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Chevillotte T, Chan SK, Grobost P, Laouissat F, Darnis A, Silvestre C, Roussouly P. Quantifying the Spinal Lordosis Ratio Unique to the Type of Spinal Sagittal Alignment in a Normal Population. Global Spine J 2024; 14:1110-1115. [PMID: 36207768 DOI: 10.1177/21925682221133748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Data collection of radiological parameters in non-pathological adult spines. OBJECTIVES Establishing a baseline database for measurements of the spinal lordosis ratio between upper and lower arcs of the lumbar spine unique to each type of spine described by Roussouly's classification. Illustrating the importance of correct rationing of the upper and lower arcs. METHODS Standardised standing true lateral plain radiographs of the spine (including base of skull and proximal femurs) from 373 adult volunteers were obtained. Exclusion criteria : any history of disease involving the spine, pelvis, hips or lower limbs. Incidental detection of any spinal deformity on radiography also excluded further participation in this study. Sacro-pelvic parameters data collected : Pelvic Incidence (PI), Pelvic Tilt (PT), Sacral Slope (SS), location of Inflection Point, number of vertebras in the spinal lordosis and type of Roussouly's spine. Values of upper arc, lower arc and spinal lordosis ratio (SLR) was determined. RESULTS Bivariate analysis revealed statistically significant (P < .0001) correlation between the types of sagittal spinal alignments based on Roussouly's classification and the SLR. Type 1: SLR .76 ± .17, Type 2: SLR .60 ± .18, Type 3 with anteverted pelvis: SLR .53 ± .11, Type 3: SLR .49 ± .12, Type4: SLR .41 ± .11. CONCLUSION With this data we are able to quantify the ratio of lumbar lordosis unique to each type of Roussouly's spine. It functions as a guide when planning lumbar spine surgeries in order to restore the SLR correctly and thus prevent post-op complications such as proximal junction kyphosis.
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Affiliation(s)
- Thomas Chevillotte
- Institut de la Colonne Vertébrale (ICV) Lyon Charcot, Sainte-Foy-les-Lyon, France
| | - Sook-Kwan Chan
- Department of Orthopaedics, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | - Pierre Grobost
- Institut de la Colonne Vertébrale (ICV) Lyon Charcot, Sainte-Foy-les-Lyon, France
| | - Fethi Laouissat
- Hôpital privé de l'est Lyonnaise (HPEL), Saint-Priest, France
| | - Alice Darnis
- Institut de la Colonne Vertébrale (ICV) Lyon Charcot, Sainte-Foy-les-Lyon, France
| | - Clément Silvestre
- Institut de la Colonne Vertébrale (ICV) Lyon Charcot, Sainte-Foy-les-Lyon, France
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Müller JA, Krenn VA, Böni T, Haeusler M. The influence of lumbosacral transitional vertebrae on lumbar lordosis and the angle of pelvic incidence. J Anat 2024; 244:594-600. [PMID: 38030157 PMCID: PMC10941542 DOI: 10.1111/joa.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023] Open
Abstract
Pelvic incidence and lumbar lordosis have only normative values for spines comprising five lumbar and five sacral vertebrae. However, it is unclear how pelvic incidence and lumbar lordosis are affected by the common segmentation anomalies at the lumbo-sacral border leading to lumbosacral transitional vertebrae, including lumbarisations and sacralisations. In lumbosacral transitional vertebrae it is not trivial to identify the correct vertebral endplates to measure pelvic incidence and lumbar lordosis because ontogenetically the first sacral vertebra represents the first non-mobile sacral segment in lumbarisations, but the second segment in sacralisations. We therefore assessed pelvic incidence and lumbar lordosis with respect to both of these vertebral endplates. The type of segmentation anomaly was differentiated using spinal counts, spatial relationship with the iliac crest and morphological features. We found significant differences in pelvic incidence and lumbar lordosis between lumbarisations, sacralisations and the control group. The pelvic incidence in the sacralised group was mostly below the range of the lubarisation group and the control group when measured the traditional way at the first non-mobile segment (30.2°). However, the ranges of the sacralisation and lubarisation groups were completely encompassed by the control group when measured at the ontogenetically true first sacral vertebra. The mean pelvic incidence of the sacraliation group thus increased from 30.2° to 58.6°, and the mean pelvic incidence of the total sample increased from 45.6° to 51.2°, making it statistically indistinguishable from the control sample, whose pelvic incidence was 50.2°. Our results demonstrate that it is crucial to differentiate sacralisations from lumbarisation in order to assess the reference vertebra for pelvic incidence measurement. Due to their significant impact on spino-pelvic parameters, lumbosacral transitional vertebrae should be evaluated separately when examining pelvic incidence and lumbar lordosis.
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Affiliation(s)
- Jonas A Müller
- Institute of Evolutionary Medicine, University of Zürich, Zürich, Switzerland
| | - Viktoria A Krenn
- Institute of Evolutionary Medicine, University of Zürich, Zürich, Switzerland
- Department of Evolutionary Anthropology, University of Vienna, Vienna, Austria
- Frauenhofer Innovation Center for Digitization and Artificial Intelligence - KI4LIFE, Frauenhofer Austria Research, Klagenfurt, Austria
| | - Thomas Böni
- Institute of Evolutionary Medicine, University of Zürich, Zürich, Switzerland
- Balgrist University Hospital, Zürich, Switzerland
| | - Martin Haeusler
- Institute of Evolutionary Medicine, University of Zürich, Zürich, Switzerland
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Pour AE, Innmann MM, Reichel F, Schaper B, Renkawitz T, Merle C, Grammatopoulos G. How Do Spinopelvic Characteristics Change Post-Total Hip Arthroplasty? A Longitudinal Assessment Raising Awareness of the Postoperative Period. J Arthroplasty 2024:S0883-5403(24)00199-2. [PMID: 38460739 DOI: 10.1016/j.arth.2024.02.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Spinopelvic characteristics, including sacral slope (SS), are commonly evaluated in different positions pre-total hip arthroplasty (THA). This study aimed to: 1) investigate the change in spinopelvic parameters at 7 days (early) and 1-year post-THA; and 2) identify patient characteristics associated with a change in SS of more than 7° post-THA. METHODS We prospectively studied 250 patients who underwent unilateral THA [132 women, age 66 years (range, 32 to 88)] and underwent biplanar images preoperatively and at 7 days and 1-year post-THA. Parameters measured included pelvic incidence, standing lumbar lordosis, SS, and proximal femoral angle (PFA). A SS change ≥ 7° was considered the threshold as it would result in more than a 5° change in cup orientation. RESULTS Early post-THA SSstanding remained within ± 6º from preoperative measurements in 75% of patients, reduced by ≥ 7° in 9%, and increased by ≥ 7° in 16%. Those that showed a reduction in SS had the lowest PFA and the highest SS pre-THA (P = .028, .107, and < 0.001, respectively). From 7 days until the 1-year mark, pelvic tilt increased, SS reduced (mean: -4º, range: -29 to 17º, P < .001), and patients stood with greater hip extension ΔPFAstanding (mean 7°, range: -34 to 37°, P < .001). At 1 year, SSseated had remained within ± 6º, relative to the pre-THA value, in 49% of patients. CONCLUSIONS Standing spinopelvic characteristics, especially SSstanding, remain within ±6° in three-quarters of patients both early- and at 1-year post-THA. In the remaining cases, pelvic tilt changes significantly. In 9% of cases, SS reduces ≥ 7° early THA, probably due to the alleviation of fixed-flexion contractures. The SSseated changes by ≥ ± 7° in almost 50% of cases in this study, and its clinical value as a preoperative planning tool should be questioned. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- Aidin E Pour
- Department of Orthopaedic Surgery, Yale University, New Haven, Connecticut
| | - Moritz M Innmann
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ontario, Canada; Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Bibiane Schaper
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christian Merle
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ontario, Canada; Diakonie Klinikum Stuttgart, Stuttgart, Germany
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Torabian KA, Cherian NJ, Eberlin CT, Dean MC, Dowley KS, LaPorte ZL, Kucharik MP, Gillinov SM, Martin SD. The Effect of Pelvic Incidence on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement and Acetabular Labral Tears. Am J Sports Med 2024; 52:631-642. [PMID: 38369972 PMCID: PMC10905981 DOI: 10.1177/03635465231219261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/06/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND In the setting of femoroacetabular impingement (FAI), decompression osteoplasties reconcile deleterious loading patterns caused by cam and pincer lesions. However, native variations of spinopelvic sagittal alignment may continue to perpetuate detrimental effects on the labrum, chondrolabral junction, and articular cartilage after hip arthroscopy. PURPOSE To evaluate the effect of pelvic incidence (PI) on postoperative outcomes after hip arthroscopy for acetabular labral tears in the setting of FAI. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective query of prospectively collected data identified patients ≥18 years of age who underwent primary hip arthroscopy for FAI and acetabular labral tears between February 2014 and January 2022, with 3-, 6-, 12-, and 24-month follow-ups. Measurements for PI, pelvic tilt (PT), sacral slope (SS), and acetabular version were obtained via advanced diagnostic imaging. Patients were stratified into low-PI (<45°), moderate-PI (45°≤ PI ≤ 60°), and high-PI (>60°) cohorts. Patient-reported outcome measures (PROMs), clinically meaningful outcomes (ie, minimal clinically important difference, Patient Acceptable Symptom State, substantial clinical benefit, and maximal outcome improvement), visual analog scale (VAS) pain scores, and patient satisfaction were compared across cohorts. RESULTS A total of 74 patients met eligibility criteria and were stratified into low-PI (n = 28), moderate-PI (n = 31), and high-PI (n = 15) cohorts. Correspondingly, patients with high PI displayed significantly greater values for PT (P = .001), SS (P < .001), acetabular version (P < .001), and acetabular inclination (P = .049). By the 12- and 24-month follow-ups, the high-PI cohort was found to have significantly inferior PROMs, VAS pain scores, rates of clinically meaningful outcome achievement, and satisfaction relative to patients with moderate and/or low PI. No significant differences were found between cohorts regarding rates of revision arthroscopy, subsequent spine surgery, or conversion to total hip arthroplasty. CONCLUSION After hip arthroscopy, patients with a high PI (>60°) exhibited inferior PROMs, rates of achieving clinically meaningful thresholds, and satisfaction at 12 and 24 months relative to patients with low or moderate PI. Conversely, the outcomes of patients with low PI (<45°) were found to match the trajectory of those with a neutral spinopelvic alignment (45°≤ PI ≤ 60°). These findings highlight the importance of analyzing spinopelvic parameters preoperatively to prognosticate outcomes before hip arthroscopy for acetabular labral tears and FAI.
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Affiliation(s)
- Kaveh A. Torabian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathan J. Cherian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA
| | - Christopher T. Eberlin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Michael C. Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kieran S. Dowley
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zachary L. LaPorte
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael P. Kucharik
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Stephen M. Gillinov
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Scott D. Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Shen Y, Sardar ZM, Malka M, Katiyar P, Greisberg G, Hassan F, Reyes JL, Le Huec JC, Bourret S, Hasegawa K, Wong HK, Liu G, Dennis Hey HW, Riahi H, Kelly M, Lombardi JM, Lenke LG. Characteristics of Spinal Morphology According to the "Current" and "Theoretical" Roussouly Classification Systems in a Diverse, Asymptomatic Cohort: Multi-Ethnic Alignment Normative Study (MEANS). Global Spine J 2024:21925682241235611. [PMID: 38417069 DOI: 10.1177/21925682241235611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
STUDY DESIGN Cross-sectional cohort study. OBJECTIVE To classify spinal morphology using the "current" and "theoretical" Roussouly systems and assess sagittal alignment in an asymptomatic cohort. METHODS 467 asymptomatic volunteers were recruited from 5 countries. Radiographic parameters were measured via the EOS imaging system. "Current" and "theoretical" Roussouly classification was assigned with sagittal whole spine imaging using sacral slope (SS), pelvic incidence (PI), and the lumbar apex. One-way analysis of variance (ANOVA) was performed to compare subject characteristics across Roussouly types, followed by post hoc Bonferroni correction. RESULTS Volunteers were categorized into 4 groups (Types 1-4) and 1 subgroup (Type 3 AP) using the "current" and "theoretical" Roussouly systems. The mean PI in "current" Roussouly groups was 40.8° (Type 1), 43.6° (Type 2), 52.4° (Type 3), 62.4° (Type 4), and 43.7° (Type 3AP). The mean PI in "theoretical" Roussouly groups was 36.5° (Type 1), 39.1°(Type 2), 52.5° (Type 3), 67.3° (Type 4), and 51.0° (Type 3AP). The difference in PI between "current" and "theoretical" Roussouly types was significant for Type 1 (P = .02), Type 2 (P < .001), Type 4 (P < .001), and Type 3AP (P < .001). 34.7% of subjects had a "current" Roussouly type different from the "theoretical" type. Type 3 theoretical shape had the most frequent mismatch, constituting 61.1% of the mismatched subjects. 51.5% of mismatched Type 3 become "current" Type 4. CONCLUSION The distribution of Roussouly types differs depending on whether the "current" or "theoretical" classification are employed. A sizeable proportion of volunteers exhibited current and theoretical type mismatch, highlighting the need to interpret sagittal alignment cautiously when utilizing the Roussouly system.
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Affiliation(s)
- Yong Shen
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Matan Malka
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Prerana Katiyar
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Gabriella Greisberg
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Fthimnir Hassan
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Justin L Reyes
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | | | - Stephane Bourret
- Bordeaux University, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | - Hee Kit Wong
- Department of Orthopedic Surgery, National University Hospital, Singapore
| | - Gabriel Liu
- Department of Orthopedic Surgery, National University Hospital, Singapore
| | | | - Hend Riahi
- Institut Kassab d'Orthopédie, La Manouba, Tunisia
| | - Michael Kelly
- Rady Children's Hospital, University of California, San Diego, CA, USA
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
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Yoshikawa K, Tamaki T, Kimura T, Matsumoto Y, Endo R, Tsushima E. Association Between Anterior Hip Capsule Thickening and Sagittal Pelvic Alignment Among Patients With Developmental Dysplasia of the Hip. Cureus 2024; 16:e54370. [PMID: 38500889 PMCID: PMC10945461 DOI: 10.7759/cureus.54370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION The pathogenesis and pathology of secondary osteoarthritis (OA) of the hip, which is mainly due to developmental dysplasia of the hip (DDH), in Japan are obscure. There are some reports on the thickening of the hip capsule, but the relationship between the thickness of the hip capsule and the pelvic alignment due to hip deformity is not well known. This research investigated whether the capsular thickness of female DDH patients was related to pelvic alignment. METHODS This single-center cross-sectional study included female patients aged 50-79 years (n=13) who had undergone primary total hip arthroplasty (THA) due to secondary hip OA with a background of DDH. The part of the hip capsule including the iliofemoral ligament was resected and measured directly with a digital caliper. The Sharp angle, center-edge (CE) angle, sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and lumbar lordosis angle (LLA) were measured with an X-ray image to investigate the relationship between the capsular thickness and the pelvic posture. RESULTS Pearson's correlation coefficient showed a negative correlation between hip capsular thickness and Sharp angle (r=-0.57, p>0.05). No significant correlation was found between the thickness of the hip capsule and the sagittal X-ray parameters including SS, PT, PI, LLA, and CE angle in the coronal plane. CONCLUSION The thickness of the hip capsule is moderately associated with the Sharp angle on the coronal plane. The results of this study suggest that the thickness of the joint capsule does not necessarily relate to the degenerative process among patients with DDH and the process can be complex to apply two-dimensional postural indices for the explanation.
