{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:52:53Z","timestamp":1786125173654,"version":"build-2736575974"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2019,7,2]],"date-time":"2019-07-02T00:00:00Z","timestamp":1562025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Previous studies have reported correlations and precise quantitative relationships between sagittal alignment and health-related quality-of-life (HRQOL) scores. These studies have not reported the extent of uncertainty in these relationships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To explore the uncertainty in the overall relationships between sagittal alignment and HRQOL and in the predictions of individual patient pain and disability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective analysis of all new adult patients with long-cassette radiographs and complete outcomes questionnaires presenting to the senior author from 2012 to 2014 was performed. Univariable maximum a posteriori linear regression analyses using Bayesian methods were performed. High-density probability intervals for mean regression relationships and for individual values were calculated using minimally informative prior distributions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 134 patients satisfied inclusion criteria and were included. For Oswestry Disability Index (ODI) vs pelvic incidence-lumbar lordosis (LL), the 90% high-density probability interval ranged from \u20130.04 to 0.23, indicating that both the magnitude and direction of the relationship were uncertain. For both ODI vs sagittal vertical axis and ODI vs LL, there was uncertainty in the magnitude of the slope. Wide regions of uncertainty were also seen for predicting individual patient scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>We report the previously unpublished degree of uncertainty in the mean quantitative relationships between radiographic sagittal alignment and patient-reported outcomes and in individual patient outcomes scores. Based on these results, establishing treatment thresholds or predicting an individual's outcome is unreliable. Further research efforts should be focused on developing multilevel hierarchical models incorporating parameter uncertainty and heterogeneous effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyz228","type":"journal-article","created":{"date-parts":[[2019,5,20]],"date-time":"2019-05-20T15:18:16Z","timestamp":1558365496000},"page":"485-491","source":"Crossref","is-referenced-by-count":13,"title":["Uncertainty in the Relationship Between Sagittal Alignment and Patient-Reported Outcomes"],"prefix":"10.1227","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1468-8611","authenticated-orcid":false,"given":"Peter D","family":"Angevine","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bray","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Cloney","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani","family":"Malone","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Scripps Clinic, La Jolla, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,4]]},"reference":[{"issue":"2","key":"bib1-20231011","first-page":"E282","article-title":"Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves","volume":"7","author":"Legaye","year":"1998","journal-title":"Spine"},{"issue":"1","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1097\/BRS.0000000000001171","article-title":"Defining spino-pelvic alignment thresholds: should operative goals in adult spinal deformity surgery account for age","volume":"41","author":"Lafage","year":"2016","journal-title":"Spine"},{"issue":"13","key":"bib3-20231011","doi-asserted-by":"crossref","first-page":"E803","DOI":"10.1097\/BRS.0b013e318292b7b9","article-title":"Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity","volume":"38","author":"Schwab","year":"2013","journal-title":"Spine"},{"issue":"22","key":"bib4-20231011","doi-asserted-by":"crossref","first-page":"2940","DOI":"10.1097\/00007632-200011150-00017","article-title":"The oswestry disability index","volume":"25","author":"Fairbank","year":"2000","journal-title":"Spine"},{"issue":"5","key":"bib5-20231011","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3109\/07853890109002087","article-title":"EQ-5D: a measure of health status from the EuroQol group","volume":"33","author":"Rabin","year":"2001","journal-title":"Ann Med"},{"issue":"3","key":"bib6-20231011","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1097\/00005650-200503000-00003","article-title":"US valuation of the EQ-5D health states: development and testing of the D1 valuation model","volume":"43","author":"Shaw","year":"2005","journal-title":"Med Care"},{"issue":"18","key":"bib8-20231011","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1097\/01.brs.0000179086.30449.96","article-title":"The impact of positive sagittal balance in adult spinal deformity","volume":"30","author":"Glassman","year":"2005","journal-title":"Spine"},{"issue":"15","key":"bib9-20231011","doi-asserted-by":"crossref","first-page":"E519","DOI":"10.1097\/BRS.0b013e3181a9c7ad","article-title":"Can C7 plumbline and gravity line predict health related quality of life in adult scoliosis","volume":"34","author":"Mac-Thiong","year":"2009","journal-title":"Spine"},{"issue":"19","key":"bib10-20231011","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.2106\/JBJS.M.01459","article-title":"The T1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life","volume":"96","author":"Protopsaltis","year":"2014","journal-title":"J Bone Joint Surg Am"},{"issue":"3","key":"bib11-20231011","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1097\/BRS.0000000000001202","article-title":"The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases","volume":"41","author":"Bess","year":"2016","journal-title":"Spine"},{"issue":"22","key":"bib13-20231011","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1097\/BRS.0000000000001613","article-title":"Baseline patient-reported outcomes correlate weakly with radiographic parameters. A multicenter, prospective NIH adult symptomatic lumbar scoliosis study of 286 patients","volume":"41","author":"Chapman","year":"2016","journal-title":"Spine"},{"issue":"6","key":"bib14-20231011","doi-asserted-by":"crossref","first-page":"573","DOI":"10.3171\/2017.8.SPINE161266","article-title":"Sagittal radiographic parameters demonstrate weak correlations with pretreatment patient-reported health-related quality of life measures in symptomatic de novo degenerative lumbar scoliosis: a European multicenter analysis","volume":"28","author":"Faraj","year":"2018","journal-title":"J Neurosurg Spine"},{"issue":"8","key":"bib15-20231011","doi-asserted-by":"crossref","first-page":"2176","DOI":"10.1007\/s00586-016-4872-y","article-title":"Are sagittal spinopelvic radiographic parameters significantly associated with quality of life of adult spinal deformity patients? Multivariate linear regression analyses for pre-operative and short-term post-operative health-related quality of life","volume":"26","author":"Takemoto","year":"2017","journal-title":"Eur Spine J"},{"issue":"5","key":"bib16-20231011","doi-asserted-by":"crossref","first-page":"E282","DOI":"10.1097\/BRS.0000000000001229","article-title":"Clinical relevance of the SRS-Schwab classification for degenerative lumbar scoliosis","volume":"41","author":"Ha","year":"2016","journal-title":"Spine"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/neurosurgery\/advance-article-pdf\/doi\/10.1093\/neuros\/nyz228\/28896267\/nyz228.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyz228","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:51:20Z","timestamp":1786121480000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyz228"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,2]]},"references-count":14,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyz228","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,2]]}}}