title: Sagittal spinopelvic malalignment in Parkinson disease: prevalence and associations with disease severity.
abstract: METHODS
  Prospective study.
  
  
  OBJECTIVE
  Our objectives were to evaluate the prevalence of sagittal spinopelvic malalignment in a consecutive series of patients with Parkinson disease (PD) and to identify factors associated with sagittal spinopelvic deformity in this population.
  
  
  BACKGROUND
  PD is a degenerative neurological condition characterized by tremor, rigidity, bradykinesia, and loss of postural reflexes. The prevalence of spinal deformity in PD is higher than that of age-matched adults without PD.
  
  
  METHODS
  This study was a prospective assessment of consecutive patients with PD presenting to a neurology clinic during 12 months. Inclusion criteria included age more than 21 years and diagnosis of PD. Age- and sex-matched control group was selected from patients with cervical spondylosis. Clinical and demographic factors were collected including Unified Parkinson Disease Rating Scale score and Hoehn and Yahr stage. Full-length standing spine radiographs were assessed. Patients were grouped into either low C7 sagittal vertical axis (SVA) (<5 cm) or high C7 SVA (≥5 cm) and into matched (≤10°) or mismatched (>10°) pelvic incidence (PI)-lumbar lordosis.
  
  
  RESULTS
  Eighty-nine patients met criteria (41 males/48 females), including 52 with low C7 SVA and 37 with high C7 SVA. Significantly higher prevalence of high C7 SVA was found in PD (41.6 vs. 16.8%; P < 0.001). The high C7 SVA group was significantly older (72.4 vs. 65.1 yr; P < 0.001) and had a higher proportion of females (68% vs. 44%; P = 0.034), greater severity of PD based on Hoehn and Yahr stage (1.89 vs. 1.37; P < 0.001) and Unified Parkinson Disease Rating Scale (30.5 vs. 17.2; P = 0.002. Unified Parkinson Disease Rating Scale significantly correlated with C7 SVA (r = 0.474). Compared with the matched (≤10°) PI-lumbar lordosis group, the mismatch PI-lumbar lordosis group had higher C7 SVA, higher PI, higher pelvic tilt, lower lumbar lordosis, and lower thoracic kyphosis (P ≤ 0.003).
  
  
  CONCLUSIONS
  Patients with PD have a high prevalence of sagittal spinopelvic malalignment than control group patients. Greater severity of PD is associated with sagittal spinopelvic malalignment.
  
  
  METHODS
  3.
authors.affiliation: *Department of Neurosurgery, Spine Center, Hallym University Sacred Heart Hospital, Anyang, Korea †Department of Neurosurgery, University of Virginia, Charlottesville, VA ‡Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY §Department of Neurosurgery, University of California San Francisco, San Francisco, CA ¶Department of Orthopaedic Surgery, Keio University, Tokyo, Japan ‖Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea; and **Department of Neurosurgery, Spine and Spinal Cord Research Institute, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Jae Keun
authors.initials: JK
authors.lastname: Oh
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Jong Sam
authors.initials: JS
authors.lastname: Baik
authors.forename: Yoon
authors.initials: Y
authors.lastname: Ha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000000981:diagnostic imaging*; D010388:Pelvis / Q000000981:diagnostic imaging*; D015995:Prevalence; D011446:Prospective Studies; D011859:Radiography; D012720:Severity of Illness Index; D013122:Spinal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D013131:Spine / Q000000981:diagnostic imaging*