Defining “Normal” Static and Dynamic Spinopelvic Characteristics

Verhaegen, Jeroen; Innmann, Moritz M.; Batista, Nuno Alves; Dion, Charles-Antoine; Horton, Isabel; Pierrepont, J; Merle, Christian; Grammatopoulos, George

doi:10.2106/jbjs.oa.22.00007

Cited by 14 publications

(24 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The exclusion criteria were an age of <18 or ≥50 years, signs of hip osteoarthritis (Tönnis grade of ≥2), pediatric deformity (hip dislocation or previous femoral or acetabular osteotomy), osteonecrosis, history of a neuromuscular disorder, spinal pathology (history of spinal surgery or Oswestry Disability Index (ODI) of >15 on a scale of 0 [none] to 50 [maximal disability]), or radiographs of insufficient quality. These exclusion criteria were applied because they have been shown to influence spinopelvic characteristics 10-12 . An a priori sample size calculation based on the reported difference in LSTV prevalence documented between young adults with hip pathology (40%) 7 and controls (15%) 5 was performed in IBM SPSS (version 27).…”

Section: Methodsmentioning

confidence: 99%

Prevalence of Lumbosacral Transitional Vertebral Anomalies Among Healthy Volunteers and Patients with Hip Pathology

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background: A lumbosacral transitional vertebra (LSTV) has been reported to be prevalent among patients with hip dysplasia. The aims of this study were to determine the (1) prevalence of an LSTV in young patients presenting with hip pain and a group of asymptomatic volunteers, (2) effect of an LSTV on spinopelvic characteristics, and (3) presence of low back pain among patients with an LSTV.Methods: This cross-sectional study included 102 patients with hip pathology and 51 asymptomatic volunteers (mean age, 33.9 ± 7.3 years; mean body mass index, 26.0 ± 5.0 kg/m 2 ; 57.5% female). Participants underwent radiographic assessment of the lumbar spine and pelvis in standing and deep-seated positions. LSTV occurrence was classified according to the Castellvi system. Spinopelvic characteristics included lumbar lordosis (including segmental lumbar angles), pelvic tilt, and hip flexion (pelvic-femoral angle). Differences between standing and deep-seated values were calculated. Low back pain was assessed using the Oswestry Disability Index. Results:The prevalence of LSTV type ‡II was 8.5%, with no difference between patients and volunteers (p = 0.386).Individuals with an LSTV had a greater standing L1-L5 angle (mean, 51.6°± 11.7°versus 38.9°± 9.3°; p < 0.001). The overall spinal flexion (change in L1-S1 angle between the standing and deep-seated positions) in individuals with an LSTV was similar to that in individuals without an LSTV; restricted L5-S1 mobility was compensated for at L1-L2 (10.2°± 5.8°in those with versus 8.4°± 4.1°in those without an LSTV; p = 0.070). No significant difference in the presence of low back pain was found (p = 0.250).Conclusions: An LSTV was found in 8.5% of young adults, with no difference between patients with hip pathology and controls. Individuals with an LSTV have greater standing lumbar lordosis, with altered mechanics at the cephalad adjacent level, which may predispose these individuals to degenerative changes at this level.

show abstract

Section: Methodsmentioning

confidence: 99%

Prevalence of Lumbosacral Transitional Vertebral Anomalies Among Healthy Volunteers and Patients with Hip Pathology

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…Surgeons should be aware this does not replace the need for a dynamic assessment of pelvic motion, which may also have implications on fragment correction. Furthermore, dynamic spinopelvic characteristics might be age-dependent [57]. However, we only used a control group of volunteers older than 45 years, with minimal expected age-related differences, and we believe any differences are likely to be clinically unimportant [57].…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, we did not account for femoral head or neck morphology in the control group. CT scans did not extend below the level of the lesser trochanter, nor were the femoral condyles included, which dependent [57]. However, we only used a control group of volunteers older than 45 years, with minimal expected agerelated differences, and we believe any differences are likely to be clinically unimportant [57].…”

Section: Limitationsmentioning

confidence: 99%

“…CT scans did not extend below the level of the lesser trochanter, nor were the femoral condyles included, which dependent [57]. However, we only used a control group of volunteers older than 45 years, with minimal expected agerelated differences, and we believe any differences are likely to be clinically unimportant [57]. Furthermore, the principal aim of this study was to provide thresholds of morphologic features, and thus a description of compensatory patterns was out of this study's scope.…”

