A Comprehensive Analysis of the SRS-Schwab Adult Spinal Deformity Classification and Confounding Variables
A Comprehensive Analysis of the SRS-Schwab Adult Spinal Deformity Classification and Confounding Variables
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DOI：
10.1097/brs.0000000000001355
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发表时间：
2016-05-01
期刊：
影响因子：
3
通讯作者：
Dahl, Benny
中科院分区：
文献类型：
--
作者：
Hallager, Dennis Winge;Hansen, Lars Valentin;Dahl, Benny
研究设计.对一个连续的，前瞻性队列的横断面分析。评估脊柱侧凸研究协会（SRS）-Schwab成人脊柱畸形分类法通过广泛使用的健康相关生活质量（HRQOL）评分对患者进行分组的能力，并检查可能的混杂变量。SRS-Schwab成人脊柱畸形分类包括被认为对HRQOL重要的矢状面修正因子，并且该分类的临床影响已在国际脊柱研究组数据库的患者中得到验证;然而，骨盆倾斜修正因子报告了不确定的结果，并且未评价潜在的混杂变量。在2013年3月至2014年5月期间，前瞻性入组了来自我们门诊的所有具有足够X线片的成人脊柱畸形患者。对每种SRS-Schwab修正因子进行HRQOL方差分析和事后分析。年龄、脊柱手术史和脊柱畸形的病因被认为是潜在的混杂因素，并采用多变量比例优势回归评估其对SRS-Schwab修正剂和综合奥斯韦斯特里残疾指数（ODI）评分之间相关性的影响。P值经多重检验调整。460例合格患者中有292例纳入分析。SRS-Schwab分类显著区分正常和异常矢状面修正分类之间的HRQOL评分。个体等级比较显示结果不明确;然而，根据任何HRQOL评分，盆腔炎等级+与+ +不能区分患者。所有修改者显示出显着的比例优势更差的综合ODI分数随着年级水平的增加，效果是强大的混淆。但年龄组和病原学对个体差异有显著性。根据最广泛使用的HRQOL评分，SRS-Schwab矢状面修正法可靠地将0级与+/ + +级患者分组，在调整潜在混杂因素后，等级水平增加对ODI评分恶化几率的影响仍然显著。但年龄组和病因学的影响不容忽视。
Study Design. Cross-sectional analyses on a consecutive, prospective cohort.Objective. To evaluate the ability of the Scoliosis Research Society (SRS)-Schwab Adult Spinal Deformity Classification to group patients by widely used health-related quality-of-life (HRQOL) scores and examine possible confounding variables.Summary of Background Data. The SRS-Schwab Adult Spinal Deformity Classification includes sagittal modifiers considered important for HRQOL and the clinical impact of the classification has been validated in patients from the International Spine Study Group database; however, equivocal results were reported for the Pelvic Tilt modifier and potential confounding variables were not evaluated.Methods. Between March 2013 and May 2014, all adult spinal deformity patients from our outpatient clinic with sufficient radiographs were prospectively enrolled. Analyses of HRQOL variance and post hoc analyses were performed for each SRS-Schwab modifier. Age, history of spine surgery, and aetiology of spinal deformity were considered potential confounders and their influence on the association between SRS-Schwab modifiers and aggregated Oswestry Disability Index (ODI) scores was evaluated with multivariate proportional odds regressions. P values were adjusted for multiple testing.Results. Two hundred ninety-two of 460 eligible patients were included for analyses. The SRS-Schwab Classification significantly discriminated HRQOL scores between normal and abnormal sagittal modifier classifications. Individual grade comparisons showed equivocal results; however, Pelvic Tilt grade+versus+ +did not discriminate patients according to any HRQOL score. All modifiers showed significant proportional odds for worse aggregated ODI scores with increasing grade levels and the effects were robust to confounding. However, age group and aetiology had individual significant effects.Conclusion. The SRS-Schwab sagittal modifiers reliably grouped patients graded 0 versus+/ + +according to the most widely used HRQOL scores and the effects of increasing grade level on odds for worse ODI scores remained significant after adjusting for potential confounders. However, effects of age group and aetiology should not be neglected.