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Affiliation(s)
- Koji Yoshikawa
- Physiotherapy, Naka Orthopedic Kyoto Saiin Rehabilitation Clinic, Kyoto, JPN
- Health Sciences, Hirosaki University, Hirosaki, JPN
| | - Tatsuya Tamaki
- Orthopedic Surgery, Naka Orthopedic Kyoto Kitano Main Institution, Kyoto, JPN
| | - Tetsuya Kimura
- Orthopedic Surgery, Naka Orthopedic Kyoto Saiin Rehabilitation Clinic, Kyoto, JPN
| | - Yuji Matsumoto
- Physiotherapy, Naka Orthopedic Kyoto Kitano Main Institution, Kyoto, JPN
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Zhou H, Liang Z, Li P, Shi H, Liang A, Gao W, Huang D, Peng Y. Correlation analysis of surgical outcomes and spino-pelvic parameters in patients with degenerative lumbar scoliosis. Front Surg 2024; 10:1319884. [PMID: 38239662 PMCID: PMC10794318 DOI: 10.3389/fsurg.2023.1319884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/04/2023] [Indexed: 01/22/2024] Open
Abstract
Objectives The study aims to analyze factors that affect the postoperative health-related quality of life (HRQOL) of degenerative lumbar scoliosis (DLS) patients and explore the appropriate pelvic incidence minus lumbar lordosis (PI-LL) value for Chinese DLS patients. Methods DLS patients who met the inclusion and exclusion criteria were included in this study. General information, spino-pelvic parameters, and HRQOL were collected. Correlation analysis was used to explore the spino-pelvic parameters that affect the postoperative HRQOL. Thresholds of each parameter were obtained using the receiver operating characteristic (ROC) curve. Regardless of the effect of age, DLS patients were classified into three groups according to the SRS-Schwab classification: group 0 means PI-LL < 10°, group+means PI-LL = 10-20°, and group ++ means PI-LL > 20°. Postoperative HRQOL was analyzed using variance methods. The ROC curve was used to measure the appropriate PI-LL threshold. When considering the effect of age, the patients with Oswestry Disability Index (ODI) < 75% percentile were considered to have a satisfactory clinical outcome, which was drawn to an equation between PI-LL, age, and PI by multiple linear regression equation. Results A total of 71 patients were included. Compared with the control group, there were significant differences in both postoperative ODI and Scoliosis Research Society 22 (SRS-22) scores when the postoperative Cobb angle ≤11°, postoperative lumbar lordosis index (LLI) > 0.8, postoperative sagittal vertical axis (SVA) ≤ 5 cm, postoperative T1 pelvic angle (TPA) ≤ 16° and postoperative global tilt (GT) ≤ 22°, respectively. Regardless of the effect of age, there was a statistical difference in postoperative HRQOL between group 0 and group ++. The PI-LL threshold derived from the ROC curve was 14.4°. Compared with the PI-LL > 14° group, the PI-LL ≤ 14° group achieved a lower postoperative ODI score and a higher postoperative SRS-22 score. Considering the influence of age, the equation for ideal PI-LL was PI-LL = 0.52age + 0.38PI-39.4 (R = 0.509, p = 0.001). Conclusions PI-LL was an important parameter that affects the postoperative HRQOL of DLS patients. Sufficient LL should be restored during the operation (LL ≥ PI-14°). The appropriate PI-LL value was affected by age. Smaller LL needed to be restored as the age increased.
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Affiliation(s)
- Hang Zhou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhancheng Liang
- Department of Spinal Surgery, Fosun Group, Foshan Fosun Chancheng Hospital, Foshan, Guangdong, China
| | - Pengfei Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Huihong Shi
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Anjing Liang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wenjie Gao
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Dongsheng Huang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yan Peng
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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McCarthy MH, Lafage R, Smith JS, Bess S, Ames CP, Klineberg EO, Kim HJ, Shaffrey CI, Burton DC, Mundis GM, Gupta MC, Schwab FJ, Lafage V. How Much Lumbar Lordosis does a Patient Need to Reach their Age-Adjusted Alignment Target? A Formulated Approach Predicting Successful Surgical Outcomes. Global Spine J 2024; 14:41-48. [PMID: 35442842 PMCID: PMC10676150 DOI: 10.1177/21925682221092003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Identify optimal lumbar lordosis in adult deformity correction to achieve age-adjusted targets and sustained alignment. METHODS Surgical adult spinal deformity patients reaching an age-adjusted ideal alignment at one year were identified. Multilinear regression analysis was used to identify the relationship between regional curvatures (LL and TK) that enabled achievement of a given global alignment (T1 pelvic angle, TPA) based on pelvic incidence (PI). RESULTS 347 patients out of 1048 available reached their age-adjusted TPA within 5° (60-year-old, 72% women, body mass index 29 ± 6.2). They had a significant improvement in all sagittal parameters (except PI) from pre-operative baseline to 1 year following surgery (P < .001). Multilinear regression predicting L1-S1 based on TK, TPA, and PI demonstrated excellent results (R2 = .85). Simplification of the coefficients of prediction combined with a conversion to an age-based formula led to the following: LL = PI - 0.3TK - 0.5Age + 10. Internal validation of the formula led to a mean error of -.4°, and an absolute error of 5.0°. Internal validation on patients with an age-adjusted alignment revealed similar accuracy across the entire age-adjusted TPA spectrum (ranges of LL errors: ME = .2° to 1.7°, AE = 4.0° to 5.3°). CONCLUSION This study provides a simple guideline to identify the amount of LL needed to reach a given alignment (i.e., age-adjusted target) based on PI and associated TK. Implementation of this predictive formula during pre-operative surgical planning may help to reduce unexpected sub-optimal post-operative alignment outcomes.
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Affiliation(s)
- Michael H. McCarthy
- Indiana Spine Group, Carmel, IN, USA; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Renaud Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Justin S. Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Shay Bess
- Denver International Spine Center, Denver, CO, USA
| | - Christopher P. Ames
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Eric O. Klineberg
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Han J. Kim
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | | | - Douglas C. Burton
- Department of Orthopaedic Surgery, The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Manish C. Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Frank J. Schwab
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - International Spine Study Group (ISSG)
- Indiana Spine Group, Carmel, IN, USA; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
- Denver International Spine Center, Denver, CO, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, USA
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Department of Orthopaedic Surgery, The University of Kansas Medical Center, Kansas City, KS, USA
- San Diego Center for Spinal Disorders, La Jolla, CA, USA
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
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Ani F, Protopsaltis TS, Parekh Y, Odeh K, Lafage R, Smith JS, Eastlack RK, Lenke L, Schwab F, Mundis GM, Gupta MC, Klineberg EO, Lafage V, Hart R, Burton D, Ames CP, Shaffrey CI, Bess S. Determining the best vertebra for measuring pelvic incidence and spinopelvic parameters in adult spinal deformity patients with transitional anatomy. J Neurosurg Spine 2024; 40:92-98. [PMID: 37862715 DOI: 10.3171/2023.8.spine23432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/08/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE The aim of this study was to determine if spinal deformity patients with L5 sacralization should have pelvic incidence (PI) and other spinopelvic parameters measured from the L5 or S1 endplate. METHODS This study was a multicenter retrospective comparative cohort study comprising a large database of adult spinal deformity (ASD) patients and a database of asymptomatic individuals. Linear regression modeling was used to determine normative T1 pelvic angle (TPA) and PI - lumbar lordosis (LL) mismatch (PI-LL) based on PI and age in a database of asymptomatic subjects. In an ASD database, patients with radiographic evidence of L5 sacralization had the PI, LL, and TPA measured from the superior endplate of S1 and then also from L5. The differences in TPA and PI-LL from normative were calculated in the sacralization cohort relative to L5 and S1 and correlated to the Oswestry Disability Index (ODI). Patients were grouped based on the Scoliosis Research Society (SRS)-Schwab PI-LL modifier (0, +, or ++) using the L5 PI-LL and S1 PI-LL. Baseline ODI and SF-36 Physical Component Summary (PCS) scores were compared across and within groups. RESULTS Among 1179 ASD patients, 276 (23.4%) had transitional anatomy, 176 with sacralized L5 (14.9%) and 100 (8.48%) with lumbarization of S1. The 176 patients with sacralized L5 were analyzed. When measured using the L5 superior endplate, pelvic parameters were significantly smaller than those measured relative to S1 (PI: 24.5° ± 11.0° vs 55.7° ± 12.0°, p = 0.001;TPA: 11.2° ± 12.0° vs 20.3° ± 12.5°, p = 0.001; and PI-LL: 0.67° ± 21.1° vs 11.4° ± 20.8°, p = 0.001). When measured from S1, 76 (43%), 45 (25.6%), and 55 (31.3%) patients had SRS-Schwab PI-LL modifiers of 0, +, and ++, respectively, compared with 124 (70.5%), 22 (12.5%), and 30 (17.0%), respectively, when measured from L5. There were significant differences in ODI and PCS scores as the SRS-Schwab grade increased regardless of L5 or S1 measurement. The L5 group had lower PCS functional scores for SRS-Schwab modifiers 0 and ++ relative to same grades in the S1 group. Offset from normative TPA (0.5° ± 11.1° vs 9.6° ± 10.8°, p = 0.001) and PI-LL (4.5° ± 20.4° vs 15.2° ± 19.3°, p = 0.001) were smaller when measuring from L5. Moreover, S1 measurements were more correlated with health status by ODI (TPA offset from normative: S1, R = 0.326 vs L5, R = 0.285; PI-LL offset from normative: S1, R = 0.318 vs L5, R = 0.274). CONCLUSIONS Measuring the PI and spinopelvic parameters at L5 in sacralized anatomy results in underestimating spinal deformity and is less correlated with health-related quality of life. Surgeons may consider measuring PI and spinopelvic parameters relative to S1 rather than at L5 in patients with a sacralized L5.
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Affiliation(s)
- Fares Ani
- 1Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | | | - Yesha Parekh
- 2Department of Orthopedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Khalid Odeh
- 1Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Renaud Lafage
- 3Department of Orthopedic Surgery, Lenox Hill, Northwell Health, New York, New York
| | - Justin S Smith
- 4Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Robert K Eastlack
- 5Department of Orthopedic Surgery, Scripps Memorial Hospital, La Jolla, California
| | - Lawrence Lenke
- 6Department of Orthopedic Surgery, Columbia University, New York, New York
| | - Frank Schwab
- 3Department of Orthopedic Surgery, Lenox Hill, Northwell Health, New York, New York
| | - Gregory M Mundis
- 5Department of Orthopedic Surgery, Scripps Memorial Hospital, La Jolla, California
| | - Munish C Gupta
- 7Department of Orthopedic Surgery, Washington University in St. Louis, Missouri
| | - Eric O Klineberg
- 8Department of Orthopedic Surgery, University of California, Davis, California
| | - Virginie Lafage
- 3Department of Orthopedic Surgery, Lenox Hill, Northwell Health, New York, New York
| | - Robert Hart
- 9Department of Orthopedic Surgery, Swedish Medical Center, Seattle, Washington
| | - Douglas Burton
- 10Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Christopher P Ames
- 11Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Shay Bess
- 13Department of Spine Surgery, Denver International Spine Center, Denver, Colorado
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10
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Protopsaltis TS, Ani F, Soroceanu A, Lafage R, Kim HJ, Balouch E, Norris Z, Smith JS, Daniels AH, Klineberg EO, Ames CP, Hart R, Bess S, Shaffrey CI, Schwab FJ, Lenke LG, Lafage V, Gupta MC. Clinical outcomes and proximal junctional failure in adult spinal deformity patients corrected to normative alignment versus functional alignment. J Neurosurg Spine 2023; 39:757-764. [PMID: 37503890 DOI: 10.3171/2023.5.spine221266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/19/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE The objective of this study was to explore the rate of proximal junctional failure (PJF) and functional outcomes of normative alignment goals compared with alignment targets based on age-appropriate physical function. METHODS Baseline relationships between age, pelvic incidence (PI), and a component of the T1 pelvic angle (TPA) within the fusion were analyzed in adult spinal deformity (ASD) patients and compared with those of asymptomatic patients. Linear regression modeling was used to determine alignment based on PI and age in asymptomatic patients (normative alignment), and in ASD patients, alignment corresponding to age-appropriate functional status (functional alignment). A cohort of 288 ASD patients was split into two groups based on whether the patient was closer to their normative or functional alignment goal at their 6-week postoperative radiographic follow-up. The rates of proximal junctional kyphosis (PJK) and PJF were determined for each cohort. RESULTS In the 288 ASD patients included in this pre- to postoperative analysis, there was no difference in baseline alignment or health-related quality of life (HRQOL) between the normative alignment and functional alignment groups. At 6 weeks, patients with normative alignment had a smaller TPA (4.45° vs 14.1°) and PI minus lumbar lordosis (-7.24° vs 7.4°) (both p < 0.0001) and higher PJK (40% vs 27.2%, p = 0.03) and PJF (17% vs 6.8%, p = 0.008) rates than patients with functional alignment. CONCLUSIONS Correction in ASD patients to normative alignment resulted in higher rates of PJK and PJF without improvements in HRQOL. Correction in ASD patients to functional alignment that mirrors the physical function of their age-matched asymptomatic peers is recommended.
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Affiliation(s)
| | - Fares Ani
- 1Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | | | - Renaud Lafage
- 3Department of Orthopedic Surgery, Northwell Health, New York, New York
| | - Han Jo Kim
- 4Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Eaman Balouch
- 1Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Zoe Norris
- 5Department of Orthopedic Surgery, George Washington University, Washington, DC
| | - Justin S Smith
- 6Department of Neurological Surgery, University of Virginia Health, Charlottesville, Virginia
| | - Alan H Daniels
- 7Department of Orthopedic Surgery, Brown University, East Providence, Rhode Island
| | - Eric O Klineberg
- 8Department of Orthopedic Surgery, University of California, Davis, California
| | - Christopher P Ames
- 9Department of Neurological Surgery, University of California, San Francisco, California
| | - Robert Hart
- 10Department of Orthopedic Surgery, Swedish Medical Center, Seattle, Washington
| | - Shay Bess
- 11Department of Spine Surgery, Denver International Spine Center, Denver, Colorado
| | | | - Frank J Schwab
- 3Department of Orthopedic Surgery, Northwell Health, New York, New York
| | - Lawrence G Lenke
- 13Department of Orthopedic Surgery, Columbia University, New York, New York; and
| | - Virginie Lafage
- 3Department of Orthopedic Surgery, Northwell Health, New York, New York
| | - Munish C Gupta
- 14Department of Orthopedic Surgery, Washington University in St. Louis, Missouri
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11
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Maria CW, Patryk W, Mateusz Ż, Marcin T. Is sagittal spinopelvic alignment a cause of low back pain in pediatric spine pathologies? A review. J Child Orthop 2023; 17:548-555. [PMID: 38050600 PMCID: PMC10693838 DOI: 10.1177/18632521231215853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Purpose Altered spinopelvic morphology is observed in many spine pathologies occurring during growth. The aim of the study is to better understand the sagittal compensatory mechanisms and their possible influence on the occurrence of pain in selected pediatric spine pathologies. Methods A bibliographic search in the PubMed database included articles published between September 1965 and July 2023. The keywords contained in the search were "spondylolysis," "spondylolisthesis," "scoliosis," "kypho," "sagittal," "pediatric," "child," "adolescent," "grow," "development," and "pain." Results The largest diversity in sagittal alignment patterns was reported in idiopathic scoliosis, with global flattening of the spine being the most common. Kyphotic deformations occurring during growth are characterized by structural thoracic or thoracolumbar kyphosis compensated by lumbar hyperlordosis and lower pelvic incidence. Whereas in spondylolisthesis, altered morphology of the spinopelvic junction with high values of pelvic incidence is observed. Pain does not seem to be related to sagittal alignment in idiopathic scoliosis. In Scheuermann disease, it is localized at the apex of the deformity and is associated with the curve pattern, whereas in spondylolisthesis, sagittal alignment correlates with pain scores only in high-grade slips. Conclusion Most of the patients with spine disorders that occurred during growth present a clinically balanced posture in the sagittal plane. It suggests that compensatory mechanisms before achieving skeletal maturity are really significant. A comprehension of sagittal alignment in spine deformities and its relationship to pain is essential for the proper assessment and treatment of these disorders.
