Objective

To raise the diagnostic criteria, classification and treatment strategy of dynamic sagittal imbalance (DSI).

Methods

One hundred thirty-three adult spinal deformity (ASD) patients with stooping and back pain after walking were retrospectively analyzed. Based on the radiographic parameters and Oswestry Disability Index (ODI) scores, the diagnostic criteria of DSI were raised. DSI patients received nonoperative treatment and (or) surgery. Radiographic parameters and health-related quality of life (HRQOL) outcomes would be measured and compared between prewalk and postwalk and among each subgroup.

Results

One hundred thirty-three ASD patients with stooping and back pain after walking were enrolled in our study. The quantitative diagnostic criteria was prewalk SVA < 40 mm and postwalk SVA-prewalk SVA ≥ 20 mm after 10-min walk. Based on the quantitative diagnostic criteria of DSI raised by our team, DSI patients could be classified into three groups: 20 mm ≤ ΔSVA < 60 mm (mild, 31.0%), 60 mm ≤ ΔSVA < 100 mm (moderate, 42.1%) and ΔSVA ≥ 100 mm (severe, 27.0%). After nonoperative treatment, the ΔSVA in mild and moderate group was prominently decreased (P < 0.001) with the significant improvement of HRQOL outcomes (P < 0.001), while there was no significant change in ΔSVA and clinical outcomes in group C (P > 0.05). Patients who received the operative treatment showed prominent improvement in ΔSVA and clinical outcomes (P < 0.001).

Conclusion

Our study proposed a quantitative diagnostic criteria and novel classification of DSI. Nonoperative treatment is effective for most DSI patients with ΔSVA < 100 mm, while the majority of DSI patients with ΔSVA ≥ 100 mm need operative intervention.

中文翻译：

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成人脊柱畸形动态矢状位失衡的特征及治疗。

目的

为了提高动态矢状位不平衡（DSI）的诊断标准，分类和治疗策略。

方法

回顾性分析了133例成人脊柱畸形（ASD）患者在行走后出现弯腰和背痛的情况。基于放射学参数和Oswestry残疾指数（ODI）评分，提出了DSI的诊断标准。DSI患者接受非手术治疗和（或）手术。放射线参数和与健康有关的生活质量（HRQOL）结果将被测量，并在步行前和步行后以及每个亚组之间进行比较。

结果

我们的研究纳入了133名ASD患者，这些患者在行走后会下弯和背痛。定量诊断标准为行走10分钟后行走前SVA <40 mm，行走后SVA-行走前SVA≥20 mm。根据我们团队提出的DSI定量诊断标准，DSI患者可分为三组：20 mm≤ΔSVA<60 mm（轻度，31.0％），60 mm≤ΔSVA<100 mm（中度，42.1％）和ΔSVA≥100毫米（严重，27.0％）。非手术治疗后，轻度和中度组的ΔSVA显着下降（P  <0.001），HRQOL结果显着改善（P  <0.001），而C组的ΔSVA和临床结局无明显变化（P > 0.05）。接受手术治疗的患者在ΔSVA和临床结局方面均表现出显着改善（P  <0.001）。

结论

我们的研究提出了定量诊断标准和DSI的新颖分类。对于大多数ΔSVA<100 mm的DSI患者，非手术治疗有效，而大多数ΔSVA≥100 mm的DSI患者需要手术干预。