Comparison of sacroiliac joint degeneration between patients with sagittal imbalance and lumbar spinal stenosis

Kwon, Byung Taek; Kim, Ho-Joong; Yang, Hee-Jong; Park, Sang Min; Chang, Bong Soon; Yeom, Jin Sup

doi:10.1007/s00586-020-06558-6

Cited by 14 publications

(8 citation statements)

References 23 publications

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“…In our investigation, PR remained constant with age, while PI showed an increase and STA a decrease with age. These findings are in line with those of Kwon et al who found a correlation between PI and age [ 9 ], yet somewhat contradict those of Baker et al [ 22 ], who investigated a smaller cohort of patients without spinal disease. Based on our results, the surgical restoration of the sagittal profile in adult spinal deformity with increasing age should aim for increased lumbar lordosis in line with increasing PI to reduce the risk of persistent imbalance and worse patient outcome [ 7 , 8 ].…”

Section: Discussionsupporting

confidence: 83%

“…Furthermore, as we only included scans acquired in a supine position, quantitative parameters of spinopelvic orientation, such as sagittal balance, could not be measured. This is an important limitation, because recent studies have underlined the importance of lumbar lordosis and sagittal vertical axis for degenerative lesions of the SIJ [ 9 ]. Furthermore, clinical and epidemiological patient data, such as occupational or recreational physical activity, were not available due to the retrospective setting of this investigation.…”

Section: Discussionmentioning

confidence: 99%

“…The degeneration of the SIJ is affected by the spino-pelvic parameters. A recent study by Kwon et al [ 9 ] found a positive correlation between pelvic incidence and SIJ degeneration in adult spinal deformity, but not in controls with normal sagittal balance. Another aspect that has received very little attention from the scientific community is the association of degeneration of the lumbar spine and the SIJ.…”

Section: Introductionmentioning

confidence: 99%

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Unexpected Sex Differences in the Relationship of Sacroiliac Joint and Lumbar Spine Degeneration

et al. 2022

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The relationship between degenerative changes of the sacroiliac joints and the lumbar spine on CT has not been studied yet. The aim of this analysis is to determine the nature of their association as well as the influence of fixed anatomical spinopelvic parameters on sacroiliac joint degeneration. For this institutional review-board-approved investigation, imaging datasets as well as electronic medical records of 719 patients without back pain from the clinical routine of our department of radiology were included. Age, sex, weight category (slim, normal, obese), parity in women and indication for imaging were noted for all patients. The presence of degenerative lesions of the lumbar spine (disc degeneration, endplate degeneration, spondylophytes, and facet joint osteoarthritis) was noted separately at each lumbar segment (L1 to L5). Sacroiliac joints were assessed for sclerosis and osteophytes. Fixed anatomical spinopelvic parameters were measured: pelvic radius = PR; pelvic incidence = PI; sacral table angle = STA. Correlation as well as regression analyses were performed; data were analyzed for males and females separately. PI increased significantly with age in both women and men, while STA decreased and PR remained constant; neither of them was associated with SIJ degeneration. SIJ degeneration correlated with disc degeneration (tau = 0.331; p < 0.001), spondylophytes (tau = 0.397; p < 0.001), and facet joint degeneration (tau = 0.310; p < 0.001) in men, but with no parameter of spinal degeneration in women. Lumbar spinal degeneration increased the risk of sacroiliac joint degeneration in men significantly (OR 7.2; 95%CI 2.8–19.0), but it was not a significant covariable in women. Fixed spinopelvic parameters have little impact on sacroiliac joint degeneration. The degeneration of the sacroiliac joints and the lumbar spine appear to be parallel processes in men, but are largely unrelated in women.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Unexpected Sex Differences in the Relationship of Sacroiliac Joint and Lumbar Spine Degeneration

et al. 2022

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“…Lee et al 14 suggested that hip extensor muscle power is the key to the successful pelvic compensation. Degeneration of the sacroiliac joints in patients with sagittal imbalance support this opinion 15. Another possible explanation is the neurological cause of stooping.…”

Section: Discussionmentioning

confidence: 76%

“…Degeneration of the sacroiliac joints in patients with sagittal imbalance support this opinion. 15 Another possible explanation is the neurological cause of stooping. Camptocormia with a neurological origin, such as in Parkinson disease, suggests that subclinical motor neuron deterioration in the elderly population could cause a distinct subtype of spinal deformity as in group 4.…”

Section: Muscle Cross-sectional Area and Pathophysiology Of Failure O...mentioning

confidence: 99%

A Complement Type to SRS-Schwab Adult Spinal Deformity Classification: The Failure of Pelvic Compensation

Kwon

Lee

Park

et al. 2022

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Study Design. Retrospective review. Objective. To determine characteristics of patients with adult spinal deformity (ASD) who showed failed pelvic compensation even with significant sagittal imbalance. Background. Patients who show failed pelvic compensation despite significant sagittal imbalance reportedly present distinct clinical outcomes. However, to our knowledge, no study has clearly defined or characterized this subgroup of patients with ASD. Materials and Methods. We examined 126 patients who underwent reconstructive spinal surgery for ASD between September 2016 and September 2020. Radiographic spinopelvic parameters were assessed. The patients were divided into four quadrant groups based on the two axes of pelvic tilt/pelvic incidence (PT/PI) and the sagittal vertical axis (SVA) with reference to the population median values (0.68 and 147.5 mm, respectively). Patients with low PT/PI and high SVA were considered to have failed pelvic compensation, and they were compared with other patient groups.Results. Patients with failed pelvic compensation (low PT/PI and high SVA) had worse clinical outcomes than those with successful pelvic compensation (high PT/PI and high SVA) at one year after surgery. Regarding radiographic outcomes, patients with failed pelvic compensation showed a significantly larger postoperative SVA even after correcting the PI−lumbar lordosis mismatch was corrected to a comparable range with the group of successful pelvic compensation. Notably, patients with failed pelvic compensation showed larger cross-sectional areas of the psoas and back extensor muscles than those with successful pelvic compensation. This suggests that failure of pelvic compensation did not occur because of back muscle weakness, which implies another underlying pathophysiology, including neurological origin. Conclusion.Compared with patients with successful pelvic compensation, those with failed pelvic compensation showed lower postoperative improvements in clinical and radiographic outcomes. Therefore, it is important to consider pelvic compensation when planning surgical correction of deformities. Distinct surgical approaches, including overcorrection of the PI−lumbar lordosis mismatch or global sagittal alignment, should be attempted to ensure postoperative symptom improvement.

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Sacroiliac joint degeneration in degenerative lumbar spondylolisthesis and related risk factors: a retrospective study

et al. 2023

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Comparison of sacroiliac joint degeneration between patients with sagittal imbalance and lumbar spinal stenosis

Cited by 14 publications

References 23 publications

Unexpected Sex Differences in the Relationship of Sacroiliac Joint and Lumbar Spine Degeneration

Unexpected Sex Differences in the Relationship of Sacroiliac Joint and Lumbar Spine Degeneration

A Complement Type to SRS-Schwab Adult Spinal Deformity Classification: The Failure of Pelvic Compensation

Sacroiliac joint degeneration in degenerative lumbar spondylolisthesis and related risk factors: a retrospective study

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