Abstract
STUDY DESIGN.: Prospective multicenter analysis of Adult Spinal Deformity (ASD) patients. OBJECTIVE.: To introduce the lumbar pelvic angle (LPA), a novel parameter of spinopelvic alignment. SUMMARY OF BACKGROUND DATA.: The T1 Pelvic angle (TPA), a measure of global spinopelvic alignment, correlates with HRQOL, but it may not be measureable on all intraoperative x-rays. In patients with prior interbody fusion at L5-S1, the plane of the S1 endplate can be blurred, creating error in PI-LL measure. The Lumbar Pelvic Angle (LPA) is more readily measured on intraoperative imaging than the TPA. METHODS.: ASD patients were included with either coronal Cobb angle >20°, SVA>5?cm, thoracic kyphosis>60°, or PT >25°. Measures of disability included ODI, SRS and SF36. Baseline and 2-yr follow-up radiographic and HRQOL outcomes were evaluated. Linear regressions compared LPA with radiographic parameters and HRQOL. RESULTS.: 852 ASD patients (407 operative) were enrolled (mean age 53.7). Baseline LPA correlated with PI-LL (r?=?0.79), PT (r?=?0.78), TPA (r?=?0.82) and SVA (r?=?0.61) (all p?<?0.001). PI-LL, LPA and TPA correlated with ODI (r?=?0.42/0.29/0.45), SF36 PCS (-0.43/-0.28/-.45) SRS (-0.354/-0.23/-.37) with all p?<?0.001. At 2-years follow-up, LPA correlated with PI-LL (r?=?0.77), PT (r?=?0.78), TPA (r?=?0.83) and SVA (r?=?0.57) (all p?<?0.001). Categorizing patients by increasing LPA (<7°; 7–15°; >15°) revealed progressive increases in all HRQOL, PI-LL (-3.2°/12.7°/32.4°) and TPA (9.7°/20.1°/34.6°) with all p?<?0.001. Moderate disability (ODI?=?40) corresponded to LPA 10.1°, PI-LL 12.6° and TPA 20.6°. Mild disability (ODI?=?20) corresponded to LPA 7.2°, PI-LL 4.2° and TPA 14.7°. CONCLUSIONS.: LPA correlates with TPA, PI-LL and HRQOL in ASD patients. LPA can be used as an intraoperative tool to gauge correction with a target LPA of less than 7.2°. LPA predicts global alignment as it correlates with baseline and 2 year TPA and SVA. Along with the CTPA and TPA, LPA completes the fan of spinopelvic alignment.Level of Evidence: 3
| Original language | English (US) |
|---|---|
| Journal | Spine |
| DOIs | |
| State | Accepted/In press - Jul 24 2017 |
Fingerprint
ASJC Scopus subject areas
- Orthopedics and Sports Medicine
- Clinical Neurology
Cite this
The Lumbar Pelvic Angle (LPA), the Lumbar Component of the T1 Pelvic Angle, Correlates with HRQOL, PI-LL Mismatch and it Predicts Global Alignment. / International Spine Study Group.
In: Spine, 24.07.2017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The Lumbar Pelvic Angle (LPA), the Lumbar Component of the T1 Pelvic Angle, Correlates with HRQOL, PI-LL Mismatch and it Predicts Global Alignment
AU - International Spine Study Group.
AU - Protopsaltis, Themistocles S.
AU - Lafage, Renaud
AU - Smith, Justin S.
AU - Passias, Peter G.
AU - Shaffrey, Christopher I.
AU - Kim, Han Jo
AU - Mundis, Gregory M.
AU - Ames, Christopher P.
AU - Burton, Douglas C.
AU - Bess, Shay
AU - Klineberg, Eric Otto
AU - Hart, Robert A.
AU - Schwab, Frank J.
