Novel radiographic parameters for the assessment of total body sagittal alignment in adult spinal deformity patients

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OBJECTIVE

In this study, the authors’ goal was to develop and validate novel radiographic parameters that better describe total body sagittal alignment (TBSA).

METHODS

One hundred sixty-six consecutive operative spinal deformity patients were evaluated using full-body stereoradiographic imaging. Seven TBSA parameters were measured and then correlated to 6 commonly used spinopelvic measurements. TBSA measures consisted of 4 distance measures relating the cranial center of mass (CCOM) to the sacrum, hips, knees, and ankles, and 3 angular measures relating the CCOM to the hips, knees, and ankles. Furthermore, each TBSA parameter was correlated to patient-reported outcome (PRO) scores using the Oswestry Disability Index (ODI) and Scoliosis Research Society–22 (SRS-22) instruments. Thirty patients were randomly selected for inter- and intraobserver reliability testing of the TBSA parameters using intraclass correlation coefficients (ICCs).

RESULTS

All TBSA radiographic parameters demonstrated strong linear correlation with the currently accepted primary measure of sagittal balance, the C7 sagittal vertical axis (r = 0.55–0.96, p < 0.001). Moreover, 5 of 7 TBSA measures correlated strongly with ODI and SRS-22 total scores (r = 0.42–0.51, p < 0.001). Inter- and intraobserver reliability for all TBSA measures was good to excellent (interrater ICC = 0.70–0.98, intrarater ICC = 0.77–1.0).

CONCLUSIONS

In spine deformity patients, novel TBSA radiographic parameters correlated well with PROs and with currently utilized spinal sagittal measurements. Inter- and intrarater reliability was high for these novel parameters. This is the first study to propose a reliable method for measuring head-to-toe global spinal alignment.

ABBREVIATIONS CCOM = cranial center of mass; CL = cervical lordosis; CrAS = cranium-ankle-sacrum angle; CrHS = cranium-hip-sacrum angle; CrKS = cranium-knee-sacrum angle; CrSVA = cranial SVA; CrSVA-A = CrSVA to the ankle; CrSVA-H = CrSVA to the hip center; CrSVA-K = CrSVA to the knee center; CrSVA-S = CrSVA to the sacrum; ICC = intraclass correlation coefficient; LL = lumbar lordosis; ODI = Oswestry Disability Index; PRO = patient-reported outcome; SRS-22 = Scoliosis Research Society–22; SVA = sagittal vertical axis; TBSA = total body sagittal alignment; TK = thoracic kyphosis; TLK = thoracolumbar kyphosis.
Article Information

Contributor Notes

Correspondence Ji Hao Cui: The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan City, China. cuispine@aliyun.com.INCLUDE WHEN CITING Published online May 24, 2019; DOI: 10.3171/2019.3.SPINE18703.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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