Analysis of the Sagittal Balance in Patients with Adult Spinal Deformity: Modified Sagittal Vertical Axis

Abstract Objective: The overall sagittal balance of patient with adult spinal deformity (ASD) is crucial for satisfactory postoperative outcome. SVA is the parameter often used to assess the sagittal balance. However, pelvis often rotates backward to compensate for sagittal imbalance in patients with ASD. In the case, SVA cannot reflect the real sagittal balance. Modified sagittal vertical axis (MSVA) is the parameter we found to better assess the real sagittal balance in patients with ASD. And we want to explore the relationship between MSVA and the quality of life. Methods: We used sample of 60 patients with ASD who underwent long-segment orthopedic surgery (≥4 vertebrae) between the period of 2015 and 2018. The paired-sample t test and Pearson correlation analysis were used for statistical analysis. P value <0.05 was considered significant. Results: SVA, TK, TLK, LL, SS, PT, PI-LL and MSVA were significantly changed in 60 patients preoperatively and postoperatively (p<0.05). The ODI, SRS22, VAS scores were significantly improved postoperatively (p<0.05). Pearson correlation analysis was used to conclude that postoperative SVA, postoperative MSVA and postoperative quality of life score were related. Postoperative MSVA has the strongest correlation with the quality-of-life score. Conclusions: Through spinal orthopedic surgery, the postoperative spinal parameters and quality of life of patients with ASD were significantly improved. MSVA is of great significance for evaluating postoperative sagittal balance and quality of life of patients with ASD.

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Thoracolumbar Slope Is Useful Parameter for Evaluating HealthRelated Quality of Life and Sagittal Imbalance Aggravation in Adult Spinal Deformity: A Prospective Observational Cohort Study

Neurospine ◽

10.14245/ns.2142408.204 ◽

2021 ◽

Vol 18 (3) ◽

pp. 467-474

Author(s):

Bong Ju Moon ◽

Moon-Soo Han ◽

Jae-Young Kim ◽

Jung-Kil Lee

Keyword(s):

Quality Of Life ◽

Short Form ◽

Adult Spinal Deformity ◽

Vertical Axis ◽

Clinical Situation ◽

Sagittal Imbalance ◽

Sagittal Vertical Axis ◽

Highly Correlated

Objective: The purpose of the present study was to evaluate the natural course of primary degenerative sagittal imbalance (PDSI), its aggravating factors, and health-related quality of life (HRQoL) associated with various spinal alignment parameters (SAPs) in patients with PDSI who have not undergone surgery.Methods: One hundred three participants volunteered to participate. The SAPs, including T1 pelvic angle (T1PA), thoracolumbar tilt, and thoracolumbar slope (TLS), were measured on whole-spine standing radiographs. The back and lumbar muscle volumes were measured. To determine HRQoL at baseline and at 2-year follow-up, face-to-face questionnaires were administered, which included visual analogue scale of the back and leg, physical component summary/mental component summary of 36-item Short Form Health Survey, Oswestry Disability Index (ODI), and Mini-Mental State Examination.Results: Overall HRQoL measures had improved after 2 years of follow-up compared to baseline. PDSI aggravation was observed in 18 participants (26.1%). TLS, sagittal vertical axis (SVA), and T1PA were strongly correlated with each other. TLS, SVA, and T1PA were correlated with ODI score. Among them, TLS was most highly correlated with ODI score. TLS greater than -3.5° was a predicting factor for PDSI aggravation (p = 0.034; 95% confidence interval, 1.173–63.61; odds ratio, 8.636).Conclusion: The present study implied that PDSI does not necessarily worsen with aging. TLS is an appropriate parameter for assessing the clinical situation in patients with PDSI. Furthermore, a TLS greater than -3.5° predicts PDSI aggravation; thus, TLS may be a useful parameter for predicting prognosis in PDSI.

