Lumbar Spine Degeneration and Flatback Deformity Alter Sitting-Standing Spinopelvic Mechanics—Implications for Total Hip Arthroplasty

Buckland, Aaron J.; Abotsi, Edem J.; Vasquez-Montes, Dennis; Ayres, Ethan W.; Varlotta, Christopher; Vigdorchik, Jonathan M.

doi:10.1016/j.arth.2019.11.020

Cited by 20 publications

(12 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Due to higher standing SVA, patients with a kyphotic and imbalanced spine usually experience a smaller extent of trunk shifting from standing to sitting positions. This adhered to the findings of a recent work by Buckland et al (ΔSVA = 4.9, 3.0, and 3.2 cm in normal, degenerative, and flatback spine respectively, P < 0.01) [ 26 ], and with the present study (Table 4 ). However, depending on the type of sagittal alignment [ 15 ], different spinal degenerative cascades would occur [ 27 ].…”

Section: Discussionsupporting

confidence: 94%

Paradoxical spinopelvic motion: does global balance influence spinopelvic motion in total hip arthroplasty?

Lin

Chen

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Recent research has proposed a classification of spinopelvic stiffness according to pelvic spatial orientation for risk stratification in patients who undergo total hip arthroplasty (THA). However, the influence of global alignment was not investigated, and this study evaluated the effect of global balance (sagittal vertical axis [SVA]) on spinopelvic motion. Methods We conducted a retrospective review of consecutive primary THA patients. We measured SVA, spinopelvic parameters (pelvic tilt [PT], pelvic incidence, and sacral slope), thoracic kyphosis (TK), lumbar lordosis (LL), proximal femur angle (PFA), and cup version using functional radiographs of patients in the standing and upright sitting positions. Linear regression was performed to identify parameters related to global trunk alignment change (∆SVA). Spinopelvic stiffness was defined as PT position change < 10°, and a subset of patients with PT change < 0° was categorized into a paradoxical spinopelvic motion group. Results One hundred twenty-four patients were analyzed (mean age: 65 years, 61% female). In univariate regression analysis, ∆TK, ∆LL, and ∆PFA were correlated to ∆SVA. In multivariate regression analysis, ΔLL (p < 0.001) and ΔPFA (p < 0.001) were found to be correlated to ΔSVA (ΔSVA = − 11.97 + 0.05ΔTK – 0.23ΔLL – 0.17ΔPFA; adjusted R2 = 0.558). Spinopelvic stiffness was observed in 40 patients (32%), including five (4%) with paradoxical motion (∆PT = − 3° ± 1°, p < 0.001) with characteristics of balanced standing global trunk alignment (standing SVA = − 1.0 ± 5.1 cm), similar stiffness of the lumbosacral spine (∆LL = − 7° ± 5°), higher hip motion (∆PFA = − 78° ± 6°, p = 0.017), and higher anterior trunk shift (∆SVA = 6.2 ± 2.0 cm, p = 0.003) from standing to sitting as compared to the stiffness group. Two of these five patients experienced dislocation events after THA. Conclusions The lumbosacral and hip motions were the major contributors to global alignment postural change. Paradoxical motion is a rare but dangerous clinical condition in THA that might be related to a disproportionally large trunk shift in the stiff lumbosacral spine causing excessive hip motion. In paradoxical motion, diminishing functional acetabular clearance during position change might pose the prosthesis at higher risk of impingement and instability than spinopelvic stiffness.

show abstract

Section: Discussionsupporting

confidence: 94%

Paradoxical spinopelvic motion: does global balance influence spinopelvic motion in total hip arthroplasty?

Lin

Chen

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…At the segmental level of the spine, ASD-sag also showed a decrease in lumbar (L1L3–L3L5) mobility during sit-to-stand and stand-to-sit. This is in agreement with other studies that showed a lesser variation of radiographic lumbar lordosis between the standing and sitting positions in ASD ( Buckland et al, 2020 ). ASD-sag showed a fixed and decreased lumbar lordosis during the whole sit-to-stand in contrast to the other groups who were able to restore normal lumbar lordosis during standing ( Figure 4 ).…”

Section: Discussionsupporting

confidence: 94%

Alteration of the Sitting and Standing Movement in Adult Spinal Deformity

Saad

Semaan

Kawkabani

et al. 2022

Front. Bioeng. Biotechnol.

