Preoperative and postoperative sagittal plane analysis in adult idiopathic scoliosis in patients older than 40 years of age

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• 作者：Felisa Sá ; nchez-Mariscal ; MD ; PhD ; ^{f3130@hotmail.com} ; Alejandro Gomez-Rice ; MD ; Tamara Rodrí ; guez-Ló ; pez ; MD ; PhD ; Lorenzo Zú ; ñ ; iga ; MD ; Javier Pizones ; MD ; PhD ; Ana Nú ; ñ ; ez-Garcí ; a ; MD ; Enrique Izquierdo ; MD ; PhD
• 关键词：Adult scoliosis ; HRQOL measures ; IP-LL mismatch ; Lumbar lordosis gap ; Pelvic tilt ; Sagittal profile ; Sagittal vertical axis
• 刊名：The Spine Journal
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：17
• 期：1
• 页码：56-61
• 全文大小：214 K
• 卷排序：17

文摘

Most of the papers correlate sagittal radiographic parameters with health-related quality of life (HRQOL) scores for patients with scoliosis. However, we do not know how changes in sagittal profile influence clinical outcomes after surgery in adult population operated for mainly frontal deformity.PurposeThis study aimed to analyze spinal sagittal profile in a population operated on adult idiopathic scoliosis (AS) and to describe variations in sagittal parameters after surgery and the association between those variations and clinical outcomes.Design/SettingThis is a historical cohort study.Patient SampleWe included in this study 40 patients operated on AS, older than 40 at the time of surgery (mean age 54.9), and with more than 2-year follow-up (mean 7.4 years).Outcome MeasuresFull-length free-standing radiographs, Scoliosis Research Society 22 (SRS22) and Short Form 36 (SF36) instruments, and satisfaction with outcomes were available at final follow-up.MethodsSagittal preoperative and final follow-up radiographic parameters, radiographic correlation with HRQOL scores at final follow-up, and association between satisfaction and changes in sagittal profile were analyzed. A multivariate analysis was performed. No funds were received for this article.ResultsPreoperatively, the spinal sagittal plane tended to exhibit kyphosis. Most sagittal parameters did not improve at final follow-up with respect to preoperative values. We saw, after univariate analysis, that worse sagittal profile leads to worse HRQOL, but after multivariate analysis, only spinal tilt (ST) persisted as possible predictor for worse SRS activity scores. Frontal Cobb significantly improved. Most patients (82%) were satisfied with final outcomes. Variations in sagittal profile parameters did not differ between satisfied and dissatisfied patients.ConclusionsAlthough most sagittal plane parameters did not improve after surgery, surgical treatment in AS achieves a high satisfaction rate. Good clinical results do not correlate with improving sagittal plane parameters. Sagittal profile measurements are not helpful to decide surgical treatment in patients with mainly frontal deformity.