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Published in: European Spine Journal 1/2014

01-01-2014 | Original Article

Correlation between clinical outcome and spinopelvic parameters in ankylosing spondylitis

Authors: Jong Ki Shin, Jung Sub Lee, Tae Sik Goh, Seung Min Son

Published in: European Spine Journal | Issue 1/2014

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Abstract

Purpose

Little data are available on the relationship between sagittal spinopelvic parameters and health related quality of life (HRQOL) in ankylosing spondylitis (AS) patients. The aim of this study was to identify the relationships between spinopelvic parameters and HRQOL in AS.

Methods

The study and control groups comprised 107 AS patients and 40 controls. All underwent anteroposterior and lateral radiographs of the whole spine including hip joints and completed clinical questionnaires. The radiographic parameters examined were sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis. A Visual Analogue Scale (VAS: 0–10) score for back pain, the Oswestry disability index (ODI) questionnaire, Scoliosis Research Society (SRS-22) questionnaire and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were administered to evaluate QOL. Statistical analysis was performed to identify significant differences between the study and control groups. In addition, correlations between radiological parameters and clinical questionnaires were sought.

Results

The AS patients and controls were found to be significantly different in terms of sagittal vertical axis, sacral slope, pelvic tilt, pelvic incidence, and lumbar lordosis. However, no significant intergroup difference was observed for thoracic kyphosis (P > 0.05). Of the 107 AS patients, there were 18 women and 89 men. Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. Multiple regression analysis was performed to identify predictors of clinical outcome, and the results obtained revealed that sagittal vertical axis and sacral slope significantly predicted VAS, ODI and BASDAI scores and that sagittal vertical axis and lumbar lordosis predicted SRS-22 scores.

