL in patients with AS, with particular importance of SVA, SS, and GK for clinical results in AS.
Highlights
Studies on characteristic spinal deformities in Japanese patients with ankylosing spondylitis (AS) and data demonstrating a relationship between health-related quality of life (HRQOL) and spinopelvic alignment in these patients are lacking
The inclusion criteria were as follows: (1) patients categorized as having a sagittal balance defect for sagittal modifiers according to the adult spinal deformity classification by Schwab et al [9] and associated back pain as a chief complaint; and (2) patients with no history of fresh vertebral body fracture within 3 months, any neurological deficit, or spinal surgery
When comparing the AS and degenerative lumbar kyphosis (DLKS) groups, Global kyphosis (GK) was significantly greater (45.9 ± 17.8 vs. 30.3 ± 15.7, P < 0.001) and pelvic tilt (PT) was smaller (28.7 ± 12.4 vs. 35.3 ± 8.31, P = 0.006) in the former group, whereas no significant differences were found in sagittal vertical axis (SVA) (85.8 ± 75.3 vs. 86.1 ± 57.1, P = 0.986), sacral slope (SS) (23.2 ± 12.2 vs. 24.4 ± 14.6, P = 0.707), Fig. 1 Sagittal spinopelvic parameters for radiologic measurements
Summary
Studies on characteristic spinal deformities in Japanese patients with ankylosing spondylitis (AS) and data demonstrating a relationship between health-related quality of life (HRQOL) and spinopelvic alignment in these patients are lacking. The severity of AS progression is characterized by compromised sagittal balance due to thoracic kyphosis, ankylosis of the sacroiliac and hip joints, and a limitation of chest wall expansion [2]; the association between AS progression and health-related quality of life (HRQOL) remains unknown. In the only previous report dealing with the association between sagittal balance and HRQOL in AS, the participants were Korean and had near-normal thoracic kyphosis [3]. Many studies have documented associations between sagittal balance and HRQOL for grading spinal deformity progression in adults [6]. Our aims were (i) to characterize the sagittal spinal deformity associated with progression of thoracic kyphosis in AS by comparing sagittal spinopelvic parameters between AS and degenerative lumbar kyphosis (DLKS) and (ii) to reveal the relationship between sagittal spinopelvic parameters and HRQOL in AS and to identify sagittal spinopelvic parameters that affect HRQOL in patients with AS
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