European Spine Journal ( IF 2.8 ) Pub Date : 2020-06-02 , DOI: 10.1007/s00586-020-06474-9 Adam M Wegner 1 , Sravisht Iyer 2 , Lawrence G Lenke 3 , Han Jo Kim 2 , Michael P Kelly 4
Purpose
To investigate GAP scores in an asymptomatic cohort of adults, including older adults with age-expected changes in spinal alignment.
Methods
One hundred and twenty asymptomatic volunteers underwent full-body radiographic scans. Demographics and sagittal radiographic parameters (pelvic incidence, sacral slope, L1-S1 lordosis, L4-S1 lordosis, and global tilt) were measured and GAP scores calculated (www.gapcalculator.com). Mann–Whitney U test compared groups.
Results
Eighty-five individuals (65 female, average age 48 ± 16 years, BMI 27 ± 6 kg/cm2) were analyzed. The median GAP score was that of a proportioned spine (0, range 0–10). 20% were moderately disproportioned and 6% were severely disproportioned. The mean relative pelvic version, relative lumbar lordosis (RLL), lumbar distribution index (LDI), and relative spinopelvic alignment were all considered aligned, although the mean RLL and LDI scores were both greater than 1. When categorized by age (< 60 years, ≥ 60 years), the median GAP score of the younger group was 0 (normal), while the median GAP score of the older cohort was 1 (normal) and different from the younger group (p < 0.001).
Conclusion
Most patients in this asymptomatic, nonoperative cohort were normally proportioned. However, a large percentage of asymptomatic volunteers were moderately or severely disproportioned. Older patients had higher scores, indicating some disproportion. There was also a small number of severely sagittally misaligned and poorly proportioned, yet asymptomatic, volunteers. Further refinement of individualized targets is needed to determine the effect on mechanical complications and quality of life given the divergent recommendations of age-adjusted targets and GAP targets.
中文翻译:
无症状,非手术队列中的总体比对和比例(GAP)评分:年龄调整和基于骨盆发病率的比对目标存在差异。
目的
调查无症状人群的GAP评分,包括年龄较大的脊柱排列发生预期变化的成年人。
方法
120名无症状志愿者接受了全身X线扫描。测量人口统计学和矢状位影像学参数(骨盆发病率,骨斜率,L1-S1脊柱前凸,L4-S1脊柱前凸和整体倾斜),并计算GAP分数(www.gapcalculator.com)。Mann–Whitney U检验比较了各组。
结果
分析了八十五个人(65名女性,平均年龄48±16岁,BMI 27±6 kg / cm 2)。GAP得分的中位数是脊椎的比例得分(0,范围0-10)。20%为中等比例失调,而6%为严重比例失调。平均相对骨盆版本,相对腰椎前凸(RLL),腰椎分布指数(LDI)和相对脊髓盆腔排列均被认为是对齐的,尽管平均RLL和LDI得分均大于1。按年龄分类(<60岁) ,≥60岁),年轻组的GAP得分中位数为0(正常),而老年组的GAP得分中位数为1(正常),与年轻组不同(p <0.001)。
结论
在无症状,非手术队列中,大多数患者通常是按比例分配的。但是,无症状的志愿者中有很大比例是不适当的。老年患者得分较高,表明存在一定比例。也有少数严重的矢状错位和比例不佳但无症状的志愿者。考虑到年龄调整后的目标和GAP目标的不同建议,需要进一步细化个性化目标,以确定对机械并发症和生活质量的影响。