• Joshua Bakhsheshian, Justin K Scheer, Jeffrey L Gum, Lance Horner, Richard Hostin, Virginie Lafage, Shay Bess, Themistocles S Protopsaltis, Douglas C Burton, Malla Keefe, Robert A Hart, Gregory M Mundis, Christopher I Shaffrey, Frank Schwab, Justin S Smith, Christopher P Ames, and International Spine Study Group (ISSG).
• *Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles †University of California San Diego School of Medicine, La Jolla, CA ‡Norton Leatherman Spine Center, Louisville, KY §University of Nevada School of Medicine, Reno, NV ∥Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX ¶Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY #Rocky Mountain Hospital for Children, Denver, CO **Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS ††Department of Neurological Surgery, University of California, San Francisco, CA ‡‡Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR §§Scripps Health, La Jolla, CA ∥∥Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA.
• Clin Spine Surg. 2017 Mar 1; 30 (2): E124-E131.

Study DesignThis is a review of a prospective multicenter database.ObjectiveTo investigate the relationship between preoperative disability and sagittal deformity in patients with high Oswestry Disability Index (ODI) and no sagittal malalignment, or low ODI and high sagittal malalignment.Summary Of Background DataThe relationship between ODI and sagittal malalignment varies between each adult spinal deformity (ASD) patient.MethodsA prospective multicenter database of 365 patients with ASD undergoing surgical reconstruction was analyzed. Inclusion criteria entailed: age 18 years or above and the presence of spinal deformity as defined by a coronal Cobb angle≥20 degrees, sagittal vertical axis (SVA)≥5 cm, pelvic tilt (PT) angle≥25 degrees, or thoracic kyphosis≥60 degrees. Radiographic and health-related quality of life (HRQOL) variables were examined and compared, preoperatively and at 2-year postoperative follow-up. Group 1 (low disability high sagittal-LDHS) consisted of ODI<40 and SVA≥5 cm or PT≥25 degrees or pelvic incidence-lumbar lordosis≥11 degrees and group 2 (high disability low sagittal-HDLS) consisted of ODI>40 and SVA<5 cm and PT<25 degrees and pelvic incidence-lumbar lordosis<11 degrees.ResultsOf 264 patients with follow-up, 58 (22.0%) patients were included in LDHS and 30 (11.4%) were included in HDLS. Both groups had similar demographics and preoperative coronal angles. HDLS had worse baseline HRQOL for all measures (P<0.05) except leg and back pain. HDLS had a higher rate of self-reported leg weakness, arthritis, depression and neurological disorder. Both groups had similar 2-year improvements in HRQOL (P>0.05), except only HDLS had a significant Scoliosis Research Society Mental improvement and a significantly higher rate of reaching minimal clinically important differences in Scoliosis Research Society Mental scores (P<0.05).ConclusionsThere is an association of worse baseline HRQOL measures, weakness, arthritis, and mental disease in HDLS. Furthermore, HDLS patients demonstrated similar improvements to LDHS. However, HDLS had greater improvements in the mental domains, perhaps indicating the responsiveness of the mental disability to surgical treatment.Level Of EvidenceLevel III.

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