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Affiliation(s)
- Czubak-Wrzosek Maria
- Department of Spine Disorders and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Wrzosek Patryk
- Department of Spine Disorders and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Żebrowski Mateusz
- Department of Spine Disorders and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Tyrakowski Marcin
- Department of Spine Disorders and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
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12
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van Erp JH, Gielis WP, Arbabi V, de Gast A, Weinans H, Kaas L, Castelein RM, Schlösser TP. Unravelling the hip-spine dilemma from the CHECK-cohort: is sagittal pelvic morphology linked to radiographic signs of femoroacetabular impingement? Hip Int 2023; 33:1079-1085. [PMID: 36571206 DOI: 10.1177/11207000221145670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION To date the aetiology of femoroacetabular impingement (FAI) is still not completely understood. There are mechanical theories that suggest symptomatic FAI is linked to sagittal pelvic morphology and spinopelvic-femoral dynamics. The aim of this study is to evaluate the relation of sagittal pelvic morphology and orientation to radiographic signs of FAI. Additionally, we test whether the relation between FAI and spinopelvic parameters differs in osteoarthritic hips. METHODS From a prospective, observational cohort study, 1002 patients between 45 and 65 years old with a first episode of knee or hip pain were followed for 8 years. All patients who had lateral lumbar radiographs and clinical and radiographic follow-up of the hips were included in the present study. Range of internal rotation of the hip as well as radiographic signs of FAI (alpha and Wiberg angle) and presence of hip osteoarthritis (Kellgren and Lawrence) were systematically measured at baseline. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS)) were measured at 8-year follow-up. Associations between PI, PT, SS and FAI parameters were tested using generalised estimating equations. RESULTS 421 subjects, 842 hips, were included. No significant relations between PI, PT or SS and alpha or Wiberg angle were found. Comparison of hips with and without radiological sign(s) of FAI showed no differences in PI, PT or SS. There was no relation between range of internal rotation of the hip and spinopelvic parameters. CONCLUSION Sagittal pelvic morphology and orientation are not related to the presence of radiological signs of FAI in this study population.
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Affiliation(s)
- Joost Hj van Erp
- Clinical Orthopaedic Research Center - mN, Zeist, The Netherlands
- Department of Orthopaedics, Diakonessenhuis, Utrecht, The Netherlands
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
| | - Willem-Paul Gielis
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
| | - Vahid Arbabi
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
- Orthopedic-BioMechanics Research Group, Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Iran
| | - Arthur de Gast
- Clinical Orthopaedic Research Center - mN, Zeist, The Netherlands
- Department of Orthopaedics, Diakonessenhuis, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Laurens Kaas
- Department of Orthopaedic Surgery, St. Antonius hospital, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
| | - Tom Pc Schlösser
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
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13
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Withrow JS, Monterey MD, Narro A, Haley L, Martinez Cruz M, Budde B, Trimble D, Sheinberg D, Zaragoza J, Li W, Li Z, Caridi J, Quinn JC. Characterization of the influence of spinopelvic parameters on thoracolumbar trauma. J Neurosurg Spine 2023; 39:700-708. [PMID: 37728377 DOI: 10.3171/2023.6.spine23515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/08/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE The current Roussouly classification identifies four groups of "normal" sagittal spine morphology, which has greatly expanded the understanding of normal heterogeneity of the spine. While there has been extensive characterization of the influence of spinopelvic parameters on outcomes after degenerative spine surgery, the influence of spinopelvic parameters on thoracolumbar trauma has yet to be described. The goal of this study was to determine if spinopelvic parameters and global spine morphology influence fracture location, fracture morphology, and rate of neurological deficit in the setting of thoracolumbar trauma. METHODS Of 2896 patients reviewed in the authors' institutional spine database between January 2014 and April 2020 with an ICD-9/10 diagnosis of thoracolumbar trauma, 514 met the inclusion criteria of acute thoracolumbar fracture on CT and visible femoral heads on sagittal CT. Pelvic incidence (PI) was calculated on sagittal CT. Demographic and clinical data including age, sex, BMI, smoking status, concomitant cervical fracture, mechanism of injury, major fracture location, neurological deficit, AO Spine thoracolumbar injury classification, and management type (operative vs nonoperative) were collected. Patients were stratified into high-PI (≥ 50°) and low-PI (< 50°) groups. RESULTS Patients with high PI had a lower incidence of fractures in the lower lumbar spine (below L2) compared with patients with low PI (16% vs 8%, p < 0.01). The last lordotic vertebrae were observed between T10 and L4, and of fractures that occurred at these levels, 75% were at the last lordotic vertebrae. Fall from height was the most common cause of neurological deficit, accounting for 47%. Of the patients presenting with a fall from height, AO Spine type B distraction injuries were more common in the high-PI group (41% vs 18%, p = 0.01). Similarly, within the same subgroup, AO Spine type A compression injuries were more common in the low-PI group (73% vs 53%, p = 0.01). CONCLUSIONS Spinopelvic parameters and sagittal balance influence the location and morphology of thoracolumbar fractures. Fractures of the thoracolumbar junction are strongly associated with the inflection point, which is defined by sagittal alignment. While the importance of considering sagittal balance is known for decision-making in degenerative spinal pathology, further studies are required to determine if spinopelvic parameters and sagittal balance should play a role in the decision-making for management of thoracolumbar fractures.
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Affiliation(s)
- Joseph S Withrow
- 1Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Michael D Monterey
- 1Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Analisa Narro
- 1Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Lauren Haley
- 1Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Marco Martinez Cruz
- 1Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Bradley Budde
- 1Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Duncan Trimble
- 1Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Dallas Sheinberg
- 1Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Jennifer Zaragoza
- 1Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Wen Li
- 2Department of Internal Medicine, Division of Clinical and Translational Sciences, The University of Texas McGovern Medical School at Houston
- 3Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston
| | - Zhouxuan Li
- 4Department of Biostatistics and Data Science, The University of Texas School of Public Health, Houston, Texas; and
| | - John Caridi
- 5Department of Neurosurgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - John C Quinn
- 1Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston
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14
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Nguyen TP, Kim JH, Kim SH, Yoon J, Choi SH. Machine Learning-Based Measurement of Regional and Global Spinal Parameters Using the Concept of Incidence Angle of Inflection Points. Bioengineering (Basel) 2023; 10:1236. [PMID: 37892966 PMCID: PMC10604057 DOI: 10.3390/bioengineering10101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
This study delves into the application of convolutional neural networks (CNNs) in evaluating spinal sagittal alignment, introducing the innovative concept of incidence angles of inflection points (IAIPs) as intuitive parameters to capture the interplay between pelvic and spinal alignment. Pioneering the fusion of IAIPs with machine learning for sagittal alignment analysis, this research scrutinized whole-spine lateral radiographs from hundreds of patients who visited a single institution, utilizing high-quality images for parameter assessments. Noteworthy findings revealed robust success rates for certain parameters, including pelvic and C2 incidence angles, but comparatively lower rates for sacral slope and L1 incidence. The proposed CNN-based machine learning method demonstrated remarkable efficiency, achieving an impressive 80 percent detection rate for various spinal angles, such as lumbar lordosis and thoracic kyphosis, with a precise error threshold of 3.5°. Further bolstering the study's credibility, measurements derived from the novel formula closely aligned with those directly extracted from the CNN model. In conclusion, this research underscores the utility of the CNN-based deep learning algorithm in delivering precise measurements of spinal sagittal parameters, and highlights the potential for integrating machine learning with the IAIP concept for comprehensive data accumulation in the domain of sagittal spinal alignment analysis, thus advancing our understanding of spinal health.
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Affiliation(s)
- Thong Phi Nguyen
- Department of Mechanical Engineering, BK21 FOUR ERICA-ACE Center, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan-si 15588, Gyeonggi-do, Republic of Korea
- Department of Mechanical Engineering, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan-si 15588, Gyeonggi-do, Republic of Korea
| | - Ji-Hwan Kim
- Department of Orthopedic Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Seong-Ha Kim
- Department of Orthopedic Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Jonghun Yoon
- Department of Mechanical Engineering, BK21 FOUR ERICA-ACE Center, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan-si 15588, Gyeonggi-do, Republic of Korea
- Department of Mechanical Engineering, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan-si 15588, Gyeonggi-do, Republic of Korea
- AIDICOME Inc., 221, 5th Engineering Building, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan-si 15588, Gyeonggi-do, Republic of Korea
| | - Sung-Hoon Choi
- Department of Orthopedic Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
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15
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Aubert T, Gerard P, Auberger G, Rigoulot G, Riouallon G. Low pelvic incidence with low lordosis and distal apex of lumbar lordosis associated with higher rates of abnormal spinopelvic mobility in patients undergoing THA. Bone Jt Open 2023; 4:668-675. [PMID: 37659768 PMCID: PMC10474956 DOI: 10.1302/2633-1462.49.bjo-2023-0091.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2023] Open
Abstract
Aims The risk factors for abnormal spinopelvic mobility (SPM), defined as an anterior rotation of the spinopelvic tilt (∆SPT) ≥ 20° in a flexed-seated position, have been described. The implication of pelvic incidence (PI) is unclear, and the concept of lumbar lordosis (LL) based on anatomical limits may be erroneous. The distribution of LL, including a unusual shape in patients with a high lordosis, a low pelvic incidence, and an anteverted pelvis seems more relevant. Methods The clinical data of 311 consecutive patients who underwent total hip arthroplasty was retrospectively analyzed. We analyzed the different types of lumbar shapes that can present in patients to identify their potential associations with abnormal pelvic mobility, and we analyzed the potential risk factors associated with a ∆SPT ≥ 20° in the overall population. Results ΔSPT ≥ 20° rates were 28.3%, 11.8%, and 14.3% for patients whose spine shape was low PI/low lordosis (group 1), low PI anteverted (group 2), and high PI/high lordosis (group 3), respectively (p = 0.034). There was no association between ΔSPT ≥ 20° and PI ≤ 41° (odds ratio (OR) 2.01 (95% confidence interval (CI)0.88 to 4.62), p = 0.136). In the multivariate analysis, the following independent predictors of ΔSPT ≥ 20° were identified: SPT ≤ -10° (OR 3.49 (95% CI 1.59 to 7.66), p = 0.002), IP-LL ≥ 20 (OR 4.38 (95% CI 1.16 to 16.48), p = 0.029), and group 1 (OR 2.47 (95% CI 1.19; to 5.09), p = 0.0148). Conclusion If the PI value alone is not indicative of SPM, patients with a low PI, low lordosis and a lumbar apex at L4-L5 or below will have higher rates of abnormal SPM than patients with a low PI anteverted and high lordosis.
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Affiliation(s)
- Thomas Aubert
- Department of Orthopaedic Surgery, Deaconess Saint Simon Cross Hospital Group, Paris, Île-de-France, France
| | - Philippe Gerard
- Department of Orthopaedic Surgery, Deaconess Saint Simon Cross Hospital Group, Paris, Île-de-France, France
| | - Guillaume Auberger
- Department of Orthopaedic Surgery, Deaconess Saint Simon Cross Hospital Group, Paris, Île-de-France, France
| | | | - Guillaume Riouallon
- Orthopaedic department, Paris Saint Joseph Hospital Group, Paris, Île-de-France, France
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16
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Lodde MF, Fischer TM, Riesenbeck O, Roßlenbroich S, Katthagen JC, Rometsch D, Günes D, Schneider M, Raschke MJ, Liljenqvist U. Analysis of the Spinopelvic Parameters in Patients with Fragility Fractures of the Pelvis. J Clin Med 2023; 12:4445. [PMID: 37445480 DOI: 10.3390/jcm12134445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND We investigated the spinopelvic parameters of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) in patients with fragility fractures of the pelvis (FFPs). We hypothesized that these parameters differ from asymptomatic patients. METHODS All patients treated for FFPs in a center of maximal care of the German Spine Society (DWG) between 2017 and 2021 were included. The inclusion criteria were age ≥ 60 years and the availability of a standing lateral radiograph of the spine and pelvis in which the spine from T12 to S1 and both femoral heads were visible. The baseline characteristics and study parameters were calculated and compared with databases of asymptomatic patients. The two-sample t-Test was performed with p < 0.05. RESULTS The study population (n = 57) consisted of 49 female patients. The mean age was 81.0 years. The mean LL was 47.9°, the mean PT was 29.4°, the mean SS was 34.2° and the mean PI was 64.4°. The mean value of LLI was 0.7. LL, LLI and SS were significantly reduced, and PI and PT were significantly increased compared to asymptomatic patients. CONCLUSIONS The spinopelvic parameters in patients with FFPs differ significantly from asymptomatic patients. In patients with FFPs, LL, LLI and SS are significantly reduced, and PI and PT are significantly increased. The sagittal spinopelvic balance is abnormal in patients with FFPs.
