title: Preoperative and postoperative sagittal plane analysis in adult idiopathic scoliosis in patients older than 40 years of age.
abstract: Most of the papers correlate sagittal radiographic parameters with health-related quality of life (HRQOL) scores for patients with scoliosis. However, we do not know how changes in sagittal profile influence clinical outcomes after surgery in adult population operated for mainly frontal deformity.
  
  
  
  This study aimed to analyze spinal sagittal profile in a population operated on adult idiopathic scoliosis (AS) and to describe variations in sagittal parameters after surgery and the association between those variations and clinical outcomes.
  
  
  
  This is a historical cohort study.
  
  
  
  We included in this study 40 patients operated on AS, older than 40 at the time of surgery (mean age 54.9), and with more than 2-year follow-up (mean 7.4 years).
  
  
  
  Full-length free-standing radiographs, Scoliosis Research Society 22 (SRS22) and Short Form 36 (SF36) instruments, and satisfaction with outcomes were available at final follow-up.
  
  
  
  Sagittal preoperative and final follow-up radiographic parameters, radiographic correlation with HRQOL scores at final follow-up, and association between satisfaction and changes in sagittal profile were analyzed. A multivariate analysis was performed. No funds were received for this article.
  
  
  
  Preoperatively, the spinal sagittal plane tended to exhibit kyphosis. Most sagittal parameters did not improve at final follow-up with respect to preoperative values. We saw, after univariate analysis, that worse sagittal profile leads to worse HRQOL, but after multivariate analysis, only spinal tilt (ST) persisted as possible predictor for worse SRS activity scores. Frontal Cobb significantly improved. Most patients (82%) were satisfied with final outcomes. Variations in sagittal profile parameters did not differ between satisfied and dissatisfied patients.
  
  
  
  Although most sagittal plane parameters did not improve after surgery, surgical treatment in AS achieves a high satisfaction rate. Good clinical results do not correlate with improving sagittal plane parameters. Sagittal profile measurements are not helpful to decide surgical treatment in patients with mainly frontal deformity.
authors: Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain. Electronic address: f3130@hotmail.com.
authors: Felisa
authors: F
authors: Sánchez-Mariscal
authors: Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain.
authors: Alejandro
authors: A
authors: Gomez-Rice
authors: Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain.
authors: Tamara
authors: T
authors: Rodríguez-López
authors: Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain.
authors: Lorenzo
authors: L
authors: Zúñiga
authors: Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain.
authors: Javier
authors: J
authors: Pizones
authors: Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain.
authors: Ana
authors: A
authors: Núñez-García
authors: Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain.
authors: Enrique
authors: E
authors: Izquierdo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Adult scoliosis; HRQOL measures; IP-LL mismatch; Lumbar lordosis gap; Pelvic tilt; Sagittal profile; Sagittal vertical axis