The impact of positive sagittal balance in adult spinal deformity
The impact of positive sagittal balance in adult spinal deformity
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DOI：
10.1097/01.brs.0000179086.30449.96
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发表时间：
2005-09-15
期刊：
影响因子：
3
通讯作者：
Schwab, F
中科院分区：
文献类型：
--
作者：
Glassman, SD;Bridwell, K;Schwab, F
研究设计。这项研究是对2002年和2003年在多中心前瞻性数据库中登记的752名成年脊柱畸形患者的回顾。对矢状位平衡为正的患者(N=352)进行进一步的放射学参数和健康状况评估，包括脊柱侧弯研究会患者问卷、MOS简表-12和OSwestry残疾指数。检查具有正矢状位平衡的成人畸形患者，以确定该组内可能不同预测临床影响的参数。背景数据摘要。在一项对298名成年脊柱畸形患者的多中心研究中，正矢状面平衡被确定为与不良健康状况结果高度相关的放射学参数。根据36英寸立位X线片的标准化方案进行放射学评估。记录正矢状面平衡和局部矢状面Cobb角的大小。放射学参数和健康状况测量之间的统计相关性被进行。对潜在的混杂变量进行评估。352例患者均为正矢状面平衡。C7垂线偏差1~271 mm。随着C7垂直线偏差的增加，所有健康状况的测量结果都显示出明显较差的分数。腰椎区相对后凸患者的残疾程度明显高于腰椎矢状面Cobb测量值正常或前凸的患者。这项研究表明，尽管即使是轻微的正矢状面平衡也是有害的，但症状的严重程度是以线性方式增加的，并伴随着进行性矢状面失衡。研究结果还显示，脊柱后凸在上胸段较好，但在腰椎中耐受性很差。
Study Design. This study is a retrospective review of 752 patients with adult spinal deformity enrolled in a multicenter prospective database in 2002 and 2003. Patients with positive sagittal balance (N=352) were further evaluated regarding radiographic parameters and health status measures, including the Scoliosis Research Society patient questionnaire, MOS short form-12, and Oswestry Disability Index.Objectives. To examine patients with adult deformity with positive sagittal balance to define parameters within that group that might differentially predict clinical impact.Summary of Background Data. In a multicenter study of 298 adults with spinal deformity, positive sagittal balance was identified as the radiographic parameter most highly correlated with adverse health status outcomes.Methods. Radiographic evaluation was performed according to a standarized protocol for 36-inch standing radiographs. Magnitude of positive sagittal balance and regional sagittal Cobb angle measures were recorded. Statistical correlation between radiographic parameters and health status measures were performed. Potentially confounding variables were assessed.Results. Positive sagittal balance was identified in 352 patients. The C7 plumb line deviation ranged from 1 to 271 mm. All measures of health status showed significantly poorer scores as C7 plumb line deviation increased. Patients with relative kyphosis in the lumbar region had significantly more disability than patients with normal or lordotic lumbar sagittal Cobb measures.Conclusions. This study shows that although even mildly positive sagittal balance is somewhat detrimental, severity of symptoms increases in a linear fashion with progressive sagittal imbalance. The results also show that kyphosis is more favorable in the upper thoracic region but very poorly tolerated in the lumbar spine.