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Affiliation(s)
- Moritz F Lodde
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Thies M Fischer
- Department for Spine Surgery and Scoliosis, St. Franziskus-Hospital GmbH Münster, Hohenzollernring 70, 48145 Münster, Germany
| | - Oliver Riesenbeck
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Steffen Roßlenbroich
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - J Christoph Katthagen
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Daria Rometsch
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, Kardinal-von-Galen-Ring 10, 48149 Münster, Germany
| | - Dennis Günes
- Department for Spine Surgery and Scoliosis, St. Franziskus-Hospital GmbH Münster, Hohenzollernring 70, 48145 Münster, Germany
| | - Marc Schneider
- Department for Spine Surgery and Scoliosis, St. Franziskus-Hospital GmbH Münster, Hohenzollernring 70, 48145 Münster, Germany
| | - Michael J Raschke
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Ulf Liljenqvist
- Department for Spine Surgery and Scoliosis, St. Franziskus-Hospital GmbH Münster, Hohenzollernring 70, 48145 Münster, Germany
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Labbus K, Bürger J, Löchel J, Schäfer FM, Putzier M, Zahn RK. Impact of Individual Spinopelvic Anatomy on the Localization and Severity of Symptomatic Isthmic Spondylolisthesis. Global Spine J 2023:21925682231178206. [PMID: 37283373 DOI: 10.1177/21925682231178206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVES Isthmic spondylolisthesis (iSPL) occurs most commonly in L5/S1 and L4/5. This study investigates the association between spinopelvic anatomy and the pathogenesis of iSPL. METHODS Spinopelvic parameters as well as severity of slip grade were measured in sagittal spine radiographs of symptomatic patients with iSPL in segments L4/5 and L5/S1. Means were calculated and differences between both groups were analyzed. A correlation between the analyzed parameters and degree of slippage was performed. RESULTS We included 73 subjects in this study; 11 in L4/5 group and 62 in L5/S1 group. Pelvic anatomy significantly differed between L4/5 and L5/S1 iSPL (Pelvic Incidence (PI) 54.8° vs 66.3°, P value = .006; Pelvic Radius (PR) 124.4 mm vs 137.4 mm; P value = .005 and Sacral Table Angle (STA) 101.0° vs 92.2°, P value < .001). The relative degree of slippage was significantly higher in the L5/S1 group (L4/5 29.1% vs L5/S1 40.1%, P value .022). We also observed a significant correlation between pelvic anatomy and the severity of the slip in iSPL at the L5/S1 level. CONCLUSIONS Pelvic parameters PI and STA play an important role concerning the level of occurrence and severity of iSPL. Spinopelvic anatomy determines the pathogenesis of iSPL.
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Affiliation(s)
- Kirsten Labbus
- Center for Musculoskeletal Surgery (CMSC), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Justus Bürger
- Center for Musculoskeletal Surgery (CMSC), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jannis Löchel
- Center for Musculoskeletal Surgery (CMSC), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Frederik Maximilian Schäfer
- Institute for Radiology, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Putzier
- Center for Musculoskeletal Surgery (CMSC), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Karl Zahn
- Center for Musculoskeletal Surgery (CMSC), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany
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18
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Lukas KJ, Verhaegen JCF, Livock H, Kowalski E, Phan P, Grammatopoulos G. The effect of ethnicity on the age-related changes of spinopelvic characteristics: a systematic review. Bone Joint Res 2023; 12:231-244. [PMID: 37051815 PMCID: PMC10065848 DOI: 10.1302/2046-3758.124.bjr-2022-0335.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Aims Spinopelvic characteristics influence the hip’s biomechanical behaviour. However, to date there is little knowledge defining what ‘normal’ spinopelvic characteristics are. This study aims to determine how static spinopelvic characteristics change with age and ethnicity among asymptomatic, healthy individuals. Methods This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify English studies, including ≥ 18-year-old participants, without evidence of hip or spine pathology or a history of previous surgery or interventional treatment, documenting lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). From a total of 2,543 articles retrieved after the initial database search, 61 articles were eventually selected for data extraction. Results When all ethnicities were combined the mean values for LL, SS, PT, and PI were: 47.4° (SD 11.0°), 35.8° (SD 7.8°), 14.0° (SD 7.2°), and 48.8° (SD 10°), respectively. LL, SS, and PT had statistically significant (p < 0.001) changes per decade at: −1.5° (SD 0.3°), −1.3° (SD 0.3°), and 1.4° (SD 0.1°). Asian populations had the largest age-dependent change in LL, SS, and PT compared to any other ethnicity per decade at: −1.3° (SD 0.3°) to −0.5° (SD 1.3°), –1.2° (SD 0.2°) to −0.3° (SD 0.3°), and 1.7° (SD 0.2°) versus 1.1° (SD 0.1°), respectively. Conclusion Ageing alters the orientation between the spine and pelvis, causing LL, SS, and PT to modify their orientations in a compensatory mechanism to maintain sagittal alignment for balance when standing. Asian populations have the largest degree of age-dependent change to their spinopelvic parameters compared to any other ethnicity, likely due to their lower PI. Cite this article: Bone Joint Res 2023;12(4):231–244.
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Affiliation(s)
- Kenneth J. Lukas
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Jeroen C. F. Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, Antwerp, Belgium
| | - Holly Livock
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Philippe Phan
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Correspondence should be sent to George Grammatopoulos. E-mail:
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Morimoto T, Kobayashi T, Tsukamoto M, Hirata H, Yoshihara T, Toda Y, Mawatari M. Hip-Spine Syndrome: A Focus on the Pelvic Incidence in Hip Disorders. J Clin Med 2023; 12. [PMID: 36902823 DOI: 10.3390/jcm12052034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/15/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Since Offierski and MacNab reported a close association between the hip and spine as hip-spine syndrome in 1983, many studies on spinal alignment in hip disorders have been conducted. Notably, the pelvic incidence angle (PI) is the most important parameter and is determined by the anatomical variations in the sacroiliac joint and hip. Studies on the association of the PI with hip disorders can help in understanding the pathophysiology of hip-spine syndrome. A PI increase has been observed during the evolution of bipedal locomotion in humans and in the acquisition of gait during child development. Although the PI is a fixed parameter that is stable and unaffected by posture from adulthood onwards, it has become clear that it increases in the standing position in older people. While it may be associated with a greater risk of developing or progressing to spinal disorders, the association between the PI and hip disorders remains controversial because of the multifactorial nature of hip osteoarthritis (HOA) and the wide range of PIs in HOA (18-96°), making the interpretation of results difficult. However, several hip disorders (i.e., femoroacetabular impingement and rapid destructive coxarthrosis) have been shown to be associated with the PI. Further investigation on this topic is, therefore, warranted.
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20
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Ye J, Yin TC, Gupta S, Farooqi AS, Wan W, Yilgor C, Sides BA, Gupta MC. Use of the Global Alignment and Proportion score to predict postoperative health-related quality of life in adult spinal deformity surgery. J Neurosurg Spine 2023; 38:340-347. [PMID: 36683189 DOI: 10.3171/2022.9.spine22809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/30/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The purpose of this study was to validate the Global Alignment and Proportion (GAP) score as a predictor of health-related quality of life (HRQOL) outcomes for patients undergoing adult spinal deformity (ASD) surgery. METHODS This was a retrospective cohort study of patients with ASD undergoing long-segment spine fusions (≥ 5 vertebrae fused) at a single institution over a 2-year period (n = 85). Radiographic parameters were measured at preoperative, 6-week postoperative, 1-year postoperative, and 2-year postoperative visits. GAP scores were calculated using 4 sagittal parameters: relative pelvic version, relative lumbar lordosis, lordosis distribution index, and relative spinopelvic alignment. Patients were stratified into 3 GAP categories at each time point: proportioned (score 0-2), moderately disproportioned (score 3-6), and severely disproportioned (score ≥ 7). HRQOL outcomes were collected at preoperative, 1-year postoperative, and 2-year postoperative visits; these measures included patient self-reported outcome measures (i.e., PROMIS), Scoliosis Research Society-22 spinal deformity questionnaire (SRS-22), and Oswestry Disability Index (ODI) scores. RESULTS Overall, 42% of cases were revision surgeries and 96.5% of patients underwent fusion to the sacrum. The mean preoperative GAP score significantly improved from preoperative (7.84) to immediate postoperative (3.31) assessment (p < 0.001). Similarly, the percentage of patients categorized as proportioned improved from 9.4% at preoperative to 45.9% at immediate postoperative evaluation. The preoperative GAP score or category was not significantly associated with any preoperative HRQOL outcome metrics. The immediate postoperative GAP score was not correlated with any 1-year HRQOL outcomes. However, the immediate postoperative GAP score was significantly associated with 2-year SRS-22 outcomes, including SRS-22 function (r = -0.35, p < 0.01), self-image (r = -0.27, p = 0.044), and subtotal (r = -0.35, p < 0.01) scores. As compared to severely disproportioned patients, proportioned patients had better SRS-22 pain (4.08 vs 3.17, p = 0.04), satisfaction (4.40 vs 3.50, p = 0.02), and subtotal (4.01 vs 3.27, p = 0.036) scores. The immediate postoperative GAP score was also significantly associated with 2-year PROMIS outcomes, including PROMIS pain (r = 0.31, p = 0.023) and physical function (r = -0.35, p < 0.01) scores. As compared to severely disproportioned patients, proportioned patients had better PROMIS pain (53.18 vs 63.60, p = 0.025) and physical function (41.66 vs 34.18, p = 0.017) scores. Postoperative GAP score or category did not predict any ODI outcomes. CONCLUSIONS The postoperative GAP score is a predictor of long-term HRQOL outcomes following ASD surgery, and proportioned patients are more likely to have less pain and be satisfied with their surgery. However, the postoperative GAP score does not predict outcomes as measured by ODI.
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Affiliation(s)
- Jichao Ye
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tsung-Cheng Yin
- 2Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sachin Gupta
- 3Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ali S Farooqi
- 3Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wenbing Wan
- 4The Second Affiliated Hospital of Nanchang University, Nanchang, Jangxi, China
| | - Caglar Yilgor
- 5Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey; and
| | - Brenda A Sides
- 6Department of Orthopaedic Surgery, Barnes-Jewish Hospital, Washington University in St. Louis, Missouri
| | - Munish C Gupta
- 6Department of Orthopaedic Surgery, Barnes-Jewish Hospital, Washington University in St. Louis, Missouri
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21
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Labott JR, Smith JRH, Mara KC, Wyles CC, Taunton MJ, Abdel MP. Pubic Symphysis to Sacrococcygeal Joint: A Poor Correlate to Other Spinopelvic Measurements. J Arthroplasty 2023:S0883-5403(23)00072-4. [PMID: 36754336 DOI: 10.1016/j.arth.2023.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The hip-spine relationship is increasingly recognized as critical for optimizing stability following total hip arthroplasty (THA). However, these measurements are not routinely obtained during THA workup. It has been suggested that insight can be gained from supine antero-posterior pelvis radiograph, measuring the distance from the superior border of the pubic symphysis to the sacro-coccygeal joint (PSCD). This study assessed the correlation between PSCD and lateral lumbar radiographic metrics in a cohort of preoperative THA patients. METHODS We retrospectively evaluated 250 consecutive patients who underwent THA with preoperative supine antero-posterior pelvis and lateral lumbar radiographs. The mean age was 68 years (range, 42 to 89), 61% were women, and the mean body mass index was 30 kg/m2 (range, 19 to 52). Two reviewers measured PSCD, pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), and lumbar lordosis (LL). Inter-observer reliability was calculated for all measurements, and correlation coefficients were calculated for PSCD with respect to PT, SS, PI, and LL. RESULTS Correlations between PSCD and lumbar radiographic metrics were all statistically significant, except for PI in men but graded as "weak" or "very weak" for men and women, respectively, as follows: PT = -0.30 (P < .01) and -0.46 (P < .01); SS = 0.27 (P < .01) and 0.22 (P < .01); PI = -0.04 (P = .70) and -0.19 (P = .02); and LL = 0.45 (P < .01) and 0.30 (P < .01). Inter-observer reliability was graded as "strong" for every metric. CONCLUSION The PSCD was weakly correlated with all evaluated lateral lumbar radiographic metrics in both sexes, despite strong inter-observer reliability. Therefore, PSCD cannot reliably serve as a proxy for evaluating the hip-spine relationship.
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Affiliation(s)
- Joshua R Labott
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kristin C Mara
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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22
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Im SK, Lee KY, Lee JH. The Impact of Upper Instrumented Vertebra Orientation on Proximal Junctional Kyphosis: A Novel and Fixed Parameter, Fused Spinopelvic Angle. Spine (Phila Pa 1976) 2022; 47:1651-1658. [PMID: 36129995 PMCID: PMC9632945 DOI: 10.1097/brs.0000000000004442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/16/2022] [Accepted: 07/05/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To evaluate the impact of upper instrumented vertebra (UIV) orientation including the fused spinopelvic angle (FSPA) on proximal junctional kyphosis (PJK). SUMMARY OF BACKGROUND DATA PJK is a challenging complication after adult spinal deformity (ASD) surgery. Some studies proposed UIV orientation act as a risk factor of PJK, but there remain debates because UIV orientation is changed by position. Therefore, we investigated the relationship between the FSPA, a novel parameter for the relationship between UIV and pelvis which did not change by position, and PJK. MATERIALS AND METHODS ASD patients who underwent long-segment fusion to the pelvis and followed up for more than two years were included. Comparative analysis was performed on spinopelvic parameters including UIV orientation parameters (UIV slope angle and FSPA) between PJK and non-PJK group. Binary regression analysis was conducted to find out the risk factors for PJK. And correlation analysis was conducted to find out the parameters that affect the FSPA. RESULTS A total of 190 patients were included. PJK incidence was 13.2% (25/190). PJK group showed a significantly greater postoperative UIV slope (21.3° vs. 18.8°, P =0.041) and significantly lesser postoperative FSPA (-0.9° vs. 4.5°, P <0.001). In binary regression analysis, only FSPA acted as a risk factor of PJK (odds ratio=0.920, P =0.004). The FSPA has strong positive correlation with pelvic incidence (PI)-lumbar lordosis (LL) ( r =0.666, P <0.001) and negative correlation with lordosis distribution index (LDI) ( r =-0.228, P =0.004). CONCLUSION The FSPA is a fixed parameter which is not dependent on position. A reduction of the FSPA increases the risk for PJK. The FSPA can be adjusted through PI-LL and LDI. Thus, surgeons should increase the FSPA by adjusting the PI-LL and LDI during ASD surgery to prevent PJK.
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Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To provide the age- and pelvic incidence-related variations of sagittal alignment in asymptomatic Chinese population. METHODS This study recruited asymptomatic adult subjects. All subjects undertook the standing whole spinal radiograph and the sagittal parameters were measured: sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI) and pelvic tilt (PT). All subjects were divided into young, middle aged and elderly groups, then each age group was further divided into 5 subgroups (very low, low, average, high and very high) based on PI values. The relations between PI, age and other parameters were evaluated. The differences in sagittal parameters of each PI subgroup were compared. RESULTS 546 subjects were included with an average age of 38.6 years (18 to 81). The number of subjects over 70 years and with very low PI was relatively small. The average of PI, TPA, PT and LL were 45.9° ± 8.4°, 6.4° ± 6.2°, 11.9° ± 6.6° and 49.2° ± 10.1°, respectively. SVA, TPA, TK and PT increased with age (P < 0.05), while SVA, TPA, PT, PI-LL also increased with PI (P < 0.05). LL, PT, TPA, PI-LL and LL-TK were different among the 5 PI subgroups (P < 0.05). However, the values of LL in elderly subjects with high and very high PI were similar. CONCLUSION The age- and PI-related variations in sagittal alignment of Chinese population were provided. The sagittal parameters were significantly influenced by age and PI. The individual pelvic morphology should be carefully considered during the assessment and restoration of sagittal balance.
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Affiliation(s)
- Siyu Zhou
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China
| | - Zhuoran Sun
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China
| | - Wei Li
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China
| | - Da Zou
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China
| | - Weishi Li
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China,Weishi Li, Department of Orthopaedic, Peking
University Third Hospital, Beijing 100191, China.