Section: Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study

Verhaegen

DeVries

Rakhra

et al. 2023

Clin Orthop Relat Res

View full text Add to dashboard Cite

Background Acetabular morphology is an important determinant of hip biomechanics. To identify features of acetabular morphology that may be associated with the development of hip symptoms while accounting for spinopelvic characteristics, one needs to determine acetabular characteristics in a group of individuals older than 45 years without symptoms or signs of osteoarthritis. Previous studied have used patients with unknown physical status to define morphological thresholds to guide management. Questions/purposes (1) To determine acetabular morphological characteristics in males and females between 45 and 60 years old with a high Oxford hip score (OHS) and no signs of osteoarthritis; (2) to compare these characteristics with those of symptomatic hip patients treated with hip arthroscopy or periacetabular osteotomy (PAO) for various kinds of hip pathology (dysplasia, retroversion, and cam femoroacetabular impingement); and (3) to assess which radiographic or CT parameters most accurately differentiate between patients who had symptomatic hips and those who did not, and thus, define thresholds that can guide management. Methods Between January 2018 and December 2018, 1358 patients underwent an abdominopelvic CT scan in our institution for nonorthopaedic conditions. Of those, we considered 5% (73) of patients as potentially eligible as controls based on the absence of major hip osteoarthritis, trauma, or deformity. Patients were excluded if their OHS was 43 or less (2% [28]), if they had a PROMIS less than 50 (1% [18]), or their Tönnis score was higher than 1 (0.4% [6]). Another eight patients were excluded because of insufficient datasets. After randomly selecting one side for each control, 40 hips were left for analysis (age 55 ± 5 years; 48% [19 of 40] were in females). In this comparative study, this asymptomatic group was compared with a group of patients treated with hip arthroscopy or PAO. Between January 2013 and December 2020, 221 hips underwent hip preservation surgery. Of those, eight were excluded because of previous pelvic surgery, and 102 because of insufficient CT scans. One side was randomly selected in patients who underwent bilateral procedure, leaving 48% (107 of 221) of hips for analysis (age 31 ± 8 years; 54% [58 of 107] were in females). Detailed radiographic and CT assessments (including segmentation) were performed to determine acetabular (depth, cartilage coverage, subtended angles, anteversion, and inclination) and spinopelvic (pelvic tilt and incidence) parameters. Receiver operating characteristics (ROC) analysis was used to assess diagnostic accuracy and determine which morphological parameters (and their threshold) differentiate most accurately between symptomatic patients and asymptomatic controls. Results Acetabular morphology in asymptomatic hips was characterized by a mean depth of 22 ± 2 mm, with an articular cartilage surface of 2619 ± 415 mm2, covering 70% ± 6% of the articular surface, a mean acetabular inclination of 48° ± 6°, and a minimal difference between anatomical (24° ± 7°) and functional (22° ± 6°) anteversion. Patients with symptomatic hips generally had less acetabular depth (20 ± 4 mm versus 22 ± 2 mm, mean difference 3 mm [95% CI 1 to 4]; p < 0.001). Hips with dysplasia (67% ± 5% versus 70% ± 6%, mean difference 6% [95% CI 0% to 12%]; p = 0.03) or retroversion (67% ± 5% versus 70% ± 6%, mean difference 6% [95% CI 1% to 12%]; p = 0.04) had a slightly lower relative cartilage area compared with asymptomatic hips. There was no difference in acetabular inclination (48° ± 6° versus 47° ± 7°, mean difference 0.5° [95% CI -2° to 3°]; p = 0.35), but asymptomatic hips had higher anatomic anteversion (24° ± 7° versus 19° ± 8°, mean difference 6° [95% CI 3° to 9°]; p < 0.001) and functional anteversion (22° ± 6° versus 13°± 9°, mean difference 9° [95% CI 6° to 12°]; p < 0.001). Subtended angles were higher in asymptomatic at 105° (124° ± 7° versus 114° ± 12°, mean difference 11° [95% CI 3° to 17°]; p < 0.001), 135° (122° ± 9° versus 111° ± 12°, mean difference 10° [95% CI 2° to 15°]; p < 0.001), and 165° (112° ± 9° versus 102° ± 11°, mean difference 10° [95% CI 2° to 14°]; p < 0.001) around the acetabular clockface. Symptomatic hips had a lower pelvic tilt (8° ± 8° versus 11° ± 5°, mean difference 3° [95% CI 1° to 5°]; p = 0.007). The posterior wall index had the highest discriminatory ability of all measured parameters, with a cutoff value of less than 0.9 (area under the curve [AUC] 0.84 [95% CI 0.76 to 0.91]) for a symptomatic acetabulum (sensitivity 72%, specificity 78%). Diagnostically useful parameters on CT scan to differentiate between symptomatic and asymptomatic hips were acetabular depth less than 22 mm (AUC 0.74 [95% CI 0.66 to 0.83]) and functional anteversion less than 19° (AUC 0.79 [95% CI 0.72 to 0.87]). Subtended angles with the highest accuracy to differentiate between symptomatic and asymptomatic hips were those at 105° (AUC 0.76 [95% CI 0.65 to 0.88]), 135° (AUC 0.78 [95% CI 0.70 to 0.86]), and 165° (AUC 0.77 [95% CI 0.69 to 0.85]) of the acetabular clockface. Conclusion An anatomical and functional acetabular anteversion of 24° and 22°, with a pelvic tilt of 10°, increases the acetabular opening and allows for more impingement-free flexion while providing sufficient posterosuperior coverage for loading. Hips with lower anteversion or a larger difference between anatomic and functional anteversion were more likely to be symptomatic. The importance of sufficient posterior coverage was also illustrated by the posterior wall indices and subtended angles at 105°, 135°, and 165° of the acetabular clockface having a high discriminatory ability to differentiate between symptomatic and asymptomatic hips. Future research should confirm whether integrating these parameters when selecting patients for hip preservation procedures can improve postoperative outcomes. Level of Evidence Level III, prognostic study.

