Role of Ethnicity in Alignment Compensation: Propensity Matched Analysis of Differential Compensatory Mechanism Recruitment Patterns for Sagittal Malalignment in 288 ASD Patients from Japan, Korea, and United States

International Spine Study Group (ISSG)

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Abstract

Study Design. Retrospective review of adult spinal deformity patients in a multiethnic database. Objective. To investigate the role of ethnicity on recruitment of compensatory mechanisms for sagittal spinal deformity. Summary of Background Data. While the impacts of age, sex, and pelvic morphology on the ability to compensate for sagittal malalignment have been investigated, the role of ethnicity in compensatory mechanism recruitment is poorly understood. Methods. Patients from USA (85% Caucasian) >25 y/o were propensity matched by age, sex, and pelvic incidence with patients from Korea and Japan. Only primary patients or those with existing fusion below T12 were retained for analysis. Groups were subclassified by deformity severity (aligned: sagittal vertical axis (SVA) <50 mm; moderate malalignment: SVA 50-100 mm; severe malalignment: SVA >100 mm). Radiographic measurements including pelvic retroversion, thoracic kyphosis, loss of lumbar lordosis (PI minus LL), cervical lordosis, and cervical SVA were compared between the groups. Results. There were 288 patients (96 each in USA, KOR, JPN), with similar age (64-67 yr) and PI (49-53°). USA had smaller pelvic incidence minus lumbar lordosis in every alignment group (P <0.05). In moderate malalignment, JPN had more pelvic retroversion than USA (30° vs. 20°), and KOR had more thoracic hypokyphosis than USA (15 vs. 31°). In severe malalignment, JPN had more pelvic retroversion than USA (39° vs. 27°), and KOR had more thoracic hypokyphosis than USA (15° vs. 31°). KOR had smaller cSVA than USA in both aligned (11 vs. 27 mm) and moderate (19 vs. 31 mm) malalignment. In severe malalignment, KOR had less cervical lordosis (13° KOR vs. 15° USA vs. 27° JPN). All differences with P <0.05. Conclusion. Compensation for sagittal is ethnicity dependent. Korean patients favor thoracic compensation via hypokyphosis, and Japanese patients favor pelvic compensation via retroversion. Patient ethnicity should be considered when evaluating the sagittal plane and surgical correction strategies.

Original languageEnglish
Pages (from-to)E234-E240
JournalSpine
Volume42
Issue number4
DOIs
Publication statusPublished - 2017 Feb 15

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Korea
Japan
Lordosis
Thorax
Kyphosis
Incidence
Databases

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

@article{2d0cc1efb222403a909d3cb18497fca0,
title = "Role of Ethnicity in Alignment Compensation: Propensity Matched Analysis of Differential Compensatory Mechanism Recruitment Patterns for Sagittal Malalignment in 288 ASD Patients from Japan, Korea, and United States",
abstract = "Study Design. Retrospective review of adult spinal deformity patients in a multiethnic database. Objective. To investigate the role of ethnicity on recruitment of compensatory mechanisms for sagittal spinal deformity. Summary of Background Data. While the impacts of age, sex, and pelvic morphology on the ability to compensate for sagittal malalignment have been investigated, the role of ethnicity in compensatory mechanism recruitment is poorly understood. Methods. Patients from USA (85{\%} Caucasian) >25 y/o were propensity matched by age, sex, and pelvic incidence with patients from Korea and Japan. Only primary patients or those with existing fusion below T12 were retained for analysis. Groups were subclassified by deformity severity (aligned: sagittal vertical axis (SVA) <50 mm; moderate malalignment: SVA 50-100 mm; severe malalignment: SVA >100 mm). Radiographic measurements including pelvic retroversion, thoracic kyphosis, loss of lumbar lordosis (PI minus LL), cervical lordosis, and cervical SVA were compared between the groups. Results. There were 288 patients (96 each in USA, KOR, JPN), with similar age (64-67 yr) and PI (49-53°). USA had smaller pelvic incidence minus lumbar lordosis in every alignment group (P <0.05). In moderate malalignment, JPN had more pelvic retroversion than USA (30° vs. 20°), and KOR had more thoracic hypokyphosis than USA (15 vs. 31°). In severe malalignment, JPN had more pelvic retroversion than USA (39° vs. 27°), and KOR had more thoracic hypokyphosis than USA (15° vs. 31°). KOR had smaller cSVA than USA in both aligned (11 vs. 27 mm) and moderate (19 vs. 31 mm) malalignment. In severe malalignment, KOR had less cervical lordosis (13° KOR vs. 15° USA vs. 27° JPN). All differences with P <0.05. Conclusion. Compensation for sagittal is ethnicity dependent. Korean patients favor thoracic compensation via hypokyphosis, and Japanese patients favor pelvic compensation via retroversion. Patient ethnicity should be considered when evaluating the sagittal plane and surgical correction strategies.",
author = "{International Spine Study Group (ISSG)} and Diebo, {Bassel G.} and Isaac Gammal and Yoon Ha and Yoon, {Seung Hwan} and Chang, {Jae Won} and Byeongwoo Kim and Morio Matsumoto and Yu Yamato and Daisaku Takeuchi and Naobumi Hosogane and Mitsuru Yagi and Hiroshi Taneichi and Frank Schwab and Virginie Lafage and Christopher Ames",
year = "2017",
month = "2",
day = "15",
doi = "10.1097/BRS.0000000000001744",
language = "English",
volume = "42",
pages = "E234--E240",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Role of Ethnicity in Alignment Compensation

T2 - Propensity Matched Analysis of Differential Compensatory Mechanism Recruitment Patterns for Sagittal Malalignment in 288 ASD Patients from Japan, Korea, and United States

AU - International Spine Study Group (ISSG)

AU - Diebo, Bassel G.