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Lumbar Level Significantly Influences Postoperative Global Sagittal Balance Following Pedicle Subtraction Osteotomy

Global Spine Journal ◽

10.1177/21925682211032563 ◽

2021 ◽

pp. 219256822110325

Author(s):

Athan G. Zavras ◽

T. Barrett Sullivan ◽

Navya Dandu ◽

Howard S. An ◽

Christopher J. DeWald ◽

...

Keyword(s):

Sagittal Balance ◽

Sagittal Alignment ◽

Adult Spinal Deformity ◽

Vertical Axis ◽

Pedicle Subtraction Osteotomy ◽

Current Evidence ◽

Sacral Slope ◽

Sagittal Vertical Axis ◽

Lumbar Level ◽

Global Sagittal Alignment

Study Design: Retrospective cohort study. Objectives: The current evidence regarding how level of lumbar pedicle subtraction osteotomy (PSO) influences correction of sagittal alignment is limited. This study sought to investigate the relationship of lumbar level and segmental angular change (SAC) of PSO with the magnitude of global sagittal alignment correction. Methods: This study retrospectively evaluated 53 consecutive patients with adult spinal deformity who underwent lumbar PSO at a single institution. Radiographs were evaluated to quantify the effect of PSO on lumbar lordosis (LL), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), T1-spinopelvic inclination (T1SPI), T1-pelvic alignment (TPA), and sagittal vertical axis (SVA). Results: Significant correlations were found between PSO SAC and the postoperative increase in LL ( r = 0.316, P = .021) and PT ( r = 0.352, P = .010), and a decrease in TPA ( r = −0.324, P = .018). PSO level significantly correlated with change in T1SPI ( r = −0.305, P = .026) and SVA ( r = −0.406, P = .002), with more caudal PSO corresponding to a greater correction in sagittal balance. On multivariate analysis, more caudal PSO level independently predicted a greater reduction in T1SPI (β = −3.138, P = .009) and SVA (β = −29.030, P = .001), while larger PSO SAC (β = −0.375, P = .045) and a greater number of fusion levels (β = −1.427, P = .036) predicted a greater reduction in TPA. Conclusion: This study identified a gain of approximately 3 degrees and 3 cm of correction for each level of PSO more caudal to L1. Additionally, a larger PSO SAC predicted greater improvement in TPA. While further investigation of these relationships is warranted, these findings may help guide preoperative PSO level selection.

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Factors Affecting Quality of Life of Hemodialysis Patients - with Focus on Resilience, Symptom Experience and Self-management

Journal of Health Informatics and Statistics ◽

10.21032/jhis.2021.46.4.429 ◽

2021 ◽

Vol 46 (4) ◽

pp. 429-434

Author(s):

Hyun-Young Jung ◽

Yong-Kyung Park ◽

Soon-Rim Suh

Keyword(s):

Quality Of Life ◽

Pearson Correlation ◽

Nursing Intervention ◽

Hemodialysis Patients ◽

Symptom Experience ◽

Factors Affecting ◽

Medical Institutions ◽

Pearson Correlation Analysis ◽

Influential Variable

Objectives: The purpose of this study was to investigate the factors affecting quality of life of hemodialysis patients.Methods: As a descriptive study, the data were collected from 172 hemodialysis patients receiving hemodialysis at 4 medical institutions. Collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation analysis and multiple regression.Results: The influential variable of the quality of Life of hemodialysis patients were resilience, symptom experience and monthly income less than 2 million won. These factors explained for 48.7% of the quality of Life of hemodialysis patients.Conclusions: The most ideal method to increase the quality of hemodialysis patients’ lives is to develop an integrated nursing intervention that will increase patients’ resilience and reduce the intensity of symptoms.

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Relationship between body mass index and sagittal vertical axis change as well as health-related quality of life in 564 patients after deformity surgery

Journal of Neurosurgery Spine ◽

10.3171/2019.4.spine18485 ◽

2019 ◽

Vol 31 (5) ◽

pp. 697-702 ◽

Cited By ~ 1

Author(s):

Nitin Agarwal ◽

Federico Angriman ◽

Ezequiel Goldschmidt ◽

James Zhou ◽

Adam S. Kanter ◽

...

