Abstract
Purpose
Little data are available on the relationship between sagittal spinopelvic parameters and health related quality of life (HRQOL) in ankylosing spondylitis (AS) patients. The aim of this study was to identify the relationships between spinopelvic parameters and HRQOL in AS.
Methods
The study and control groups comprised 107 AS patients and 40 controls. All underwent anteroposterior and lateral radiographs of the whole spine including hip joints and completed clinical questionnaires. The radiographic parameters examined were sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis. A Visual Analogue Scale (VAS: 0–10) score for back pain, the Oswestry disability index (ODI) questionnaire, Scoliosis Research Society (SRS-22) questionnaire and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were administered to evaluate QOL. Statistical analysis was performed to identify significant differences between the study and control groups. In addition, correlations between radiological parameters and clinical questionnaires were sought.
Results
The AS patients and controls were found to be significantly different in terms of sagittal vertical axis, sacral slope, pelvic tilt, pelvic incidence, and lumbar lordosis. However, no significant intergroup difference was observed for thoracic kyphosis (P > 0.05). Of the 107 AS patients, there were 18 women and 89 men. Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. Multiple regression analysis was performed to identify predictors of clinical outcome, and the results obtained revealed that sagittal vertical axis and sacral slope significantly predicted VAS, ODI and BASDAI scores and that sagittal vertical axis and lumbar lordosis predicted SRS-22 scores.
Conclusions
AS patients and normal controls were found to be significantly different in terms of sagittal spinopelvic parameters. Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. In particular, sagittal vertical axis, sacral slope and lumbar lordosis were found to be significant parameters in prediction of clinical outcomes in AS patient.
Similar content being viewed by others
References
Angevine PD, McCormick PC (2007) The importance of sagittal balance: how good is the evidence? J Neurosurg Spine 6:101–103
Arun R, Dabke HV, Mehdian H (2011) Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction. Eur Spine J 20:2252–2260
Bae JS, Jang JS, Lee SH, Kim JU (2012) Radiological analysis of lumbar degenerative kyphosis in relation to pelvic incidence. Spine J 12:1045–1051
Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18:40–47
Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupère G, Pélissier J (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422
Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P, Jenkinson T (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the bath ankylosing spondylitis functional index. J Rheumatol 21:2281–2285
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
Debarge R, Demey G, Roussouly P (2011) Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J 20:619–625
Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 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 30:2024–2029
Jackson RP, Hales C (2000) Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine 25:2808–2815
Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine 25:575–586
Jackson RP, Peterson MD, McManus AC, Hales C (1998) Compensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients. Spine 23:1750–1767
Kim KT, Lee SH, Suk KS, Lee JH, Im YJ (2007) Spinal pseudarthrosis in advanced ankylosing spondylitis with sagittal plane deformity: clinical characteristics and outcome analysis. Spine 32:1641–1647
Lee JH, Kim KT, Suk KS, Lee SH, Jeong BO, Kim JS, Eoh JH, Kim YJ (2010) Analysis of spinopelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine 35:E1386–E1391
Lefage 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 34:E599–E606
Legaye J, Duval-Beaupère G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103
Qian BP, Qiu Y, Wang B, Sun X, Zhu ZZ, Jiang J, Ji ML (2012) Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis. Eur Spine J 21:711–718
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
Schwab F, Dubey A, Pagala M, Gamez L, Farcy JP (2003) Adult scoliosis: a health assessment analysis by SF-36. Spine 28:602–606
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 28:2001–2005
van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arth Rheum 27:361–368
White AA 3rd, Panjabi MM, Thomas CL (1977) The clinical biomechanics of kyphotic deformities. Clin Orthop Relat Res 128:8–17
Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC Jr, Dijkmans B, Dougados M, Géher P, Inman RD, Khan MA, Kvien TK, Leirisalo-Repo M, Olivieri I, Pavelka K, Sieper J, Stucki G, Sturrock RD, van der Linden S, Wendling D, Böhm H, van Royen BJ, Braun J (2006) ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 65:442–452
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shin, J.K., Lee, J.S., Goh, T.S. et al. Correlation between clinical outcome and spinopelvic parameters in ankylosing spondylitis. Eur Spine J 23, 242–247 (2014). https://doi.org/10.1007/s00586-013-2929-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-013-2929-8