Correlation of radiographic parameters and clinical symptoms in adult scoliosis.
METHODS
This study is a retrospective review of the initial enrollment data from a prospective multicentered study of adult spinal deformity.


OBJECTIVE
The purpose of this study is to correlate radiographic measures of deformity with patient-based outcome measures in adult scoliosis.


BACKGROUND
Prior studies of adult scoliosis have attempted to correlate radiographic appearance and clinical symptoms, but it has proven difficult to predict health status based on radiographic measures of deformity alone. The ability to correlate radiographic measures of deformity with symptoms would be useful for decision-making and surgical planning.


METHODS
The study correlates radiographic measures of deformity with scores on the Short Form-12, Scoliosis Research Society-29, and Oswestry profiles. Radiographic evaluation was performed according to an established positioning protocol for anteroposterior and lateral 36-inch standing radiographs. Radiographic parameters studied were curve type, curve location, curve magnitude, coronal balance, sagittal balance, apical rotation, and rotatory subluxation.


RESULTS
The 298 patients studied include 172 with no prior surgery and 126 who had undergone prior spine fusion. Positive sagittal balance was the most reliable predictor of clinical symptoms in both patient groups. Thoracolumbar and lumbar curves generated less favorable scores than thoracic curves in both patient groups. Significant coronal imbalance of greater than 4 cm was associated with deterioration in pain and function scores for unoperated patients but not in patients with previous surgery.


CONCLUSIONS
This study suggests that restoration of a more normal sagittal balance is the critical goal for any reconstructive spine surgery. The study suggests that magnitude of coronal deformity and extent of coronal correction are less critical parameters.
Glassman
Steven D
SD
Department of Orthopaedic Surgery, University of Louisville School of Medicine and the Kenton D. Leatherman Spine Center, Louisville, KY, USA. tallgeyer@spinemds.com
Berven
Sigurd
S
Bridwell
Keith
K
Horton
William
W
Dimar
John R
JR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011788:Quality of Life; D011859:Radiography; D012600:Scoliosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012720:Severity of Illness Index; D013904:Thoracic Vertebrae / Q000473:pathology / Q000503:physiopathology