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Dietz N, Gruter BE, Nevzati E, Cho SK, Farshad M, Williams B, Hollis P, Spiessberger A. Compensatory mechanisms in adult degenerative thoracolumbar spinal deformity - Radiographic patterns, their reversibility after corrective surgery, and the influence of pelvic morphology. J Craniovertebr Junction Spine 2022; 13:454-459. [PMID: 36777913 PMCID: PMC9910128 DOI: 10.4103/jcvjs.jcvjs_120_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Loss of lumbar lordosis (LL) in degenerative deformity activates spinal compensatory mechanisms to maintain neutral C7 sagittal vertical axis (C7SVA), such as an increase in pelvic tilt (PT) and decreased thoracic kyphosis (TK). We study the extent to which PT increase and TK reduction contribute to the compensation of pelvic incidence (PI)-LL mismatch. Methods A cohort of 43 adult patients with adult degenerative thoracolumbar deformity were included in this retrospective study. Radiographic spinopelvic measurements were obtained before and after corrective surgery. Pearson correlations were calculated. Results Preoperative PI-LL mismatch significantly correlated with an increase in PT and a decrease in TK in the whole cohort r = +0.66 (95% confidence interval [CI] 0.44-0.8) and r = -0.67 (95% CI - 0.81--0.47), respectively, at a relative rate of 0.37 (standard deviation [SD]: 0.07) and - 0.57 (SD: 0.09), respectively. In patients with low PI, only TK showed a significant correlation with PI-LL mismatch, r = -0.56 (95% CI - 0.8 to - 0.16), at a rate of - 0.57 (SD: 0.19). The high PI subgroup showed a significant correlation with PT, TK, and C7SVA, r = 0.62 (95% CI 0.26-0.82), r = -0.8 (95% CI - 0.9--0.58), and r = 0.71 (95% CI 0.41-0.87) at rates of 0.48 (SD: 0.11), -0.72 (SD: 0.12), and 0.62 (SD: 1.27). Conclusions Decreased TK represented a more consistent compensatory mechanism in patients with high and low PI when compared to an increase in PT. PI-LL mismatch induced more pronounced changes in TK than did PT in both subgroups. Patients with high PI relied more on increases in PT and a relative decrease in TK to compensate for PI-LL mismatch than patients with low PI.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | | | - Edin Nevzati
- Department of Neurosurgery, Luzerner Kantonsspital, Luzern, Switzerland
| | - Samuel K Cho
- Department of Orthopedic Surgery, Icahn School of Medicine, Mount Sinai Hospital, NY, USA
| | - Mazda Farshad
- Department of Orthopedic Surgery, "Balgrist" University Hospital Zurich, Zurich, Switzerland
| | - Brian Williams
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - Peter Hollis
- Department of Neurosurgery, North Shore University Hospital, NY, USA
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Xu S, Guo C, Liang Y, Zhu Z, Liu H. Sagittal Parameters of Spine-Pelvis-Hip Joints in Patients with Lumbar Spinal Stenosis. Orthop Surg 2022; 14:2854-2862. [PMID: 36125192 PMCID: PMC9627079 DOI: 10.1111/os.13467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To explore sagittal compensation characteristics, including extra spinal‐pelvic parameters and distal hip parameters, for analysis in middle‐aged to the older patients with lumbar spinal stenosis (LSS) without spinal deformity and clarify the fitting relationship between the main sagittal parameters. Methods This retrospective single‐center study included 205 patients with LSS in our department from January 2016 to December 2018, including 153 women (74.6%), with an average age of 67.6 ± 7.1 years. Sagittal parameters were obtained on the whole spinal lateral radiograph. Spinal parameters include thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), and lumbar lordosis (LL). Pelvic parameters include pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Hip parameters include pelvic rotation (PR) and hip inclination angle (HIA). Spine‐pelvic parameter is spino‐sacral angle (SSA). Sagittal balance parameter is sagittal vertical axis (SVA). PI‐LL, PT, SVA, HIA, and TLK were regarded as primary results, and the others were secondary outcomes. The independent sample t‐test was used to compare gender. Pearson correlation analysis was used to evaluate the correlation between primary results and secondary results. We take PI‐LL, PT, SVA, and TLK as dependent variables and include relevant factors for analysis. Results In the case of gender, PI, PI‐LL, and PT were found smaller in men than women, but TK is greater in men than women (27.3° ± 6.1° vs 23.3° ± 7.7°, p = 0.033). PI‐LL was positively correlated with PT (r = 0.608, p < 0.001) and negatively correlated with HIA (r = −0.193, p = 0.010); PT was negatively correlated with HIA (r = −0.289, p < 0.01). As to the relationship between primary and secondary results, HIA was positively correlated with SS and PR (p < 0.01). SVA was positively correlated with SSA (r = 0.341, p = 0.010). The positive influencing factors and risk factors of SVA were SSA, and PI‐LL played a negative regulatory role through proximal TK, the distal PT plays a positive regulatory role. The regulation of PI‐LL was compensated through both TK and PT, with a fitting relationship of PI‐LL = 0.5 × PT − 0.2 × TK. Conclusion There was a close interaction among spine‐pelvic‐hip sagittal parameters. We found the matching of PI‐LL in the domestic middle‐aged and elderly LSS population is regulated by thoracic spine and pelvis.
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Affiliation(s)
- Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, People's Republic of China
| | - Chen Guo
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, People's Republic of China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, People's Republic of China
| | - Zhenqi Zhu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, People's Republic of China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, People's Republic of China
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He L, Gong S, Li T, Gu M, Xu Z, Chen H, Yi C. Pelvic incidence-guided reduction in transverse parts of U-shaped sacral fractures: Technical recommendations. J Orthop Surg (Hong Kong) 2022; 30:10225536221143551. [PMID: 36450299 DOI: 10.1177/10225536221143551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The purpose of this study is to present a surgical technique that simultaneously reduces and fixates the transverse parts of U-shaped sacral fractures. METHODS The sacral fracture was exposed through a posterior median approach. In a flexion injury, the rotation of the lower sacral segment is reduced by distraction along a pre-curved rod. Then, lordotic restoration is performed with a Weber clamp placed at the lower sacral segment through dragging. In an extension injury, longitudinal distraction is performed along the spinopelvic rod to reduce the vertical displacement. Next, the transverse displacement is reduced by a dissector placed between the upper and lower sacral segments through levering. The sagittal reduction on the lateral pelvic view was judged by PI. A regression analysis of Oswestry disability index (ODI) with Z-scores of PI, lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT) was performed. RESULTS At the 1-year follow-up, the average PI, LL, SS, and PT values were 51.6 (range: 43.1-76.0), 44.8 (34.6 - 60.1), 35.4 (18.1 - 48.0), and 16.7 (2.2-35.4) degrees, respectively. All patients were able to maintain an upright stance. The average ODI was 27.6% (2-72%). Surprisingly, the regression analysis demonstrated a significant linear relationship between ODI and LL (R2 = 0.367, p = .048) but not between ODI and PI (R2 = 0.227, p = .138). CONCLUSIONS Using PI as guidance, the surgical procedures were helpful to reduce the PI of transverse sacral fractures into the normal range. However, the relationship between PI and the prognosis remains to be evaluated by future researches.
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Affiliation(s)
- Li He
- Department of Traumatic Surgery, Tongji Medical College, Tongji Hospital, Ringgold: 66375Huazhong University of Science and Technology, Wuhan, China
| | - Song Gong
- Department of Traumatic Surgery, Tongji Medical College, Tongji Hospital, Ringgold: 66375Huazhong University of Science and Technology, Wuhan, China
| | - Tianyu Li
- Department of Traumatic Surgery, Tongji Medical College, Tongji Hospital, Ringgold: 66375Huazhong University of Science and Technology, Wuhan, China
| | - Meiqi Gu
- Department of Traumatic Surgery, Tongji Medical College, Tongji Hospital, Ringgold: 66375Huazhong University of Science and Technology, Wuhan, China
| | - Zhe Xu
- Department of Traumatic Surgery, Tongji Medical College, Tongji Hospital, Ringgold: 66375Huazhong University of Science and Technology, Wuhan, China
| | - Hua Chen
- The Department of Orthopaedic Trauma, Chinese PLA General Hospital, Beijing, China
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Medical College, Tongji Hospital, Ringgold: 66375Huazhong University of Science and Technology, Wuhan, China
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İplikçioğlu AC, Karabağ H. Validity and Reliability of Spinopelvic Parameters Measured on Computed Tomography. Int J Spine Surg 2022; 16:875-880. [PMID: 36007956 PMCID: PMC10151393 DOI: 10.14444/8344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study aimed to measure pelvic incidence (PI) and other spinopelvic sagittal parameters on supine computed tomography (CT) and to assess the validity and reliability of measurements from supine CT images when compared with standing x-ray images. Difficulties in superimposition of femur heads and obtaining the perfect midsagittal view of the sacral endplate may cause relatively low intra- and interobserver agreements. Some authors reported that PI values measured by CT had higher reliability, but both validity and reliability of CT measurement of spinopelvic parameters compared with standing x-ray imaging methods have not been reported previously. METHODS PI, pelvic tilt (PT), and sacral slope (SS) were measured on standing lateral x-ray and spinopelvic supine CT images of 33 asymptomatic volunteers. RESULTS The mean PI, PT, and SS in standing x-ray images were 45.2°, 10°, and 35.3°, respectively, whereas those in supine CT images were 44.5°, 8.2°, and 36.2°, respectively. No significant differences were found in each parameter. Excellent correlations were found between each parameter obtained from x-ray and CT images. Intra- and interobserver reliabilities were excellent in both x-ray and CT image measurements, although those from CT images were higher. CONCLUSION Spinopelvic sagittal parameters could be measured on supine CT by using a simple method with high reliability and validity; thus, CT could be a good alternative to standing x-ray imaging. In the supine position, PI does not change but PT decreases by a small amount and SS increases almost by the same amount because of the mathematical relationship between PT and SS (PI = PT + SS). CLINICAL RELEVANCE Supine CT is an efficient diagnostic tool for the reliable extraction of spinopelvic sagittal parameters. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Hamza Karabağ
- Department of Neurosurgery, Harran University, Şanlıurfa, Turkey
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Arand C, Noser H, Kamer L, Gehweiler D, Handrich K, Rommens PM, Wagner D. Is there a correlation between pelvic incidence and orientation of the acetabulum? An analysis based on a three-dimensional statistical model of the pelvic ring. J Anat 2022; 241:756-764. [PMID: 35662008 PMCID: PMC9358766 DOI: 10.1111/joa.13708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 12/29/2022] Open
Abstract
The pelvic ring is a complex anatomical structure building up the connection between the trunk and the legs. Whilst there is a broad discussion in the literature about the dynamic interaction between spine, pelvis and the hip joints, there is still little information about the relation and interaction of the constant pelvic parameters. Based on a three‐dimensional (3D) statistical model consisting of 150 uninjured and bony healthy pelves (100 Europeans, 50 Japanese; 81 males, 69 females; average age 74.3 years ± 17.5 years) an evaluation of pelvic incidence (PI) and acetabular orientation in anteversion and inclination was performed and potential correlations of these intraindividual constant parameters were investigated. Pelvic incidence is defined as the angle between the perpendicular to the sacral plate at its midpoint and the line connecting this point to the middle axis of the femoral heads. Acetabular anteversion is defined as the angle between the perpendicular to the best‐fit plane on the acetabular rim and the coronal plane measured in strict lateral view. Acetabular inclination is defined as the angle between the perpendicular to the best‐fit plane on the acetabular rim and the sagittal plane in strict frontal view. Data were further analysed with regard to different subgroup's age, sex and ethnicity. A positive correlation between PI and acetabular anteversion could be demonstrated. Further, PI and also the acetabular parameters anteversion and inclination were found to be significantly higher in the European individuals than in the Asian. The results of the present study demonstrate a relation between the anatomical configuration of the constant pelvic parameters building up the connection points to the next proximal respectively caudal skeleton section. The findings might lead to more comprehensive treatment strategies in case of trauma or degenerative pathologies of the pelvis in the future.
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Affiliation(s)
- Charlotte Arand
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
| | | | - Lukas Kamer
- AO Research Institute Davos, Davos, Switzerland
| | | | - Kirstin Handrich
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
| | - Pol M Rommens
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
| | - Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
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Kim Y, Pour AE, Lazennec JY. Low pelvic incidence is a risk factor for intraoperative complications in minimally invasive anterolateral approach for total hip arthroplasty. Hip Int 2022; 32:304-311. [PMID: 32865038 DOI: 10.1177/1120700020953525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Minimally invasive anterolateral approach (ALA) has gained popularity in recent years as better postoperative functional recovery and lower risk of postoperative dislocation are claimed. However, difficulties for femur exposure and intraoperative complications during femoral canal preparation and component placement have been reported. This study analyses the effect of anatomical factors on difficulties for femoral access and intraoperative complications with a modified minimally invasive ALA. MATERIAL AND METHODS 310 consecutive patients who had primary unilateral total hip arthroplasty (THA) by single surgeon using same approach and technique, and being suitable for EOS were included. All patients underwent pre- and postoperative standing and sitting full-body EOS acquisitions and pelvic and femoral parameters were measured. All intra- and postoperative complications for femoral preparation and implantation were assessed. Intraoperative complications included femoral fractures and difficulties for femoral exposure. RESULTS 10 patients (3.2%) had intraoperative femoral fractures (2 greater trochanter, 8 calcar). Difficult access to the proximal femur was reported for 10 other patients (3.2%). Patients with intraoperative complications presented a significantly lower pelvic incidence (PI) than patients without intraoperative complications (mean PI: 39.4° vs. 56.9°, p < 0.001). CONCLUSIONS The pelvic incidence can be useful to detect anatomically less favourable patients for THA implantation using ALA.
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Affiliation(s)
- Youngwoo Kim
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan.,Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Aidin Eslam Pour
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jean Yves Lazennec
- Department of Orthopaedic and Trauma Surgery, University Hospital Pitié Salpêtrière, Paris, France
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30
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Coscia A, Paige K, Hostetter M, O’Neill K, Coscia M, Coscia E, Coscia M. Transverse Pedicle Angle Is Associated With Pelvic Incidence and Increased in Lumbar Isthmic Spondylolisthesis. Global Spine J 2022; 12:359-365. [PMID: 32935588 PMCID: PMC9121163 DOI: 10.1177/2192568220951190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Retrospective radiographic review. OBJECTIVES Investigate and quantify transverse pedicle angle (TPA), the medial-to-lateral pedicle angulation, and its potential association with pelvic incidence (PI) in patients with isthmic lumbar spondylolisthesis (ISLS) and compare to those with degenerative lumbar spondylolisthesis (DSLS) and controls. METHODS A total of 200 patients (64 ISLS, 70 DSLS, 66 control) were included. TPA was calculated at the L3-5 vertebral levels using axial computed tomography slices. PI was measured on lateral radiographs. Two independent observers completed the measurements. As a sensitivity analysis, TPA was also measured at the most cranial and caudal aspects of the L3-5 vertebral levels of a subset of participants (29 ISLS, 31 DSLS, 35 control) and the cranial to caudal change (ΔTPA) was calculated. RESULTS TPA values (mean ± SD) at L4 and L5 for ISLS (L4: 17.3° ± 3.7°, L5: 26.0° ± 5.2°) were significantly higher than those for the DSLS (L4: 14.3° ± 3.8°, L5: 22.2° ± 5.0°) and control (L4: 14.5° ± 3.9°, L5: 20.7° ± 3.8°) groups. TPA in the DSLS group was significantly higher than controls at L5, but not L4. High PI predicted wider TPA at L5 in both DSLS and ISLS. ΔTPA (mean ± SD) increased sequentially proceeding through the L3-5 spinal levels for the ISLS (L3: 6.8° ± 4.4°, L4: 8.7° ± 5.2°, L5: 15.6° ± 9.0°), DSLS (L3: 8.2° ± 6.0°, L4: 8.3° ± 5.9°, L5: 18.3° ± 7.2°), and control (L3: 6.8° ± 4.4°, L4: 8.2° ± 4.7°, L5: 17.7° ± 7.0°) groups. CONCLUSIONS TPA was significantly increased in ISLS compared with DSLS and controls. High PI significantly predicted high TPA at the L5 vertebral level in ISLS and DSLS. ΔTPA increased sequentially proceeding through the lumbar spine across groups.
