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Correlation of Radiographic Parameters and Clinical Symptoms in Adult Scoliosis

Glassman, Steven D., MD*; Berven, Sigurd, MD; Bridwell, Keith, MD; Horton, William, MD§; Dimar, John R., MD*

doi: 10.1097/01.brs.0000155425.04536.f7

Study Design. This study is a retrospective review of the initial enrollment data from a prospective multicentered study of adult spinal deformity.

Objectives. The purpose of this study is to correlate radiographic measures of deformity with patient-based outcome measures in adult scoliosis.

Summary of Background Data. Prior studies of adult scoliosis have attempted to correlate radiographic appearance and clinical symptoms, but it has proven difficult to predict health status based on radiographic measures of deformity alone. The ability to correlate radiographic measures of deformity with symptoms would be useful for decision-making and surgical planning.

Methods. The study correlates radiographic measures of deformity with scores on the Short Form-12, Scoliosis Research Society-29, and Oswestry profiles. Radiographic evaluation was performed according to an established positioning protocol for anteroposterior and lateral 36-inch standing radiographs. Radiographic parameters studied were curve type, curve location, curve magnitude, coronal balance, sagittal balance, apical rotation, and rotatory subluxation.

Results. The 298 patients studied include 172 with no prior surgery and 126 who had undergone prior spine fusion. Positive sagittal balance was the most reliable predictor of clinical symptoms in both patient groups. Thoracolumbar and lumbar curves generated less favorable scores than thoracic curves in both patient groups. Significant coronal imbalance of greater than 4 cm was associated with deterioration in pain and function scores for unoperated patients but not in patients with previous surgery.

Conclusions. This study suggests that restoration of a more normal sagittal balance is the critical goal for any reconstructive spine surgery. The study suggests that magnitude of coronal deformity and extent of coronal correction are less critical parameters.

This study correlates radiographic measures of deformity with patient-based outcome measures in adult scoliosis. This study demonstrates that sagittal balance is the most important and reliable radiographic predictor of clinical health status, as patients with sagittal imbalance reported worse self-assessment in pain function and self-image domains.

From the *Department of Orthopaedic Surgery, University of Louisville School of Medicine and the Kenton D. Leatherman Spine Center, Louisville, KY, †University of California, San Francisco, San Francisco, CA,; ‡Washington University, St. Louis, MO, and; §Emory University, Atlanta, GA.

Acknowledgment date: November 3, 2003. First revision date: March 19, 2004. Acceptance date: April 19, 2004.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Corporate/Industry funds were received to support this work. One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript, e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, or decision-making position.

Address correspondence and reprint requests to Steven D. Glassman, MD, 210 East Gray Street, Suite 900, Louisville, KY 40202; E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.