Wesley M Durand1, Alan H Daniels2, David K Hamilton3, Peter Passias4, Han Jo Kim5, Themistocles Protopsaltis4, Virginie LaFage5, Justin S Smith6, Christopher Shaffrey7, Munish Gupta8, Michael P Kelly8, Eric Klineberg9, Frank Schwab5, Doug Burton10, Shay Bess11, Christopher Ames12, Robert Hart13. 1. Warren Alpert Medical School of Brown University, Providence, RI, USA. 2. Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI, 02914, USA. alandanielsmd@gmail.com. 3. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 4. Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA. 5. Hospital for Special Surgery, New York, NY, USA. 6. University of Virginia Health System, Charlottesville, VA, USA. 7. Duke University, Durham, NC, USA. 8. Washington University, St. Louis, MO, USA. 9. University of California-Davis, Sacramento, CA, USA. 10. University of Kansas Hospital, Kansas City, KS, USA. 11. Denver International Spine Center, Denver, CO, USA. 12. University of California-San Francisco, San Francisco, CA, USA. 13. Swedish Neuroscience Institute, Seattle, WA, USA.
Abstract
PURPOSE: Analysis of interactions of spinal alignment metrics may uncover novel alignment parameters, similar to PI-LL. This study utilized a data-driven approach to hypothesis generation by testing all possible division interactions between spinal alignment parameters. METHODS: This study was a retrospective cohort analysis. In total, 1439 patients with baseline ODI were included for hypothesis generation. In total, 666 patients had 2-year postoperative follow-up and were included for validation. All possible combinations of division interactions between baseline metrics were assessed with linear regression against baseline ODI. RESULTS: From 247 raw alignment metrics, 32,398 division interactions were considered in hypothesis generation. Conceptually, the TPA divided by PI is a measure of the relative alignment of the line connecting T1 to the femoral head and the line perpendicular to the sacral endplate. The mean TPA/PI was 0.41 at baseline and 0.30 at 2 years postoperatively. Higher TPA/PI was associated with worse baseline ODI (p < 0.0001). The change in ODI at 2 years was linearly associated with the change in TPA/PI (p = 0.0172). The optimal statistical grouping of TPA/PI was low/normal (≤ 0.2), medium (0.2-0.4), and high (> 0.4). The R-squared for ODI against categorical TPA/PI alone (0.154) was directionally higher than that for each of the individual Schwab modifiers (SVA: 0.138, PI-LL 0.111, PT 0.057). CONCLUSION: This study utilized a data-driven approach for hypothesis generation and identified the spino-pelvic ratio (TPA divided by PI) as a promising measure of sagittal spinal alignment among ASD patients. Patients with SPR > 0.2 exhibited inferior ODI scores. LEVEL OF EVIDENCE: III.
PURPOSE: Analysis of interactions of spinal alignment metrics may uncover novel alignment parameters, similar to PI-LL. This study utilized a data-driven approach to hypothesis generation by testing all possible division interactions between spinal alignment parameters. METHODS: This study was a retrospective cohort analysis. In total, 1439 patients with baseline ODI were included for hypothesis generation. In total, 666 patients had 2-year postoperative follow-up and were included for validation. All possible combinations of division interactions between baseline metrics were assessed with linear regression against baseline ODI. RESULTS: From 247 raw alignment metrics, 32,398 division interactions were considered in hypothesis generation. Conceptually, the TPA divided by PI is a measure of the relative alignment of the line connecting T1 to the femoral head and the line perpendicular to the sacral endplate. The mean TPA/PI was 0.41 at baseline and 0.30 at 2 years postoperatively. Higher TPA/PI was associated with worse baseline ODI (p < 0.0001). The change in ODI at 2 years was linearly associated with the change in TPA/PI (p = 0.0172). The optimal statistical grouping of TPA/PI was low/normal (≤ 0.2), medium (0.2-0.4), and high (> 0.4). The R-squared for ODI against categorical TPA/PI alone (0.154) was directionally higher than that for each of the individual Schwab modifiers (SVA: 0.138, PI-LL 0.111, PT 0.057). CONCLUSION: This study utilized a data-driven approach for hypothesis generation and identified the spino-pelvic ratio (TPA divided by PI) as a promising measure of sagittal spinal alignment among ASDpatients. Patients with SPR > 0.2 exhibited inferior ODI scores. LEVEL OF EVIDENCE: III.