Abstract
Abstract
INTRODUCTION
It has been proposed that achieving optimal spinopelvic alignment is needed to attain clinical improvement. This study assessed whether obtaining optimal spinopelvic alignment was necessary to achieve a minimal clinically important difference (MCID) or substantial clinical benefit (SCB).
METHODS
Multicenter retrospective review. Inclusion criteria were age = 18 yr, and 1 of the following: coronal cobb >20°, SVA > 5 cm, PT > 20°, PI-LL > 10°. Patients underwent circumferential minimally invasive surgical or hybrid surgery and had 2-yr minimum follow-up. Based on optimal spinopelvic parameters (PI-LL ± 10°, PT < 20°, SVA < 5 cm), patients were divided into aligned (AL) or mal-aligned (MAL) groups. MCID and SCB were defined as a 12.8 and 18.5 Oswestry Disability Index (ODI) improvement, respectively.
RESULTS
A total of 153 patients were identified (74 AL and 149 MAL). Although baseline SVA was similar, PI-LL (9.9° vs 17.7°, P = .002) and PT (19° vs 24.7°, P = .001) significantly differed between AL and MAL groups, respectively. As expected postoperatively, the AL and MAL groups differed significantly in PI-LL (–0.9° vs 13.1°, P < .001), PT (14° vs 25.5°, P = .001), SVA (11.8 mm vs 48.3 mm, P < .001), respectively. There was no difference in the proportion of AL or MAL patients who achieved MCID (52.75 vs 61.1%, P > .05) or SCB (40.5% vs 46.3%, P > .05), respectively. On multivariate analysis controlling for surgical and demographic differences, achieving optimal spinopelvic parameters was not associated with achieving MCID (odds ratio [OR] 0.645, 95% confidence interval [CI] 0.31-1.33) or SCB (OR 0.644, 95% CI 0.31-1.35) ODI.
CONCLUSION
Achieving optimal spinopelvic alignment did not appear to be a predictor for obtaining a MCID or SCB. Since spinopelvic parameters are correlated with clinical outcomes, our findings suggest that other factors such as age may influence the radiographic thresholds (SVA, PT, PI-LL) needed to achieve meaningful improvement.
