Abstract
Purpose
This study aimed to investigate how preoperative motion analysis results affect the postoperative clinical outcomes of patients undergoing surgery for adult spinal deformity (ASD).
Methods
Patients who underwent surgery for ASD and whose motion analysis results were available were included. All patients underwent preoperative three-dimensional gait analysis using a motion analysis system. Univariate and multivariate regression analyses were performed to determine the predictive parameters of the 12-month postoperative Oswestry Disability Index (ODI). According to the mean anterior pelvic tilt (Ant-PT) angle in the motion analysis, the patients were divided into two groups: small and high Ant-PT angle groups. The 12-month postoperative ODI between the two groups was compared.
Results
A total of 111 patients who met the inclusion criteria were enrolled in the study. In the multivariate regression analysis, the preoperative sacral slope and mean Ant-PT angle were significant predictors of the 12-month postoperative ODI (p = 0.013 and p = 0.009, respectively). The high Ant-PT angle group showed a poorer 12-month postoperative ODI than did the small Ant-PT angle group, with a mean ODI of 21.9 ± 8.4 and 16.7 ± 8.5, respectively (p = 0.002). Simple linear regression analysis revealed that the Ant-PT angle was positively correlated with the postoperative sagittal vertical axis in all follow-up periods.
Conclusion
The study highlights that a high preoperative Ant-PT angle in motion analyses is associated with poor clinical outcomes after surgery for ASD. Therefore, it is necessary to observe and consider the dynamic gait pattern related to the compensatory mechanism for sagittal imbalance in the decision-making process for ASD surgery.
Similar content being viewed by others
References
Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:1259–1265. https://doi.org/10.1001/jama.2010.338
Turner JD, Walker CT, Mundis GM, Kakarla UK (2015) Health burden of adult spinal deformity compared with other chronic diseases. World Neurosurg 84:876
Acaroglu E (2016) Decision-making in the treatment of adult spinal deformity. EFORT Open Rev 1:167–176. https://doi.org/10.1302/2058-5241.1.000013
Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, Lenke LG, Hilton JF, Shainline M, Baldus C (2009) Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine 34:2171–2178
Sharma A, Tanenbaum JE, Hogue O, Mehdi S, Vallabh S, Hu E, Benzel EC, Steinmetz MP, Savage JW (2019) Predicting clinical outcomes following surgical correction of adult spinal deformity. Neurosurgery 84:733–740. https://doi.org/10.1093/neuros/nyy190
(2016) Outcomes of operative and nonoperative treatment for adult spinal deformity: a prospective, multicenter, propensity-matched cohort assessment with minimum 2-year follow-up. Neurosurgery 78:851–861
Bridwell KH, Baldus C, Berven S, Charles Edwards I, Glassman S, Hamill C, Horton W, Lenke LG, Ondra S, Schwab F (2010) Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to three-to five-years follow-up. Spine 35:1849–1854
Lenke LG, Fehlings MG, Shaffrey CI, Cheung KM, Carreon L, Dekutoski MB, Schwab FJ, Boachie-Adjei O, Kebaish KM, Ames CP (2016) Neurologic outcomes of complex adult spinal deformity surgery: results of the prospective, multicenter Scoli-RISK-1 study. Spine 41:204–212
Smith JS, Klineberg E, Schwab F, Shaffrey CI, Moal B, Ames CP, Hostin R, Fu KM, Burton D, Akbarnia B, Gupta M, Hart R, Bess S, Lafage V, International Spine Study G (2013) Change in classification grade by the SRS-Schwab adult spinal deformity classification predicts impact on health-related quality of life measures: prospective analysis of operative and nonoperative treatment. Spin (Phila Pa 1976) 38:1663–1671. https://doi.org/10.1097/BRS.0b013e31829ec563
Scheer JK, Smith JS, Clark AJ, Lafage V, Kim HJ, Rolston JD, Eastlack R, Hart RA, Protopsaltis TS, Kelly MP (2015) Comprehensive study of back and leg pain improvements after adult spinal deformity surgery: analysis of 421 patients with 2-year follow-up and of the impact of the surgery on treatment satisfaction. J Neurosurg Spine 22:540–553
Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, DeWald C, Mehdian H, Shaffrey C, Tribus C (2012) Scoliosis Research Society—Schwab adult spinal deformity classification: a validation study. Spine 37:1077–1082
Worley N, Marascalchi B, Jalai CM, Yang S, Diebo B, Vira S, Boniello A, Lafage V, Passias PG (2016) Predictors of inpatient morbidity and mortality in adult spinal deformity surgery. Eur Spine J 25:819–827
Yoshida G, Hasegawa T, Yamato Y, Kobayashi S, Shin O, Banno T, Mihara Y, Arima H, Ushirozako H, Yasuda T (2019) Minimum clinically important differences in Oswestry disability index domains and their impact on adult spinal deformity surgery. Asian Spine J 13:35
Marks MC, Stanford CF, Mahar AT, Newton PO (2003) Standing lateral radiographic positioning does not represent customary standing balance. Spine 28:1176–1182
Kim H-J, Chun H-J, Shen F, Kang K-T, Chang B-S, Lee C-K, Yeom JS (2020) Analysis of pelvic compensation for dynamic sagittal imbalance using motion analysis. Eur Spine J 29:428–437. https://doi.org/10.1007/s00586-019-06267-9
Kim H-J, Shen F, Kang K-T, Chun H-J, Kim ST, Chang B-S, Lee C-K, Yeom JS (2019) Failure of pelvic compensation in patients with severe positive sagittal imbalance: comparison between static radiographs and gait analysis of spinopelvic parameters in adult spinal deformity and lumbar stenosis. Spine 44:E759–E765
Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353
Sebaaly A, Grobost P, Mallam L, Roussouly P (2018) Description of the sagittal alignment of the degenerative human spine. Eur Spine J 27:489–496
Bari TJ, Hansen LV, Gehrchen M (2020) Surgical correction of adult spinal deformity in accordance to the Roussouly classification: effect on postoperative mechanical complications. Spine Deform 8:1027–1037
Yilgor C, Sogunmez N, Boissiere L, Yavuz Y, Obeid I, Kleinstuck F, Perez-Grueso FJS, Acaroglu E, Haddad S, Mannion AF, Pellise F, Alanay A (2017) Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Jt Surg (Am Vol) 99:1661–1672. https://doi.org/10.2106/jbjs.16.01594
Acaroglu RE, Dede O, Pellisé F, Guler UO, Domingo-Sabat M, Alanay A (2016) Adult spinal deformity: a very heterogeneous population of patients with different needs. Acta Orthop Traumatol Turc 50:57–62
Lee C-S, Lee C-K, Kim Y-T, Hong Y-M, Yoo J-H (2001) Dynamic sagittal imbalance of the spine in degenerative flat back: significance of pelvic tilt in surgical treatment. Spine 26:2029–2035
Terran J, Schwab F, Shaffrey CI, Smith JS, Devos P, Ames CP, Fu K-MG, Burton D, Hostin R, Klineberg E (2013) The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 73:559–568
Bess S, Protopsaltis TS, Lafage V, Lafage R, Ames CP, Errico T, Smith JS (2016) Clinical and radiographic evaluation of adult spinal deformity. J Spinal Disord Tech 29:6–16
Lafage R, Schwab F, Challier V, Henry JK, Gum J, Smith J, Hostin R, Shaffrey C, Kim HJ, Ames C (2016) Defining spino-pelvic alignment thresholds: Should operative goals in adult spinal deformity surgery account for age? Spine 41:62–68
Lafage R, Schwab F, Glassman S, Bess S, Harris B, Sheer J, Hart R, Line B, Henry J, Burton D (2017) Age-adjusted alignment goals have the potential to reduce PJK. Spine 42:1275–1282
Acknowledgements
This work was supported by the CG Bio Co., Ltd. [Grant Number B-2009/636-104].
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author declares that he has no relevant or material financial interests that relate to the research described in this paper.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Ham, DW., Kim, HJ., Park, SM. et al. Effects of preoperative spinopelvic compensation states on the patient-reported outcomes of adult spinal deformity surgery: three-dimensional motion analysis results. Eur Spine J 31, 3687–3695 (2022). https://doi.org/10.1007/s00586-022-07419-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-022-07419-0