Skip to main content

Advertisement

SpringerLink
Log in

The cranial sagittal vertical axis (CrSVA) is a better radiographic measure to predict clinical outcomes in adult spinal deformity surgery than the C7 SVA: a monocentric study

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

Abstract

Purpose

Our study aimed to confirm the correlation between the Cranial Sagittal Vertical Axis (CrSVA) and patient-reported outcomes and to compare clinical correlation between CrSVA and C7 SVA in adult spinal deformity (ASD) patients.

Methods

108 consecutive ASD patients were evaluated using the EOS® 2D/3D radio-imaging device. A vertical plumb line from the cranial center was utilized to measure the distance to the posterior corner of S1 (CrSVA-S), and to the centers of the hip (CrSVA-H), the knee (CrSVA-K), and ankle (CrSVA-A), as well as measuring the standard C7 SVA. We analyzed the correlation between each CrSVA parameter with the Oswestry Disability Index (ODI) and Scoliosis Research Society form (SRS-22r).

Results

All 4 CrSVA measures demonstrated strong correlation with the ODI and SRS-22r total score and the pain, self-image, and function subscores. Of note, CrSVA-A (Global SVA) also strongly correlated with the SRS satisfaction subscore. Univariate linear regression showed similar results. The strongest predictor of outcomes was CrSVA, not C7 SVA; (CrSVA-H for ODI, SRS total score, and the pain, self-image, and function subscores; and Global SVA for satisfaction and mental health subscores).

Conclusions

The clinical correlation effect of outcome scores to the CrSVA measures is validated. Global SVA has an especially strong correlation with ODI and all the SRS subscores. Our study confirms that CrSVA is a stronger predictor of preoperative clinical outcomes than the C7 SVA in adult deformity patients.

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. Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 30(6):682–688

    Article  PubMed  Google Scholar 

  2. Birknes JK, White AP, Albert TJ, Shaffrey CI et al (2008) Adult degenerative scoliosis: a review. Neurosurgery 63:94–103

    Article  PubMed  Google Scholar 

  3. Sengupta K (2012) Adult spinal deformity. In: Rao RD, Smuck M (eds) Orthopaedic knowledge update: spine, 4th edn. American Academy of Orthopaedic Surgeons, Rosemont, pp 349–367

    Google Scholar 

  4. 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 34:E599–E606

    Article  PubMed  Google Scholar 

  5. Lazennec JY, Ramare S, Arafati N et al (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9:47–55

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Yoshimoto H, Sato S, Masuda T et al (2005) Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain. Spine 30:1650–1657

    Article  PubMed  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

    Article  PubMed  Google Scholar 

  8. D’Andrea LP, Betz RR, Lenke LG, Clements DH, Lowe TG, Merola A et al (2000) Do radiographic parameters correlate with clinical outcomes in adolescent idiopathic scoliosis. Spine 25(14):1795–1802

    Article  PubMed  Google Scholar 

  9. Deviren V, Berven S, Kleinstueck F, Antinnes J, Smith JA, Hu SS (2002) Predictors of flexibility and pain patterns in thoracolumbar and lumbar idiopathic scoliosis. Spine 27(21):2346–2349

    Article  PubMed  Google Scholar 

  10. Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine 27:387–392

    Article  PubMed  Google Scholar 

  11. Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS (2002) Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine 27(7):776–786

    Article  PubMed  Google Scholar 

  12. Mac-Thiong JM, Transfeldt EE, Mehbod AA, Perra JH, Denis F, Garvey TA et al (2009) Can C7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine 34(15):E519–E527

    Article  PubMed  Google Scholar 

  13. Daubs MD, Lenke LG, Bridwell KH, Kim YJ, Hung M, Cheh G et al (2013) Does correction of preoperative coronal imbalance make a difference in outcomes of adult patients with deformity? Spine 38(6):476–483

    Article  PubMed  Google Scholar 

  14. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30(18):2024–2029

    Article  PubMed  Google Scholar 

  15. Sánchez-Mariscal F, Gomez-Rice A, Izquierdo E, Pizones J, Zúñiga L, Alvarez-González P (2012) Correlation of radiographic and functional measurements in patients who underwent primary scoliosis surgery in adult age. Spine 37(7):592–598

