PT  - JOURNAL ARTICLE
AU  - Horn, Samantha R.
AU  - Bortz, Cole A.
AU  - Ramachandran, Subaraman
AU  - Poorman, Gregory W.
AU  - Segreto, Frank
AU  - Siow, Matt
AU  - Sure, Akhila
AU  - Vasquez-Montes, Dennis
AU  - Diebo, Bassel
AU  - Tishelman, Jared
AU  - Moon, John
AU  - Zhou, Peter
AU  - Beaubrun, Bryan
AU  - Vira, Shaleen
AU  - Jalai, Cyrus
AU  - Wang, Charles
AU  - Shenoy, Kartik
AU  - Behery, Omar
AU  - Errico, Thomas
AU  - Lafage, Virginie
AU  - Buckland, Aaron
AU  - Passias, Peter G.
TI  - Suboptimal Age-Adjusted Lumbo-Pelvic Mismatch Predicts Negative Cervical-Thoracic Compensation in Obese Patients
AID  - 10.14444/6034
DP  - 2019 Jul 01
TA  - International Journal of Spine Surgery
PG  - 6034
4099  - https://www.ijssurgery.com/content/early/2019/07/09/6034.short
4100  - https://www.ijssurgery.com/content/early/2019/07/09/6034.full
AB  - Background Given the paucity of literature regarding compensatory mechanisms used by obese patients with sagittal malalignment, it is necessary to gain a better understanding of the effects of obesity on compensation after comparing the degree of malalignment to age-adjusted ideals. This study aims to compare baseline alignment of obese and nonobese patients using age-adjusted spino-pelvic alignment parameters, describing associated spinal changes.Methods Patients ≥ 18 years with full-body stereoradiographs were propensity-score matched for sex, baseline pelvic incidence (PI), and categorized as nonobese (body mass index < 30kg/m2) or obese (body mass index ≥ 30). Age-adjusted ideals were calculated for sagittal vertical axis, spino-pelvic mismatch (PI-LL), pelvic tilt, and T1 pelvic angle using established formulas. Patients were stratified as meeting alignment ideals, being above ideal, or being below. Spinal alignment parameters included C0-C2, C2-C7, C2-T3, cervical thoracic pelvic angle, cervical sagittal vertical axis SVA, thoracic kyphosis, T1 pelvic angle, T1 slope, sagittal vertical axis, lumbar lordosis (LL), PI, PI-LL, pelvic tilt. Lower-extremity parameters included sacrofemoral angle, knee flexion (KA), ankle flexion (AA), pelvic shift (PS), and global sagittal angle (GSA). Independent t tests compared parameters between cohorts.Results Included: 800 obese, 800 nonobese patients. Both groups recruited lower-extremity compensation: sacrofemoral angle (P = .004), KA, AA, PS, GSA (all P < .001). Obese patients meeting age-adjusted PI-LL had greater lower-extremity compensation than nonobese patients: lower sacrofemoral angle (P = .002), higher KA (P = .008), PS (P = .002), and GSA (P = .02). Obese patients with PI-LL mismatch higher than age-adjusted ideal recruited greater lower-extremity compensation than nonobese patients: higher KA, AA, PS, GSA (all P < .001). Obese patients showed compensation through the cervical spine: increased C0-C2, C2-C7, C2-T3, and cervical sagittal vertical axis (all P < .001), high T1 pelvic angle (P < .001), cervical thoracic pelvic angle (P = .03), and T1 slope (P < .001), with increased thoracic kyphosis (P = .015) and decreased LL (P < .001) compared to nonobese patients with PI-LL larger than age-adjusted ideal.Conclusions Regardless of malalignment severity, obese patients recruited lower-limb compensation more than nonobese patients. Obese patients with PI-LL mismatch larger than age-adjusted ideal also develop upper-cervical and cervicothoracic compensation for malalignment.Level of Evidence IIIClinical Relevance Clinical evaluation should extend to the cervical spine in obese patients not meeting age-adjusted sagittal alignment ideals.