Abstract
Purpose
The aim of this study is to determine the correlation between photographic sagittal parameters and patient-reported outcome measures (PROM) results in adult patients operated on spinal deformity.
Methods
Non-concurrent prospective study. Inclusion criteria: age at surgery older than 25, minimum 2-year follow-up after a 5 or more level fusion for adult spinal deformity (ASD). Full body lateral standing photographs were taken with adhesive markers placed on ten bony landmarks. SRS-22 and SF-36 questionnaires were completed for every patient. The following photographic parameters were measured: lumbar angle, lumbar curve, thoracic inclination (TI), trunk angle, pelvic tilt, head angle, neck angle, cervicothoracic angle, lumbar vector angle (LVA), dorsal vector angle (DVA), cervical vector angle (CVA), cranial pelvic angle (CrPA), cranial sacral angle (CrSA), fibular inclination angle (FIA) and cranial sagittal vertical axis measured to sacrum (Cr-S), greater trochanter (Cr-GT), knee (Cr-K) and ankle (Cr-A).
Results
65 patients (58 female) operated on ASD in a single institution were included. Age at surgery was 61 years (26–67). Postoperative follow-up was 53 months (24–120). Spearman rank order test showed several significant (p ≤ 0.01) correlations. After multivariate linear regression analysis age, LVA and TI remained as predictors for SRS image scores (corrected r2 0.41), LVA for SRS satisfaction (corrected r2 0.27), CrPA and age for SRS total scores (corrected r2 0.33), FIA and age for SF36 physical functioning (corrected r2 0.36) and CrSA for SF36 role physical (corrected r2 0.14).
Conclusions
Some sagittal photographic parameters may predict mid-term clinical results after ASD surgery.
Similar content being viewed by others
References
do Rosário JL (2014) Photographic analysis of human posture: a literature review. J Bodyw Mov Ther 18:56–61
Helmy NA, El-Sayyad MM, Kattabei OM (2015) Intra-rater and inter-rater reliability of Surgimap Spine software for measuring spinal postural angles from digital photographs. Bull Fac Phys Ther 20:193–199
Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS, Boachie-Adjei O, Burton DC, Akbarnia BA, Mundis GM, Ames CP, Kebaish K, Hart RA, Farcy JP, Lafage V, International Spine Study Group (ISSG) (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 38:E803–E812
Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 30:682–688
Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30:2024–2029
Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (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
Claeys K, Brumagne S, Deklerck J, Vanderhaeghen J, Dankaerts W (2016) Sagittal evaluation of usual standing and sitting spinal posture. J Bodyw Mov Ther 20:326–333
Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, Ames C, Smith JS, Shaffrey CI, Glassman S, Farcy JP, Lafage V (2014) The comprehensive anatomical spinal osteotomy classification. Neurosurgery 74:112–120
Vedantam R, Lenke LG, Bridwell KH, Linville DL, Blanke K (2000) The effect of variation in arm position on sagittal spinal alignment. Spine (Phila Pa 1976) 25:2204–2209
Miranda R, Schor E, Girão MJ (2009) Postural evaluation in women with chronic pelvic pain. Rev Bras Ginecol Obstet 31:353–360
Engsberg JR, Lenke LG, Bridwell KH, Uhrich ML, Trout CM (2008) Relationships between spinal landmarks and skin surface markers. J Appl Biomech 24:94–97
Claus AP, Hides JA, Moseley GL, Hodges PW (2009) Is “ideal” sitting posture real? Measurement of spinal curves in four sitting postures. Man Ther 14:404–408
Dunk NM, Lalonde J, Callaghan JP (2005) Implications for the use of postural analysis as a clinical diagnostic tool: reliability of quantifying upright standing spinal postures from photographic images. J Manip Physiol Ther 28:386–392
Saito ET, Akashi PM, Sacco Ide C (2009) Global body posture evaluation in patients with temporomandibular joint disorder. Clinics (Sao Paulo) 64:35–39
Ferreira EA, Duarte M, Maldonado EP, Burke TN, Marques AP (2010) Postural assessment software (PAS/SAPO): validation and reliabiliy. Clinics (Sao Paulo) 65:675–681
Cuccia AM, Carola C (2009) The measurement of craniocervical posture: a simple method to evaluate head position. Int J Pediatr Otorhinolaryngol 73:1732–1736
Guan X, Fan G, Wu X, Zeng Y, Su H, Gu G, Zhou Q, Gu X, Zhang H, He S (2015) Photographic measurement of head and cervical posture when viewing mobile phone: a pilot study. Eur Spine J 24:2892–2898
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 the head. Surg Radiol Anat 8:169–173
Suk KS, Kim KT, Lee SH, Kim JM (2003) Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine (Phila Pa 1976) 28:2001–2005
Kim YC, Lenke LG, Lee SJ et al (2017) 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
Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A (2019) Sagittal balance of the spine. Eur Spine J 28:1889–1905
Shimizu T, Lehman RA Jr, Sielatycki JA, Pongmanee S, Cerpa M, Takemoto M, Lenke LG (2020) Reciprocal change of sagittal profile in unfused spinal segments and lower extremities after complex adult spinal deformity surgery including spinopelvic fixation: a full-body X-ray analysis. Spine J 20:380–390
Larson AN, Schueler BA, Dubousset J (2019) Radiation in spine deformity: state-of-the-art reviews. Spine Deform 7:386–394
