Sagittal vertical axis, spinosacral angle, T1 pelvic angle, and spinopelvic angle: which parameters can predict improvement in quality of life after surgical correction of ankylosing spondylitis?

Mohammed Khalid Saleh, Mohamed Abdallah Esawy, Yehia Elbromboly, Elsayed Mohamed Selim Ali

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Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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Mohammed Khalid SalehOrthopedic Department, Zagazig University Hospital, Qumia, Nour Hoda Street, Zagazig, Egypt.ORCID http://orcid.org/0000-0001-7537-2018

Mohamed Abdallah EsawyOrthopedic Department, Zagazig University Hospital, Qumia, Nour Hoda Street, Zagazig, Egypt.ORCID http://orcid.org/0009-0009-6447-310X

Yehia ElbrombolyOrthopedic Department, Zagazig University Hospital, Qumia, Nour Hoda Street, Zagazig, Egypt.ORCID http://orcid.org/0000-0001-8098-2611

Elsayed Mohamed Selim AliOrthopedic Department, Zagazig University Hospital, Qumia, Nour Hoda Street, Zagazig, Egypt. sayedselemali@zu.edu.eg.ORCID http://orcid.org/0000-0002-1127-1127

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6 · The paper itself

Abstract

introductionSpinal deformities in patients with ankylosing spondylitis (AS) can significantly impact their health-related quality of life (HRQoL). However, studies evaluating the relationship between specific spinal alignment parameters and HRQoL in these patients remain limited.

aimThis study aimed to examine the correlations between SVA, SSA, TPA, and SPA and HRQoL in surgically treated kyphosis patients with ankylosing spondylitis. It also aims to determine which measures are better at predicting HRQoL.

methodsA retrospective review was conducted on consecutive AS patients with thoracolumbar kyphosis who underwent corrective surgery. Inclusion criteria consisted of a global kyphosis (GK) angle exceeding 40°, physical activity limitations, difficulty lying flat, impaired forward vision, or dissatisfaction with appearance. Patient-reported outcomes, including the Oswestry Disability Index (ODI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Short Form-36 (SF-36) questionnaire, were extracted from medical records alongside radiological assessments.

resultsA total of 60 patients (36 males, 24 females) were included, with a mean age of 37.01 ± 9.9 years and an average follow-up of 32.6 ± 6.5 months. Post-operatively, HRQoL significantly improved, with ODI scores decreasing from 79.3 ± 7.6 to 26.8 ± 6.7. At the final follow-up, all patients exhibited minimal disease activity (BASDAI < 4). Radiographic analysis demonstrated significant improvements (P < 0.001), including reductions in GK, SVA, and TPA, along with increases in SSA and SPA. SSA was the only parameter significantly correlated with SF-36 scores. Additionally, ODI scores showed a significant positive correlation with GK, while BASDAI was positively associated with TPA and SPA. BASFI exhibited a significant positive correlation with SPA.

conclusionCorrective surgery for kyphosis in AS patients leads to substantial improvements in spinal alignment and HRQoL. Analysis of radiographic parameters revealed several significant but modest correlations with HRQoL measures. SSA demonstrated the strongest correlation with HRQoL, particularly SF-36 scores, albeit of modest strength. Furthermore, TPA and SPA were significantly associated with BASDAI, while SPA correlated significantly with BASFI. These findings highlight that sagittal alignment is one of multiple factors influencing patient-reported outcomes and provides valuable insights for surgical planning and patient counseling. However, the modest strength of these relationships underscores that HRQoL is multifactorial and not solely dependent on radiographic alignment.

Indexed as

KyphosisPelvisQuality of LifeSpondylitis, AnkylosingAdultDisability EvaluationFemaleHumansLumbar VertebraeMaleMiddle AgedPatient Reported Outcome MeasuresRadiographyRetrospective StudiesSacrumThoracic VertebraeAnkylosing spondylitisHealth-related quality of lifeSagittal vertical axisSpinopelvic angleSpinosacral angleT1 pelvic angle

Identifiers

PMID42014648

DOI10.1016/j.clineuro.2018.04.006

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