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Xipho-pubic angle (XPA) correlates with patient’s reported outcomes in a population of adult spinal deformity: results from a multi-center cohort study

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Abstract

Study design

Retrospective multi-center cohort study.

Purpose

Sagittal misalignment causes changes in the abdominal shape. Xipho-pubic angle (XPA) has been previously described to radiographically evaluate the shape of the abdominal cavity in patients with spine deformity. The aims of this study are to evaluate the correlation of XPA-to-spinopelvic sagittal parameters and to patients’ health-related quality-of-life (HRQoL) scores.

Methods

278 patients from a multi-center database with diagnosis adult spinal deformity (ASD) (one or more of: coronal Cobb angle > 20°, sagittal vertical axis (SVA) > 50 mm, pelvic tilt (PT) > 25°, and thoracic kyphosis > 60°) were included. Cut-off values for moderate and severe disability (ODI—Oswestry Disability Index—20 and 40%) were calculated. Pearson’s correlation was tested between XPA and spinopelvic parameters and between XPA and HRQoL scores.

Results

The cut-off value of XPA to identify ODI severe disability (40/100) was identified with XPA smaller than 103°; minimal (20/100) disability was identified by XPA greater than 113°. XPA showed strong correlation to sagittal spinopelvic parameters—PT, SVA, lumbar lordosis (LL), pelvic incidence (PI) minus LL—and to HRQoL scores—ODI, SF-36 PCS and SRS-22 activity and pain. XPA was the parameter with the strongest correlation to HRQoL scores.

Conclusions

Xipho-pubic angle reflects changes in spinal changes and has strong correlation to HRQoL and spinopelvic parameters. It can discriminate between patients with minimal, moderate, and severe disability as measured by ODI scores.

Graphical Abstract

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References

  1. Dubousset J (1994) Three-dimensional analysis of the scoliotic deformity. Pediatr Spine 1994:479–496

    Google Scholar 

  2. Bess S, Line B, Fu KM et al (2016) The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases. Spine (Phila Pa 1976) 41:224–233. https://doi.org/10.1097/brs.0000000000001202

    Article  Google Scholar 

  3. Schwab F, Dubey A, Gamez L et al (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976) 30:1082–1085. https://doi.org/10.1097/01.brs.0000160842.43482.cd

    Article  Google Scholar 

  4. Schwab F, Ungar B, Blondel B et al (2012) Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 37:1077–1082. https://doi.org/10.1097/brs.0b013e31823e15e2

    Article  Google Scholar 

  5. Lafage V, Schwab F, Patel A et al (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 34:E599–E606. https://doi.org/10.1097/brs.0b013e3181aad219

    Article  Google Scholar 

  6. Garbossa D, Pejrona M, Damilano M et al (2014) Pelvic parameters and global spine balance for spine degenerative disease: The importance of containing for the well being of content. Eur Spine J 23:S616–S627. https://doi.org/10.1007/s00586-014-3558-6

    Article  Google Scholar 

  7. Lamartina C, Berjano P (2014) Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J 23:1177–1189. https://doi.org/10.1007/s00586-014-3227-9

    Article  PubMed  Google Scholar 

  8. Berjano P, Langella F, Damilano M et al (2015) Fusion rate following extreme lateral lumbar interbody fusion. Eur Spine J 24(Suppl 3):369–371. https://doi.org/10.1007/s00586-015-3929-7

    Article  PubMed  Google Scholar 

  9. Kim KT, Suk KS, Cho YJ et al (2002) Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine (Phila Pa 1976) 27:612–618. https://doi.org/10.1097/00007632-200203150-00010

    Article  Google Scholar 

  10. Diebo BG, Henry J, Lafage V, Berjano P (2015) Sagittal deformities of the spine: factors influencing the outcomes and complications. Eur Spine J 24(Suppl 1):3–15. https://doi.org/10.1007/s00586-014-3653-8

    Article  Google Scholar 

  11. Liu C, Zheng G, Zhang Y et al (2015) The radiologic, clinical results and digestive function improvement in patients with ankylosing spondylitis kyphosis after pedicle subtraction osteotomy. Spine J 15:1988–1993. https://doi.org/10.1016/j.spinee.2015.04.030

    Article  PubMed  Google Scholar 

  12. Langella F, Villafañe JH, Ismael M et al (2015) Reliability of the xipho-pubic angle in patients with sagittal imbalance of the spine. J Neurosurg Sci (Epub ahead of print)

  13. Grevitt M, Khazim R, Webb J et al (1997) The short form-36 health survey questionnaire in spine surgery. J Bone Joint Surg Br 79:48–52. https://doi.org/10.1302/0301-620X.79B1.1269

    Article  CAS  PubMed  Google Scholar 

  14. Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine (Phila Pa 1976) 25:2940–2952. https://doi.org/10.1097/00007632-200011150-00017 (discussion 2952)

    Article  CAS  Google Scholar 

  15. Bridwell KH, Berven S, Glassman SD et al (2007) Is the SRS-22 instrument responsive to change in adult scoliosis patients having primary spinal deformity surgery? Spine (Phila Pa 1976) 32:2220–2225. https://doi.org/10.1097/brs.0b013e31814cf120

    Article  Google Scholar 

  16. Rillardon L, Levassor N, Guigui P et al (2003) Validation of a tool to measure pelvic and spinal parameters of sagittal balance. Rev Chir orthop{é}dique r{é}paratrice l’appareil Mot 89:218–227

