• Frank J Schwab, Benjamin Blondel, Shay Bess, Richard Hostin, Christopher I Shaffrey, Justin S Smith, Oheneba Boachie-Adjei, Douglas C Burton, Behrooz A Akbarnia, Gregory M Mundis, Christopher P Ames, Khaled Kebaish, Robert A Hart, Jean-Pierre Farcy, Virginie Lafage, and International Spine Study Group (ISSG).
• Spine Division, NYU Hospital for Joint Diseases, New York, NY, USA.
• Spine. 2013 Jun 1;38(13):E803-12.

Study DesignProspective multicenter study evaluating operative (OP) versus nonoperative (NONOP) treatment for adult spinal deformity (ASD).ObjectiveEvaluate correlations between spinopelvic parameters and health-related quality of life (HRQOL) scores in patients with ASD.Summary Of Background DataSagittal spinal deformity is commonly defined by an increased sagittal vertical axis (SVA); however, SVA alone may underestimate the severity of the deformity. Spinopelvic parameters provide a more complete assessment of the sagittal plane but only limited data are available that correlate spinopelvic parameters with disability. METHODS.: Baseline demographic, radiographical, and HRQOL data were obtained for all patients enrolled in a multicenter consecutive database. Inclusion criteria were: age more than 18 years and radiographical diagnosis of ASD. Radiographical evaluation was conducted on the frontal and lateral planes and HRQOL questionnaires (Oswestry Disability Index [ODI], Scoliosis Research Society-22r and Short Form [SF]-12) were completed. Radiographical parameters demonstrating highest correlation with HRQOL values were evaluated to determine thresholds predictive of ODI more than 40.ResultsFour hundred ninety-two consecutive patients with ASD (mean age, 51.9 yr) were enrolled. Patients from the OP group (n = 178) were older (55 vs. 50.1 yr, P < 0.05), had greater SVA (5.5 vs. 1.7 cm, P < 0.05), greater pelvic tilt (PT; 22° vs. 11°, P < 0.05), and greater pelvic incidence/lumbar lordosis PI/LL mismatch (PI-LL; 12.2 vs. 4.3; P < 0.05) than NONOP group (n = 314). OP group demonstrated greater disability on all HRQOL measures compared with NONOP group (ODI = 41.4 vs. 23.9, P < 0.05; Scoliosis Research Society score total = 2.9 vs. 3.5, P < 0.05). Pearson analysis demonstrated that among all parameters, PT, SVA, and PI-LL correlated most strongly with disability for both OP and NONOP groups (P < 0.001). Linear regression models demonstrated threshold radiographical spinopelvic parameters for ODI more than 40 to be: PT 22° or more (r = 0.38), SVA 47 mm or more (r = 0.47), PI - LL 11° or more (r = 0.45).ConclusionASD is a disabling condition. Prospective analysis of consecutively enrolled patients with ASD demonstrated that PT and PI-LL combined with SVA can predict patient disability and provide a guide for patient assessment for appropriate therapeutic decision making. Threshold values for severe disability (ODI > 40) included: PT 22° or more, SVA 47 mm or more, and PI - LL 11° or more.

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