AU - Gammal, Isaac

AU - Ha, Yoon

AU - Yoon, Seung Hwan

AU - Chang, Jae Won

AU - Kim, Byeongwoo

AU - Matsumoto, Morio

AU - Yamato, Yu

AU - Takeuchi, Daisaku

AU - Hosogane, Naobumi

AU - Yagi, Mitsuru

AU - Taneichi, Hiroshi

AU - Schwab, Frank

AU - Lafage, Virginie

AU - Ames, Christopher

PY - 2017/2/15

Y1 - 2017/2/15

N2 - Study Design. Retrospective review of adult spinal deformity patients in a multiethnic database. Objective. To investigate the role of ethnicity on recruitment of compensatory mechanisms for sagittal spinal deformity. Summary of Background Data. While the impacts of age, sex, and pelvic morphology on the ability to compensate for sagittal malalignment have been investigated, the role of ethnicity in compensatory mechanism recruitment is poorly understood. Methods. Patients from USA (85% Caucasian) >25 y/o were propensity matched by age, sex, and pelvic incidence with patients from Korea and Japan. Only primary patients or those with existing fusion below T12 were retained for analysis. Groups were subclassified by deformity severity (aligned: sagittal vertical axis (SVA) <50 mm; moderate malalignment: SVA 50-100 mm; severe malalignment: SVA >100 mm). Radiographic measurements including pelvic retroversion, thoracic kyphosis, loss of lumbar lordosis (PI minus LL), cervical lordosis, and cervical SVA were compared between the groups. Results. There were 288 patients (96 each in USA, KOR, JPN), with similar age (64-67 yr) and PI (49-53°). USA had smaller pelvic incidence minus lumbar lordosis in every alignment group (P <0.05). In moderate malalignment, JPN had more pelvic retroversion than USA (30° vs. 20°), and KOR had more thoracic hypokyphosis than USA (15 vs. 31°). In severe malalignment, JPN had more pelvic retroversion than USA (39° vs. 27°), and KOR had more thoracic hypokyphosis than USA (15° vs. 31°). KOR had smaller cSVA than USA in both aligned (11 vs. 27 mm) and moderate (19 vs. 31 mm) malalignment. In severe malalignment, KOR had less cervical lordosis (13° KOR vs. 15° USA vs. 27° JPN). All differences with P <0.05. Conclusion. Compensation for sagittal is ethnicity dependent. Korean patients favor thoracic compensation via hypokyphosis, and Japanese patients favor pelvic compensation via retroversion. Patient ethnicity should be considered when evaluating the sagittal plane and surgical correction strategies.

AB - Study Design. Retrospective review of adult spinal deformity patients in a multiethnic database. Objective. To investigate the role of ethnicity on recruitment of compensatory mechanisms for sagittal spinal deformity. Summary of Background Data. While the impacts of age, sex, and pelvic morphology on the ability to compensate for sagittal malalignment have been investigated, the role of ethnicity in compensatory mechanism recruitment is poorly understood. Methods. Patients from USA (85% Caucasian) >25 y/o were propensity matched by age, sex, and pelvic incidence with patients from Korea and Japan. Only primary patients or those with existing fusion below T12 were retained for analysis. Groups were subclassified by deformity severity (aligned: sagittal vertical axis (SVA) <50 mm; moderate malalignment: SVA 50-100 mm; severe malalignment: SVA >100 mm). Radiographic measurements including pelvic retroversion, thoracic kyphosis, loss of lumbar lordosis (PI minus LL), cervical lordosis, and cervical SVA were compared between the groups. Results. There were 288 patients (96 each in USA, KOR, JPN), with similar age (64-67 yr) and PI (49-53°). USA had smaller pelvic incidence minus lumbar lordosis in every alignment group (P <0.05). In moderate malalignment, JPN had more pelvic retroversion than USA (30° vs. 20°), and KOR had more thoracic hypokyphosis than USA (15 vs. 31°). In severe malalignment, JPN had more pelvic retroversion than USA (39° vs. 27°), and KOR had more thoracic hypokyphosis than USA (15° vs. 31°). KOR had smaller cSVA than USA in both aligned (11 vs. 27 mm) and moderate (19 vs. 31 mm) malalignment. In severe malalignment, KOR had less cervical lordosis (13° KOR vs. 15° USA vs. 27° JPN). All differences with P <0.05. Conclusion. Compensation for sagittal is ethnicity dependent. Korean patients favor thoracic compensation via hypokyphosis, and Japanese patients favor pelvic compensation via retroversion. Patient ethnicity should be considered when evaluating the sagittal plane and surgical correction strategies.

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U2 - 10.1097/BRS.0000000000001744

DO - 10.1097/BRS.0000000000001744

M3 - Article

C2 - 28207663

AN - SCOPUS:84975471182

VL - 42

SP - E234-E240

JO - Spine

JF - Spine

SN - 0362-2436

IS - 4

ER -