Comparison of structural disease burden to health-related quality of life scores in 264 adult spinal deformity patients with 2-year follow-up: Novel insights into drivers of disability

Joshua Bakhsheshian, Justin K. Scheer, Jeffrey L. Gum, Lance Horner, Richard Hostin, Virginie Lafage, Shay Bess, Themistocles S. Protopsaltis, Douglas C. Burton, Malla Keefe, Robert A. Hart, Gregory M. Mundis, Christopher I. Shaffrey, Frank Schwab, Justin S. Smith, Christopher P. Ames

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Study Design: This is a review of a prospective multicenter database. Objective: To investigate the relationship between preoperative disability and sagittal deformity in patients with high Oswestry Disability Index (ODI) and no sagittal malalignment, or low ODI and high sagittal malalignment. Summary of Background Data: The relationship between ODI and sagittal malalignment varies between each adult spinal deformity (ASD) patient. Methods: A prospective multicenter database of 365 patients with ASD undergoing surgical reconstruction was analyzed. Inclusion criteria entailed: age 18 years or above and the presence of spinal deformity as defined by a coronal Cobb angle≥20 degrees, sagittal vertical axis (SVA)≥5 cm, pelvic tilt (PT) angle≥25 degrees, or thoracic kyphosis≥60 degrees. Radiographic and health-related quality of life (HRQOL) variables were examined and compared, preoperatively and at 2-year postoperative follow-up. Group 1 (low disability high sagittal - LDHS) consisted of ODI<40 and SVA≥5 cm or PT≥25 degrees or pelvic incidence-lumbar lordosis≥11 degrees and group 2 (high disability low sagittal - HDLS) consisted of ODI>40 and SVA<5 cm and PT<25 degrees and pelvic incidence-lumbar lordosis<11 degrees. Results: Of 264 patients with follow-up, 58 (22.0%) patients were included in LDHS and 30 (11.4%) were included in HDLS. Both groups had similar demographics and preoperative coronal angles. HDLS had worse baseline HRQOL for all measures (P<0.05) except leg and back pain. HDLS had a higher rate of self-reported leg weakness, arthritis, depression and neurological disorder. Both groups had similar 2-year improvements in HRQOL (P>0.05), except only HDLS had a significant Scoliosis Research Society Mental improvement and a significantly higher rate of reaching minimal clinically important differences in Scoliosis Research Society Mental scores (P<0.05). Conclusions: There is an association of worse baseline HRQOL measures, weakness, arthritis, and mental disease in HDLS. Furthermore, HDLS patients demonstrated similar improvements to LDHS. However, HDLS had greater improvements in the mental domains, perhaps indicating the responsiveness of the mental disability to surgical treatment. Level of Evidence: Level III.

Original languageEnglish (US)
Pages (from-to)E124-E131
JournalClinical Spine Surgery
Issue number2
StatePublished - Jan 1 2017


  • adult spinal deformity
  • health-related quality of life
  • mental health
  • sagittal alignment
  • sagittal vertical axis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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