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Sagittal malalignment has a significant association with postoperative leg pain in adult spinal deformity patients

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Abstract

Purpose

To evaluate the association between spinopelvic sagittal parameters and leg pain in patients with adult spinal deformity (ASD) after adjusting for demographic and surgical variables.

Methods

A multicenter prospective ASD database (European Spine Study Group) was retrospectively reviewed. The characteristics (age, sex, body mass index, comorbidity, history of spine surgery, and radiographical coronal and sagittal parameters) of patients with preoperative and 6-month postoperative leg pain (PostLP; numerical rating scale score ≥5) were analyzed using univariate and multivariate analyses.

Results

In this study, 204 patients (164 women and 40 men; mean age 53.1 years) were included. Fifty-three percent of the patients had preoperative leg pain (PreLP). The patients with PreLP had significantly worse sagittal parameters and less coronal Cobb angle than those with less leg pain; however, this association disappeared after adjustment for covariates. The PreLP of the ASD patients was successfully treated surgically in most cases; however, 24 % of the patients still had unexpected residual leg pain. Postoperative sagittal malalignment (sagittal vertical axis ≥40 mm, T1 sagittal tilt ≥0°, pelvic tilt ≥30°) was a significant risk factor of PostLP even after adjusting for covariates.

Conclusions

Leg pain in patients with ASD was significantly associated with sagittal malalignment especially after surgical treatments. As these patients lose flexibility in the fused spinal segment, they can only depend on the remaining compensatory mechanisms below the pelvis (e.g., the hips and knees) to maintain a balanced posture. This may lead to a predisposition of these patients to postoperative leg symptoms related to spinal sagittal malalignment.

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Author information

Authors and Affiliations

  1. Spine Unit 1, Bordeaux University Hospital, Bordeaux, France

    Mitsuru Takemoto, Louis Boissière, Felipe Novoa, Jean-Marc Vital, Ibrahim Obeid & Ibrahim Obeid

  2. Department of Orthopaedic and Spine Surgery, Kyoto City Hospital, Nakagyo-ku, Mibu-Higashi-Takada-cho 1-2, Kyoto, 604-8845, Japan

    Mitsuru Takemoto

  3. Spine Surgery Unit, Hospital Vall d’Hebron, Barcelona, Spain

    Ferran Pellisé

  4. Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain

    Francisco Javier Sanchez Pérez-Grueso

  5. Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland

    Frank Kleinstück

  6. Spine Surgery Unit, Ankara Acibadem ARTES Spine Center, Ankara, Turkey

    Emre R. Acaroglu

  7. Spine Surgery Unit, Acibadem University, Istanbul, Turkey

    Ahmet Alanay

Authors
  1. Mitsuru Takemoto
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  2. Louis Boissière
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  3. Felipe Novoa
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  4. Jean-Marc Vital
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  5. Ferran Pellisé
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  6. Francisco Javier Sanchez Pérez-Grueso
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  7. Frank Kleinstück
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  8. Emre R. Acaroglu
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  9. Ahmet Alanay
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  10. Ibrahim Obeid
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  11. Ibrahim Obeid
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Consortia

On behalf of European Spine Study Group, ESSG

Corresponding author

Correspondence to Mitsuru Takemoto.

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Grants/research support

Pellise F: Depuy Synthes, K2M; Perez-Grueso F.S: Depuy Synthes, K2M; Acaroglu E: Fondation Cotrel, Depuy Synthes, Medtronic, Consultant: Medtronic, AOSpine; Alanay A; Depuy Synthes Consultant: Depuy Spine, Stryker, Medtronic; Obeid I: Depuy Synthes; ESSG: Depuy Synthes.

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Takemoto, M., Boissière, L., Novoa, F. et al. Sagittal malalignment has a significant association with postoperative leg pain in adult spinal deformity patients. Eur Spine J 25, 2442–2451 (2016). https://doi.org/10.1007/s00586-016-4616-z

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  • DOI: https://doi.org/10.1007/s00586-016-4616-z

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