View full text Add to dashboard Cite

Adults with spinal deformity (ASD) are known to have spinal malalignment affecting their quality of life and daily life activities. While walking kinematics were shown to be altered in ASD, other functional activities are yet to be evaluated such as sitting and standing, which are essential for patients’ autonomy and quality of life perception. In this cross-sectional study, 93 ASD subjects (50 ± 20 years; 71 F) age and sex matched to 31 controls (45 ± 15 years; 18 F) underwent biplanar radiographic imaging with subsequent calculation of standing radiographic spinopelvic parameters. All subjects filled HRQOL questionnaires such as SF36 and ODI. ASD were further divided into 34 ASD-sag (with PT > 25° and/or SVA >5 cm and/or PI-LL >10°), 32 ASD-hyperTK (with only TK >60°), and 27 ASD-front (with only frontal malalignment: Cobb >20°). All subjects underwent 3D motion analysis during the sit-to-stand and stand-to-sit movements. The range of motion (ROM) and mean values of pelvis, lower limbs, thorax, head, and spinal segments were calculated on the kinematic waveforms. Kinematics were compared between groups and correlations to radiographic and HRQOL scores were computed. During sit-to-stand and stand-to-sit movements, ASD-sag had decreased pelvic anteversion (12.2 vs 15.2°), hip flexion (53.0 vs 62.2°), sagittal mobility in knees (87.1 vs 93.9°), and lumbar mobility (L1L3-L3L5: −9.1 vs −6.8°, all p < 0.05) compared with controls. ASD-hyperTK showed increased dynamic lordosis (L1L3–L3L5: −9.1 vs −6.8°), segmental thoracic kyphosis (T2T10–T10L1: 32.0 vs 17.2°, C7T2–T2T10: 30.4 vs 17.7°), and thoracolumbar extension (T10L1–L1L3: −12.4 vs −5.5°, all p < 0.05) compared with controls. They also had increased mobility at the thoracolumbar and upper-thoracic spine. Both ASD-sag and ASD-hyperTK maintained a flexed trunk, an extended head along with an increased trunk and head sagittal ROM. Kinematic alterations were correlated to radiographic parameters and HRQOL scores. Even after controlling for demographic factors, dynamic trunk flexion was determined by TK and PI-LL mismatch (adj. R2 = 0.44). Lumbar sagittal ROM was determined by PI-LL mismatch (adj. R2 = 0.13). In conclusion, the type of spinal deformity in ASD seems to determine the strategy used for sitting and standing. Future studies should evaluate whether surgical correction of the deformity could restore sitting and standing kinematics and ultimately improve quality of life.

show abstract

“…1 Lumbar degenerative disease without fusion has also been shown to alter normal spinopelvic biomechanics and places patients at increased risk of dislocation following THA. 13…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11] Loss of mobility at the hip joint increases compensatory spinopelvic motion, while loss of spinopelvic motion requires an increased range of motion at the hip. [9][10][11][12][13] However, it is not well understood how specific morphological changes of the hip or spine, as identified on anteroposterior (AP) pelvic radiographs or lateral lumbar spine radiographs respectively, affect hip and spinopelvic mobility as assessed in the sagittal plane. This study aims to characterize the changes in spinopelvic biomechanics associated with specific morphological features of hip OA and lumbar DDD.…”

Section: Introductionmentioning

confidence: 99%

Anteroposterior pelvic radiograph findings correlate with sagittal spinopelvic motion

et al. 2023

View full text Add to dashboard Cite

AimsIt has been well documented in the arthroplasty literature that lumbar degenerative disc disease (DDD) contributes to abnormal spinopelvic motion. However, the relationship between the severity or pattern of hip osteoarthritis (OA) as measured on an anteroposterior (AP) pelvic view and spinopelvic biomechanics has not been well investigated. Therefore, the aim of the study is to examine the association between the severity and pattern of hip OA and spinopelvic motion.MethodsA retrospective chart review was conducted to identify patients undergoing primary total hip arthroplasty (THA). Plain AP pelvic radiographs were reviewed to document the morphological characteristic of osteoarthritic hips. Lateral spine-pelvis-hip sitting and standing plain radiographs were used to measure sacral slope (SS) and pelvic femoral angle (PFA) in each position. Lumbar disc spaces were measured to determine the presence of DDD. The difference between sitting and standing SS and PFA were calculated to quantify spinopelvic motion (ΔSS) and hip motion (ΔPFA), respectively. Univariate analysis and Pearson correlation were used to identify morphological hip characteristics associated with changes in spinopelvic motion.ResultsIn total, 139 patients were included. Increased spinopelvic motion was observed in patients with loss of femoral head contour, cam deformity, and acetabular bone loss (all p < 0.05). Loss of hip motion was observed in patients with loss of femoral head contour, cam deformity, and acetabular bone loss (all p < 0.001). A decreased joint space was associated with a decreased ΔPFA (p = 0.040). The presence of disc space narrowing, disc space narrowing > two levels, and disc narrowing involving the L5–S1 segment were associated with decreased spinopelvic motion (all p < 0.05).ConclusionPreoperative hip OA as assessed on an AP pelvic radiograph predicts spinopelvic motion. These data suggest that specific hip osteoarthritic morphological characteristics listed above alter spinopelvic motion to a greater extent than others.Cite this article: Bone Joint J 2023;105-B(5):496–503.

show abstract

Lumbar Spine Degeneration and Flatback Deformity Alter Sitting-Standing Spinopelvic Mechanics—Implications for Total Hip Arthroplasty

Cited by 20 publications

References 41 publications

Paradoxical spinopelvic motion: does global balance influence spinopelvic motion in total hip arthroplasty?

Paradoxical spinopelvic motion: does global balance influence spinopelvic motion in total hip arthroplasty?

Alteration of the Sitting and Standing Movement in Adult Spinal Deformity

Anteroposterior pelvic radiograph findings correlate with sagittal spinopelvic motion

Contact Info

Product

Resources

About