Correlations between spinopelvic parameters and health-related quality of life in degenerative lumbar scoliosis patients before and after long -level fusion surgery

Background: For degenerative lumbar scoliosis (DLS), prior studies mainly focused on the preoperative relationship between spinopelvic parameters and health-related quality of life (HRQoL), lacking an exhaustive evaluation of the postoperative situation. Therefore, the postoperative parameters most closely bonded with clinical outcomes has not yet been well-defined in DLS patients. The objective of this study was to comprehensively assess the correlation between radiographic parameters and HRQoL before and after surgery, and to identified the most valuable spinopelvic parameters for postoperative curative effect.

Methods: This study retrospectively reviewed 130 consecutive patients who underwent long-level fusion with at least 1 year follow-up. Standing whole-spine radiographs and HRQoL measurements were examined preoperatively and at final follow-up. Spinopelvic parameters included thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence minus lumbar lordosis (PI-LL), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), sagittal vertical axis (SVA), T1 pelvic angle (TPA), Global tilt (GT), Cobb angle (CA), apical vertebral translation (AVT) and coronal vertical axis (CVA). HRQoL was evaluated using the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Chinese version of Lumbar Stiffness Disability Index (C-LSDI), Japanese Orthopedic Association-29 (JOA-29), Scoliosis Research Society-22 (SRS-22),and the 36-item Short Form Health Survey (SF-36) total and subscale scores. Pearson's correlation analysis was performed to determine relationships between them.

Results: The study population included 104 women and 26 men with an average age of 62.9 years. Both coronal and sagittal parameters showed significant correlations with HRQoL scores pre- and post-operatively. Among the coronal parameters, only CA showed correlations with SRS-22 subscale scores, and its correlation with Self-image scores were observed both before and after surgery. Among sagittal parameters, PT, PI-LL, LL, SVA, TPA, and GT showed significant correlations with HRQoL before surgery, including ODI, JOA-29, and SF-36 PCS. At final follow-up, except for AVT, CVA, and LL, all other sagittal parameters were significantly correlated with HRQoL.

Conclusions: HRQoL scores not only correlated with radiological parameters before surgery, but also after long-term follow-up. Besides, sagittal parameters, especially postoperative PI-LL, SVA, TPA, GT, were more closely correlated with clinical outcome measurements.