Clinical photographs in the assessment of adult spinal deformity: a comparison to radiographic parameters

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  • 1 Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
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OBJECTIVE

The goal of this study was to reliably predict sagittal and coronal spinal alignment with clinical photographs by using markers placed at easily localized anatomical landmarks.

METHODS

A consecutive series of patients with adult spinal deformity were enrolled from a single center. Full-length standing radiographs were obtained at the baseline visit. Clinical photographs were taken with reflective markers placed overlying C2, S1, the greater trochanter, and each posterior-superior iliac spine. Sagittal radiographic parameters were C2 pelvic angle (CPA), T1 pelvic angle (TPA), and pelvic tilt. Coronal radiographic parameters were pelvic obliquity and T1 coronal tilt. Linear regressions were performed to evaluate the relationship between radiographic parameters and their photographic “equivalents.” The data were reanalyzed after stratifying the cohort into low–body mass index (BMI) (< 30) and high-BMI (≥ 30) groups. Interobserver and intraobserver reliability was assessed for clinical measures via intraclass correlation coefficients (ICCs).

RESULTS

A total of 38 patients were enrolled (mean age 61 years, mean BMI 27.4 kg/m2, 63% female). All regression models were significant, but sagittal parameters were more closely correlated to photographic parameters than coronal measurements. TPA and CPA had the strongest associations with their photographic equivalents (both r2 = 0.59, p < 0.001). Radiographic and clinical parameters tended to be more strongly correlated in the low-BMI group. Clinical measures of TPA and CPA had high intraobserver reliability (all ICC > 0.99, p < 0.001) and interobserver reliability (both ICC > 0.99, p < 0.001).

CONCLUSIONS

The photographic measures of spinal deformity developed in this study were highly correlated with their radiographic counterparts and had high inter- and intraobserver reliability. Clinical photography can not only reduce radiation exposure in patients with adult spinal deformity, but also be used to assess deformity when full-spine radiographs are unavailable.

ABBREVIATIONS

ASD = adult spinal deformity; BMI = body mass index; CPA = C2 pelvic angle; CPAc = CPA clinical; GT = greater trochanter; PO = pelvic obliquity; POc = PO clinical; PSIS = posterior superior iliac spine; PT = pelvic tilt; PTc = PT clinical; TPA = T1 pelvic angle; TPAc = TPA clinical.
Illustrations from Walker et al. (pp 80–90). © Barrow Neurological Institute, Phoenix, Arizona.

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Contributor Notes

Correspondence Themistocles S. Protopsaltis: NYU Langone Orthopedic Hospital, New York, NY. themistocles.protopsaltis@langone.org.

INCLUDE WHEN CITING Published online May 14, 2021; DOI: 10.3171/2020.11.SPINE201732.

Disclosures Dr. Fischer—consulting and personal fees: Expert Connect, Stryker. Dr. Buckland—consulting and personal fees: NuVasive, Stryker. Dr. Errico—board or committee member: Harms Study Group (no funding provided). Dr. Protopsaltis—consulting and personal fees: Globus Medical, Stryker K2M, Medicrea, NuVasive, Medtronic; stock or stock options: SpineAlign; royalties: Altus.

  • 1

    Ames CP, Scheer JK, Lafage V, et al. . Adult spinal deformity: epidemiology, health impact, evaluation, and management. Spine Deform. 2016;4(4):310322.

    • Search Google Scholar
    • Export Citation
  • 2

    Pérennou D, Marcelli C, Hérisson C, Simon L. Adult lumbar scoliosis. epidemiologic aspects in a low-back pain population. Spine (Phila Pa 1976). 1994;19(2):123128.

    • Search Google Scholar
    • Export Citation
  • 3

    Francis RS. Scoliosis screening of 3,000 college-aged women. The Utah Study—phase 2. Phys Ther. 1988;68(10):15131516.

  • 4

    Carter OD, Haynes SG. Prevalence rates for scoliosis in US adults: results from the first National Health and Nutrition Examination Survey. Int J Epidemiol. 1987;16(4):537544.

    • Search Google Scholar
    • Export Citation
  • 5

    Schwab F, Dubey A, Gamez L, et al. . Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976). 2005;30(9):10821085.

    • Search Google Scholar
    • Export Citation
  • 6

    Glassman SD, Bridwell K, Dimar JR, et al. . The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005;30(18):20242029.

    • Search Google Scholar
    • Export Citation
  • 7

    Lafage V, Schwab F, Patel A, et al. . Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976). 2009;34(17):E599E606.

    • Search Google Scholar
    • Export Citation
  • 8

    Protopsaltis T, Schwab F, Bronsard N, et al. . The T1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life. J Bone Joint Surg Am. 2014;96(19):16311640.

    • Search Google Scholar
    • Export Citation
  • 9

    Schwab FJ, Lafage V, Farcy JP, et al. . Predicting outcome and complications in the surgical treatment of adult scoliosis. Spine (Phila Pa 1976). 2008;33(20):22432247.

    • Search Google Scholar
    • Export Citation
  • 10

    Bess S, Line B, Fu KM, et al. . The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases. Spine (Phila Pa 1976). 2016;41(3):224233.

    • Search Google Scholar
    • Export Citation
  • 11

    Ronckers CM, Land CE, Miller JS, et al. . Cancer mortality among women frequently exposed to radiographic examinations for spinal disorders. Radiat Res. 2010;174(1):8390.

    • Search Google Scholar
    • Export Citation
  • 12

    Protopsaltis T, Bronsard N, Soroceanu A, et al. . Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA. Eur Spine J. 2017;26(4):11111120.

    • Search Google Scholar
    • Export Citation
  • 13

    Ryan DJ, Protopsaltis TS, Ames CP, et al. . T1 pelvic angle (TPA) effectively evaluates sagittal deformity and assesses radiographical surgical outcomes longitudinally. Spine (Phila Pa 1976). 2014;39(15):12031210.

    • Search Google Scholar
    • Export Citation
  • 14

    Yagi M, Ames CP, Keefe M, et al. . A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan. Eur Spine J. 2018;27(3):678684.

    • Search Google Scholar
    • Export Citation
  • 15

    Schwab FJ, Blondel B, Bess S, et al. . Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976). 2013;38(13):E803E812.

    • Search Google Scholar
    • Export Citation
  • 16

    Lafage V, Diebo BG, Schwab F. Sagittal Spino-Pelvic Alignment: From the Theory to Clinical Application. Editorial Médica Panamericana;2014.

    • Search Google Scholar
    • Export Citation
  • 17

    Vialle R, Levassor N, Rillardon L, et al. . Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am. 2005;87(2):260267.

    • Search Google Scholar
    • Export Citation
  • 18

    Oren JH, Tishelman JC, Day LM, et al. . Measurement of spinopelvic angles on prone intraoperative long-cassette lateral radiographs predicts postoperative standing global alignment in adult spinal deformity surgery. Spine Deform. 2019;7(2):325330.

    • Search Google Scholar
    • Export Citation
  • 19

    Bridwell KH, Baldus C, Berven S, et al. . Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to three- to five-years follow-up. Spine (Phila Pa 1976). 2010;35(20):18491854.

    • Search Google Scholar
    • Export Citation
  • 20

    Smith JS, Shaffrey CI, Bess S, et al. . Recent and emerging advances in spinal deformity. Neurosurgery. 2017;80(3S):S70S85.

  • 21

    Ilharreborde B, Ferrero E, Alison M, Mazda K. EOS microdose protocol for the radiological follow-up of adolescent idiopathic scoliosis. Eur Spine J. 2016;25(2):526531.

    • Search Google Scholar
    • Export Citation

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