AU - Lafage, Virginie
PY - 2017/7/24
Y1 - 2017/7/24
N2 - STUDY DESIGN.: Prospective multicenter analysis of Adult Spinal Deformity (ASD) patients. OBJECTIVE.: To introduce the lumbar pelvic angle (LPA), a novel parameter of spinopelvic alignment. SUMMARY OF BACKGROUND DATA.: The T1 Pelvic angle (TPA), a measure of global spinopelvic alignment, correlates with HRQOL, but it may not be measureable on all intraoperative x-rays. In patients with prior interbody fusion at L5-S1, the plane of the S1 endplate can be blurred, creating error in PI-LL measure. The Lumbar Pelvic Angle (LPA) is more readily measured on intraoperative imaging than the TPA. METHODS.: ASD patients were included with either coronal Cobb angle >20°, SVA>5?cm, thoracic kyphosis>60°, or PT >25°. Measures of disability included ODI, SRS and SF36. Baseline and 2-yr follow-up radiographic and HRQOL outcomes were evaluated. Linear regressions compared LPA with radiographic parameters and HRQOL. RESULTS.: 852 ASD patients (407 operative) were enrolled (mean age 53.7). Baseline LPA correlated with PI-LL (r?=?0.79), PT (r?=?0.78), TPA (r?=?0.82) and SVA (r?=?0.61) (all p?<?0.001). PI-LL, LPA and TPA correlated with ODI (r?=?0.42/0.29/0.45), SF36 PCS (-0.43/-0.28/-.45) SRS (-0.354/-0.23/-.37) with all p?<?0.001. At 2-years follow-up, LPA correlated with PI-LL (r?=?0.77), PT (r?=?0.78), TPA (r?=?0.83) and SVA (r?=?0.57) (all p?<?0.001). Categorizing patients by increasing LPA (<7°; 7–15°; >15°) revealed progressive increases in all HRQOL, PI-LL (-3.2°/12.7°/32.4°) and TPA (9.7°/20.1°/34.6°) with all p?<?0.001. Moderate disability (ODI?=?40) corresponded to LPA 10.1°, PI-LL 12.6° and TPA 20.6°. Mild disability (ODI?=?20) corresponded to LPA 7.2°, PI-LL 4.2° and TPA 14.7°. CONCLUSIONS.: LPA correlates with TPA, PI-LL and HRQOL in ASD patients. LPA can be used as an intraoperative tool to gauge correction with a target LPA of less than 7.2°. LPA predicts global alignment as it correlates with baseline and 2 year TPA and SVA. Along with the CTPA and TPA, LPA completes the fan of spinopelvic alignment.Level of Evidence: 3
AB - STUDY DESIGN.: Prospective multicenter analysis of Adult Spinal Deformity (ASD) patients. OBJECTIVE.: To introduce the lumbar pelvic angle (LPA), a novel parameter of spinopelvic alignment. SUMMARY OF BACKGROUND DATA.: The T1 Pelvic angle (TPA), a measure of global spinopelvic alignment, correlates with HRQOL, but it may not be measureable on all intraoperative x-rays. In patients with prior interbody fusion at L5-S1, the plane of the S1 endplate can be blurred, creating error in PI-LL measure. The Lumbar Pelvic Angle (LPA) is more readily measured on intraoperative imaging than the TPA. METHODS.: ASD patients were included with either coronal Cobb angle >20°, SVA>5?cm, thoracic kyphosis>60°, or PT >25°. Measures of disability included ODI, SRS and SF36. Baseline and 2-yr follow-up radiographic and HRQOL outcomes were evaluated. Linear regressions compared LPA with radiographic parameters and HRQOL. RESULTS.: 852 ASD patients (407 operative) were enrolled (mean age 53.7). Baseline LPA correlated with PI-LL (r?=?0.79), PT (r?=?0.78), TPA (r?=?0.82) and SVA (r?=?0.61) (all p?<?0.001). PI-LL, LPA and TPA correlated with ODI (r?=?0.42/0.29/0.45), SF36 PCS (-0.43/-0.28/-.45) SRS (-0.354/-0.23/-.37) with all p?<?0.001. At 2-years follow-up, LPA correlated with PI-LL (r?=?0.77), PT (r?=?0.78), TPA (r?=?0.83) and SVA (r?=?0.57) (all p?<?0.001). Categorizing patients by increasing LPA (<7°; 7–15°; >15°) revealed progressive increases in all HRQOL, PI-LL (-3.2°/12.7°/32.4°) and TPA (9.7°/20.1°/34.6°) with all p?<?0.001. Moderate disability (ODI?=?40) corresponded to LPA 10.1°, PI-LL 12.6° and TPA 20.6°. Mild disability (ODI?=?20) corresponded to LPA 7.2°, PI-LL 4.2° and TPA 14.7°. CONCLUSIONS.: LPA correlates with TPA, PI-LL and HRQOL in ASD patients. LPA can be used as an intraoperative tool to gauge correction with a target LPA of less than 7.2°. LPA predicts global alignment as it correlates with baseline and 2 year TPA and SVA. Along with the CTPA and TPA, LPA completes the fan of spinopelvic alignment.Level of Evidence: 3
UR - http://www.scopus.com/inward/record.url?scp=85025828851&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85025828851&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000002346
DO - 10.1097/BRS.0000000000002346
M3 - Article
C2 - 28742755
AN - SCOPUS:85025828851
JO - Spine
JF - Spine
SN - 0362-2436
ER -