title: Sagittal malalignment has a significant association with postoperative leg pain in adult spinal deformity patients.
abstract: To evaluate the association between spinopelvic sagittal parameters and leg pain in patients with adult spinal deformity (ASD) after adjusting for demographic and surgical variables.
  
  
  
  A multicenter prospective ASD database (European Spine Study Group) was retrospectively reviewed. The characteristics (age, sex, body mass index, comorbidity, history of spine surgery, and radiographical coronal and sagittal parameters) of patients with preoperative and 6-month postoperative leg pain (PostLP; numerical rating scale score ≥5) were analyzed using univariate and multivariate analyses.
  
  
  
  In this study, 204 patients (164 women and 40 men; mean age 53.1 years) were included. Fifty-three percent of the patients had preoperative leg pain (PreLP). The patients with PreLP had significantly worse sagittal parameters and less coronal Cobb angle than those with less leg pain; however, this association disappeared after adjustment for covariates. The PreLP of the ASD patients was successfully treated surgically in most cases; however, 24 % of the patients still had unexpected residual leg pain. Postoperative sagittal malalignment (sagittal vertical axis ≥40 mm, T1 sagittal tilt ≥0°, pelvic tilt ≥30°) was a significant risk factor of PostLP even after adjusting for covariates.
  
  
  
  Leg pain in patients with ASD was significantly associated with sagittal malalignment especially after surgical treatments. As these patients lose flexibility in the fused spinal segment, they can only depend on the remaining compensatory mechanisms below the pelvis (e.g., the hips and knees) to maintain a balanced posture. This may lead to a predisposition of these patients to postoperative leg symptoms related to spinal sagittal malalignment.
authors.affiliation: Spine Unit 1, Bordeaux University Hospital, Bordeaux, France. m.take@mac.com.|Department of Orthopaedic and Spine Surgery, Kyoto City Hospital, Nakagyo-ku, Mibu-Higashi-Takada-cho 1-2, Kyoto, 604-8845, Japan. m.take@mac.com.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Takemoto
authors.affiliation: Spine Unit 1, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Boissière
authors.affiliation: Spine Unit 1, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Felipe
authors.initials: F
authors.lastname: Novoa
authors.affiliation: Spine Unit 1, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Vital
authors.affiliation: Spine Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Pellisé
authors.affiliation: Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Francisco Javier Sanchez
authors.initials: FJ
authors.lastname: Pérez-Grueso
authors.affiliation: Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Kleinstück
authors.affiliation: Spine Surgery Unit, Ankara Acibadem ARTES Spine Center, Ankara, Turkey.
authors.forename: Emre R
authors.initials: ER
authors.lastname: Acaroglu
authors.affiliation: Spine Surgery Unit, Acibadem University, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Alanay
authors.affiliation: Spine Unit 1, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Obeid
authors.affiliation: Spine Unit 1, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Obeid
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000150:complications / Q000601:surgery*; D007866:Leg; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000209:etiology; D010149:Postoperative Pain / Q000453:epidemiology*; D010388:Pelvis; D011184:Postoperative Period; D011187:Posture; D011788:Quality of Life; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery; D013123:Spinal Fusion; D013131:Spine / Q000601:surgery
keywords: Adult spinal deformity; Global tilt; Leg pain; Sagittal balance; Surgical treatment