Course and Predictors of Adult Spinal Sagittal Disorders: A 10-Year Prospective Case Series

Area of Science:

• Orthopedics and Spine Surgery
• Biomedical Engineering
• Geriatric Medicine

Background:

• Adult spinal deformity (ASD) encompasses diverse thoracolumbar spine abnormalities in adults.
• Radiographic deterioration involves decreased lumbar lordosis, increased pelvic tilt, and altered sagittal vertical axis.
• Sagittal malalignment significantly impacts patient function and quality of life.

Purpose of the Study:

• To investigate the 10-year natural progression of adult spinal deformity (ASD).
• To identify determinants associated with postural malalignments in ASD patients.
• To analyze changes in spinopelvic alignment and functional outcomes.

Main Methods:

• Prospective case series of 204 adult participants with ASD (mean age 62.7 years).
• Full spine radiographs measured SRS-Schwab sagittal modifiers (PI-LL, PT, SVA) over 10 years.
• Scoliosis Research Society 22r (SRS-22r) questionnaire assessed functional status.

Main Results:

• The mean SRS-Schwab score significantly worsened over 10 years (1.1 to 1.5, P <0.001).
• Spinal deformity deteriorated in 37% of participants, remained stable in 50%, and improved in 13%.
• Poor SRS-22r function scores and severe pelvic tilt (PT > 30°) predicted worsening sagittal alignment.

Conclusions:

• Significant variability exists in the 10-year natural course of adult spinal deformity.
• Poor self-assessed function and abnormal pelvic tilt are risk factors for deteriorating spinopelvic alignment.
• Tailored preventive strategies are essential for managing ASD, considering individual risk factors.