Are Measurements of Sacral Slopes Reliable?

Imai, Norio; Miyasaka, Dai; Horigome, Yoji; Suzuki, Hayato; Takubo, Ryota; Endo, Naoto

doi:10.12691/ajcmr-2-3-2

Cited by 6 publications

(9 citation statements)

References 31 publications

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“…However, this was only a 4°d ifference in pelvic tilt between patients with and without DDD in the sitting position (mean sacral slope of 16°v ersus 20°, respectively). This small difference in pelvic tilt between groups is comparable to the expected error in the measurement technique [18], confirming that patients with lumbar DDD are not predisposed to excessive pelvic tilt when sitting. Most patients, regardless of whether they have DDD, sit within a similar range of pelvic tilt (Fig.…”

Section: Discussionsupporting

confidence: 61%

“…We did not evaluate the accuracy of methods for measuring pelvic, lumbar, and femoral angles. The accuracy of the measurements is disputed in the literature, since accuracy is dependent on the ability to identify landmarks in the presence of degenerative diseases of the spine [18,27]. However, excellent intra-and interobserver reliability for measuring sacral slope and lumbar lordosis angles on lateral radiographs has been reported [9].…”

Section: Discussionmentioning

confidence: 99%

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Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Esposito

Miller

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

202

177

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Background Sitting pelvic tilt dictates the proximity of the rim of the acetabulum to the proximal femur and, therefore, the risk of impingement in patients undergoing total hip arthroplasty (THA). Sitting position is achieved through a combination of lumbar spine segmental motions and/or femoroacetabular articular motion in the lumbarpelvic-femoral complex. Multilevel degenerative disc disease (DDD) may limit spine flexion and therefore increase femoroacetabular flexion in patients having THAs, but this has not been well characterized. Therefore, we measured standing and sitting lumbar-pelvic-femoral alignment in patients with radiographic signs of DDD and in patients with no radiographic signs of spine arthrosis.Questions/purposes We asked: (1) Is there a difference in standing and sitting lumbar-pelvic-femoral alignment before surgery among patients undergoing THA who have no radiographic signs of spine arthrosis compared with those with preexisting lumbar DDD? (2) Do patients with lumbar DDD experience less spine flexion moving from a standing to a sitting position and therefore compensate with more femoroacetabular flexion compared with patients who have no radiographic signs of arthrosis? Methods Three hundred twenty-five patients undergoing primary THA had preoperative low-dose EOS spine-toankle lateral radiographs in standing and sitting positions. Eighty-three patients were excluded from this study for scoliosis (39 patients), spondylolysis (15 patients), not having five lumbar vertebrae (7 patients), surgical or disease fusion (11 patients), or poor image quality attributable to high BMI (11 patients). In the remaining 242 of 325 patients (75%), two observers categorized the lumbar spine as either without radiographic arthrosis or having DDD based on defined radiographic criteria. Sacral slope, lumbar lordosis, and proximal femur angles were measured, and these angles were used to calculate lumbar spine flexion and femoroacetabular flexion in standing and sitting positions. Patients were aligned in a standardized sitting position so that their femurs were parallel to the floor to achieve approximately 90°of apparent hip flexion. Results After controlling for age, sex, and BMI, we found patients with DDD spines had a mean of 5°more posterior pelvic tilt (95% CI, À2°to À8°lower sacral slope angles; p \0.01) and 7°less lumbar lordosis (95% CI, À10°to À3°; p \ 0.01) in the standing position compared with patients without radiographic arthrosis. However, in the sitting position, patients with DDD spines had 4°less posterior pelvic tilt (95% CI, 1°-7°higher sacral slope angles; p = 0.02). From standing to sitting position, patients with DDD

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Esposito

Miller

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

202

177

View full text Add to dashboard Cite

show abstract

“…There have been studies that attempted to establish anthropometric parameters of the normal and dysplastic acetabulum based on 3D images; however, subjective, descriptive methods were mainly used for acetabular orientation, especially in patients with dysplastic or spastic changes. These studies, which focused on the orientation of components in total hip replacement, could provide objective descriptions of the position of the acetabular component in relation to the pelvis, but the descriptions were based on reference planes of low accuracy in dynamic situations because of changes in pelvic tilt with different body positions [ 5 , 15 , 18 - 20 , 40 , 41 ]. APP and STC planes are surfaces determined by anatomic points such as anterior superior iliac spine (ASIS) or posterior superior iliac spine (PSIS).…”

Section: Discussionmentioning

confidence: 99%

An accurate method of radiological assessment of acetabular volume and orientation in computed tomography spatial reconstruction

Jóźwiak

Rychlik

Musielak

et al. 2015

BMC Musculoskelet Disord

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BackgroundTwo-dimensional (2D) measurements of acetabular morphology and orientation are well known; there is less information on these acetabular characteristics in three dimensions. One important reason is the lack of standardized reference planes for the pelvis, especially in relation to the spinopelvic unit; another is that no method precisely assesses the acetabulum in three-dimensional (3D) orientation based on its axis rather than on the directions of the edges of the acetabular rim. We present an objective, highly reliable and accurate, axis-based approach to acetabular anthropometry in the measurement of acetabular volume and spatial orientation in both normal and pathologic hips. This was done using reference planes based on the sacral base (SB) and true acetabular axis in 3D computed tomography (CT) pelvic reconstruction.MethodsRadiological examinations of 30 physiologic pelves (60 acetabula) were included in the study. Reliability and accuracy of the method were verified by comparing acetabular angles in 2D pelvic scans with 3D reconstructions. We also applied the method to two pathologic acetabula.ResultsComparison of axis position in the horizontal plane revealed significant positive correlations between 2D angle measurements (acetabular anteversion angle [AAA] and anterior acetabular index [AAI]) and 3D measurement of anteversion angle (p < 0.001 and p = 0.012, respectively). In the frontal plane, there was no difference between abduction angle, measured on topogram, and inclination angle, obtained from a 3D model (p = 0.517). In the sagittal plane, there was a significant negative correlation between AAA and acetabular tilt (p < 0.001). Inter- and intra-observer reproducibility was excellent for determination of the sacral-base plane and assessment of volume, with Fleiss κ coefficients of 0.850 and 0.783, respectively, and intraclass correlation coefficients of 0.900 and 0.950, respectively. Inter-observer reproducibility for evaluation of acetabular axis ranged from 0.783 to 0.883, and intra-rater reliability ranged from 0.850 to 0.900 for all 3D angles.ConclusionsOur method is a new, reliable diagnostic tool for assessing the acetabula in both normal and pathologic hip joints. The sacral-base plane can be used as a stable reference that takes the relationship of the acetabulum to the spinopelvic unit into consideration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0503-8) contains supplementary material, which is available to authorized users.

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“…Sacral slope is one of many measurements used to assess sagittal balance. The inter‐ and intraobserver reliability of sacral slope has been demonstrated in previous studies [24,30,31]. It can be difficult to accurately measure sacral slope in those with high‐grade spondylolisthesis or dystrophic end‐plate changes.…”

Section: Discussionmentioning

confidence: 89%

The Relationship Between Sacral Slope and Symptomatic Isthmic Spondylolysis in a Cohort of High School Athletes: A Retrospective Analysis

Hanke

Tuakli‐Wosornu

Harrison

et al. 2017

PM&R

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Are Measurements of Sacral Slopes Reliable?

Cited by 6 publications

References 31 publications

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

An accurate method of radiological assessment of acetabular volume and orientation in computed tomography spatial reconstruction

The Relationship Between Sacral Slope and Symptomatic Isthmic Spondylolysis in a Cohort of High School Athletes: A Retrospective Analysis

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