Skip to main content
SpringerLink
Log in

Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Little information is available on the relationship between cervical sagittal alignment and health-related quality of life (HRQOL) in adolescent idiopathic scoliosis (AIS) patients. The aim of this study was to identify relationships between postoperative cervical sagittal alignment and HRQOL in AIS.

Methods

The study and control groups comprised 67 AIS patients (51 girls and 16 boys). All underwent anteroposterior and lateral plain radiography and completed clinical questionnaires. The radiographic parameters investigated were pre- and postoperative C2–C7 lordosis, C2–C7 sagittal vertical axis (SVA), T1 slope, T1 slope minus C2–C7 lordosis (TS-CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI). The Korean version of the SRS-22 questionnaire and the previously validated Short Form-36 (SF-36) outcome questionnaire were administered to evaluate HRQOL at last follow-up visits. Statistical analysis was performed to determine the significances of differences between preoperative and last follow-up radiological findings. In addition, correlations between radiological parameters and clinical questionnaire scores were sought.

Results

Radiological sagittal parameters were found to be significantly increased after surgical correction in terms of C2–C7 lordosis (3.5 ± 11.4), C2–C7 SVA (1.5 ± 6.0), T1 slope (3.5 ± 6.1), and TK (6.0 ± 8.1). However, no significant difference was observed for TS-CL, LL, PT, SS, and PI (P > 0.05). Correlation analysis revealed significant relationships between radiographic parameters and questionnaire scores. Multiple regression analysis was performed to identify predictors of HRQOL, and the results obtained revealed that postoperative T1 slope significantly predicted SRS, PCS, and MCS scores and that postoperative C2–C7 SVA predicted SRS scores.

Conclusions

Changes in cervical sagittal parameters were significant after deformity correction in AIS patients. Correlation analysis revealed significant relationships between postoperative radiographic parameters and HRQOL. In particular, T1 slope and C2–C7 SVA were found to be significant predictors of HRQOL in AIS patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bridwell KH, Betz R, Capelli AM, Huss G, Harvey C (1990) Sagittal plane analysis in idiopathic scoliosis patients treated with Cotrel–Dubousset instrumentation. Spine 15:644–649

    Article  CAS  PubMed  Google Scholar 

  2. Canavese F, Turcot K, De Rosa V, de Coulon G, Kaelin A (2011) Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. Eur Spine J 20:1141–1148

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dickson RA, Lawton JO, Archer IA, Butt WP (1984) The pathogenesis of idiopathic scoliosis: biplanar spinal asymmetry. J Bone Joint Surg 66:8–15

    CAS  Google Scholar 

  4. Edgar MA, Mehta MH (1988) Long-term follow-up of fused and unfused idiopathic scoliosis. J Bone Joint Surg 70:712–716

    CAS  Google Scholar 

  5. Faldini C, Pagkrati S, Leonetti D, Miscione MT, Giannini S (2011) Sagittal segmental alignment as predictor of adjacent-level degeneration after a Cloward procedure. Clin Orthop Relat Res 469:674–681

    Article  PubMed  Google Scholar 

  6. Halm H, Castro WH, Jerosch J, Winkelmann W (1995) Sagittal plane correction in King-classified idiopathic scoliosis patients treated with Cotrel–Dubousset instrumentation. Acta Orthop Belg 61:294–301

    CAS  PubMed  Google Scholar 

  7. Han CW, Lee EJ, Iwaya T, Kataoka H, Kohzuki M (2004) Development of the Korean version of short-form 36-item health survey: health related QOL of healthy elderly people and elderly patients in Korea. Tohoku J Exp Med 203:189–194

    Article  PubMed  Google Scholar 

  8. Hardacker JW, Shuford RF, Capicotto PN, Pryor PW (1997) Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine 22:1472–1480

    Article  CAS  PubMed  Google Scholar 

  9. Hilibrand AS, Tannenbaum DA, Graziano GP, Loder RT, Hensinger RN (1995) The sagittal alignment of the cervical spine in adolescent idiopathic scoliosis. J Pediatr Orthop 15:627–632

    Article  CAS  PubMed  Google Scholar 

  10. Hwang SW, Samdani AF, Tantorski M, Cahill P, Nydick J, Fine A, Betz RR, Antonacci MD (2011) Cervical sagittal plane decompensation after surgery for adolescent idiopathic scoliosis: an effect imparted by postoperative thoracic hypokyphosis. J Neurosurg Spine 15:491–496

    Article  PubMed  Google Scholar 

  11. Ilharreborde B, Ferrero E, Alison M, Mazda K (2016) EOS microdose protocol for the radiological follow-up of adolescent idiopathic scoliosis. Eur Spine J 25:526–531

