The spino-pelvic ratio: a novel global sagittal parameter associated with clinical outcomes in adult spinal deformity patients.,European Spine Journal

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The spino-pelvic ratio: a novel global sagittal parameter associated with clinical outcomes in adult spinal deformity patients.
European Spine Journal ( IF 2.6 ) Pub Date : 2020-06-01 , DOI: 10.1007/s00586-020-06472-x
Wesley M Durand ₁ , Alan H Daniels ₂ , David K Hamilton ₃ , Peter Passias ₄ , Han Jo Kim ₅ , Themistocles Protopsaltis ₄ , Virginie LaFage ₅ , Justin S Smith ₆ , Christopher Shaffrey ₇ , Munish Gupta ₈ , Michael P Kelly ₈ , Eric Klineberg ₉ , Frank Schwab ₅ , Doug Burton ₁₀ , Shay Bess ₁₁ , Christopher Ames ₁₂ , Robert Hart ₁₃ ,

Affiliation

Warren Alpert Medical School of Brown University, Providence, RI, USA.
Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI, 02914, USA.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA.
Hospital for Special Surgery, New York, NY, USA.
University of Virginia Health System, Charlottesville, VA, USA.
Duke University, Durham, NC, USA.
Washington University, St. Louis, MO, USA.
University of California-Davis, Sacramento, CA, USA.
University of Kansas Hospital, Kansas City, KS, USA.
Denver International Spine Center, Denver, CO, USA.
University of California-San Francisco, San Francisco, CA, USA.
Swedish Neuroscience Institute, Seattle, WA, USA.

Purpose

Analysis of interactions of spinal alignment metrics may uncover novel alignment parameters, similar to PI-LL. This study utilized a data-driven approach to hypothesis generation by testing all possible division interactions between spinal alignment parameters.

Methods

This study was a retrospective cohort analysis. In total, 1439 patients with baseline ODI were included for hypothesis generation. In total, 666 patients had 2-year postoperative follow-up and were included for validation. All possible combinations of division interactions between baseline metrics were assessed with linear regression against baseline ODI.

Results

From 247 raw alignment metrics, 32,398 division interactions were considered in hypothesis generation. Conceptually, the TPA divided by PI is a measure of the relative alignment of the line connecting T1 to the femoral head and the line perpendicular to the sacral endplate. The mean TPA/PI was 0.41 at baseline and 0.30 at 2 years postoperatively. Higher TPA/PI was associated with worse baseline ODI (p < 0.0001). The change in ODI at 2 years was linearly associated with the change in TPA/PI (p = 0.0172). The optimal statistical grouping of TPA/PI was low/normal (≤ 0.2), medium (0.2–0.4), and high (> 0.4). The R-squared for ODI against categorical TPA/PI alone (0.154) was directionally higher than that for each of the individual Schwab modifiers (SVA: 0.138, PI-LL 0.111, PT 0.057).

Conclusion

This study utilized a data-driven approach for hypothesis generation and identified the spino-pelvic ratio (TPA divided by PI) as a promising measure of sagittal spinal alignment among ASD patients. Patients with SPR > 0.2 exhibited inferior ODI scores.

Level of evidence

III.

中文翻译：

脊柱骨盆比率：与成人脊柱畸形患者临床结局相关的新的全局矢状参数。

目的

脊柱对准度量的相互作用的分析可以发现新颖的对准参数，类似于PI-LL。这项研究通过测试脊柱排列参数之间所有可能的除法相互作用，利用数据驱动的方法生成假设。

方法

这项研究是一项回顾性队列分析。总共包括1439例基线ODI患者以进行假设产生。总共666例患者接受了2年的术后随访，并纳入验证。基线指标之间的除法相互作用的所有可能组合均针对基线ODI进行了线性回归评估。

结果

从247个原始比对指标中，在假设生成中考虑了32,398个部门之间的相互作用。从概念上讲，TPA除以PI是连接T1到股骨头的线和垂直于the骨终板的线的相对对齐的量度。术后TPA / PI的平均值在基线为0.41，在术后2年为0.30。TPA / PI升高与基线ODI恶化相关（p <0.0001）。2年时ODI的变化与TPA / PI的变化线性相关（p = 0.0172）。TPA / PI的最佳统计分组为低/正常（≤0.2），中（0.2-0.4）和高（> 0.4）。ODI相对于单独的TPA / PI的R平方（0.154）在方向上高于各个Schwab修饰剂的S平方（SVA：0.138，PI-LL 0.111，PT 0.057）。