Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 15;46(4):223-231.
doi: 10.1097/BRS.0000000000003780.

A New Global Spinal Balance Classification Based on Individual Pelvic Anatomical Measurements in Patients With Adult Spinal Deformity

Hiroaki Nakashima  1   2 , Noriaki Kawakami  1   3 , Tetsuya Ohara  1 , Toshiki Saito  1 , Ryoji Tauchi  1 , Shiro Imagama  2
Affiliations

A New Global Spinal Balance Classification Based on Individual Pelvic Anatomical Measurements in Patients With Adult Spinal Deformity

Hiroaki Nakashima et al. Spine (Phila Pa 1976). .

Abstract

Study design: A retrospective study.

Objective: This study aims to establish a new, easy-to-implement global spinal balance (GSB) classification based on individual pelvic anatomical measurements in adult spinal deformity patients, and to validate this classification in terms of patients' quality of life (QOL).

Summary of background data: Coronal (central sacral vertical line) and sagittal (C7 sagittal vertical axis [C7 SVA]) lines are standard parameters to evaluate GSB. However, these parameters do not consider individual differences in height and physique. Therefore, a new classification to more simply evaluate GSB related to QOL would be a beneficial tool.

Methods: This study included 279 patients with adult spinal deformity. The enrollment criteria included age >18 years and scoliosis >30°. GSB was evaluated based on C7 coronal vertical axis and C7 SVA, and was graded with our sagittal (Grades 1-3) and coronal classifications (Grades 1-3), where larger values represented worse GSB. In addition, total global balance classification (Grades 1-3) was also established based on both coronal and sagittal classifications. Patient self-assessment measures of health status were collected using the Scoliosis Research Society patient questionnaire (SRS-22). The relationships between responses to the SRS-22 and GSB were evaluated using partial correlation coefficients, adjusted by age.

Results: A newly described coronal classification correlated with the preoperative function (P < 0.02), pain (P = 0.001), subtotal (P < 0.001) domains in the SRS-22, whereas a newly described sagittal classification was correlated with the preoperative subtotal domain (P < 0.001). There were also significant correlations between total global balance and the preoperative function (P = 0.03) and subtotal domains (P < 0.001) in the SRS-22.

Conclusion: We present a simple new classification for GSB that strongly correlates with QOL in patients with adult spinal deformity, thereby translating clinical data into meaningful patient outcomes and livelihoods.Level of Evidence: 4.

PubMed Disclaimer

References

    1. 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; 30:1082–1085.
    1. Diebo BG, Shah NV, Boachie-Adjei O, et al. Adult spinal deformity. Lancet 2019; 394:160–172.
    1. Ames C, Gammal I, Matsumoto M, et al. Geographic and ethnic variations in radiographic disability thresholds: Analysis of North American and Japanese operative adult spinal deformity populations. Neurosurgery 2016; 78:793–801.
    1. Schwab F, Dubey A, Pagala M, et al. Adult scoliosis: a health assessment analysis by SF-36. Spine (Phila Pa 1976) 2003; 28:602–606.
    1. Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 2005; 30:682–688.

MeSH terms