Features of Sagittal Spino-Pelvic Relations in Patients With Hip-Spine Syndrome

Averkiev, V. A.; Kudyashev, A.L.; Artyukh, Vasiliy A.; Надулич, Константин Алексеевич; Teremshonok, A. V.; Nagorny, E. B.

doi:10.14531/ss2012.4.49-54

Cited by 5 publications

(1 citation statement)

References 14 publications

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“…Вместе с тем прогрессирующие анатомобиомеханические изменения при различных патологических процессах в тазобедренных суставах или в позвоночно-двигательных сегментах пояснично-крестцового отдела позвоночника приводят к изменениям в системе тазобедренные суставы -таз -пояснично-крестцовый отдел позвоночника, отягощая уже существующую деформацию и прогрессирование дегенеративно-дистрофических заболеваний. Эти явления происходят за счет изменения положения (верзии) таза в сагиттальной плоскости и в достаточно полной мере описаны у пациентов с различной патологией позвоночника, дисплазией тазобедренных суставов, hip-spine-синдромом, коксартрозом [10][11][12][13][14][15][16].…”

Section: обоснованиеunclassified

Evaluation of radiological indices of the spine and pelvis ratios in children with a severe form of slipped capital femoral epiphysis

Barsukov

Bortulev

Vissarionov

et al. 2022

Pediatr Traum Orthop Reconstr Surg

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BACKGROUND: Slipped capital femoral epiphysis is one of the most severe diseases of the hip joint in children and is characterized by the displacement of the proximal femoral epiphysis, occurring as a result of a decrease in the mechanical strength of its growth plate. Some pathological processes in the hip joints and lumbosacral spine cause changes in the position (vergence) of the pelvis in the sagittal plane and the development of degenerative dystrophic diseases. The analysis of the spinepelvis relationships in children with slipped capital femoral epiphysis may provide the basis for the development of new approaches to the surgical correction of the deformity of the hip component of the affected joint. AIM: To assess the radiological parameters of the frontal and sagittal spinepelvis relations in children with proximal femur deformity in slipped capital femoral epiphysis. MATERIALS AND METHODS: The study included 30 patients (30 hips) aged 1114 years with a severe form of slipped capital femoral epiphysis characterized by the presence of a posterior displacement of the epiphysis of 60 combined with the downward displacement of no more than 10 in one of the joints and absence of displacement (pre-slip stage) in the other. Patients underwent clinical and radiological examinations. The radiographs taken in the standing position were used to assess the values of thoracic kyphosis and lumbar lordosis, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), sagittal vertical axis (SVA), and spinesacral angle (SSA). The obtained data were subjected to statistical processing. RESULTS: The patients had pelvic retroversion (decreased values of the PI and SS indices and increased PT index) and formed hypolordotic type of vertical posture according to P. Roussouly classification. In addition, thoracic hyperkyphosis occurred, and the SVA shifted to the front, which can be considered a mechanism of trunk balance compensation for the existing pelvic retroversion and reduction of lumbar lordosis to maintain the ability to move in an upright position. CONCLUSIONS: Children with this severe form of slipped capital femoral epiphysis are characterized by pelvic retroversion, decreased lumbar lordosis and increased thoracic kyphosis, positive trunk imbalance, and PT toward the affected limb. Planning and reconstructive restorative interventions on the affected hip joint should consider existing pathological changes to restore the correct spinepelvis relationships and prevent degenerative dystrophic processes in the lumbosacral spine.

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Section: обоснованиеunclassified

Evaluation of radiological indices of the spine and pelvis ratios in children with a severe form of slipped capital femoral epiphysis

Barsukov

Bortulev

Vissarionov

et al. 2022

Pediatr Traum Orthop Reconstr Surg

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Influence of the modified Dunn procedure on the spine–pelvis relationship in children with severe slipped capital femoral epiphysis