show abstract

“…Aging causes a posterior tilt of the pelvis, 1 and weight gain causes kyphosis deformity of the spine 2 . These conditions are then compensated for by the hip and knee joints, causing flexion contractures of the hip and knee joints 3 and may lead to changes in gait and the risk of falling due to changes in the centre of gravity balance 4 .…”

Section: Introductionmentioning

confidence: 99%

Relationship between sacral‐abdominal wall distance and grip strength in postmenopausal osteoporotic patients

Nagai,

Miyagami,

Nakamura

et al. 2023

JCSM Rapid Communications

View full text Add to dashboard Cite

BackgroundAn increase in waist circumference (WC) is a factor in lifestyle‐related diseases. The rectus abdominis muscle is a skeletal muscle that attaches to the pelvis from the xiphoid process and is thought to be affected by kyphosis deformity and posterior pelvic tilt. The purpose of this study is to examine differences between sacral‐abdominal wall distance (SAD) and WC and to determine whether they are associated with fall risk, frailty, markers of sarcopenia (grip strength and lean body mass), and spinal alignment. A secondary objective is to examine these differences by stratification by grip strength.MethodsThis retrospective study included 239 women aged 65 years or older (mean age 76.5 ± 6.7 years) attending an outpatient osteoporosis clinic. Bone mineral density and skeletal body composition (muscle mass index and trunk lean mass) were measured using dual‐energy X‐ray absorptiometry. SAD, pelvic tilt, and sagittal longitudinal axis were measured from simple X‐ray images of the spine sides. WC, grip strength, frailty, and fall risk score were investigated. Statistics were performed using Stat Flex, with two‐sided P < 0.05 being significantly different.ResultsWC was correlated with SAD (R = 0.68, P < 0.001). The SAD cut‐off value for a WC of 90 cm was 167 mm. The relationship between grip strength, SAD, and WC, weaker grip strength was associated with greater SAD; however, no significant difference was noted in WC. WC was not correlated with pelvic alignment but was correlated with body mass index (P < 0.01). Meanwhile, SAD was correlated with body mass index, pelvic tilt, sagittal longitudinal axis (P < 0.01), spinal alignment, and WC. Logistic regression analysis was performed with a grip strength of less than 18 kg as the objective variable. We found that the conditions for a grip strength of less than 18 kg were older age (P < 0.001), increased SAD (P = 0.02), and decreased trunk lean body mass. There was a decrease in grip strength (P < 0.05) and an increase in frailty (P < 0.05) and falls (P < 0.01) score in patients with SAD of 167 mm or greater.ConclusionsSAD and WC were found to be correlated; SAD was associated with body weight, posterior pelvic tilt, and anterior spinal tilt deformity, while WC was related to body weight. Increased SAD was found to be linked with decreased grip strength and increased risk of falls. This study was the first to examine a new measurement, SAD, for its utility in assessing grip strength, spinal alignment, frailty, and fall risk.

show abstract

Defining “Normal” Static and Dynamic Spinopelvic Characteristics

Cited by 14 publications

References 33 publications

Prevalence of Lumbosacral Transitional Vertebral Anomalies Among Healthy Volunteers and Patients with Hip Pathology

Prevalence of Lumbosacral Transitional Vertebral Anomalies Among Healthy Volunteers and Patients with Hip Pathology

Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study

Relationship between sacral‐abdominal wall distance and grip strength in postmenopausal osteoporotic patients

Contact Info

Product

Resources

About