Correlation of radiographic parameters and clinical symptoms in adult scoliosis

Steven D. Glassman, Sigurd Berven, Keith Bridwell, William Horton, John R. Dimar

Research output: Contribution to journalReview articlepeer-review

691 Scopus citations

Abstract

Study Design. This study is a retrospective review of the initial enrollment data from a prospective multicentered study of adult spinal deformity. Objectives. The purpose of this study is to correlate radiographic measures of deformity with patient-based outcome measures in adult scoliosis. Summary of Background Data. Prior studies of adult scoliosis have attempted to correlate radiographic appearance and clinical symptoms, but it has proven difficult to predict health status based on radiographic measures of deformity alone. The ability to correlate radiographic measures of deformity with symptoms would be useful for decision-making and surgical planning. Methods. The study correlates radiographic measures of deformity with scores on the Short Form-12, Scoliosis Research Society-29, and Oswestry profiles. Radiographic evaluation was performed according to an established positioning protocol for anteroposterior and lateral 36-inch standing radiographs. Radiographic parameters studied were curve type, curve location, curve magnitude, coronal balance, sagittal balance, apical rotation, and rotatory subluxation. Results. The 298 patients studied include 172 with no prior surgery and 126 who had undergone prior spine fusion. Positive sagittal balance was the most reliable predictor of clinical symptoms in both patient groups. Thoracolumbar and lumbar curves generated less favorable scores than thoracic curves in both patient groups. Significant coronal imbalance of greater than 4 cm was associated with deterioration in pain and function scores for unoperated patients but not in patients with previous surgery. Conclusions. This study suggests that restoration of a more normal sagittal balance is the critical goal for any reconstructive spine surgery. The study suggests that magnitude of coronal deformity and extent of coronal correction are less critical parameters.

Original languageEnglish
Pages (from-to)682-688
Number of pages7
JournalSpine
Volume30
Issue number6
DOIs
StatePublished - Mar 1 2005

Keywords

  • Adult scoliosis
  • Outcome measures
  • Radiographic measures
  • Sagittal balance

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