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Defining age-adjusted spinopelvic alignment thresholds: should we integrate BMI?

Peter G Passias1,2, Frank A Segreto3, Bailey Imbo3

  • 1Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA. Peter.Passias@nyumc.org.

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Summary

This study establishes age- and BMI-adjusted spinal alignment targets for improved patient management. Findings indicate that both age and obesity influence spinal alignment, suggesting adjusted goals for older and obese individuals.

Keywords:
Adult spinal deformity (ASD)Alignment thresholdsBody mass index (BMI)Health-related-quality-of-life (HRQL)

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Area of Science:

  • Spine surgery
  • Orthopedics
  • Radiographic analysis

Background:

  • Patient-specific management in spinal deformities is crucial for optimal outcomes.
  • Current alignment targets may not adequately account for patient demographics like age and BMI.
  • Developing tailored targets can enhance surgical planning and patient care.

Purpose of the Study:

  • To establish age- and BMI-adjusted spinal alignment targets.
  • To improve patient-specific management and operative treatment outcomes in spinal alignment.
  • To provide evidence-based guidelines for orthopedic surgeons.

Main Methods:

  • Retrospective review of a stereographic database of adult spinal deformity (ASD) patients.
  • Stratification of patients by age and BMI (non-obese <30, obese ≥30).
  • Linear regression analysis to determine age- and BMI-specific radiographic thresholds (PT, SVA, PILL, TPA).

Main Results:

  • Spinal alignment parameters (PT, SVA, PILL, TPA) increase with both age and BMI (R>0.5, p<0.001).
  • Obese patients exhibited significantly higher SVA values compared to non-obese patients across all age groups.
  • Specific normative ranges for alignment parameters were established for different age and BMI strata.

Conclusions:

  • Significant associations exist between age, BMI, and sagittal spinal alignment.
  • BMI, particularly obesity, substantially influences alignment norms, especially SVA.
  • Age-adjusted alignment thresholds should incorporate BMI, suggesting less stringent goals for older and obese patients.