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Affiliation(s)
- Atticus Coscia
- University of Cincinnati College of Medicine, Cincinnati, OH, USA,Atticus Coscia, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0212, USA.
| | - Katie Paige
- State University of New York at Buffalo, Buffalo, NY, USA
| | | | | | | | - Erin Coscia
- Marian College of Osteopathic Medicine, Indianapolis, IN, USA
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Abstract
AIMS Pelvic incidence (PI) is a position-independent spinopelvic parameter traditionally used by spinal surgeons to determine spinal alignment. Its relevance to the arthroplasty surgeon in assessing patient risk for total hip arthroplasty (THA) instability preoperatively is unclear. This study was undertaken to investigate the significance of PI relative to other spinopelvic parameter risk factors for instability to help guide its clinical application. METHODS Retrospective analysis was performed of a multicentre THA database of 9,414 patients with preoperative imaging (dynamic spinopelvic radiographs and pelvic CT scans). Several spinopelvic parameter measurements were made by engineers using advanced software including sacral slope (SS), standing anterior pelvic plane tilt (APPT), spinopelvic tilt (SPT), lumbar lordosis (LL), and PI. Lumbar flexion (LF) was determined by change in LL between standing and flexed-seated lateral radiographs. Abnormal pelvic mobility was defined as ∆SPT ≥ 20° between standing and flexed-forward positions. Sagittal spinal deformity (SSD) was defined as PI-LL mismatch > 10°. RESULTS PI showed a positive correlation with parameters of SS, SPT, and LL (r-value range 0.468 to 0.661). Patients with a higher PI value showed higher degrees of standing LL, likely as a compensatory measure to maintain sagittal spine balance. There was a positive correlation between LL and LF such that patients with less standing LL had decreased LF (r = 0.49). Similarly, there was a positive correlation between increased SSD and decreased LF (r = 0.54). PI in isolation did not show any significant correlation with lumbar (r = 0.04) or pelvic mobility (r = 0.02). The majority of patients (range 89.4% to 94.2%) had normal lumbar and pelvic mobility regardless of the PI value. CONCLUSION The PI value alone is not indicative of either spinal or pelvic mobility, and thus in isolation may not be a risk factor for THA instability. Patients with SSD had higher rates of spinopelvic stiffness, which may be the mechanism by which PI relates to THA instability risk, but further clinical studies are required. Cite this article: Bone Joint J 2022;104-B(3):352-358.
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Affiliation(s)
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | | | - Douglas A Dennis
- Colorado Joint Replacement, Denver, Colorado, USA.,Department of Bioengineering, University of Tennessee, Knoxville, Tennessee, USA.,Department of Bioengineering, Denver University, Denver, Colorado, USA.,Department of Orthopaedics, University of Colorado School of Medicine Denver, Denver, Colorado, USA
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Yamada S, Ebara T, Uehara T, Matsuki T, Kimura S, Satsukawa Y, Yoshihara A, Aoki K, Inada A, Kamijima M. Can Hip-Knee Line Angle Distinguish the Size of Pelvic Incidence?-Development of Quick Noninvasive Assessment Tool for Pelvic Incidence Classification. Int J Environ Res Public Health 2022; 19:1387. [PMID: 35162404 DOI: 10.3390/ijerph19031387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/07/2022] [Accepted: 01/22/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to explore effective measurement angles for pelvic incidence (PI) classification and to develop a quick, noninvasive assessment tool for PI classification. We defined five variation types of hip–knee line (HKL) angles and tested the discrimination ability of the receiver operating characteristic (ROC) analysis using 125 photographs of upright standing posture from the right lateral side. ROC analysis revealed an applicable HKL angle defined by the line connecting the most raised part of the buttock and the central point of the knee and the midthigh line. The acceptable cut-off points for discriminating small or large PIs in terms of HKL angle were 18.5° for small PI (sensitivity, 0.91; specificity, 0.79) and 21.5° for large PI discrimination (sensitivity, 0.74; specificity, 0.72). In addition, we devised a quick noninvasive assessment tool for PI classification using the cut-offs of the HKL angle with a view to practical application. The results of intra- and inter-rater reliability ensured a substantial/moderate level of the tool (Cohen’s kappa coefficient, 0.79; Fleiss’s kappa coefficient, 0.50–0.54). These results revealed that the HKL angle can distinguish the size of the PI with a high/moderate discrimination ability. Furthermore, the tool indicated acceptable inter-/intra-rater reliability for practical applications.
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Mu X, Yu C, Kim SW, Ou Y, Wei J, Schöller K. Correlation of Modic Changes with Sagittal Lumbopelvic Parameters. J Pain Res 2022; 14:3877-3885. [PMID: 34984029 PMCID: PMC8699776 DOI: 10.2147/jpr.s345098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The main aim of this retrospective study was to analyze lumbopelvic sagittal parameters among the three different types of Modic changes (MCs). Furthermore, correlations between the sizes of MCs and the number of involved lumbar levels with lumbopelvic parameters are investigated. Methods A total of 263 adult subjects with MCs at a single institution from September 2015 to October 2020 who underwent lumbar x-ray examinations and magnetic resonance imaging were included in this retrospective study. Types of MCs, sizes of MCs, lumbar levels involved by MCs as well as lumbopelvic sagittal parameters from each subject were evaluated by two authors. Results Lumbar lordosis (LL), sacral slope (SS), and pelvic incidence (PI) in subjects with MC grade 1 were significantly smaller than in those with MC grade 2 and grade 3 (p<0.05). Lumbopelvic sagittal parameters decreased significantly as the sizes aggravated (p<0.01). Triple lumbar levels with MCs showed a significant increase in PI-LL (p<0.05) and decrease in LL (p<0.01), SS (p<0.01), and PI (p<0.01) when compared to MCs at single and double lumbar levels. Conclusion MC grade 1, severe MCs, and lumbar multi-segmental MCs were significantly linked to lumbar sagittal imbalance.
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Affiliation(s)
- Xiaoping Mu
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, Guangxi, People's Republic of China
| | - Chengqiang Yu
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, Guangxi, People's Republic of China
| | - Seong Woong Kim
- Department of Neurosurgery, Justus-Liebig-University, Giessen, Hessen, Germany
| | - Yufu Ou
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, Guangxi, People's Republic of China
| | - Jianxun Wei
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, Guangxi, People's Republic of China
| | - Karsten Schöller
- Clinic for Spinal Surgery, Schoen Clinic Hamburg Eilbek, Hamburg, Germany
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Passias PG, Naessig S, Kummer N, Passfall L, Lafage R, Lafage V, Line B, Diebo BG, Protopsaltis T, Kim HJ, Eastlack R, Soroceanu A, Klineberg EO, Hart RA, Burton D, Bess S, Schwab F, Shaffrey CI, Smith JS, Ames CP. Predicting development of severe clinically relevant distal junctional kyphosis following adult cervical deformity surgery, with further distinction from mild asymptomatic episodes. J Neurosurg Spine 2021:1-8. [PMID: 34920417 DOI: 10.3171/2021.8.spine21533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This retrospective cohort study aimed to develop a formal predictive model distinguishing between symptomatic and asymptomatic distal junctional kyphosis (DJK). In this study the authors identified a DJK rate of 32.2%. Predictive models were created that can be used with high reliability to help distinguish between severe symptomatic DJK and mild asymptomatic DJK through the use of surgical factors, radiographic parameters, and patient variables. METHODS Patients with cervical deformity (CD) were stratified into asymptomatic and symptomatic DJK groups. Symptomatic: 1) DJK angle (DJKA) > 10° and either reoperation due to DJK or > 1 new-onset neurological sequela related to DJK; or 2) either a DJKA > 20° or ∆DJKA > 20°. Asymptomatic: ∆DJK > 10° in the absence of neurological sequelae. Stepwise logistic regressions were used to identify factors associated with these types of DJK. Decision tree analysis established cutoffs. RESULTS A total of 99 patients with CD were included, with 32.2% developing DJK (34.3% asymptomatic, 65.7% symptomatic). A total of 37.5% of asymptomatic patients received a reoperation versus 62.5% symptomatic patients. Multivariate analysis identified independent baseline factors for developing symptomatic DJK as follows: pelvic incidence (OR 1.02); preoperative cervical flexibility (OR 1.04); and combined approach (OR 6.2). Having abnormal hyperkyphosis in the thoracic spine, more so than abnormal cervical lordosis, was a factor for developing symptomatic disease when analyzed against asymptomatic patients (OR 1.2). Predictive modeling identified factors that were predictive of symptomatic versus no DJK, as follows: myelopathy (modified Japanese Orthopaedic Association score 12-14); combined approach; uppermost instrumented vertebra C3 or C4; preoperative hypermobility; and > 7 levels fused (area under the curve 0.89). A predictive model for symptomatic versus asymptomatic disease (area under the curve 0.85) included being frail, T1 slope minus cervical lordosis > 20°, and a pelvic incidence > 46.3°. Controlling for baseline deformity and disability, symptomatic patients had a greater cervical sagittal vertical axis (4-8 cm: 47.6% vs 27%) and were more malaligned according to their Scoliosis Research Society sagittal vertical axis measurement (OR 0.1) than patients without DJK at 1 year (all p < 0.05). Despite their symptomatology and higher reoperation rate, outcomes equilibrated in the symptomatic cohort at 1 year following revision. CONCLUSIONS Overall, 32.2% of patients with CD suffered from DJK. Symptomatic DJK can be predicted with high reliability. It can be further distinguished from asymptomatic occurrences by taking into account pelvic incidence and baseline cervicothoracic deformity severity.
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Affiliation(s)
- Peter G Passias
- 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Sara Naessig
- 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Nicholas Kummer
- 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Lara Passfall
- 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Renaud Lafage
- 2Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- 3Lenox Hill Hospital, Northwell Health, Department of Orthopaedics, New York, New York
| | - Breton Line
- 4Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado
| | - Bassel G Diebo
- 5Department of Orthopedics, SUNY Downstate Medical Center, Brooklyn, New York
| | | | - Han Jo Kim
- 2Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Robert Eastlack
- 6Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | - Alex Soroceanu
- 7Department of Orthopaedic Surgery, University of Calgary, Alberta, Canada
| | - Eric O Klineberg
- 8Department of Orthopaedic Surgery, University of California, Davis, California
| | - Robert A Hart
- 9Department of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, Washington
| | - Douglas Burton
- 10Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Shay Bess
- 4Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado
| | - Frank Schwab
- 3Lenox Hill Hospital, Northwell Health, Department of Orthopaedics, New York, New York
| | | | - Justin S Smith
- 12Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and
| | - Christopher P Ames
- 13Department of Neurological Surgery, University of California, San Francisco, California
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Abstract
AIMS Spinopelvic mobility plays an important role in functional acetabular component position following total hip arthroplasty (THA). The primary aim of this study was to determine if spinopelvic hypermobility persists or resolves following THA. Our second aim was to identify patient demographic or radiological factors associated with hypermobility and resolution of hypermobility after THA. METHODS This study investigated patients with preoperative posterior hypermobility, defined as a change in sacral slope (SS) from standing to sitting (ΔSSstand-sit) ≥ 30°. Radiological spinopelvic parameters, including SS, pelvic incidence (PI), lumbar lordosis (LL), PI-LL mismatch, anterior pelvic plane tilt (APPt), and spinopelvic tilt (SPT), were measured on preoperative imaging, and at six weeks and a minimum of one year postoperatively. The severity of bilateral hip osteoarthritis (OA) was graded using Kellgren-Lawrence criteria. RESULTS A total of 136 patients were identified as having preoperative spinopelvic hypermobility. At one year after THA, 95% (129/136) of patients were no longer categorized as hypermobile on standing and sitting radiographs (ΔSSstand-sit < 30°). Mean ΔSSstand-sit decreased from 36.4° (SD 5.1°) at baseline to 21.4° (SD 6.6°) at one year (p < 0.001). Mean SSseated increased from baseline (11.4° (SD 8.8°)) to one year after THA by 11.5° (SD 7.4°) (p < 0.001), which correlates to an 8.5° (SD 5.5°) mean decrease in seated functional cup anteversion. Contralateral hip OA was the only radiological predictor of hypermobility persisting at one year after surgery. The overall reoperation rate was 1.5%. CONCLUSION Spinopelvic hypermobility was found to resolve in the majority (95%) of patients one year after THA. The increase in SSseated was clinically significant, suggesting that current target recommendations for the hypermobile patient (decreased anteversion and inclination) should be revisited. Cite this article: Bone Joint J 2021;103-B(12):1766-1773.
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Affiliation(s)
- Peter K Sculco
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Eric N Windsor
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Seth A Jerabek
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - David J Mayman
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Ameer Elbuluk
- Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Aaron J Buckland
- Spine Research Center, NYU Langone Health, New York, New York, USA.,Melbourne Orthopaedic Group, Windsor, Australia
| | - Jonathan M Vigdorchik
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
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Lee KY, Lee JH, Im SK. Optimal Lumbar Lordosis Correction for Adult Spinal Deformity with Severe Sagittal Imbalance in Patients Over Age 60: Role of Pelvic Tilt and Pelvic Tilt Ratio. Spine (Phila Pa 1976) 2021; 46:E1246-E1253. [PMID: 33907085 PMCID: PMC8565504 DOI: 10.1097/brs.0000000000004068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/26/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES The purpose of this study was to evaluate optimal and ideal target values of the spine balance correction in elderly patients with adult spinal deformity who were over the age of 60 years. SUMMARY OF BACKGROUND DATA The target values of the Scoliosis Research Society -Schwab classification to obtain satisfactory alignment and favorable outcomes are used in many spinal reconstruction surgeries. However, uniformly applying the Scoliosis Research Society-Schwab classification to all elderly patients aged 60 years or older showing sagittal malalignment may lead to several inconsistencies. METHODS This study included 121 patients (average age 70.5 yr and a minimum 2-yr follow-up) with adult spinal deformity who underwent long-segment fusion from T10 to sacrum. We used Pearson's correlation coefficient to analyze the relationship between clinical and radiographic parameters, and multilinear regression analysis and multivariate logistic regression model (backward elimination method) were conducted using the correlation factors of postoperative (Post) and last follow-up (Last) sagittal vertical axis to find the risk factors of Post sagittal imbalance. RESULTS Logistic regression analysis with the correlation factors of Post and Last sagittal vertical axis led to risk factors of Post sagittal imbalance, and after confirming the significance of each path, it was confirmed that the effects of pelvic incidence (PI)- lumbar lordosis (LL) and Post pelvic tilt ratio (PTr) were valid (P < 0.05). After using ROC curve, target value of PI-LL was 1.33, and that of PTr was 25.95%. CONCLUSION Through our study, the risk factors of Post sagittal imbalance were the Post value of PI-LL and that of PTr, and target value of PI-LL was <1.33 and that of PTr was <25.95%. These target values can be effective guidelines for spine surgeons who perform spine reconstruction surgeries for elderly patients with a pure sagittal imbalance based on Schwab's formula.Level of Evidence: 4.