  17. Benoist M (2003) Natural history of the aging spine. Eur Spine J 12:86–90. https://doi.org/10.1007/s00586-003-0593-0

    Article  Google Scholar 

  18. Glassman SD, Bridwell K, Dimar JR et al (2005) The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30:2024–2029. https://doi.org/10.1097/01.brs.0000179086.30449.96

    Article  Google Scholar 

  19. Lafage R, Schwab F, Challier V et al (2016) Defining Spino-Pelvic Alignment Thresholds. Spine (Phila Pa 1976) 41:62–68. https://doi.org/10.1097/brs.0000000000001171

    Article  Google Scholar 

  20. Berjano P, Langella F, Ismael M-F et al (2014) Successful correction of sagittal imbalance can be calculated on the basis of pelvic incidence and age. Eur Spine J 23(Suppl 6):587–596. https://doi.org/10.1007/s00586-014-3556-8

    Article  PubMed  Google Scholar 

  21. Protopsaltis TS, Schwab FJ, Bronsard N et al (2014) The t1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life. J Bone Joint Surg Am 96:1631–1640. https://doi.org/10.2106/JBJS.M.01459

    Article  PubMed  Google Scholar 

  22. Smith JS, Klineberg E, Schwab F et al (2013) Change in classification grade by the SRS-Schwab adult spinal deformity classification predicts impact on health-related quality of life measures. Spine (Phila Pa 1976) 38:1663–1671. https://doi.org/10.1097/brs.0b013e31829ec563

    Article  Google Scholar 

  23. Ji ML, Qian BP, Qiu Y et al (2015) Change in abdominal morphology after surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis: a computed tomographic study. Spine (Phila Pa 1976) 40:E1244–E1249. https://doi.org/10.1097/brs.0000000000001112

    Article  Google Scholar 

  24. Ji M, Qian B, Qiu Y et al (2013) Change of aortic length after closing-opening wedge osteotomy for patients with ankylosing spondylitis with thoracolumbar kyphosis. Spine (Phila Pa 1976) 38:E1361–E1367. https://doi.org/10.1097/brs.0b013e3182a3d046

    Article  Google Scholar 

  25. Krishnakumar R, Lenke LG (2015) “Sternum-Into-Abdomen” deformity with abdominal compression following osteoporotic vertebral compression fractures managed By 2-level vertebral column resection and reconstruction. Spine (Phila Pa 1976) 40:E1035–E1039. https://doi.org/10.1097/brs.0000000000001004

    Article  CAS  Google Scholar 

  26. Ryan DJ, Protopsaltis TS, Ames CP et al (2014) T1 pelvic angle (TPA) effectively evaluates sagittal deformity and assesses radiographical surgical outcomes longitudinally. Spine (Phila Pa 1976) 39:1203–1210. https://doi.org/10.1097/brs.0000000000000382

    Article  Google Scholar 

  27. Johnston CE, Richards BS, Sucato DJ et al (2011) Correlation of preoperative deformity magnitude and pulmonary function tests in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 36:1096–1102. https://doi.org/10.1097/brs.0b013e3181f8c931

    Article  Google Scholar 

  28. Bongiovanni R, Spradley MK (2012) Estimating sex of the human skeleton based on metrics of the sternum. Forensic Sci Int 219:290-e1. https://doi.org/10.1016/j.forsciint.2011.11.034

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Francesco Langella & Pedro Berjano

  2. IRCCS Fondazione Don Carlo Gnocchi, 20121, Milan, Italy

    Jorge Hugo Villafañe

  3. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 E 17th St, New York, NY, 10003, USA

    Virginie Lafage & Frank Schwab

  4. Department of Neurosurgery, University of Virginia School of Medicine, P.O. Box 800212, Charlottesville, VA, 22908, USA

    Justin S. Smith & Christopher Shaffrey

  5. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, 10021, USA

    Han Jo Kim & Renault Lafage

  6. Department of Orthopedic Surgery, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA

    Douglas Burton

  7. Baylor Scoliosis Center, 4708 Alliance Boulevard, Suite 800, Plano, TX, 75093, USA

    Richard Hostin

  8. Rocky Mountain Hospital for Children, Presbyterian/St Luke’s Medical Center, 2055 High Street, Suite 130, Denver, CO, 80205, USA

    Shay Bess

  9. Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, Room M779, San Francisco, CA, 94143, USA

    Christopher Ames

  10. San Diego Center for Spinal Disorders, 5130 La Jolla Village Drive, Suite 300, La Jolla, CA, 92037, USA

    Gregory Mundis

  11. Department of Orthopedic Surgery, University of California Davis, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA

    Eric Klineberg

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  1. Francesco Langella
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  2. Jorge Hugo Villafañe
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  3. Virginie Lafage
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  4. Justin S. Smith
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  6. Han Jo Kim
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  7. Douglas Burton
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  8. Richard Hostin
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  9. Shay Bess
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  10. Christopher Ames
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  11. Gregory Mundis
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  12. Eric Klineberg
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  13. Frank Schwab
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  14. Renault Lafage
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  15. Pedro Berjano
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Corresponding author

Correspondence to Francesco Langella.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Langella, F., Villafañe, J.H., Lafage, V. et al. Xipho-pubic angle (XPA) correlates with patient’s reported outcomes in a population of adult spinal deformity: results from a multi-center cohort study. Eur Spine J 27, 670–677 (2018). https://doi.org/10.1007/s00586-017-5460-5

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  • DOI: https://doi.org/10.1007/s00586-017-5460-5

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