Analysis of an unexplored group of sagittal deformity patients: low pelvic tilt despite positive sagittal malalignment

Ferrero, Emmanuelle; Vira, Shaleen; Ames, Christopher P.; Kebaish, Khaled M.; Obeid, Ibrahim; O’Brien, Michael F.; Gupta, Munish C.; Boachie-Adjei, Oheneba; Smith, Justin S.; Challier, Vincent; Protopsaltis, Themistocles S.; Schwab, Frank J.; Lafage, Virginie

doi:10.1007/s00586-015-4048-1

Cited by 31 publications

(25 citation statements)

References 33 publications

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“…On the other hand, a pre-existing thoracic kyphosis is better to be reduced in type 1, extending the kyphosis in thoraco-lumbar area as was shown by Scemama et al [20]. In any case, increasing lordosis in length and angle and thus turning the spinal shape into an anteverted type 3 is a bad option and results in high rates of PJK [20,21].…”

Section: Discussionmentioning

confidence: 95%

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

et al. 2019

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Purpose To evaluate the incidence of mechanical complications in patients with adult spine deformity (ASD) treated by restoring the normal shape according to the Roussouly classification. Methods This is a retrospective multicentric study with a minimum follow-up of 2 years. Patients operated on with fusion for ASD (minimum performed fusion: L2 to sacrum) were included. Patients with a history of previous spinal fusion of more than three levels were excluded. Spinal and pelvic parameters were measured on the preoperative and the immediate postoperative follow-up. All mechanical complications were recorded. Results A total of 290 patients met the criteria of inclusion with a minimum follow-up of 2 years. Mechanical complications occurred in 30.4% of the cohort. The most common complication was PJK with an incidence of 18% while nonunion or instrumentation failure (rod breakage, implant failure) occurred in 12.4%. 66% of the patients were restored to the normal shape according to the Roussouly classification based on their PI and had a mechanical complication rate of 22.5%, whereas the remaining 34% of patients had a complication rate of 46.8% (p < 0.001). The relative risk for developing a mechanical complication if the algorithm was not met was 3 (CI 1.5-4.3; p < 0.001) Conclusion In the recent literature, there are no clear guidelines for ASD correction. Restoring the sagittal spinal contour to the normal shapes of Roussouly according to the PI could serve as a guideline for ASD treatment. Ignoring this algorithm has a threefold risk of increased mechanical complications. We recommend this algorithm for treatment of ASD. Level of evidence IV cross-sectional observational study. Graphic abstractThese slides can be retrieved under Electronic Supplementary Material. Sebaaly AY, Gehrchen M, Silvestre C, Kharrat KE, Bari TJ, Kreichati G, Rizkallah M, Roussouly P (2019) Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study. Eur Spine J;

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Section: Discussionmentioning

confidence: 95%

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

et al. 2019

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“…With the muscle shortening from standing or flexion to retroversion, and under the assumption of constant muscle volume, the corresponding increase in muscle CSA and circularity is in line with what could be expected. Though previous studies have shown that gluteus maximus activates with pelvic tilt 9 , 36 , 37 , another study found this activation was not significant when compared to neutral 38 . As a result, it may be prudent to speculate that the observed changes in muscle CSA and circularity with retroversion are likely a combination of passive and active muscle engagement.…”

Section: Discussionmentioning

confidence: 68%

Synchronous imaging of pelvic geometry and muscle morphometry: a pilot study of pelvic retroversion using upright MRI

Shaikh

Zhang

Brown

et al. 2021

Sci Rep

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This study investigated feasibility of imaging lumbopelvic musculature and geometry in tandem using upright magnetic resonance imaging (MRI) in asymptomatic adults, and explored the effect of pelvic retroversion on lumbopelvic musculature and geometry. Six asymptomatic volunteers were imaged (0.5 T upright MRI) in 4 postures: standing, standing pelvic retroversion, standing 30° flexion, and supine. Measures included muscle morphometry [cross-sectional area (CSA), circularity, radius, and angle] of the gluteus and iliopsoas, and pelvic geometry [pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), L3–S1 lumbar lordosis (LL)] L3-coccyx. With four volunteers repeating postures, and three raters assessing repeatability, there was generally good repeatability [ICC(3,1) 0.80–0.97]. Retroversion had level dependent effects on muscle measures, for example gluteus CSA and circularity increased (up to 22%). Retroversion increased PT, decreased SS, and decreased L3–S1 LL, but did not affect PI. Gluteus CSA and circularity also had level-specific correlations with PT, SS, and L3–S1 LL. Overall, upright MRI of the lumbopelvic musculature is feasible with good reproducibility, and the morphometry of the involved muscles significantly changes with posture. This finding has the potential to be used for clinical consideration in designing and performing future studies with greater number of healthy subjects and patients.

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“…If for majority of spine specialists, presence of a TLK in a pathological spine is considered as pejorative, identification of such a sagittal organization was poorly address in deformities classifications. [15].…”

Section: Discussionmentioning

confidence: 99%

“…At last follow-up, in scoliosis group, the ODI was 18 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) in the group of type 1 and type 2 with L4L5 and L5S1 left. In the type 2, the ODI was 16 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). There was no significant difference between these groups.…”

Section: Effect Of Treatment In Scoliosis Groupmentioning

confidence: 99%

Surgical treatment of thoraco-lumbar kyphosis (TLK) associated with low pelvic incidence

Scemama

Laouissat²,

Abelin-Genevois³

et al. 2017

Eur Spine J

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Analysis of an unexplored group of sagittal deformity patients: low pelvic tilt despite positive sagittal malalignment

Cited by 31 publications

References 33 publications

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

Synchronous imaging of pelvic geometry and muscle morphometry: a pilot study of pelvic retroversion using upright MRI

Surgical treatment of thoraco-lumbar kyphosis (TLK) associated with low pelvic incidence

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