Keyword(s):

Quality Of Life ◽

Vertical Axis ◽

Patient Questionnaire ◽

Health Related Quality ◽

Sagittal Vertical Axis ◽

Related Quality ◽

Health Related ◽

Secondary Outcomes ◽

The Relationship

OBJECTIVEObesity, a condition that is increasing in prevalence in the United States, has previously been associated with poorer outcomes following deformity surgery, including higher rates of perioperative complications such as deep and superficial infections. To date, however, no study has examined the relationship between preoperative BMI and outcomes of deformity surgery as measured by spine parameters such as the sagittal vertical axis (SVA), as well as health-related quality of life (HRQoL) measures such as the Oswestry Disability Index (ODI) and Scoliosis Research Society–22 patient questionnaire (SRS-22). To this end, the authors sought to clarify the relationship between BMI and postoperative change in SVA as well as HRQoL outcomes.METHODSThe authors performed a retrospective review of a prospectively managed multicenter adult spinal deformity database collected and maintained by the International Spine Study Group (ISSG) between 2009 and 2014. The primary independent variable considered was preoperative BMI. The primary outcome was the change in SVA at 1 year after deformity surgery. Postoperative ODI and SRS-22 outcome measures were evaluated as secondary outcomes. Generalized linear models were used to model the primary and secondary outcomes at 1 year as a function of BMI at baseline, while adjusting for potential measured confounders.RESULTSIncreasing BMI (compared to BMI < 18) was not associated with change of SVA at 1 year postsurgery. However, BMIs in the obese range of 30 to 34.9 kg/m2, compared to BMI < 18 at baseline, were associated with poorer outcomes as measured by the SRS-22 score (estimated change −0.47, 95% CI −0.93 to −0.01, p = 0.04). While BMIs > 30 appeared to be associated with poorer outcomes as determined by the ODI, this correlation did not reach statistical significance.CONCLUSIONSBaseline BMI did not affect the achievable SVA at 1 year postsurgery. Further studies should evaluate whether even in the absence of a change in SVA, baseline BMIs in the obese range are associated with worsened HRQoL outcomes after spinal surgery.

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Brazilian Vegetarian Population—Influence of Type of Diet, Motivation and Sociodemographic Variables on Quality of Life Measured by Specific Tool (VEGQOL)

Nutrients ◽

10.3390/nu12051406 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1406

Author(s):

Shila Minari Hargreaves ◽

Eduardo Yoshio Nakano ◽

Renata Puppin Zandonadi

Keyword(s):

Quality Of Life ◽

Pearson Correlation ◽

Intraclass Correlation ◽

Mean Value ◽

Future Research ◽

Life Questionnaire ◽

Older Individuals ◽

Eating Pattern ◽

Life Score

The adoption of a vegetarian diet has been associated with positive health outcomes. However, few studies evaluate the effect of this eating pattern on quality of life. Moreover, no specific instrument for the vegetarian population to measure the quality of life is available worldwide. Therefore, this study aimed to elaborate and validate a specific questionnaire to measure the quality of life in vegetarians. The Specific Vegetarian Quality of Life Questionnaire (VEGQOL) was constructed based on other instruments and studies related to vegetarianism. The content and semantic validation were performed by a group of experts, followed by a pilot study to evaluate the questionnaire acceptability and reproducibility. Discriminant validation was tested using the WHOQOL as the gold standard measure (Pearson correlation ranging from 0.302 of the domain 3 to 0.392 of the domain 2). Afterward, a nationwide survey was conducted using VEGQOL. Content and semantic validation selected 19 of the initial 30 items. VEGQOL presented good reproducibility (Cohen’s Kappa coefficient ranging from 0.361 to 0.730 and intraclass correlation coefficient of 0.820) and internal consistency (0.708), both adequate to evaluate the quality of life in vegetarians. The sample size (n = 5014 individuals, error of 3% at a level of significance of 5%) and distribution was representative of the Brazilian vegetarian population. In general, the quality of life of Brazilian vegetarians was considered satisfactory (VEGQOL cut off points 70–80). Among different types of vegetarians, the vegans showed better results with a VEGQOL mean value of 79.2 ± 10.7. Older individuals, the ones who adopted the diet for a longer time (VEGQOL mean value of 75.8 ± 12.7) and the ones who had other vegetarians in their social network (VEGQOL mean value of 74.6 ± 12.2) also had a better quality of life score. Individuals who adopted it for ethical or health reasons had a higher quality of life score. The questionnaire produced in this study is a useful tool for future research in this area. Results were better for vegans and for the ones who adopt the diet for ethical or health reasons.