    Article  PubMed  Google Scholar 

  12. Ilharreborde B, Vidal C, Skalli W, Mazda K (2013) Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis treated by posteromedial translation. Eur Spine J 22:330–337

    Article  PubMed  Google Scholar 

  13. Katsuura A, Kukuda S, Saruhashi Y, Mori K (2001) Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:320–324

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Knott PT, Mardjetko SM, Techy F (2010) The use of the T1 sagittal angle in predicting overall sagittal balance of the spine. Spine J 10:994–998

    Article  PubMed  Google Scholar 

  15. Kuntz C IV, Levin LS, Ondra SL, Shaffrey CI, Morgan CJ (2007) Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine 6:104–112

    Article  PubMed  Google Scholar 

  16. Lagrone MO, Bradford DS, Moe JH, Lonstein JE, Winter RB, Ogilvie JW (1988) Treatment of symptomatic flat back after spinal fusion. J Bone Joint Surg 70:569–580

    CAS  PubMed  Google Scholar 

  17. Lee JH, Park YK, Kim JH (2014) Chronic neck pain in young adults: perspectives on anatomic differences. Spine J 14:2628–2638

    Article  PubMed  Google Scholar 

  18. Lee JS, Lee DH, Suh KT, Kim JI, Lim JM, Goh TS (2011) Validation of the Korean version of the scoliosis research society-22 questionnaire. Eur Spine J 20:1751–1756

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lee JS, Suh KT, Kim JI, Lee HS, Goh TS (2013) Validation of the Korean version of the neck pain and disability scale. Asian Spine J 7:178–183

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lee JS, Youn MS, Shin JK, Goh TS, Kang SS (2015) Relationship between cervical sagittal alignment and quality of life in ankylosing spondylitis. Eur Spine J 24:1199–1203

    Article  PubMed  Google Scholar 

  21. Lee SH, Son ES, Seo EM, Suk KS, Kim KT (2015) Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment. Spine J 15:705–712

    Article  PubMed  Google Scholar 

  22. Park MS, Kelly MP, Lee DH, Min WK, Rahman RK, Riew KD (2014) Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis. Spine J 14:1228–1234

    Article  PubMed  Google Scholar 

  23. Pesenti S, Blondel B, Peltier E, Choufani E, Bollini G, Jouve JL (2016) Interest of T1 parameters for sagittal alignment evaluation of adolescent idiopathic scoliosis patients. Eur Spine J 25:424–429

    Article  CAS  PubMed  Google Scholar 

  24. Simony A, Hansen EJ, Carreon LY, Christensen SB, Andersen MO (2015) Health-related quality-of-life in adolescent idiopathic scoliosis patients 25 years after treatment. Scoliosis 10:22

    Article  PubMed  PubMed Central  Google Scholar 

  25. Song JS, Choi BW, Song KJ (2014) Risk factors for the development of adjacent segment disease following anterior cervical arthrodesis for degenerative cervical disease: comparison between fusion methods. J Clin Neurosci 21:794–798

    Article  PubMed  Google Scholar 

  26. Upadhyay SS, Mullaji AB, Luk KD, Leong JC (1995) Relation of spinal and thoracic cage deformities and their flexibilities with altered pulmonary functions in adolescent idiopathic scoliosis. Spine 20:2415–2420

    Article  CAS  PubMed  Google Scholar 

  27. Yu M, Silvestre C, Mouton T, Rachkidi R, Zeng L, Roussouly P (2013) Analysis of the cervical spine sagittal alignment in young idiopathic scoliosis: a morphological classification of 120 cases. Eur Spine J 22:2372–2381

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This study was supported by Biomedical Research Institute Grant (2015-02), Pusan National University Hospital.

Author information

Author notes

    Authors and Affiliations

    1. Department of Orthopaedic Surgery, Myungeun Hospital, Pusan, Republic of Korea

      Myung Soo Youn

    2. Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, 1-10 Ami-Dong, Seo-Gu, Pusan, 602-739, Republic of Korea

      Jong Ki Shin, Tae Sik Goh, Woong Ki Jeon & Jung Sub Lee

    3. Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea

      Sung Shik Kang

    Authors
    1. Myung Soo Youn
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Jong Ki Shin
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Tae Sik Goh
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Sung Shik Kang
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Woong Ki Jeon
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Jung Sub Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Jung Sub Lee.

    Ethics declarations

    Conflict of interest

    None of the authors has any potential conflict of interest.

    Additional information

    Myung Soo Youn and Jong Ki Shin have contributed equally to this study.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Youn, M.S., Shin, J.K., Goh, T.S. et al. Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis. Eur Spine J 25, 3114–3119 (2016). https://doi.org/10.1007/s00586-016-4488-2

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00586-016-4488-2

    Keywords

    Search

    Navigation