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Published in: European Spine Journal 6/2015

01-06-2015 | Original Article

Relationship between cervical sagittal alignment and quality of life in ankylosing spondylitis

Authors: Jung Sub Lee, Myung Soo Youn, Jong Ki Shin, Tae Sik Goh, Sung Shik Kang

Published in: European Spine Journal | Issue 6/2015

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Abstract

Purpose

Little information is available on the relationship between cervical sagittal alignment and health-related quality of life (HRQOL) in ankylosing spondylitis (AS) patients. The aim of this study was to identify relationships between cervical sagittal alignment and HRQOL in AS.

Methods

The study and control groups comprised 102 AS patients (15 women and 87 men) and age- and sex-matched 50 controls, respectively. All underwent anteroposterior and lateral radiographs and completed clinical questionnaires. The radiographic parameters examined were C2–C7 lordosis, C2–C7 sagittal vertical axis (SVA), T1 slope and T1 slope minus C2–C7 lordosis (TS-CL). A visual analogue scale (VAS 0–10) score for neck pain, the neck disability index (NDI), neck pain and disability (NPAD) scale and bath ankylosing spondylitis disease activity index (BASDAI) were administered to evaluate QOL. Statistical analysis was performed to determine the significances of differences between the study and control groups. In addition, correlations between radiological parameters and clinical questionnaires were sought.

Results

AS patients and controls were found to be different significantly in terms of C2–C7 SVA, T1 slope, and TS-CL. However, no significant intergroup difference was observed for C2–C7 lordosis (P > 0.05). Correlation analysis revealed significant relationships between radiographic parameters and QOL. Multiple regression analysis was performed to identify predictors of QOL, and the results obtained revealed that C2–C7 SVA significantly predicted VAS, NDI, and NPAD scores and that age predicted NPAD score.