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Underarm bracing for adolescent idiopathic scoliosis leads to flatback deformity

The Bone & Joint Journal ◽

10.1302/0301-620x.101b11.bjj-2019-0515.r1 ◽

2019 ◽

Vol 101-B (11) ◽

pp. 1370-1378 ◽

Cited By ~ 5

Author(s):

Jason P. Y. Cheung ◽

Christopher H. W. Chong ◽

Prudence W. H. Cheung

Keyword(s):

Quality Of Life ◽

Lumbar Spine ◽

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Pelvic Tilt ◽

Vertical Axis ◽

Sacral Slope ◽

Sagittal Vertical Axis ◽

Pelvic Parameters

Aims The aim of this study was to determine the influence of pelvic parameters on the tendency of patients with adolescent idiopathic scoliosis (AIS) to develop flatback deformity (thoracic hypokyphosis and lumbar hypolordosis) and its effect on quality-of-life outcomes. Patients and Methods This was a radiological study of 265 patients recruited for Boston bracing between December 2008 and December 2013. Posteroanterior and lateral radiographs were obtained before, immediately after, and two-years after completion of bracing. Measurements of coronal and sagittal Cobb angles, coronal balance, sagittal vertical axis, and pelvic parameters were made. The refined 22-item Scoliosis Research Society (SRS-22r) questionnaire was recorded. Association between independent factors and outcomes of postbracing ≥ 6° kyphotic changes in the thoracic spine and ≥ 6° lordotic changes in the lumbar spine were tested using likelihood ratio chi-squared test and univariable logistic regression. Multivariable logistic regression models were then generated for both outcomes with odds ratios (ORs), and with SRS-22r scores. Results Reduced T5-12 kyphosis (mean -4.3° (sd 8.2); p < 0.001), maximum thoracic kyphosis (mean -4.3° (sd 9.3); p < 0.001), and lumbar lordosis (mean -5.6° (sd 12.0); p < 0.001) were observed after bracing treatment. Increasing prebrace maximum kyphosis (OR 1.133) and lumbar lordosis (OR 0.92) was associated with postbracing hypokyphotic change. Prebrace sagittal vertical axis (OR 0.975), prebrace sacral slope (OR 1.127), prebrace pelvic tilt (OR 0.940), and change in maximum thoracic kyphosis (OR 0.878) were predictors for lumbar hypolordotic changes. There were no relationships between coronal deformity, thoracic kyphosis, or lumbar lordosis with SRS-22r scores. Conclusion Brace treatment leads to flatback deformity with thoracic hypokyphosis and lumbar hypolordosis. Changes in the thoracic spine are associated with similar changes in the lumbar spine. Increased sacral slope, reduced pelvic tilt, and pelvic incidence are associated with reduced lordosis in the lumbar spine after bracing. Nevertheless, these sagittal parameter changes do not appear to be associated with worse quality of life. Cite this article: Bone Joint J 2019;101-B:1370–1378.