Barsukov,

Bortulev,

Pozdnikin

et al. 2023

Pediatr Traum Orthop Reconstr Surg

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BACKGROUND: Slipped capital femoral epiphysis (SCFE) is one of the most severe hip joint diseases in children. It is characterized by the development of unilateral or bilateral deformity of the proximal femoral epimetaphysis of varying degrees. The pronounced deformity of the femoral component of the affected joint leads to pelvic retroversion, decreased lumbar lordosis, increased thoracic kyphosis (TK), and formation of type I (hypolordotic) vertical posture according to the Roussouly classification, contributing to degenerative and dystrophic processes in the lumbosacral spine. At present, no data in the literature present the effect of surgical treatment on frontal and sagittal spine–pelvis relationships in the patients examined. AIM:To performacomparative radiological evaluation of the sagittal spine–pelvis relationship in children with severe SCFE before and after the modified Dunn procedure. MATERIALS AND METHODS:The study included 30 patients (30 hip joints) aged 14–18 years with severe SCFE characterized byaposterior epiphysis displacement of 60° and downward of no more than 10° in one of the joints and no displacement (preslip stage) in the other. All children underwent the modified Dunn procedure on one side and fixation of the epiphysis of the femoral head withacannulated screw on the other side. Before and after surgery, the patients underwent clinical and radiologic examinations. Standing radiographs were used to evaluate lumbar lordosis, TK, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sagittal vertical axis (SVA). The obtained data were analyzed statistically. RESULTS:At the examination 3–3.5 years after the abovementioned interventions,apronounced increase was noted in the mean PI value, which began to correspond to type III (harmonious) of upright posture according to the Roussouly classification.Achange was noted in the mean values of positional indices PT (decreased) and SS (increased), and pelvic retroversion disappeared. The mean global lumbar lordosis (GLL) and lumbar lordosis increased, which led toadecrease in TK and the mean value of TK. All clinical observations showedasignificant decrease in the mean global sagittal balance index (the sagittal vertical axis (SVA)) and absence of torso imbalance. CONCLUSIONS:After performing the modified Dunn procedure on the one side and fixation of the epiphysis of the femoral head withascrew on the other side, children with severe SCFE demonstrated improvements in all the studied indices of sagittal spine–pelvis ratios. Consequently, the type of vertical posture according to the Roussouly classification changes from type I (hypolordotic) to type III (harmonious), and the probability of degenerative and dystrophic process development in the lumbosacral spine decreases.

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Surgical Correction of Trunk Balance in Spinal Deformities and in Instability of Hip Joints

Chelpachenko

Zherdev

Фисенко

et al. 2020

Russian Journal of Pediatric Surgery

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Introduction. Restoration of trunk balance is the basic task in surgical correction of spinal deformities and in hip joint instability of various etiology. Purpose. To analyze and to define the relevance of roentgen-anatomical parameters of spine-pelvis relationships for surgical correction of deformities in the thoracolumbar spine and of hip joint instability of dysplastic and neurogenic etiology. Material and methods. An X-ray analysis of parameters of the frontal and sagittal spine-pelvis balance was performed in 220 patients with dysplastic and neurogenic deformities of the thoracic and lumbar spine (n = 98) and with instability of hip joints (n = 122) but who were able to walk. They were operated in the neuro-orthopedic department with orthopedics in National Medical Research Center for Children’s Health. The reference group included 60 relatively healthy children without any scoliotic deformities of the spine and with stable hip joints. Dynamics of changes in X-ray parameters was analyzed using findings of orthostatic spondylograms from the indicated groups of children. The obtained data were compared with reference values. Results. The trial performed has revealed typical changes in spine-pelvis relationship parameters in patients with hip joint instability and spine deformities and in the reference group . The researchers also found out relations between various parameters of the trunk balance before and after surgical correction. Conclusion. While planning a surgical correction of trunk balance in spinal deformities, one should take into account parameters of spine-pelvis relationships, such as PI, SS, PT, SVA deviation and the mid-sacral line; and in case of hip joint instability - local roentgen-angulometric parameters of the femoral and acetabular components of instability. This is due to the fact that the lower the level of reconstructive surgical manipulation is located, the greater effect it has at the frontal and sagittal balance of the trunk.

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Features of Sagittal Spino-Pelvic Relations in Patients With Hip-Spine Syndrome

Cited by 5 publications

References 14 publications

Evaluation of radiological indices of the spine and pelvis ratios in children with a severe form of slipped capital femoral epiphysis

Evaluation of radiological indices of the spine and pelvis ratios in children with a severe form of slipped capital femoral epiphysis

Influence of the modified Dunn procedure on the spine–pelvis relationship in children with severe slipped capital femoral epiphysis

Surgical Correction of Trunk Balance in Spinal Deformities and in Instability of Hip Joints

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