Yoshida G, Kurosu K, Yamato Y, Hasegawa T, Yasuda T, Togawa D, Matsuyama Y (2017) Novel Measurement technique for the sagittal vertical axis and its clinical application in adult spinal deformity. Asian Spine J 11:190–197
Knott P, Sturm P, Lonner B, Cahill P, Betsch M, McCarthy R, Kelly M, Lenke L, Betz R (2016) Multicenter comparison of 3D Spinal measurements using surface topography with those from conventional radiography. Spine Deform 4:98–103
Stolinski L, Kozinoga M, Czaprowski D, Tyrakowski M, Cerny P, Suzuki N, Kotwicki T (2017) Two-dimensional digital photography for child body posture evaluation: standardized technique, reliable parameters and normative data for age 7–10 years. Scoliosis Spinal Disord 12:38
Dubousset J (1994) Three-dimensional analysis of the scoliotic deformity. In: Weinstein SL (ed) Pediatric spine: principles and practice. Raven Press, New York, pp 480–481
Roussouly P, Nnadi C (2010) Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 19:1824–1836
Protopsaltis T, Schwab F, Bronsard N, Smith JS, Klineberg E, Mundis G, Ryan DJ, Hostin R, Hart R, Burton D, Ames C, Shaffrey C, Bess S, Errico T, Lafage V, International Spine Study Group (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 Jt Surg Am 96:1631–1640
Ha WS, Shin MH (2019) Postoperative lower limb compensation in patients with adult spinal deformity. J Clin Neurosci 59:106–111
Lafage R, Schwab F, Challier V, Henry JK, Gum J, Smith J, Hostin R, Shaffrey C, Kim HJ, Ames C, Scheer J, Klineberg E, Bess S, Burton D, Lafage V, International Spine Study Group (2016) Defining spino-pelvic alignment thresholds: should operative goals in adult spinal deformity surgery account for age? Spine (Phila Pa 1976). 41:62–68
Ware JE Jr (2000) SF-36 health survey update. Spine 25:3130–3139
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 (Phila Pa 1976) 37:592–598
Qiao J, Zhu F, Xu L, Liu Z, Zhu Z, Qian B, Sun X, Qiu Y (2014) T1 pelvic angle: a new predictor for postoperative sagittal balance and clinical outcomes in adult scoliosis. Spine (Phila Pa 1976) 39:2103–2107
Kim HJ, Bridwell KH, Lenke LG, Park MS, Ahmad A, Song KS, Piyaskulkaew C, Hershman S, Fogelson J, Mesfin A (2013) Proximal junctional kyphosis results in inferior SRS pain subscores in adult deformity patients. Spine (Phila Pa 1976) 38:896–901
Takemoto M, Boissière L, Novoa F, Vital JM, Pellisé F, Pérez-Grueso FJ, Kleinstück F, Acaroglu ER, Alanay A, Obeid I, Obeid I, European Spine Study Group, ESSG (2016) Sagittal malalignment has a significant association with postoperative leg pain in adult spinal deformity patients. Eur Spine J 25:2442–2518
Zhang YP, Qian BP, Qiu Y, Qu Z, Mao SH, Jiang J, Zhu ZZ (2017) Sagittal vertical axis, spinosacral angle, spinopelvic angle, and T1 pelvic angle: which parameters may effectively predict the quality of life in ankylosing spondylitis patients with thoracolumbar kyphosis? Clin Spine Surg 30:E871–E876
Debarge R, Demey G, Roussouly P (2010) Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Eur spine J 19:65–70
Obeid I, Boissière L, Yilgor C, Larrieu D, Pellisé F, Alanay A, Acaroglu E, Perez-Grueso FJ, Kleinstück F, Vital JM, Bourghli A, European Spine Study Group, ESSG (2016) Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J 25:3644–3649
Diebo BG, Shah NV, Boachie-Adjei O, Zhu F, Rothenfluh DA, Paulino CB, Schwab FJ, Lafage V (2019) Adult spinal deformity. Lancet 394:160–172
Dubousset J, Charpak G, Skalli W, de Guise J, Kalifa G, Wicart P (2008) Skeletal and spinal imaging with EOS system. Arch Pediatr 15:665–666
Wybier M, Bossard P (2013) Musculoskeletal imaging in progress: the EOS imaging system. Jt Bone Spine 80:238–243
McKenna C, Wade R, Faria R et al (2012) EOS 2D/3D X-ray imaging system: a systematic review and economic evaluation. Health Technol Assess 16:1–188
Lenke LG, Engsberg JR, Ross SA, Reitenbach A, Blanke K, Bridwell KH (2001) Prospective dynamic functional evaluation of gait and spinal balance following spinal fusion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 26:E330–E337
Shiba Y, Taneichi H, Inami S, Moridaira H, Takeuchi D, Nohara Y (2016) Dynamic global sagittal alignment evaluated by three-dimensional gait analysis in patients with degenerative lumbar kyphoscoliosis. Eur Spine J 25:2572–2579
Snider KT, Snider EJ, Degenhardt BF, Johnson JC, Kribs JW (2011) Palpatory accuracy of lumbar spinous processes using multiple bony landmarks. J Manipulative Physiol Ther 34:306–313
Acknowledgements
The authors wish to acknowledge Jose Dominguez Pallas, clinical photographer, for his involvement.
Funding
No financial support was received for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors state no conflict of interest.
Ethical approval
This study was approved by the institutional research ethics committee. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: AG-R, CM, EI, FM-M, JAFT, FS-M. Drafting the work or revising it critically for important intellectual content: AG-R, CM, EI, FM-M, JAFT, FS-M. Final approval of the version to be published: AG-R, CM, EI, FM-M, JAFT, FS-M. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: AG-R, CM, EI, FM-M, JAFT, FS-M.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Gomez-Rice, A., Madrid, C., Izquierdo, E. et al. Photographic sagittal plane analysis and its clinical correlation after surgery for adult spinal deformity: a preliminary study. Spine Deform 9, 501–514 (2021). https://doi.org/10.1007/s43390-020-00237-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43390-020-00237-8