目的:目的是辨别颅骨矢状面垂直轴(CrSVA)是否可以最好地预测术后2年患者报告结果指标(PROMs)的轨迹。
方法:这是一项前瞻性收集的成人脊柱畸形患者资料的回顾性队列研究。CrSVA相对于骶骨,髋部(CrSVA-H),膝盖,脚踝被测量为从nasion-inion中点到垂直铅垂线的水平距离,正值表明前颅骨。还收集了标准矢状对准参数。结果变量是通过脊柱侧弯研究协会22r问卷(SRS-22r)总分和子域得分以及Oswestry残疾指数测量的PROM。采用Pearson的相关系数和单变量回归分析来研究预测因子和PROM之间的关联,在调整了术前SRS-22r评分的影响后,为每个2年的结果测量建立两个概念性多变量线性回归模型。模型1仅评估相对于C2和C7的术前和术后对准,而模型2评估相对于C2和C7以及颅骨的对准。
结果:共有363例患者接受了2年的影像学检查和PROM随访(68.0%为女性,平均[平均标准误差]年龄60.8[0.78]岁,BMI27.5[0.29],和仪表层总数12.8[0.22])。CrSVA测量值与2年SRS-22r总得分和子域得分显著相关。在单变量回归中,翻修手术,先前手术的数量,脆弱,BMI,截骨总数,较低的基线SRS-22r总评分以及术后矢状面对齐与较差的2年SRS-22r评分显著相关。在多变量回归中,在调整基线SRS-22r分数后,术前C2到骶骨矢状位垂直轴(SVA)和C7SVA被发现是2年总SRS-22r评分的唯一独立预测因素(β=-0.011[p=0.0026]和β=0.009[p=0.0211],分别)当仅相对于C2考虑对齐时。然而,在随后的模型中,CrSVA-H取代C7SVA作为驱动术后SRS-22r总分的独立因素(β=-0.006,p<0.0001)。也就是说,当模型包括相对于颅骨的对齐时,C2和C7,更大或更前CrSVA-H导致更差的SRS-22r评分,而更小或更多的后部CrSVA-H导致更好的分数。子域的类似模型再次发现CrSVA-H是功能的最佳预测因子(β=-0.0095,p<0.0001),疼痛(β=-0.0091,p<0.0001),自我形象(β=-0.0084,p=0.0004),和心理健康(β=-0.0059,p=0.0026)。
结论:在多变量回归中,C7SVA被CrSVA-H比对取代,成人脊柱畸形患者2年SRS-22r评分的独立预测因子,应被视为标准的术后矢状面对齐目标之一。
OBJECTIVE: The objective was to discern whether the cranial sagittal vertical axis (CrSVA) can best predict the trajectory of patient-reported outcome measures (PROMs) at 2 years postoperatively.
METHODS: This was a retrospective cohort study of prospectively collected adult spinal deformity patient data. CrSVA relative to the sacrum, hip (CrSVA-H), knee, and ankle was measured as the horizontal distance to the vertical plumb line from the nasion-inion midpoint, with positive values indicating an anterior cranium. Standard sagittal alignment parameters were also collected. Outcome variables were PROMs as measured by Scoliosis Research Society-22r questionnaire (SRS-22r) total and subdomain scores and the Oswestry Disability Index. Pearson\'s correlation coefficients and univariate regressions were performed to investigate associations between predictors and PROMs. Two conceptual multivariable linear regression models for each 2-year outcome measure were built after adjusting for the impact of preoperative SRS-22r scores. Model 1 assessed pre- and postoperative alignment only relative to C2 and C7, while model 2 assessed alignment relative to C2 and C7 as well as the cranium.
RESULTS: There was a total of 363 patients with 2 years of radiographic and PROM follow-up (68.0% female, mean [standard error of the mean] age 60.8 [0.78] years, BMI 27.5 [0.29], and total number of instrumented levels 12.8 [0.22]). CrSVA measures were significantly associated with the 2-year SRS-22r total and subdomain scores. In univariate regression, revision surgery, number of prior surgeries, frailty, BMI, total number of osteotomies, and lower baseline total SRS-22r score as well as postoperative sagittal alignment were significantly associated with worse 2-year SRS-22r scores. In multivariable regression, after adjusting for baseline SRS-22r scores, greater preoperative C2 to sacrum sagittal vertical axis (SVA) and C7 SVA were found to be the only independent predictors of 2-year total SRS-22r score (β = -0.011 [p = 0.0026] and β = 0.009 [p = 0.0211], respectively) when alignment was considered only relative to C2. However, in the subsequent model, CrSVA-H replaced C7 SVA as the independent factor driving postoperative SRS-22r total scores (β = -0.006, p < 0.0001). That is, when the model included alignment relative to the cranium, C2, and C7, greater or more anterior CrSVA-H resulted in worse SRS-22r scores, while smaller or more posterior CrSVA-H resulted in better scores. Similar models for subdomains again found CrSVA-H to be the best predictor of function (β = -0.0095, p < 0.0001), pain (β = -0.0091, p < 0.0001), self-image (β = -0.0084, p = 0.0004), and mental health (β = -0.0059, p = 0.0026).
CONCLUSIONS: In multivariable regression, C7 SVA was supplanted by CrSVA-H alignment as a significant, independent predictor of 2-year SRS-22r scores in patients with adult spinal deformity and should be considered as one of the standard postoperative sagittal alignment target goals.