Xipho-pubic angle (XPA) correlates with patient’s reported outcomes in a population of adult spinal deformity: results from a multi-center cohort study

Francesco Langella, Jorge Hugo Villafañe, Virginie Lafage, Justin S. Smith, Christopher Shaffrey, Han Jo Kim, Douglas Burton, Richard Hostin, Shay Bess, Christopher Ames, Gregory Mundis, Eric Klineberg, Frank Schwab, Renault Lafage, Pedro Berjano

Research output: Contribution to journalArticlepeer-review


Study design: Retrospective multi-center cohort study. Purpose: Sagittal misalignment causes changes in the abdominal shape. Xipho-pubic angle (XPA) has been previously described to radiographically evaluate the shape of the abdominal cavity in patients with spine deformity. The aims of this study are to evaluate the correlation of XPA-to-spinopelvic sagittal parameters and to patients’ health-related quality-of-life (HRQoL) scores. Methods: 278 patients from a multi-center database with diagnosis adult spinal deformity (ASD) (one or more of: coronal Cobb angle CloseSPigtSPi 20°, sagittal vertical axis (SVA) CloseSPigtSPi 50 mm, pelvic tilt (PT) CloseSPigtSPi 25°, and thoracic kyphosis CloseSPigtSPi 60°) were included. Cut-off values for moderate and severe disability (ODI—Oswestry Disability Index—20 and 40%) were calculated. Pearson’s correlation was tested between XPA and spinopelvic parameters and between XPA and HRQoL scores. Results: The cut-off value of XPA to identify ODI severe disability (40/100) was identified with XPA smaller than 103°; minimal (20/100) disability was identified by XPA greater than 113°. XPA showed strong correlation to sagittal spinopelvic parameters—PT, SVA, lumbar lordosis (LL), pelvic incidence (PI) minus LL—and to HRQoL scores—ODI, SF-36 PCS and SRS-22 activity and pain. XPA was the parameter with the strongest correlation to HRQoL scores. Conclusions: Xipho-pubic angle reflects changes in spinal changes and has strong correlation to HRQoL and spinopelvic parameters. It can discriminate between patients with minimal, moderate, and severe disability as measured by ODI scores. Graphical Abstract: These slides can be retrieved under Electronic Supplementary Material.

Original languageEnglish
Pages (from-to)670-677
Number of pages8
JournalEuropean Spine Journal
Issue number3
Publication statusPublished - Mar 1 2018


  • Abdomen
  • Health-related quality of life
  • Outcomes
  • Sagittal alignment
  • Spinal deformity

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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