Conclusions

AS patients and normal controls were found to be significantly different in terms of sagittal spinopelvic parameters. Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. In particular, sagittal vertical axis, sacral slope and lumbar lordosis were found to be significant parameters in prediction of clinical outcomes in AS patient.
Literature
1.
go back to reference Angevine PD, McCormick PC (2007) The importance of sagittal balance: how good is the evidence? J Neurosurg Spine 6:101–103PubMedCrossRef Angevine PD, McCormick PC (2007) The importance of sagittal balance: how good is the evidence? J Neurosurg Spine 6:101–103PubMedCrossRef
2.
go back to reference Arun R, Dabke HV, Mehdian H (2011) Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction. Eur Spine J 20:2252–2260PubMedCentralPubMedCrossRef Arun R, Dabke HV, Mehdian H (2011) Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction. Eur Spine J 20:2252–2260PubMedCentralPubMedCrossRef
3.
go back to reference Bae JS, Jang JS, Lee SH, Kim JU (2012) Radiological analysis of lumbar degenerative kyphosis in relation to pelvic incidence. Spine J 12:1045–1051PubMedCrossRef Bae JS, Jang JS, Lee SH, Kim JU (2012) Radiological analysis of lumbar degenerative kyphosis in relation to pelvic incidence. Spine J 12:1045–1051PubMedCrossRef
4.
go back to reference Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18:40–47PubMedCrossRef Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18:40–47PubMedCrossRef
5.
go back to reference Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupère G, Pélissier J (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422PubMedCentralPubMedCrossRef Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupère G, Pélissier J (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422PubMedCentralPubMedCrossRef
6.
go back to reference Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P, Jenkinson T (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the bath ankylosing spondylitis functional index. J Rheumatol 21:2281–2285PubMed Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P, Jenkinson T (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the bath ankylosing spondylitis functional index. J Rheumatol 21:2281–2285PubMed
7.
go back to reference Debarge R, Demey G, Roussouly P (2010) Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Eur Spine J 19:65–70PubMedCentralPubMedCrossRef Debarge R, Demey G, Roussouly P (2010) Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Eur Spine J 19:65–70PubMedCentralPubMedCrossRef
8.
go back to reference Debarge R, Demey G, Roussouly P (2011) Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J 20:619–625PubMedCentralPubMedCrossRef Debarge R, Demey G, Roussouly P (2011) Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J 20:619–625PubMedCentralPubMedCrossRef
9.
go back to reference Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 30:682–688PubMedCrossRef Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 30:682–688PubMedCrossRef
10.
go back to reference Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029PubMedCrossRef Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029PubMedCrossRef
11.
go back to reference Jackson RP, Hales C (2000) Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine 25:2808–2815PubMedCrossRef Jackson RP, Hales C (2000) Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine 25:2808–2815PubMedCrossRef
12.
go back to reference Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine 25:575–586PubMedCrossRef Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine 25:575–586PubMedCrossRef
13.
go back to reference Jackson RP, Peterson MD, McManus AC, Hales C (1998) Compensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients. Spine 23:1750–1767PubMedCrossRef Jackson RP, Peterson MD, McManus AC, Hales C (1998) Compensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients. Spine 23:1750–1767PubMedCrossRef
14.
go back to reference Kim KT, Lee SH, Suk KS, Lee JH, Im YJ (2007) Spinal pseudarthrosis in advanced ankylosing spondylitis with sagittal plane deformity: clinical characteristics and outcome analysis. Spine 32:1641–1647PubMedCrossRef Kim KT, Lee SH, Suk KS, Lee JH, Im YJ (2007) Spinal pseudarthrosis in advanced ankylosing spondylitis with sagittal plane deformity: clinical characteristics and outcome analysis. Spine 32:1641–1647PubMedCrossRef
15.
go back to reference Lee JH, Kim KT, Suk KS, Lee SH, Jeong BO, Kim JS, Eoh JH, Kim YJ (2010) Analysis of spinopelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine 35:E1386–E1391PubMedCrossRef Lee JH, Kim KT, Suk KS, Lee SH, Jeong BO, Kim JS, Eoh JH, Kim YJ (2010) Analysis of spinopelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine 35:E1386–E1391PubMedCrossRef
16.
go back to reference Lefage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34:E599–E606CrossRef Lefage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34:E599–E606CrossRef
17.
go back to reference Legaye J, Duval-Beaupère G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103PubMedCentralPubMedCrossRef Legaye J, Duval-Beaupère G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103PubMedCentralPubMedCrossRef
18.
go back to reference Qian BP, Qiu Y, Wang B, Sun X, Zhu ZZ, Jiang J, Ji ML (2012) Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis. Eur Spine J 21:711–718PubMedCentralPubMedCrossRef Qian BP, Qiu Y, Wang B, Sun X, Zhu ZZ, Jiang J, Ji ML (2012) Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis. Eur Spine J 21:711–718PubMedCentralPubMedCrossRef
19.
go back to reference Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine 27:387–392PubMedCrossRef Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine 27:387–392PubMedCrossRef
20.
go back to reference Schwab F, Dubey A, Pagala M, Gamez L, Farcy JP (2003) Adult scoliosis: a health assessment analysis by SF-36. Spine 28:602–606PubMed Schwab F, Dubey A, Pagala M, Gamez L, Farcy JP (2003) Adult scoliosis: a health assessment analysis by SF-36. Spine 28:602–606PubMed
21.
go back to reference Suk KS, Kim KT, Lee SH, Kim JM (2003) Significance of chin–brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine 28:2001–2005PubMedCrossRef Suk KS, Kim KT, Lee SH, Kim JM (2003) Significance of chin–brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine 28:2001–2005PubMedCrossRef
22.
go back to reference van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arth Rheum 27:361–368CrossRef van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arth Rheum 27:361–368CrossRef
23.
go back to reference White AA 3rd, Panjabi MM, Thomas CL (1977) The clinical biomechanics of kyphotic deformities. Clin Orthop Relat Res 128:8–17PubMed White AA 3rd, Panjabi MM, Thomas CL (1977) The clinical biomechanics of kyphotic deformities. Clin Orthop Relat Res 128:8–17PubMed
24.
go back to reference Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC Jr, Dijkmans B, Dougados M, Géher P, Inman RD, Khan MA, Kvien TK, Leirisalo-Repo M, Olivieri I, Pavelka K, Sieper J, Stucki G, Sturrock RD, van der Linden S, Wendling D, Böhm H, van Royen BJ, Braun J (2006) ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 65:442–452PubMedCrossRef Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC Jr, Dijkmans B, Dougados M, Géher P, Inman RD, Khan MA, Kvien TK, Leirisalo-Repo M, Olivieri I, Pavelka K, Sieper J, Stucki G, Sturrock RD, van der Linden S, Wendling D, Böhm H, van Royen BJ, Braun J (2006) ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 65:442–452PubMedCrossRef
Metadata
Title
Correlation between clinical outcome and spinopelvic parameters in ankylosing spondylitis
Authors
Jong Ki Shin
Jung Sub Lee
Tae Sik Goh
Seung Min Son
Publication date
01-01-2014
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 1/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-013-2929-8

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