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Affiliation(s)
- Ki Young Lee
- Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, Korea
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Xu S, Guo C, Liang Y, Zhu Z, Zhang H, Liu H. Posterior instrumented fusion on lumbar stenosis syndrome can bring benefit to proximal degenerative kyphosis: A CONSORT-compliant article. Medicine (Baltimore) 2021; 100:e27711. [PMID: 34766574 PMCID: PMC10545290 DOI: 10.1097/md.0000000000027711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The effect on degenerative thoracolumbar kyphosis (DTLK) after short-segment instrument for lumbar spinal stenosis syndrome (LSS) remains controversial. Based on the biomechanics and compensatory of the global spino-pelvic alignment, it was assumed that the interference on the lumbar spine, instead of the thoracolumbar segment, could still make a difference on the proximal spine.To explore whether DTLK could improve with only surgery for LSS and identify influencing factors on postoperative TLK.The study was performed from January 2016 to December 2018. Sixty-nine participants (25 male) diagnosed LSS with DTLK were enrolled and surgery was only for LSS. Radiological parameters included TLK, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, and osteoporosis. Clinical outcomes were visual analogue scale and Oswestry disability index. According to lower instrumented vertebrae (LIV) on L5 or S1, inter-group comparisons were performed between LIV on L5 (L5 group) and S1 (S1 group).Demographics were well-matched between L5 and S1 group with a mean follow-up of 24.3 ± 12.1 (m). TLK improved with a mean of 16.2 ± 7.6 (°) (P < .001). There was no significance on radiological and clinical parameters between L5 and S1 groups except for a larger pelvic tilt in S1 group (P = .046). Visual analogue scale (P = .787) and Oswestry disability index (P = .530) were both indifferent between normal TLK and DTLK at last (P > .05). Postoperative TLK was affected by osteoporosis and sacral slope, the latter was dominated by pelvic incidence and pelvic rotation. Osteoporosis was the risk factor for TLK correction (P = .001, odd risk = 9.58).DTLK decreased if instrument only performed for LSS, where TLK and clinical outcomes are comparably affected whether L5 or S1 is selected as LIV. This study supplements the compensatory mechanism of spino-pelvic alignment, especially for cases with severe osteoporosis.
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Affiliation(s)
- Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, P.R. China
| | - Chen Guo
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, P.R. China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, P.R. China
| | - Zhenqi Zhu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, P.R. China
| | - Hongguang Zhang
- Department of Neurosurgery, Jining Medical College Affiliated Gaotang People's Hospital, Liaocheng, Shandong, P.R. China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, P.R. China
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Abstract
AIMS Pelvic incidence (PI) is considered an important anatomical parameter for determining the sagittal balance of the spine. The contribution of an abnormal PI to hip osteoarthritis (OA) remains controversial. In this study, we aimed to investigate the relationship between PI and hip OA, and the difference in PI between hip OA without anatomical abnormalities (primary OA) and hip OA with developmental dysplasia of the hip (DDH-OA). METHODS In this study, 100 patients each of primary OA, DDH-OA, and control subjects with no history of hip disease were included. CT images were used to measure PI, sagittal femoral head coverage, α angle, and acetabular anteversion. PI was also subdivided into three categories: high PI (larger than 64.0°), medium PI (42.0° to 64.0°), and low PI (less than 42.0°). The anterior centre edge angles, posterior centre edge angles, and total sagittal femoral head coverage were measured. The correlations between PI and sagittal femoral head coverage, α angle, and acetabular anteversion were examined. RESULTS No significant difference in PI was observed between the three groups. There was no significant difference between the groups in terms of the category distribution of PI. The DDH-OA group had lower mean sagittal femoral head coverage than the other groups. There were no significant correlations between PI and other anatomical factors, including sagittal femoral head coverage, α angle, and acetabular anteversion. CONCLUSION No associations were found between mean PI values or PI categories and hip OA. Furthermore, there was no difference in PI between patients with primary OA and DDH-OA. From our evaluation, we found no evidence of PI being an independent factor associated with the development of hip OA. Cite this article: Bone Joint J 2021;103-B(11):1656-1661.
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Affiliation(s)
- Makoto Iwasa
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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Ochiai S, Seki T, Osawa Y, Kawasaki M, Yamaguchi J, Ishiguro N. Pelvic incidence affects postoperative dislocation rate in total hip arthropalsty patients with spinal fusion. Hip Int 2021; 33:377-383. [PMID: 34693795 DOI: 10.1177/11207000211054332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to compare the clinical outcome of total hip arthroplasty (THA) with and without spinal fusion (SF), and to evaluate the radiographic characteristics of patients with dislocation after THA. METHODS A case-controlled study of 53 patients (67 hips) who underwent both THA and SF was performed. The control group was matched to the SF group by age, gender and body mass index, and 106 patients (134 hips) were selected. Hip function was evaluated using the Japanese Orthopaedic Association (JOA) hip score. In addition, the incidence rates of postoperative complications were determined. Radiograph evaluation included lateral inclination and anteversion of the acetabular component. We also analysed sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). RESULTS The JOA hip score at final follow up was significantly poorer in the SF group compared to the control group. There were 5 cases of dislocations in the SF group and none in the control group. The anteversion of acetabular cup, PT, and PI were significantly higher in the SF group compare to the control group. In particular, the PI of patients with anterior dislocation were significantly higher compare to those of patients without dislocation. CONCLUSIONS Our study showed that SF is a risk factor for a poorer clinical outcome and postoperative dislocation of THA. In addition, the abnormal value of PI may be a risk factor to predict dislocation after THA with SF.
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Affiliation(s)
- Satoshi Ochiai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Lerch TD, Boschung A, Schmaranzer F, Todorski IAS, Vanlommel J, Siebenrock KA, Steppacher SD, Tannast M. Lower pelvic tilt, lower pelvic incidence, and increased external rotation of the iliac wing in patients with femoroacetabular impingement due to acetabular retroversion compared to hip dysplasia. Bone Jt Open 2021; 2:813-824. [PMID: 34619033 PMCID: PMC8558448 DOI: 10.1302/2633-1462.210.bjo-2021-0069.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS The effect of pelvic tilt (PT) and sagittal balance in hips with pincer-type femoroacetabular impingement (FAI) with acetabular retroversion (AR) is controversial. It is unclear if patients with AR have a rotational abnormality of the iliac wing. Therefore, we asked: are parameters for sagittal balance, and is rotation of the iliac wing, different in patients with AR compared to a control group?; and is there a correlation between iliac rotation and acetabular version? METHODS A retrospective, review board-approved, controlled study was performed including 120 hips in 86 consecutive patients with symptomatic FAI or hip dysplasia. Pelvic CT scans were reviewed to calculate parameters for sagittal balance (pelvic incidence (PI), PT, and sacral slope), anterior pelvic plane angle, pelvic inclination, and external rotation of the iliac wing and were compared to a control group (48 hips). The 120 hips were allocated to the following groups: AR (41 hips), hip dysplasia (47 hips) and cam FAI with normal acetabular morphology (32 hips). Subgroups of total AR (15 hips) and high acetabular anteversion (20 hips) were analyzed. Statistical analysis was performed using analysis of variance with Bonferroni correction. RESULTS PI and PT were significantly decreased comparing AR (PI 42° (SD 10°), PT 4° (SD 5°)) with dysplastic hips (PI 55° (SD 12°), PT 10° (SD 6°)) and with the control group (PI 51° (SD 9°) and PT 13° (SD 7°)) (p < 0.001). External rotation of the iliac wing was significantly increased comparing AR (29° (SD 4°)) with dysplastic hips (20°(SD 5°)) and with the control group (25° (SD 5°)) (p < 0.001). Correlation between external rotation of the iliac wing and acetabular version was significant and strong (r = 0.81; p < 0.001). Correlation between PT and acetabular version was significant and moderate (r = 0.58; p < 0.001). CONCLUSION These findings could contribute to a better understanding of hip pain in a sitting position and extra-articular subspine FAI of patients with AR. These patients have increased iliac external rotation, a rotational abnormality of the iliac wing. This has implications for surgical therapy with hip arthroscopy and acetabular rim trimming or anteverting periacetabular osteotomy (PAO). Cite this article: Bone Jt Open 2021;2(10):813-824.
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Affiliation(s)
- Till Dominic Lerch
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Adam Boschung
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Inga A S Todorski
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jan Vanlommel
- Department of Orthopaedic Surgery and Traumatology, Orthoclinic, Bruges, Belgium
| | - Klaus A Siebenrock
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Spirollari E, Feldstein E, Ng C, Vazquez S, Kinon MD, Gandhi C, Tyagi R. Correction of Sagittal Balance With Resection of Kissing Spines. Cureus 2021; 13:e16874. [PMID: 34513449 PMCID: PMC8415043 DOI: 10.7759/cureus.16874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 11/25/2022] Open
Abstract
Kissing spines syndrome, also known as Baastrup’s disease, is a common yet underdiagnosed disorder involving close approximation of adjacent spinous processes. These painful pseudoarticulations may be secondary to the compensatory mechanisms that result from sagittal imbalance. Conventional operative correction of sagittal balance includes a wide range of procedures from facetectomies to vertebral column resection. Resection of kissing spines for the operative management of sagittal imbalance is a treatment modality not extensively discussed in the literature but may offer improved patient outcomes with shorter operative times, lower risk, and reduced length of stay. A 67-year old male with a history of degenerative disk disease and scoliosis presented with neurogenic claudication and severe back pain that worsened with walking and improved with sitting. X-ray imaging of the lumbar spine revealed straightening of the normal lumbar lordotic curvature with mild rotoscoliosis. There was also evidence of retrolisthesis of L2 on L3 that worsened with flexion. The patient had Baastrup’s disease at the L3-4 and L4, 5 levels that contributed to his reduced range of motion on extension imaging. Operative treatments including long-segment fusion with interbody cages to correct sagittal balance were considered with a discussion of possible debilitating and high-risk post-surgical outcomes. Instead, the patient underwent a simple decompression surgery involving laminectomies and resection of kissing spines to correct his sagittal imbalance. Postoperative follow-up imaging demonstrated significant improvement in sagittal balance, and the patient expressed relief of back and leg pain. Although underdiagnosed, consideration of kissing spines syndrome in the surgical correction of sagittal imbalance may offer an improvement over conventional operations. Our case presents a unique surgical perspective on the treatment of spinal stenosis with kissing spines with particular regard to correcting the sagittal imbalance, avoiding debilitating procedures, and providing better immediate postoperative outcomes.
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Affiliation(s)
| | | | - Christina Ng
- Neurosurgery, Westchester Medical Center, Valhalla, USA
| | - Sima Vazquez
- Neurosurgery, Westchester Medical Center, Valhalla, USA
| | | | - Chirag Gandhi
- Neurosurgery, Westchester Medical Center, Valhalla, USA
| | - Rachana Tyagi
- Neurosurgery, Westchester Medical Center, Valhalla, USA
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Nakashima H, Ito K, Katayama Y, Tsushima M, Ando K, Kobayashi K, Machino M, Ito S, Koshimizu H, Segi N, Tomita H, Imagama S. The Level of Conus Medullaris in 629 Healthy Japanese Individuals. J Clin Med 2021; 10:jcm10143182. [PMID: 34300348 PMCID: PMC8305241 DOI: 10.3390/jcm10143182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/01/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022] Open
Abstract
The conus medullaris typically terminates at the L1 level; however, variations in its level and the factors associated with the conus medullaris level are unclear. We investigated the level of conus medullaris on magnetic resonance imaging in healthy volunteers. In total, 629 healthy adult volunteers (≥50 individuals of each sex and in each decade of age from 20 to 70) were enrolled. The level of the conus medullaris was assessed based on the T2-weighted sagittal magnetic resonance images, and factors affecting its level were investigated employing multivariate regression analysis including the participants' background and radiographical parameters. L1 was the most common conus medullaris level. Participant height was significantly shorter in the caudally placed conus medullaris (p = 0.013). With respect to the radiographical parameters, pelvic incidence (p = 0.003), and pelvic tilt (p = 0.03) were significantly smaller in participants with a caudally placed conus medullaris. Multiple regression analysis showed that the pelvic incidence (p < 0.0001) and height (p < 0.0001) were significant factors affecting the conus medullaris level. These results indicated that the length of the spinal cord varies little among individuals and that skeletal differences affect the level of the conus medullaris.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (K.A.); (K.K.); (M.M.); (S.I.); (H.K.); (N.S.); (H.T.); (S.I.)
- Correspondence:
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya 455-8530, Japan; (K.I.); (Y.K.); (M.T.)
| | - Yoshito Katayama
- Department of Orthopedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya 455-8530, Japan; (K.I.); (Y.K.); (M.T.)
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya 455-8530, Japan; (K.I.); (Y.K.); (M.T.)
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (K.A.); (K.K.); (M.M.); (S.I.); (H.K.); (N.S.); (H.T.); (S.I.)
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (K.A.); (K.K.); (M.M.); (S.I.); (H.K.); (N.S.); (H.T.); (S.I.)
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (K.A.); (K.K.); (M.M.); (S.I.); (H.K.); (N.S.); (H.T.); (S.I.)
| | - Sadayuki Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (K.A.); (K.K.); (M.M.); (S.I.); (H.K.); (N.S.); (H.T.); (S.I.)
| | - Hiroyuki Koshimizu
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (K.A.); (K.K.); (M.M.); (S.I.); (H.K.); (N.S.); (H.T.); (S.I.)
| | - Naoki Segi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (K.A.); (K.K.); (M.M.); (S.I.); (H.K.); (N.S.); (H.T.); (S.I.)
| | - Hiroyuki Tomita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (K.A.); (K.K.); (M.M.); (S.I.); (H.K.); (N.S.); (H.T.); (S.I.)
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (K.A.); (K.K.); (M.M.); (S.I.); (H.K.); (N.S.); (H.T.); (S.I.)
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Nikoobakht M, Pourmahmoudian M, Gerszten PC, Pourmahmoudian M. Global sagittal angle and spinopelvic sagittal alignment: a step toward investigation of sagittal plane deformity in upper lumbar disc herniation. Br J Neurosurg 2021:1-5. [PMID: 33983097 DOI: 10.1080/02688697.2021.1923651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Understanding the biomechanical relationship between the spine and the pelvis is important for the management of symptomatic lumbar disease. There are several different metrics that may be used to evaluate the spine in the sagittal plane. The aim of this study is to compare spinopelvic parameters and global sagittal angle (GSA) in a cohort of patients with upper lumbar disc herniations (ULDH) to identify a correlation between the pelvic incidence (PI) and GSA with ULDH. MATERIAL AND METHODS Eighty-six patients with ULDH and 86 asymptomatic control group underwent whole body biplanar stereographs- and magnetic resonance imaging . The spinopelvic parameters and GSA were measured. RESULTS PI, sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis (TK) were all significantly lower than in the control group (p < 0.01) but there was no difference in the pelvic tilt (PT). The two groups were divided into subgroups. PI in the T12-L1 and L1-L2 level groups were significantly smaller than in the control group (p < 0.05). Also, there was a significant difference in TK and LL between the L3-L4 level and control group (p < 0.05), but there was no statistically significant difference in PT between all levels and the control group. CONCLUSION This study demonstrated a unique correlation between several spinopelvic parameters and GSA and the occurrence of ULDH. Lower PI, SS, and LL in T12-L1 and L1-L2 levels indicates a flat lumbar spine which may increase mechanical stress at these levels, thereby leading to disc herniation.
