Abstract
BACKGROUND: Thresholds for spinal pelvic parameters in adult spinal deformity (ASD) were previously defined in North American patients and are commonly used to guide surgical planning. However, it is unclear whether these same threshold parameters can be more widely applied in other geographic regions and in other ethnicities. OBJECTIVE: To evaluate the variation in the radiographic disability thresholds between North American and Japanese ASD populations and to adjust sagittal modifier thresholds accordingly. METHODS: Retrospective case series of 717 patients with ASD who had baseline radiographs and Oswestry Disability Index (ODI) from North America (n 518) and Japan (n 199) were studied. Patients were compared at baseline for ODI, ODI offset from age- and ethnic-specific values (ODIni), and radiographic parameters. RESULTS: Significant differences in classification were observed: A greater proportion of Japanese patients had marked pelvic tilt deformity, whereas a greater proportion of US patients had marked SVA deformity; no difference in the pelvic incidence-lumbar lordosis mismatch sagittal modifier was observed. Health-related quality-of-life scores also differed, with a greater ODI raw value observed in the US patients but similar ODIni scores between cohorts. Stratifying ODIni scores by sagittal modifier grades revealed similar disability scores corresponding to the 0 to + thresholds for pelvic tilt, pelvic incidence-lumbar lordosis mismatch, and sagittal vertical axis across ethnicities. Finally, linear regression analysis demonstrated that compared with US patients, Japanese patients had a lower estimated ODI corresponding to established thresholds of radiographic deformity. CONCLUSION: Our findings demonstrate significant variability in health-related quality-of-life measures and radiographic parameters between North American and Japanese patients, supporting the need for population-adjusted sagittal modifiers to more accurately classify deformity.
| Original language | English |
|---|---|
| Pages (from-to) | 793-800 |
| Number of pages | 8 |
| Journal | Neurosurgery |
| Volume | 78 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 2016 Jun 1 |
| Externally published | Yes |
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Keywords
- Adult spinal deformity
- Ethnicity
- HRQOL
- Radiographic parameters
- Sagittal alignment
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
Geographic and ethnic variations in radiographic disability thresholds : Analysis of North American and Japanese operative adult spinal deformity populations. / Ames, Christopher; Gammal, Isaac; Matsumoto, Morio; Hosogane, Naobumi; Smith, Justin S.; Protopsaltis, Themistocles; Yamato, Yu; Matsuyama, Yukihiro; Taneichi, Hiroshi; Lafage, Renaud; Ferrero, Emmanuelle; Schwab, Frank J.; Lafage, Virginie.
In: Neurosurgery, Vol. 78, No. 6, 01.06.2016, p. 793-800.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Geographic and ethnic variations in radiographic disability thresholds
T2 - Analysis of North American and Japanese operative adult spinal deformity populations
AU - Ames, Christopher
AU - Gammal, Isaac
AU - Matsumoto, Morio
AU - Hosogane, Naobumi
AU - Smith, Justin S.
AU - Protopsaltis, Themistocles
AU - Yamato, Yu
AU - Matsuyama, Yukihiro
AU - Taneichi, Hiroshi
AU - Lafage, Renaud
AU - Ferrero, Emmanuelle
AU - Schwab, Frank J.
AU - Lafage, Virginie
PY - 2016/6/1
Y1 - 2016/6/1
N2 - BACKGROUND: Thresholds for spinal pelvic parameters in adult spinal deformity (ASD) were previously defined in North American patients and are commonly used to guide surgical planning. However, it is unclear whether these same threshold parameters can be more widely applied in other geographic regions and in other ethnicities. OBJECTIVE: To evaluate the variation in the radiographic disability thresholds between North American and Japanese ASD populations and to adjust sagittal modifier thresholds accordingly. METHODS: Retrospective case series of 717 patients with ASD who had baseline radiographs and Oswestry Disability Index (ODI) from North America (n 518) and Japan (n 199) were studied. Patients were compared at baseline for ODI, ODI offset from age- and ethnic-specific values (ODIni), and radiographic parameters. RESULTS: Significant differences in classification were observed: A greater proportion of Japanese patients had marked pelvic tilt deformity, whereas a greater proportion of US patients had marked SVA deformity; no difference in the pelvic incidence-lumbar lordosis mismatch sagittal modifier was observed. Health-related quality-of-life scores also differed, with a greater ODI raw value observed in the US patients but similar ODIni scores between cohorts. Stratifying ODIni scores by sagittal modifier grades revealed similar disability scores corresponding to the 0 to + thresholds for pelvic tilt, pelvic incidence-lumbar lordosis mismatch, and sagittal vertical axis across ethnicities. Finally, linear regression analysis demonstrated that compared with US patients, Japanese patients had a lower estimated ODI corresponding to established thresholds of radiographic deformity. CONCLUSION: Our findings demonstrate significant variability in health-related quality-of-life measures and radiographic parameters between North American and Japanese patients, supporting the need for population-adjusted sagittal modifiers to more accurately classify deformity.
AB - BACKGROUND: Thresholds for spinal pelvic parameters in adult spinal deformity (ASD) were previously defined in North American patients and are commonly used to guide surgical planning. However, it is unclear whether these same threshold parameters can be more widely applied in other geographic regions and in other ethnicities. OBJECTIVE: To evaluate the variation in the radiographic disability thresholds between North American and Japanese ASD populations and to adjust sagittal modifier thresholds accordingly. METHODS: Retrospective case series of 717 patients with ASD who had baseline radiographs and Oswestry Disability Index (ODI) from North America (n 518) and Japan (n 199) were studied. Patients were compared at baseline for ODI, ODI offset from age- and ethnic-specific values (ODIni), and radiographic parameters. RESULTS: Significant differences in classification were observed: A greater proportion of Japanese patients had marked pelvic tilt deformity, whereas a greater proportion of US patients had marked SVA deformity; no difference in the pelvic incidence-lumbar lordosis mismatch sagittal modifier was observed. Health-related quality-of-life scores also differed, with a greater ODI raw value observed in the US patients but similar ODIni scores between cohorts. Stratifying ODIni scores by sagittal modifier grades revealed similar disability scores corresponding to the 0 to + thresholds for pelvic tilt, pelvic incidence-lumbar lordosis mismatch, and sagittal vertical axis across ethnicities. Finally, linear regression analysis demonstrated that compared with US patients, Japanese patients had a lower estimated ODI corresponding to established thresholds of radiographic deformity. CONCLUSION: Our findings demonstrate significant variability in health-related quality-of-life measures and radiographic parameters between North American and Japanese patients, supporting the need for population-adjusted sagittal modifiers to more accurately classify deformity.
KW - Adult spinal deformity
KW - Ethnicity
KW - HRQOL
KW - Radiographic parameters
KW - Sagittal alignment
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U2 - 10.1227/NEU.0000000000001184
DO - 10.1227/NEU.0000000000001184
M3 - Article
VL - 78
SP - 793
EP - 800
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 6
ER -