Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning

Obeid, Ibrahim; Boissière, Louis; Yılgör, Çağlar; Larrieu, Daniel; Pellisé, Ferràn; Alanay, Ahmet; Acaroğlu, Emre; Pérez-Grueso, Francisco Javier Sánchez; Kleinstück, Frank; Vital, Jean-Marc; Bourghli, Anouar

doi:10.1007/s00586-016-4649-3

Cited by 113 publications

(50 citation statements)

References 17 publications

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“…Among spine pelvic parameters, low incidence angle, PT, and GT are the predominant factors. This is in accordance with the suggestions of previous literature [24]. The impact of lower limbs parameters is significant.…”

Section: Discussionsupporting

confidence: 93%

“…The understanding of sagittal alignment is now considered a key point in the evaluation of spinal degeneration as well as in hip or knee pathology as imbalance correlates with disability, pain, and suboptimal evolution after surgery [23,29]. Spinal imbalance causes the implementation of compensatory mechanisms including spine and lower limbs adaptation [24]. This study points out the magnitude of the imbalance problems in a current practice data base of spinal stenosis patients and the parasitic effects of lower limbs associated pathologies.…”

Section: Resultsmentioning

confidence: 86%

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The global alignment in patients with lumbar spinal stenosis: our experience using the EOS full-body images

Lazennec

Folinais²,

Bendaya

et al. 2016

Eur J Orthop Surg Traumatol

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Lumbar stenosis is frequently observed and treated by spine surgeons. The extent of neurological decompression and the potential spinal fixation are the basic concerns when surgery is planned. But this segmented approach to the problem is sometimes insufficient due to the complex functional situations induced by a sagittal imbalance of the patient and the combination of pathologies known as hip-spine or knee-spine syndromes. A total of 373 consecutive patients included from our EOS and clinical data base. Patients were divided in two groups. Group A included patients presenting exclusive spinal issues (172 cases) out of whom 117 (68 %) had sagittal imbalance. Among 201 patients with associated lower limbs issues (group B), 122 (61 %) had sagittal imbalance. The perception of imbalance was noticed in 54 % (93 cases) in group A and 57 % (115 cases) in group B. In the global series of 239 imbalanced cases, the key point was a spine issue for 165 patients (the 117 patients with only spine problems and 48/122 cases with combined spine and lower limbs problems). But in the patients with combined spine and lower limbs problems, we individualized hip-spine syndromes (24/122 patients) and knee-spine syndromes (13/122 patients). In some cases, (37/122 patients) the anatomical and functional situations were more complex to characterize a spine-hip or a hip-spine problem. The EOS full-body images provide new information regarding the global spinal and lower limbs alignment to improve the understanding of the patient functional posture. This study highlights the importance of the lower limb evaluation not only as compensatory mechanism of the spinal problems but also as an individualized parameter with its own influence on the global balance analysis. Level of evidence IV diagnostic case series.

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Section: Discussionsupporting

confidence: 93%

Section: Resultsmentioning

confidence: 86%

The global alignment in patients with lumbar spinal stenosis: our experience using the EOS full-body images

Lazennec

Folinais²,

Bendaya

et al. 2016

Eur J Orthop Surg Traumatol

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“…The question raised in the Letter to the Editor concerning Global Tilt parameter [1] is very important to understand spinal balance, and we completely agree with the authors.…”

Section: Dear Editorsupporting

confidence: 64%

Answer to the Letter to the Editor of Changyu Pan et al. concerning “Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning” by Obeid I et al. (Eur Spine J; [2016] 25:3644–3649)

Boissière¹,

Bourghli

Obeid³

2018

Eur Spine J

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“…One possible explanation is the fact that while some early research showed associations between both CM and SM with health-related quality of life (HRQoL) [15], other influential studies did not find substantial correlation of CM with HRQoL [16]. In this scenario, correction of SM has received substantial attention in the literature [17], and rules for very precise calculation of the amount of correction needed in the sagittal plane are widely available [18,19].…”

Section: Discussionmentioning

confidence: 99%

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

et al. 2018

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Introduction In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. Methods This is an expert's opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. Results Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. Conclusion Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction.Graphical abstract These slides can be retrieved under Electronic Supplementary Material.

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Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning

Abstract: GT appears to be the most reliable single sagittal plane parameter in ASD. It is the least affected by patient position and incorporates both the pelvic and the spinal alignment within one measure.

Cited by 113 publications

References 17 publications

The global alignment in patients with lumbar spinal stenosis: our experience using the EOS full-body images

The global alignment in patients with lumbar spinal stenosis: our experience using the EOS full-body images

Answer to the Letter to the Editor of Changyu Pan et al. concerning “Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning” by Obeid I et al. (Eur Spine J; [2016] 25:3644–3649)

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

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