PMID- 24766290
OWN - NLM
STAT- MEDLINE
DCOM- 20140923
LR  - 20161125
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 21
IP  - 2
DP  - 2014 Aug
TI  - Surgical treatment of pathological loss of lumbar lordosis (flatback) in patients 
      with normal sagittal vertical axis achieves similar clinical improvement as 
      surgical treatment of elevated sagittal vertical axis: clinical article.
PG  - 160-70
LID - 10.3171/2014.3.SPINE13580 [doi]
AB  - OBJECT: Increased sagittal vertical axis (SVA) correlates strongly with pain and 
      disability for adults with spinal deformity. A subset of patients with sagittal 
      spinopelvic malalignment (SSM) have flatback deformity (pelvic incidence-lumbar 
      lordosis [PI-LL] mismatch > 10 degrees ) but remain sagittally compensated with normal 
      SVA. Few data exist for SSM patients with flatback deformity and normal SVA. The 
      authors' objective was to compare baseline disability and treatment outcomes for 
      patients with compensated (SVA < 5 cm and PI-LL mismatch > 10 degrees ) and decompensated 
      (SVA > 5 cm) SSM. METHODS: The study was a multicenter, prospective analysis of 
      adults with spinal deformity who consecutively underwent surgical treatment for 
      SSM. Inclusion criteria included age older than 18 years, presence of adult 
      spinal deformity with SSM, plan for surgical treatment, and minimum 1-year 
      follow-up data. Patients with SSM were divided into 2 groups: those with 
      compensated SSM (SVA < 5 cm and PI-LL mismatch > 10 degrees ) and those with 
      decompensated SSM (SVA >/= 5 cm). Baseline and 1-year follow-up radiographic and 
      health-related quality of life (HRQOL) outcomes included Oswestry Disability 
      Index, Short Form-36 scores, and Scoliosis Research Society-22 scores. 
      Percentages of patients achieving minimal clinically important difference (MCID) 
      were also assessed. RESULTS: A total of 125 patients (27 compensated and 98 
      decompensated) met inclusion criteria. Compared with patients in the compensated 
      group, patients in the decompensated group were older (62.9 vs. 55.1 years; p = 
      0.004) and had less scoliosis (43 degrees  vs 54 degrees ; p = 0.002), greater SVA (12.0 cm vs. 
      1.7 cm; p < 0.001), greater PI-LL mismatch (26 degrees  vs. 20 degrees ; p = 0.013), and poorer 
      HRQOL scores (Oswestry Disability Index, Short Form-36 physical component score, 
      Scoliosis Research Society-22 total; p </= 0.016). Although these baseline HRQOL 
      differences between the groups reached statistical significance, only the mean 
      difference in Short Form-36 physical component score reached threshold for MCID. 
      Compared with baseline assessment, at 1 year after surgery improvement was noted 
      for patients in both groups for mean SVA (compensated -1.1 cm, decompensated +4.8 
      cm; p </= 0.009), mean PI-LL mismatch (compensated 6 degrees , decompensated 5 degrees ; p < 
      0.001), and all HRQOL measures assessed (p </= 0.005). No significant differences 
      were found between the compensated and decompensated groups in the magnitude of 
      HRQOL score improvement or in the percentages of patients achieving MCID for each 
      of the outcome measures assessed. CONCLUSIONS: Decompensated SSM patients with 
      elevated SVA experience significant disability; however, the amount of disability 
      in compensated SSM patients with flatback deformity caused by PI-LL mismatch but 
      normal SVA is underappreciated. Surgical correction of SSM demonstrated similar 
      radiographic and HRQOL score improvements for patients in both groups. Evaluation 
      of SSM should extend beyond measuring SVA. Among patients with concordant pain 
      and disability, PI-LL mismatch must be evaluated for SSM patients and can be 
      considered a primary indication for surgery.
FAU - Smith, Justin S
AU  - Smith JS
AD  - Department of Neurosurgery, University of Virginia Health System, 
      Charlottesville, Virginia;
FAU - Singh, Manish
AU  - Singh M
FAU - Klineberg, Eric
AU  - Klineberg E
FAU - Shaffrey, Christopher I
AU  - Shaffrey CI
FAU - Lafage, Virginie
AU  - Lafage V
FAU - Schwab, Frank J
AU  - Schwab FJ
FAU - Protopsaltis, Themistocles
AU  - Protopsaltis T
FAU - Ibrahimi, David
AU  - Ibrahimi D
FAU - Scheer, Justin K
AU  - Scheer JK
FAU - Mundis, Gregory Jr
AU  - Mundis G Jr
FAU - Gupta, Munish C
AU  - Gupta MC
FAU - Hostin, Richard
AU  - Hostin R
FAU - Deviren, Vedat
AU  - Deviren V
FAU - Kebaish, Khaled
AU  - Kebaish K
FAU - Hart, Robert
AU  - Hart R
FAU - Burton, Douglas C
AU  - Burton DC
FAU - Bess, Shay
AU  - Bess S
FAU - Ames, Christopher P
AU  - Ames CP
CN  - International Spine Study Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20140425
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
MH  - Disability Evaluation
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Quality of Life
MH  - Radiography
MH  - Spinal Curvatures/diagnostic imaging/physiopathology/*surgery
MH  - Treatment Outcome
MH  - United States
OTO - NOTNLM
OT  - HRQOL = health-related quality of life
OT  - MCID = minimal clinically important difference
OT  - PI-LL = pelvic incidence-lumbar lordosis
OT  - SF-36 = Short Form-36
OT  - SRS-22 = Scoliosis Research Society-22
OT  - SSM = sagittal spinopelvic malalignment
OT  - SVA = sagittal vertical axis
OT  - adult
OT  - deformity
OT  - flatback
OT  - lumbar
OT  - lumbar lordosis
OT  - outcome
OT  - pelvic parameter
OT  - sagittal imbalance
OT  - spine
OT  - surgery
EDAT- 2014/04/29 06:00
MHDA- 2014/09/24 06:00
CRDT- 2014/04/29 06:00
PHST- 2014/04/29 06:00 [entrez]
PHST- 2014/04/29 06:00 [pubmed]
PHST- 2014/09/24 06:00 [medline]
AID - 10.3171/2014.3.SPINE13580 [doi]
PST - ppublish
SO  - J Neurosurg Spine. 2014 Aug;21(2):160-70. doi: 10.3171/2014.3.SPINE13580. Epub 
      2014 Apr 25.