Sagittal imbalance and need for future care in elderly adults: Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study (LOHAS) — The International Society for the Study of the Lumbar Spine
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Sagittal imbalance and need for future care in elderly adults: Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study (LOHAS) (#ZSP5)

Kazuyuki Watanabe 1 , Koji Otani 1 , Miho Sekiguchi 1 , Takuya Nikaido 1 , Kinshi Kato 1 , Hiroshi Kobayashi 1 , Ryoji Tominaga 2 , Yoshihiro Konayashi 1 , Shoji Yabuki 1 , Shin-ichi Kikuchi 1 , Shinichi Konno 1
  1. Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
  2. Department of Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima, Japan

INTRODUCTION: Spinal deformity with the sagittal imbalance in the elderly causes impairments in standing and gait, and is a possible risk factor for future care needs. The purpose of this study was to clarify whether sagittal imbalance was a risk factor for the condition of needed care in the community setting.

METHODS: This study included 607 participants of the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS) in 2010. The primary outcome was a new certification of needing support or care in the national long-term care insurance system during 5-year follow-up. The sagittal vertical axis (SVA: mm) was measured on a standing whole-spine lateral radiograph. Bodily pain and depression were assessed using SF-12. The 3 minutes timed up and go (TUG) test was performed to evaluate the physical function. Comorbidities such as hypertension, diabetes, brain disease, heart disease, and smoking and drinking habits were investigated. Statistical analysis was performed using the chi-square test and Wilcoxon test. The association between SVA and new care-needs certification was evaluated by logistic regression analysis with adjustment for confounding factors.

RESULTS: During five years, 49 participants were newly certified for care needs. New care-needs certification was made in 6.1% in the SVA<40 group, 8.5% in the SVA 40-95 group, and 25.7% in the SVA>95 group. The odds ratio [95% CI] of SVA>95 group against SVA<40 group was 5.5 [1.9-15.4] and against SVA 40-95 group was 4.9 [1.7-14.7] adjusted with age (75≥), body pain, TUG (≥11 seconds), and body mass index (BMI:≥25).

DISCUSSION: The results of this study indicated that severe sagittal imbalance with SVA>95 was associated with the new certification of long-term care needs. In other words, the sagittal imbalance was a risk factor of disabilities that impair the independence of the elderly. Prevention and treatment of sagittal imbalance were considered essential to prevent future care needs for the elderly. Further study is needed to clarify whether surgical treatment for adult spinal deformities with sagittal imbalance prevents future care needs.

 

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