Conclusions

Cervical sagittal parameters were found to be significantly different in AS patients and normal controls. Correlation analysis revealed significant relationships between radiographic parameters and QOL. In particular, C2–C7 SVA was found to be a significant predictor of QOL in AS patient.
Literature
1.
go back to reference Belanger TA, Milam RA 4th, Roh JS, Bohlman HH (2005) Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis. J Bone Jt Surg Am 87:1732–1738CrossRef Belanger TA, Milam RA 4th, Roh JS, Bohlman HH (2005) Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis. J Bone Jt Surg Am 87:1732–1738CrossRef
2.
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 15:415–422CrossRefPubMedCentralPubMed 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 15:415–422CrossRefPubMedCentralPubMed
3.
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
4.
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 19:65–70CrossRefPubMedCentralPubMed 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 19:65–70CrossRefPubMedCentralPubMed
5.
go back to reference Etame AB, Than KD, Wang AC, La Marca F, Park P (2008) Surgical management of symptomatic cervical or cervicothoracic kyphosis due to ankylosing spondylitis. Spine 33:E559–E564CrossRefPubMed Etame AB, Than KD, Wang AC, La Marca F, Park P (2008) Surgical management of symptomatic cervical or cervicothoracic kyphosis due to ankylosing spondylitis. Spine 33:E559–E564CrossRefPubMed
6.
go back to reference Faldini C, Pagkrati S, Leonetti D, Miscione MT, Giannini S (2011) Sagittal segmental alignment as predictor of adjacent-level degeneration after a cloward procedure. Clin Orthop Relat Res 469:674–681CrossRefPubMedCentralPubMed Faldini C, Pagkrati S, Leonetti D, Miscione MT, Giannini S (2011) Sagittal segmental alignment as predictor of adjacent-level degeneration after a cloward procedure. Clin Orthop Relat Res 469:674–681CrossRefPubMedCentralPubMed
7.
go back to reference Hardacker JW, Shuford RF, Capicotto PN, Pryor PW (1997) Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine 22:1472–1480CrossRefPubMed Hardacker JW, Shuford RF, Capicotto PN, Pryor PW (1997) Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine 22:1472–1480CrossRefPubMed
8.
go back to reference Hoh DJ, Khoueir P, Wang MY (2008) Management of cervical deformity in ankylosing spondylitis. Neurosurg Focus 24:E9CrossRefPubMed Hoh DJ, Khoueir P, Wang MY (2008) Management of cervical deformity in ankylosing spondylitis. Neurosurg Focus 24:E9CrossRefPubMed
9.
go back to reference Katsuura A, Kukuda S, Saruhashi Y, Mori K (2001) Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:320–324CrossRefPubMedCentralPubMed Katsuura A, Kukuda S, Saruhashi Y, Mori K (2001) Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:320–324CrossRefPubMedCentralPubMed
10.
go back to reference Knott PT, Mardjetko SM, Techy F (2010) The use of the T1 sagittal angle in predicting overall sagittal balance of the spine. Spine J 10:994–998CrossRefPubMed Knott PT, Mardjetko SM, Techy F (2010) The use of the T1 sagittal angle in predicting overall sagittal balance of the spine. Spine J 10:994–998CrossRefPubMed
11.
go back to reference Kuntz C 4th, Levin LS, Ondra SL, Shaffrey CI, Morgan CJ (2007) Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine 6:104–112CrossRefPubMed Kuntz C 4th, Levin LS, Ondra SL, Shaffrey CI, Morgan CJ (2007) Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine 6:104–112CrossRefPubMed
12.
13.
go back to reference McMaster MJ (1997) Osteotomy of the cervical spine in ankylosing spondylitis. J Bone Jt Surg Br 79:197–203CrossRef McMaster MJ (1997) Osteotomy of the cervical spine in ankylosing spondylitis. J Bone Jt Surg Br 79:197–203CrossRef
15.
go back to reference Park MS, Kelly MP, Lee DH, Min WK, Rahman RK, Riew KD (2013) Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis. Spine J (in press) Park MS, Kelly MP, Lee DH, Min WK, Rahman RK, Riew KD (2013) Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis. Spine J (in press)
16.
go back to reference Shin JK, Lee JS, Goh TS, Son SM (2014) Correlation between clinical outcome and spinopelvic parameters in ankylosing spondylitis. Eur Spine J 23:242–247CrossRefPubMedCentralPubMed Shin JK, Lee JS, Goh TS, Son SM (2014) Correlation between clinical outcome and spinopelvic parameters in ankylosing spondylitis. Eur Spine J 23:242–247CrossRefPubMedCentralPubMed
17.
go back to reference Song JS, Choi BW, Song KJ (2013) Risk factors for the development of adjacent segment disease following anterior cervical arthrodesis for degenerative cervical disease: Comparison between fusion methods. J Clin Neurosci (in press) Song JS, Choi BW, Song KJ (2013) Risk factors for the development of adjacent segment disease following anterior cervical arthrodesis for degenerative cervical disease: Comparison between fusion methods. J Clin Neurosci (in press)
18.
go back to reference Song KJ, Choi BW, Choi BR, Seo GB (2010) Cross-cultural adaptation and validation of the Korean version of the neck disability index. Spine 20:E1045–E1049CrossRef Song KJ, Choi BW, Choi BR, Seo GB (2010) Cross-cultural adaptation and validation of the Korean version of the neck disability index. Spine 20:E1045–E1049CrossRef
19.
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. Arthritis Rheum 27:361–368CrossRefPubMed 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. Arthritis Rheum 27:361–368CrossRefPubMed
20.
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
21.
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 65:442–452CrossRefPubMedCentralPubMed 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 65:442–452CrossRefPubMedCentralPubMed
Metadata
Title
Relationship between cervical sagittal alignment and quality of life in ankylosing spondylitis
Authors
Jung Sub Lee
Myung Soo Youn
Jong Ki Shin
Tae Sik Goh
Sung Shik Kang
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 6/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-014-3491-8

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