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Affiliation(s)
- Mehdi Nikoobakht
- Department of Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Pourmahmoudian
- Firoozgar Clinical Research and Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Peter Carlos Gerszten
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mostafa Pourmahmoudian
- Firoozgar Clinical Research and Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
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Kim JT, Shen QH, Jeon CH, Chung NS, Jeong S, Lee HD. No linear correlation between pelvic incidence and acetabular orientation: Retrospective observational study. Medicine (Baltimore) 2021; 100:e25445. [PMID: 33847648 PMCID: PMC8051977 DOI: 10.1097/md.0000000000025445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 03/17/2021] [Indexed: 12/28/2022] Open
Abstract
Links between sagittal spinal alignment and acetabular orientation attract considerable research attention with the goal of understanding “hip-spine syndrome.” However, whether pelvic incidence (PI) is related to acetabular orientation remains debatable. The purpose of the present study was to determine: 1. whether the correlation between PI and acetabular orientation is present in pelvises of young healthy adults, and 2. whether the correlation is present in subgroups of sex, or between the left and right pelvis. We analyzed 100 abdominopelvic computed tomography (CT) scans of skeletally healthy young adults. We measured PI and acetabular orientation with three-dimensional (3D) measurements. The orientation of 200 acetabula was measured using 3D reconstructed models of 100 pelvises in the coordinate system based on the anterior pelvic plane (APP). To quantify the acetabular orientation, the radiographic definitions of anteversion and inclination were used. To examine the correlation between acetabular orientation and PI, Pearson's correlation was used. The mean PI was 46.9° ± 10.2°, and the mean acetabular orientation 15.3° ± 5.7° anteverted and 37.5° ± 3.9° inclined. While no significant difference in the PI was observed, the average acetabular orientation of female pelvises (anteversion, 17.5° ± 5.6°; inclination, 36.7° ± 3.7°) was more anteverted and less inclined compared to that of male pelvises (anteversion, 13.2° ± 4.9°; inclination, 38.3° ± 3.9°, respectively; P values < .05). The correlation between PI and acetabular orientation was statistically not significant. After division of study group by sex, the linear correlation between PI and acetabular orientation was not statistically supported. The asymmetry of the acetabular orientation between the left and right sides was not significant. The linear relationship between anatomical acetabular orientation and PI was not evident in the normal population. Our finding thus proves the absence of a linear relationship between the upper and lower articular orientation of the pelvic segment and deepens the understanding of the characteristics of acetabular orientation and PI.
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Affiliation(s)
- Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon, Korea
| | - Quan Hu Shen
- Department of Orthopaedics, Yanbian University School of Medicine, Jilin, China
| | - Chang-Hoon Jeon
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon, Korea
| | - Nam-Su Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon, Korea
| | - Seungmin Jeong
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon, Korea
| | - Han-Dong Lee
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon, Korea
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Branche K, Netsanet R, Noshchenko A, Burger E, Patel V, Ou-Yang D, Kleck CJ. Radius of Curvature in Patient-Specific Short Rod Constructs Versus Standard Pre-Bent Rods. Int J Spine Surg 2021; 14:944-948. [PMID: 33560254 DOI: 10.14444/7143] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Recent studies support the need for sagittal alignment restoration when performing lumbar degenerative spinal fusions. The development of patient-specific spine rods (PSSRs) may help maintain or improve sagittal alignment in these surgeries. METHODS A retrospective review was conducted for patients who underwent posterior spinal surgeries involving 4 or less levels. The preplanned PSSR radii of curvature (ROC) was compared with standard prebent rods with a ROC of 125 mm. All surgeries were performed at a single institution by 3 surgeons from September 2016 through October 2018. Data were then compared using a 2-tailed paired t test. PSSR had either 1 or 2 definitive ROCs. RESULTS For rods with 2 ROCs, the "cranial" curve was measured between the upper instrumented level and L4 or L5. The "caudal" curve was measured between L4 or L5 and the lower instrumented level. The PSSR with 1 ROC and the caudal portion of the rods with 2 ROCs were significantly smaller than the industry standard ROC. CONCLUSIONS PSSR demonstrate more acute ROC than industry standard rods. In PSRs, the most lordosis occurs between L4-S1 and flattens out at the thoracolumbar junction, mimicking the normal distribution of lumbar lordosis. PSSRs could help achieve or maintain sagittal alignment and prevent the sequela of flat back syndrome.
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Affiliation(s)
- Katherine Branche
- Department of Orthopedics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Rahwa Netsanet
- Department of Orthopedics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Andriy Noshchenko
- Department of Orthopedics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Evalina Burger
- Department of Orthopedics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Vikas Patel
- Department of Orthopedics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - David Ou-Yang
- Department of Orthopedics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Christopher J Kleck
- Department of Orthopedics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Mikula AL, Fogelson JL, Oushy S, Pinter ZW, Peters PA, Abode-Iyamah K, Sebastian AS, Freedman B, Currier BL, Polly DW, Elder BD. Change in pelvic incidence between the supine and standing positions in patients with bilateral sacroiliac joint vacuum signs. J Neurosurg Spine 2021; 34:617-622. [PMID: 33450735 DOI: 10.3171/2020.8.spine20742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pelvic incidence (PI) is a commonly utilized spinopelvic parameter in the evaluation and treatment of patients with spinal deformity and is believed to be a fixed parameter. However, a fixed PI assumes that there is no motion across the sacroiliac (SI) joint, which has been disputed in recent literature. The objective of this study was to determine if patients with SI joint vacuum sign have a change in PI between the supine and standing positions. METHODS A retrospective chart review identified patients with a standing radiograph, supine radiograph, and CT scan encompassing the SI joints within a 6-month period. Patients were grouped according to their SI joints having either no vacuum sign, unilateral vacuum sign, or bilateral vacuum sign. PI was measured by two independent reviewers. RESULTS Seventy-three patients were identified with an average age of 66 years and a BMI of 30 kg/m2. Patients with bilateral SI joint vacuum sign (n = 27) had an average absolute change in PI of 7.2° (p < 0.0001) between the standing and supine positions compared to patients with unilateral SI joint vacuum sign (n = 20) who had a change of 5.2° (p = 0.0008), and patients without an SI joint vacuum sign (n = 26) who experienced a change of 4.1° (p = 0.74). ANOVA with post hoc Tukey test showed a statistically significant difference in the change in PI between patients with the bilateral SI joint vacuum sign and those without an SI joint vacuum sign (p = 0.023). The intraclass correlation coefficient between the two reviewers was 0.97 for standing PI and 0.96 for supine PI (p < 0.0001). CONCLUSIONS Patients with bilateral SI joint vacuum signs had a change in PI between the standing and supine positions, suggesting there may be increasing motion across the SI joint with significant joint degeneration.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - David W Polly
- 4Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
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Haffer H, Becker L, Putzier M, Wiethölter M, Ziegeler K, Diekhoff T, Pumberger M, Hardt S. Changes of Fixed Anatomical Spinopelvic Parameter in Patients with Lumbosacral Transitional Vertebrae: A Matched Pair Analysis. Diagnostics (Basel) 2021; 11:59. [PMID: 33401698 DOI: 10.3390/diagnostics11010059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 12/02/2022] Open
Abstract
Functional spinopelvic parameters are crucial for describing spinal alignment (SA), but this is susceptible to variation. Anatomically fixed pelvic shape is defined by the parameters pelvic radius (PR), pelvic incidence (PI), and sacral table angle (STA). In patients with lumbosacral transitional vertebrae (LSTV), the spinopelvic alignment may be altered by changes of these parameters and influences of SA. There have been no reports studying the relation between LSTV, four (4 LV) and six (6 LV) lumbar vertebrae, and fixed anatomical spinopelvic parameters. A retrospective analysis of 819 abdomen–pelvis CT scans was performed, identifying 53 patients with LSTV. In a matched-pair analysis, we analyzed the influence of LSTV and the subgroups 4 LV (n = 9) and 6 LV (n = 11) on PR, PI, and STA. LSTV were classified according to Castellvi classification. In patients with 6 LV, measurement points at the superior endplates of S1 and S2 were compared. The prevalence of LSTV was 6.5% (53/819), 6 LV was 1.3% (11/819), and 4 LV was 1.1% (9/819) in our study population. PI significantly increased (p < 0.001), STA significantly decreased (p < 0.001), and PR (p = 0.051) did not differ significantly in the LSTV group (n = 53). Similar findings were observed in the 4 LV subgroup, with an increase in PI (p < 0.021), decrease in STA (p < 0.011), and no significant difference in PR (p < 0.678). The same results were obtained in the 6 LV subgroup at measuring point S2 (true S1) PI (p = 0.010), STA (p = 0.004), and PR (p = 0.859), but not at measuring point S1 (true L6). Patients with LSTV, 4 LV, and 6 LV showed significant differences in PI and STA compared to the matched control group. PR showed no significant differences. The altered spinopelvic anatomy in LSTV patients need to be reflected in preoperative planning rebalancing the sagittal SA.
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Abstract
BACKGROUND The aim of this study was to determine the contribution of individual vertebral body lordosis to lumbar lordosis and establish the relationship of vertebral body lordosis to the pelvic incidence (PI). METHODS One-hundred and two computed tomography (CT) scans on patients free of radiographic disease were measured for PI and segmental lordosis of both bone and disc from L1 to sacrum. Correlative analysis and analysis of variance (ANOVA) were used to identify contribution from bone and disc to lordosis. RESULTS The mean total bony lordosis was 10.8° (SD 11.5°), mean total disc lordosis was 36.3° (SD 9.9°), and mean combined lordosis was 47.1° (SD 10.0°). The mean PI of the entire cohort was 49.2° (SD 9.3°). One-way ANOVA demonstrated a significant difference between the PI strata in total bony lordosis values with a mean difference of 14.0° between low and high PI cohorts (P < .001) and also mid- and high PI cohorts of 9.9° (P = .008). Overall, distal lordosis represented 80.8% of the total lordosis. In the proximal lumbar segments, the mean contribution from bone was -4.0° (SD 6.8°) and the mean contribution from disc was 13.6° (SD 6.0°). In the distal, the mean contribution from bone was 14.7° (SD 6.5°) and from disc, 22.7° (SD 6.2°). CONCLUSIONS The contribution to lordosis from the vertebral bodies is greater in the proximal lumbar spine with increasing PI. With low PI, the proximal vertebral bodies demonstrate reduced contribution to lordosis and in some instances are kyphotic. Future research efforts should place greater emphasis on providing segmental rather than just global analysis of alignment. CLINICAL RELEVANCE Restoration of lumbar spine lordosis should take into account the variation in segmental lordosis contributions as it relates to PI.
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Affiliation(s)
- Joseph F Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Peter A Robertson
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
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Moridaira H, Inami S, Takeuchi D, Ueda H, Aoki H, Imura T, Taneichi H. Can we use shorter constructs while maintaining satisfactory sagittal plane alignment for adult spinal deformity? J Neurosurg Spine 2020; 34:589-596. [PMID: 33361482 DOI: 10.3171/2020.7.spine20917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Issues with spinopelvic fixation for adult spinal deformity (ASD) include loss of the physiological mobility of the entire lumbar spine, perioperative complications, and medical costs. Little is known about the factors associated with successful short fusion for ASD. The authors evaluated radiographic and clinical outcomes after shorter fusion for different subtypes of ASD at 2 years postoperatively and examined factors associated with successful short fusion. METHODS This was a single-center study of 37 patients who underwent short fusion and a minimum 2 years of follow-up for ASD in which lumbar kyphosis was the main deformity. The exclusion criteria were 1) age < 40 years, 2) previous lumbar vertebral fracture, 3) severe osteoporosis, 4) T10-L2 kyphosis > 20°, 5) scoliotic deformity with an upper end vertebra (UEV) above T12, and 6) concomitant Parkinson's disease or neurological disease. The surgical procedures, radiographic course, and Oswestry Disability Index (ODI) were assessed, and correlations between radiographic parameters and postoperative ODI at 2 years were analyzed. RESULTS A mean of 3.5 levels were fused. The mean radiographic parameters preoperatively, at 2 weeks, and at 2 years, respectively, were as follows: coronal Cobb angle: 22.9°, 11.5°, and 12.6°; lumbar lordosis (LL): 12.9°, 35.8°, and 32.2°; pelvic incidence (PI) minus LL: 35.5°, 14.7°, and 19.2°; pelvic tilt: 29.4°, 23.1°, and 25.0°; and sagittal vertical axis 85.3, 36.7, and 59.2 mm. Abnormal proximal junctional kyphosis occurred in 8 cases. Revision surgery was performed to extend the length of fusion from a lower thoracic vertebra to the pelvis in 2 cases. The mean ODI scores preoperatively and at 2 years were 50.7% and 24.1%, respectively. Patient age, number of fused intervertebral segments, and radiographic parameters were analyzed by the stepwise method to identify factors contributing to the ODI score at 2 years, preoperative PI, and sagittal vertical axis at 2 years. On receiver operating characteristic curve analysis of the minimal clinically important difference of ODI (15%) and preoperative PI, the cutoff value of the preoperative PI was 47° (area under the curve 0.75). CONCLUSIONS In terms of subtypes of ASD in which lumbar kyphosis is the main deformity, if the PI is < 47°, then the use of short fusion preserving mobile intervertebral segments can produce adequate LL for the PI, improving both postoperative global spinal alignment and quality of life.
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Saeedi M, Kamyab M, Babaee T, Behtash H, Ganjavian MS. The effects of bracing on sagittal spinopelvic parameters and Cobb angle in adolescents with idiopathic scoliosis: A before-after clinical study. Turk J Phys Med Rehabil 2020; 66:452-8. [PMID: 33364566 DOI: 10.5606/tftrd.2020.4955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/30/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to evaluate the effects of bracing on the Cobb angle and sagittal spinopelvic parameters in adolescent idiopathic scoliosis (AIS) patients. Patients and methods A total of 25 adolescents (2 males, 23 females; mean age 12.7±1.6; range, 10-15 years) with AIS who received bracing between January 2000 and June 2017 were retrospectively analyzed. The initial and final out-of-brace radiographs of 25 AIS patients were analyzed with regard to the spinopelvic parameters. The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), Cobb angle, thoracic kyphosis (TK), and lumbar lordosis (LL) were measured. Results The mean age at the initiation of bracing was 12.7±1.6 years. The mean initial Cobb angle was 31.8°±5.9°. There were no statistically significant differences between the baseline and the final measurements of the PI, PT, and SS. However, there were statistically significant differences between the baseline and the final measurements of the TK, LL, and Cobb angle. A significant correlation was observed between the PI and Cobb angle and TK and between the LL and SS. Conclusion Our study results show significant associations between the sagittal pelvic parameters and the spinal parameters during the brace treatment of adolescents with idiopathic scoliosis.
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