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Kualitas Hidup Pasien Tuberkulosis Paru yang Mengalami Stigma Diri (Quality of Life Pulmonary Tuberculosis Patients With Self Stigma))

Jurnal Kesehatan Holistic ◽

10.33377/jkh.v3i2.50 ◽

2019 ◽

Vol 3 (2) ◽

pp. 17-27

Author(s):

Yunita Sari

Keyword(s):

Quality Of Life ◽

Pulmonary Tuberculosis ◽

Descriptive Study ◽

Negative Influence ◽

Questionnaire Data ◽

Average Quality ◽

Tuberculosis Patients ◽

Pulmonary Tb ◽

Life Score

Pulmonary tuberculosis (TB) is a chronic disease that can bring about the sufferer's self-stigma and also affect his quality of life. A number of studies report that living with TB has a negative influence on the quality of life of sufferers even with or without self-stigma. The purpose of this study was to identify the quality of life of TB patients who experienced self-stigma. This research is a descriptive study, sample were 31 pulmonary TB patients. Data was collected using a questionnaire. Data analyzed by using frequency distribution and percentage. The researcher first screened TB patients who experienced self-stigma. The results showed that 25 people (80.64%) respondents experienced mild self-stigma. A total of 9 respondents (36%) had a quality of life score in the good category and as many as 16 respondents (64%) had enough category with an average quality of life score is 56.57. While respondents who had moderate self-stigma were 6 people (19.36%) with a good quality of life score was 1 person (16.67%) and enough category quality of life score were 5 people (83.33%) with an average quality of life score is 49.92.

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Tu1228 – Achalasia Quality of Life Score and Eckardt Score: A Comparison for the Assessment of Clinical Improvement Post Treatment for Achalasia

Gastroenterology ◽

10.1016/s0016-5085(19)39438-7 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-994

Author(s):

Samuel O. Slone ◽

Joel E. Richter ◽

Vic Velanovich ◽

John W. Jacobs ◽

Ambuj Kumar

Keyword(s):

Quality Of Life ◽

Clinical Improvement ◽

Post Treatment ◽

Life Score ◽

Eckardt Score

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Correlations Between Clinical Trial Outcomes Based on Symptoms, Functional Impairments, and Quality of Life in Children and Adolescents With ADHD

Journal of Attention Disorders ◽

10.1177/1087054717723984 ◽

2017 ◽

Vol 23 (13) ◽

pp. 1578-1591 ◽

Cited By ~ 7

Author(s):

David R. Coghill ◽

Alain Joseph ◽

Vanja Sikirica ◽

Mark Kosinski ◽

Caleb Bliss ◽

...

Keyword(s):

Quality Of Life ◽

Children And Adolescents ◽

Rating Scale ◽

Controlled Trial ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Parent Report ◽

Functional Impairments ◽

Risk Avoidance

Objective: To assess relationships between treatment-associated changes in measures of ADHD symptoms, functional impairments, and health-related quality of life in children and adolescents with ADHD. Method: Pearson correlation coefficients were calculated post hoc for changes from baseline to endpoint in outcomes of one randomized, placebo- and active-controlled trial of lisdexamfetamine (osmotic-release methylphenidate reference) and one of guanfacine extended-release (atomoxetine reference). Results: Changes in ADHD Rating Scale IV (ADHD-RS-IV) total score generally correlated moderately with changes in Child Health and Illness Profile−Child Edition: Parent Report Form (CHIP-CE:PRF) Achievement and Risk Avoidance ( r ≈ .4), but weakly with Resilience, Satisfaction, and Comfort ( r ≈ .2); and moderately with Weiss Functional Impairment Rating Scale–Parent (WFIRS-P) total score ( r ≈ .5). CHIP-CE:PRF Achievement and Risk Avoidance correlated moderately to strongly with WFIRS-P total score ( r ≈ .6). Conclusion: The ADHD-RS-IV, CHIP-CE:PRF, and WFIRS-P capture distinct but interconnected aspects of treatment response in individuals with ADHD.

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