    Article  PubMed  Google Scholar 

  16. Vital JM, Senegas J (1986) Anatomical bases of the study of the constraints to which the cervical spine is subject in the sagittal plane: a study of the center of gravity of head. SurgRadiolAnat 8:169–173

    CAS  Google Scholar 

  17. Yoganandan N, Pintar FA, Zhang J et al (2009) Physical properties of the human head: mass, center of gravity and moment of inertia. J Biomech 42:1177–1192

    Article  PubMed  Google Scholar 

  18. Lazennec JY, Brusson A, Rousseau MA (2013) Lumbar-pelvic-femoral balance on sitting and standing lateral radiographs. Orthop Traumatol Surg Res 99S:S87–S103

    Article  Google Scholar 

  19. Matsumoto T, Kubo S, Muratsu H et al (2011) Differing prosthetic alignment and femoral component sizing between 2 computer-assisted CT-free navigation systems in TKA. Orthopedics 34:e860–e865

    PubMed  Google Scholar 

  20. Cobb JR (1948) Outline for the study of scoliosis. Instructional course lectures. Am Acad Orthop Surg 5:261–275

    Google Scholar 

  21. Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine 25:2940–2952

    Article  CAS  PubMed  Google Scholar 

  22. Haher TR, Gorup JM, Shin TM et al (1999) Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis: a multicenter study of 244 patients. Spine 24:1435–1440

    Article  CAS  PubMed  Google Scholar 

  23. Hair JF, Anderson R, Tatham RL et al (2006) Multivariate data analysis. Prentice Hall, Upper Saddle River

    Google Scholar 

  24. Haher TR, O’Brien M, Kauffman D et al (1993) Biomechanics of the spine in sports. Clin Sports Med 12:449–464

    CAS  PubMed  Google Scholar 

  25. Guillot M, Fournier J, Vanneuville G et al (1988) Mechanics of the characteristic geometry of the human spine undergoing vertical pressure. Revue du Rhumatismeet des Maladies. Osteo Articul 55:351–359

    CAS  Google Scholar 

  26. Cecchinato R, Langella F, Bassani R, Sansone V, Lamartina C, Berjano P (2014) Variations of cervical lordosis and head alignment after pedicle subtraction osteotomy surgery for sagittal imbalance. Eur Spine J 6:644–649

    Article  Google Scholar 

  27. Obeid I, Boniello A, Boissiere L et al (2015) Cervical spine alignment following lumbar pedicle subtraction osteotomy for sagittal imbalance. Eur Spine J 24:1191–1198

    Article  PubMed  Google Scholar 

  28. Protopsaltis TS, Scheer JK, Terran JS et al (2015) How the neck affects the back: changes in regional cervical sagittal alignment correlate to HRQOL improvement in adult thoracolumbar deformity patients at 2-year follow-up. J Neurosurg Spine 23:153–158

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 892, Dongnam-ro, Gandong-gu, Seoul, 05278, Korea

    Yong-Chan Kim

  2. Department of Orthopedics, The Spine Hospital, Columbia University Medical Center, 5141 Broadway, New York, NY, USA

    Lawrence G. Lenke & Kathy M. Blanke

  3. Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Seoul, South Korea

    Seon-Jong Lee

  4. Department of Orthopedic Surgery, Norton Leatherman Spine Center, 210 E. Gray Street, Louisville, KY, USA

    Jeffrey L. Gum

  5. Department of Orthopaedic Surgery, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok, Thailand

    Sirichai Wilartratsami

Authors
  1. Yong-Chan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lawrence G. Lenke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seon-Jong Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey L. Gum
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sirichai Wilartratsami
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kathy M. Blanke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lawrence G. Lenke.

Ethics declarations

Conflict of interest

None.

The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter discussed in the manuscript. There was no company or organization that sponsored or influenced this study in any way. No monies were received for this research.

Additional information

IRB Approval Statement: This study was approved by the Institutional Review Board (IRB).

All surgeries and research for this study were performed at the Department of Orthopedic Surgery, Washington University School of Medicine in St. Louis, MO.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, YC., Lenke, L.G., Lee, SJ. et al. The cranial sagittal vertical axis (CrSVA) is a better radiographic measure to predict clinical outcomes in adult spinal deformity surgery than the C7 SVA: a monocentric study. Eur Spine J 26, 2167–2175 (2017). https://doi.org/10.1007/s00586-016-4757-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4757-0

Keywords

Search

Navigation