title: Geographic and Ethnic Variations in Radiographic Disability Thresholds: Analysis of North American and Japanese Operative Adult Spinal Deformity Populations.
abstract: Thresholds for spinal pelvic parameters in adult spinal deformity (ASD) were previously defined in North American patients and are commonly used to guide surgical planning. However, it is unclear whether these same threshold parameters can be more widely applied in other geographic regions and in other ethnicities.
  
  
  
  To evaluate the variation in the radiographic disability thresholds between North American and Japanese ASD populations and to adjust sagittal modifier thresholds accordingly.
  
  
  
  Retrospective case series of 717 patients with ASD who had baseline radiographs and Oswestry Disability Index (ODI) from North America (n = 518) and Japan (n = 199) were studied. Patients were compared at baseline for ODI, ODI offset from age- and ethnic-specific values (ODIni), and radiographic parameters.
  
  
  
  Significant differences in classification were observed: A greater proportion of Japanese patients had marked pelvic tilt deformity, whereas a greater proportion of US patients had marked SVA deformity; no difference in the pelvic incidence-lumbar lordosis mismatch sagittal modifier was observed. Health-related quality-of-life scores also differed, with a greater ODI raw value observed in the US patients but similar ODIni scores between cohorts. Stratifying ODIni scores by sagittal modifier grades revealed similar disability scores corresponding to the 0 to + thresholds for pelvic tilt, pelvic incidence-lumbar lordosis mismatch, and sagittal vertical axis across ethnicities. Finally, linear regression analysis demonstrated that compared with US patients, Japanese patients had a lower estimated ODI corresponding to established thresholds of radiographic deformity.
  
  
  
  Our findings demonstrate significant variability in health-related quality-of-life measures and radiographic parameters between North American and Japanese patients, supporting the need for population-adjusted sagittal modifiers to more accurately classify deformity.
  
  
  
  ASD, adult spinal deformityHRQOL, health-related quality of lifeLL, lumbar lordosisODI, Oswestry Disability IndexODIni, Oswestry Disability Index need for improvementPCS, physical component summaryPI, pelvic incidencePI-LL, pelvic incidence-lumbar lordosis mismatchPT, pelvic tiltSRS, Scoliosis Research SocietySVA, sagittal vertical axisTK, thoracic kyphosis.
authors.affiliation: *Neurosurgery, University of California San Francisco, San Francisco, California; ‡Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York; §Keio Spine Research Group, Shinjuku, Tokyo, Japan; ¶Department of Orthopedic Surgery, Keio University, Shinjuku, Tokyo, Japan; ‖Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; #Departments of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan; **Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan; ‡‡Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; §§Orthopedic and Spine Surgery, Hôpital Européen Georges Pompidou, APHP, Paris V University, Paris, France.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ames
authors.forename: Isaac
authors.initials: I
authors.lastname: Gammal
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Naobumi
authors.initials: N
authors.lastname: Hosogane
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Themistocles
authors.initials: T
authors.lastname: Protopsaltis
authors.forename: Yu
authors.initials: Y
authors.lastname: Yamato
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taneichi
authors.forename: Renaud
authors.initials: R
authors.lastname: Lafage
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Ferrero
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Schwab
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
mesh_terms: D000328:Adult; D006801:Humans; D007564:Japan; D016014:Linear Models; D009656:North America; D011788:Quality of Life; D011859:Radiography; D012044:Regression Analysis; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging*; D013131:Spine / Q000000981:diagnostic imaging*; D014481:United States