Research

Purpose: To analyze the relationship between radiographic balance and patient's perception of balance in long fusions to the sacrum.
Methods: We performed a retrospective review of patients with primary fusions from the sacrum to T10 or above (2/3 fused to T2 through T4 caudally). A single observer reviewed standardized full-spine radiographs from preoperative, postoperative and follow-up. Standardized outcome measures were administered at last follow-up. Radiographic balance was defined as C7 plumb line within 1.5cm of the anterior sacral promontory (sagittal) or midsacral line (coronal). Radiographic balance was compared to patient-perception of balance.
Results: Forty-four patients, average age 49 years and mean follow up of 9 years (5 to 19), were included. Despite the fact that 80% were satisfied with treatment, 41% of patients were dissatisfied with upper body alignment and 35% were concerned about public perception.
Agreement between radiographs and patient perception was 76% (coronal) and 68% (sagittal). When radiographs indicated imbalance, 70% noticed the imbalance regardless of sagittal or coronal direction.
By broadening the definition of radiographic balance to 2.5 cm, the agreement between radiographs and patient perception increased to 90% in the coronal plane and to 73% in the sagittal plane. In the coronal plane, 91% of the patients who were unbalanced by 2.5 cm or more noticed the imbalance. In the sagittal plane, 69% were still able to detect the radiographic imbalance; however, if patients felt out of balance, radiographic findings confirmed imbalance 90% of the time.
Conclusions: Although patient appreciation of imbalance in the sagittal and coronal planes was consistent with radiographic findings at the standard 1.5 cm deviation, accuracy improved when the threshold was extended to 2.5 cm. Patients noticed coronal imbalance more than sagittal imbalance. Treatment satisfaction did not reflect patient-perception of upper body alignment following long fusion to the sacrum.