Baseline Patient-Reported Outcomes Correlate Weakly With Radiographic Parameters: A Multicenter, Prospective NIH Adult Symptomatic Lumbar Scoliosis Study of 286 Patients.
Baseline Patient-Reported Outcomes Correlate Weakly With Radiographic Parameters: A Multicenter, Prospective NIH Adult Symptomatic Lumbar Scoliosis Study of 286 Patients.
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DOI：
10.1097/brs.0000000000001613
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发表时间：
2016-11-15
期刊：
影响因子：
3
通讯作者：
Bridwell KH
中科院分区：
文献类型：
--
作者：
Chapman TM Jr;Baldus CR;Lurie JD;Glassman SD;Schwab FJ;Shaffrey CI;Lafage V;Boachie-Adjei O;Kim HJ;Smith JS;Crawford CH 3rd;Lenke LG;Buchowski JM;Edwards C 2nd;Koski T;Parent S;Lewis S;Kang DG;McClendon J Jr;Metz L;Zebala LP;Kelly MP;Spratt KF;Bridwell KH
前瞻性横断面研究。确定哪些影像学参数驱动原发性成人症状性腰椎侧凸（ASLS）患者报告的结果（PROs）。先前的文献表明，PROs与矢状面畸形（矢状垂直轴[SVA]，骨盆发生率-腰椎前凸[PI-LL]不匹配，骨盆倾斜[PT]）相关。先前的工作包括翻修和原发性成人脊柱畸形患者。本研究仅针对原发性ASLS。本研究分析了2010-2014年9个中心参加NIH RO1临床试验的286例患者的前瞻性基线数据。纳入标准：40-80岁，腰椎Cobb (LC)≥30°，脊柱侧凸研究协会-23 （SRS-23）疼痛、功能或自我形象评分≤4.0或Oswestry残疾指数(ODI)≥20。患者为初次表现（无脊柱畸形手术史），具有完整的基线数据：站立的冠状位/矢状位36寸x线片和PROs （ODI, SRS-23, Short Form-12）。计算相关系数来评估研究人群和一部分ODI≥40的患者放射学参数与PROs之间的关系。采用方差分析（ANOVA）确定放射学改进剂组PROs的差异。平均年龄60.3岁。平均脊柱参数为：LL= - 39.2°；上海广电= 3.1厘米;骶骨斜率(SS)=32.5°；PT = 23.9°;PI-LL不匹配= 16.8°。种群SS、SVA及SVA修饰因子与SRS函数之间呈弱相关（0.2 ~ 0.4）。SVA和SVA调节剂与ODI呈弱相关。虽然在高症状患者的亚群分析中有更多的相关性，但都是弱的。方差分析发现SVA调节剂组报告的ODI有显著差异。在原发性ASLS患者和一部分“高症状”患者（ODI≥40）中，基线PROs和影像学参数之间仅存在弱关联。对于该患者群体，这些结果表明区域放射学参数（LC， LL， PT， PI-LL不匹配）不是pro的驱动因素，不能用于推断对患者感知病理的影响。2
Prospective, cross sectional study. Determine which radiographic parameters drive patient-reported outcomes (PROs) in primary presentation adult symptomatic lumbar scoliosis (ASLS). Previous literature suggests correlations between PROs and sagittal plane deformity (sagittal vertical axis [SVA], pelvic incidence-lumbar lordosis [PI-LL] mismatch, pelvic tilt [PT]). Prior work included revision and primary adult spinal deformity patients. This study addresses only primary presentation ASLS. Prospective baseline data were analyzed on 286 patients enrolled in an NIH RO1 clinical trial by nine centers from 2010–2014. Inclusion criteria: 40–80 years old, lumbar Cobb (LC) ≥30° and Scoliosis Research Society-23 (SRS-23) score ≤4.0 in Pain, Function or Self-Image domains or Oswestry Disability Index (ODI) ≥20. Patients were primary presentation (no prior spinal deformity surgery) and had complete baseline data: standing coronal/sagittal 36” radiographs and PROs (ODI, SRS-23, Short Form-12). Correlation coefficients were calculated to evaluate relationships between radiographic parameters and PROs for the study population and a subset of patients with ODI ≥40. ANOVA was used to identify differences in PROs for radiographic modifier groups. Mean age was 60.3 years. Mean spinopelvic parameters were: LL=−39.2°; SVA=3.1cm; sacral slope (SS)=32.5°; PT=23.9°; PI-LL mismatch=16.8°. Only weak correlations (0.2–0.4) were identified between population SS, SVA and SVA modifiers and SRS Function. SVA and SVA modifiers were weakly associated with ODI. While there were more correlations in subset analysis of high-symptom patients, all were weak. ANOVA identified significant differences in ODI reported by SVA modifier groups. In primary presentation ASLS patients and a subset of ‘high-symptom’ patients (ODI ≥40), only weak associations between baseline PROs and radiographic parameters were identified. For this patient population, these results suggest regional radiographic parameters (LC, LL, PT, PI-LL mismatch) are not drivers of PROs and cannot be used to extrapolate impact on patient-perceived pathology. 2