INFLUENCE OF THE SAGITTAL BALANCE ON THE CLINICAL OUTCOME IN SPINAL FUSION

Coutinho, Marcela Almeida Campos; Pratali, Raphael de Rezende; Motta, Marcel Machado da; Hoffman, Carla Balkanyi; Barsotti, Carlos Eduardo Gonçales; Santos, Francisco Prado Eugenio dos; Oliveira, Carlos Eduardo Algaves Soares de

doi:10.1590/S1808-185120161501153517

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Coluna/Columna 15 (1) • Jan-Mar 2016 • https://doi.org/10.1590/S1808-185120161501153517 copy

INFLUENCE OF THE SAGITTAL BALANCE ON THE CLINICAL OUTCOME IN SPINAL FUSION

INFLUÊNCIA DO EQUILÍBRIO SAGITAL NO RESULTADO CLÍNICO DE ARTRODESE DA COLUNA VERTEBRAL

INFLUENCIA DEL EQUILIBRIO SAGITAL EN EL RESULTADO CLÍNICO DE LA FUSIÓN DE COLUMNA VERTEBRAL

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

Evaluates which radiographic parameters of the sagittal and spinopelvic balance influence the clinical and functional outcomes of a sample of patients undergoing spinal fusion.

Methods:

We studied 32 patients who underwent spinal fusion. Radiographs of the total spine were obtained from all patients. The clinical and functional parameters studied were analysis of pain by visual analogic scale (VAS) and Oswestry and SRS-30 questionnaires. We analyzed the correlation between the clinical and functional parameters and radiographic parameters of the sagittal and spinopelvic balance.

Results:

There was no significant correlation between parameters pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL) and difference between PI and LL (PI-LL) and clinical parameters (p > 0.05 and r <0.2). Significant correlation were identified only between Sagittal Vertical Axis (SVA) and Satisfaction with Treatment domain of SRS-30 (r = 0.402 e p = 0.023) and between thoracic kyphosis (TK) and the total SRS-30 (r = 0.419 and p = 0.017).

Conclusions:

According to the study results, it was not possible to precisely characterize the role of the parameters of the sagittal and spinopelvic balance in the post-operative analysis of the clinical outcome of spinal fusion. There was a significant correlation only between SVA and the Satisfaction with Treatment domain of SRS-30 and between TK and total SRS-30.

Keywords:
Arthrodesis; Spine; Postural balance; Lordosis; Low back pain; Kyphosis

Variable	Mean	SD	P25	Median	P75	N
Weight (Kg)	79.23	14.32	76.50	55.00	110.00	32
Height (cm)	165.50	9.40	164.00	153.00	188.00	32
BMI (Kg/m²⁾	28.96	5.20	28.05	20.90	40.80	32
Abdominal Circumference (cm)	97.69	8.35	98.50	82.00	115.50	32
SVA(mm)	49.51	53.01	41.35	-19.17	210.15	32
SS (°)	34.31	10.93	36.50	0.00	55.00	32
PT (°)	20.63	9.62	18.50	2.00	47.00	32
PI (°)	55.59	10.06	56.00	40.00	75.00	32
TK (°)	36.59	13.17	35.00	14.00	66.00	32
Lumbar lordosis (°)	43.64	14.71	42.50	-3.00	64.00	32
PI-LL (°)	12.00	14.37	9.50	-9.00	56.00	32
Oswestry (%)	39.88	14.86	36.00	18.00	62.00	32
Function/activity	18.38	4.14	17.00	10.00	27.00	32
Pain	17.06	3.11	18.00	11.00	21.00	32
Self-image	29.84	5.62	29.50	17.00	40.00	32
Mental Health	13.34	2.03	13.00	11.00	18.00	32
Satisfaction w/ treatment	11.63	2.61	12.00	6.00	17.00	32
SRS-30 Total	91.50	12.90	94.50	66.00	110.00	32

