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. 2021 Oct;30(10):3019-3027.
doi: 10.1007/s00586-021-06965-3. Epub 2021 Sep 13.

Dose-response relationship between spino-pelvic alignment determined by sagittal modifiers and back pain-specific quality of life

Ryoji Tominaga  1   2   3 , Noriaki Kurita  4   5   6 , Yoshiyuki Kokubun  7 , Takuya Nikaido  8 , Miho Sekiguchi  8 , Koji Otani  8 , Masumi Iwabuchi  9 , Osamu Shirado  9 , Shunichi Fukuhara  6   10 , Shin-Ichi Konno  8
Affiliations

Dose-response relationship between spino-pelvic alignment determined by sagittal modifiers and back pain-specific quality of life

Ryoji Tominaga et al. Eur Spine J. 2021 Oct.

Abstract

Purpose: To determine whether abnormalities of the sagittal modifiers (SMs) of the Scoliosis Research Society (SRS)-Schwab classification truly reflect back pain (BP)-specific quality of life (QOL), it is necessary to examine their dose-response relationships and to determine clinically impactful thresholds for declines in BP-specific QOL. This study aimed to analyse the continuous dose-response relationship between each SM and BP-specific QOL.

Methods: This cross-sectional study, using data from a Japanese population-based cohort study, included 519 community-dwelling residents aged ≥ 50 years who participated in the annual health examination. The participants completed the Roland-Morris Disability Questionnaire (RDQ) on BP-specific QOL. Spino-pelvic alignment based on SMs was assessed by whole-spine X-ray examinations. We fitted general linear models with or without nonlinear terms to estimate the dose-response relationship between each SM and BP-specific QOL.

Results: Pelvic tilt, pelvic incidence minus lumbar lordosis (PI-LL), and sagittal vertical axis showed dose-response relationships with BP-specific QOL measured as the RDQ score. PI-LL was most likely to predict a minimally clinically important RDQ score when its value exceeded the 90th percentile. A nonlinear relationship between PI-LL and the BP-specific QOL score was found. RDQ increased when PI-LL exceeded 10°.

Conclusion: PI-LL might be the most sensitive of the three modifiers of the SRS-Schwab classification for determining BP-specific QOL. Moreover, BP-specific QOL worsens rapidly when the compensatory mechanism against malalignment exceeds a critical value. Therefore, we suggest that traditional classifications and surgical strategies should be re-examined regarding the dose-dependent abnormalities of the SMs to develop a more reliable classification strategy.

Keywords: Lumbar lordosis; Pelvic incidence; Pelvic tilt; Sagittal alignment; Sagittal vertical axis; Spino-pelvic alignment.

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