• Eur Spine J · Oct 2021

    Dose-response relationship between spino-pelvic alignment determined by sagittal modifiers and back pain-specific quality of life.

    • Ryoji Tominaga, Noriaki Kurita, Yoshiyuki Kokubun, Takuya Nikaido, Miho Sekiguchi, Koji Otani, Masumi Iwabuchi, Osamu Shirado, Shunichi Fukuhara, and Shin-Ichi Konno.
    • Department of Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashimahi, Aizuwakamatsu, Fukushima, 969-3492, Japan. rt0730@fmu.ac.jp.
    • Eur Spine J. 2021 Oct 1; 30 (10): 3019-3027.

    PurposeTo determine whether abnormalities of the sagittal modifiers (SMs) of the Scoliosis Research Society (SRS)-Schwab classification truly reflect back pain (BP)-specific quality of life (QOL), it is necessary to examine their dose-response relationships and to determine clinically impactful thresholds for declines in BP-specific QOL. This study aimed to analyse the continuous dose-response relationship between each SM and BP-specific QOL.MethodsThis cross-sectional study, using data from a Japanese population-based cohort study, included 519 community-dwelling residents aged ≥ 50 years who participated in the annual health examination. The participants completed the Roland-Morris Disability Questionnaire (RDQ) on BP-specific QOL. Spino-pelvic alignment based on SMs was assessed by whole-spine X-ray examinations. We fitted general linear models with or without nonlinear terms to estimate the dose-response relationship between each SM and BP-specific QOL.ResultsPelvic tilt, pelvic incidence minus lumbar lordosis (PI-LL), and sagittal vertical axis showed dose-response relationships with BP-specific QOL measured as the RDQ score. PI-LL was most likely to predict a minimally clinically important RDQ score when its value exceeded the 90th percentile. A nonlinear relationship between PI-LL and the BP-specific QOL score was found. RDQ increased when PI-LL exceeded 10°.ConclusionPI-LL might be the most sensitive of the three modifiers of the SRS-Schwab classification for determining BP-specific QOL. Moreover, BP-specific QOL worsens rapidly when the compensatory mechanism against malalignment exceeds a critical value. Therefore, we suggest that traditional classifications and surgical strategies should be re-examined regarding the dose-dependent abnormalities of the SMs to develop a more reliable classification strategy.© 2021. The Author(s).

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