Correlation		Oswestry (%)	Function/ activity	Pain	Self-image	Mental Health	Satisfaction w/ treatment	SRS-30 Total
Weight (Kg)	r	0.096	-0.122	-0.093	-0.213	-0.220	-0.255	-0.242
Weight (Kg)	p	0.600	0.506	0.614	0.242	0.226	0.158	0.182
Height (cm)	r	0.110	-0.069	-0.123	0.132	0.180	0.120	0.026
Height (cm)	p	0.549	0.708	0.504	0.473	0.323	0.514	0.886
BMI (Kg/m²⁾	r	0.034	-0.091	-0.009	-0.290	-0.318	-0.309	-0.263
BMI (Kg/m²⁾	p	0.853	0.622	0.961	0.107	0.076	0.085	0.146
Abdominal Circumference (cm)	r	-0.010	-0.135	0.056	-0.333	-0.101	-0.327	-0.289
Abdominal Circumference (cm)	p	0.955	0.461	0.761	0.062	0.582	0.068	0.108
SVA (mm)	r	0.273	-0.046	-0.089	0.164	-0.024	0.400	0.049
SVA (mm)	p	0.131	0.805	0.630	0.370	0.895	0.023	0.788
SS (°)	r	-0.112	-0.145	-0.037	0.164	0.091	-0.005	0.031
SS (°)	p	0.541	0.430	0.842	0.371	0.620	0.979	0.866
PT (°)	r	0.027	-0.210	-0.011	-0.165	-0.086	0.025	-0.115
PT (°)	p	0.883	0.248	0.952	0.368	0.640	0.892	0.530
PI (°)	r	-0.060	-0.193	0.033	0.104	0.062	0.078	0.046
PI (°)	p	0.745	0.290	0.859	0.571	0.734	0.673	0.804
TK (°)	r	-0.272	0.329	0.318	0.253	0.114	0.125	0.419
TK (°)	p	0.132	0.066	0.076	0.163	0.534	0.496	0.017
LL (°)	r	-0.259	0.142	0.149	0.182	0.143	-0.092	0.160
LL (°)	p	0.152	0.437	0.417	0.320	0.434	0.616	0.381
PI-LL (°)	r	0.164	0.169	0.340	0.059	0.093	0.010	0.095
PI-LL (°)	p	0.370	0.356	0.057	0.748	0.612	0.955	0.605

Correlation (mm)		SVA	SS	PT	LL
SS	r	-0.416
SS	p	0.018
PT	r	0.461	-0.346
PT	p	0.008	0.052
LL	r	-0.668	0.678	-0.529
LL	p	<0.001	<0.001	0.002
PI-LL	r	0.169	-0.140	0.378	-0.071
PI-LL	p	0.354	0.444	0.033	0.700

Variable	Model	Factor	Coefficient	Standard error	Value t	p
Oswestry (%)	Initial	Constant	53.74	17.24	3.12	0.004
		VAS	0.049	0.069	0.70	0.489
		PT	-0.455	0.360	-1.26	0.218
		LL	-0.390	0.325	-1.20	0.241
		PI-LL	0.248	0.207	1.20	0.242
	Final	Constant	39.88	2.63	15.18	<0.001
SRS-30 Total	Initial	Constant	81.30	15.52	5.24	<0.001
		VAS	0.072	0.062	1.15	0.260
		PT	-0.178	0.324	-0.55	0.589
		LL	0.343	0.293	1.17	0.251
		PI-LL	0.092	0.186	0.50	0.625
	Final	Constant	91.50	2.28	40.14	<0.001
VAS pain	Initial	Constant	5.879	3.359	1.75	0.091
		VAS	-0.001	0.062	1.15	0.260
		PT	-0.224	0.419	-0.54	0.597
		LL	0.216	0.417	0.52	0.609
		PI-LL	0.205	0.412	0.50	0.623
	Final	Constant	5.219	0.491	10.62	<0.001

Sociedade Brasileira de Coluna Al. Lorena, 1304 cj. 1406/1407, 01424-001 São Paulo, SP, Brasil, Tel.: (55 11) 3088-6616 - São Paulo - SP - Brazil
E-mail: coluna.columna@uol.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Raphael de Rezende Pratali-Rua Borges Lagoa, 1755, Sala 180, Vila Clementino, São Paulo, SP, Brazil. 04038-034. pratalir@gmail.com