Lumbosacral stress and age may contribute to increased pelvic incidence: an analysis of 1625 adults

Bao, Hongda; Liabaud, Barthélemy; Varghese, Jeffrey; Lafage, Renaud; Diebo, Bassel G.; Jalai, Cyrus M.; Ramchandran, Subaraman; Poorman, Gregory W.; Errico, Thomas J.; Zhu, Feng; Protopsaltis, Themistocles S.; Passias, Peter G.; Buckland, Aaron J.; Schwab, Frank J.; Lafage, Virginie

doi:10.1007/s00586-017-5324-z

Cited by 32 publications

(26 citation statements)

References 23 publications

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“…Our results were similar to those in previous studies [6, 24]. However, several studies reported that PI was influenced by age and significantly larger in late adulthood [25, 26]. The differences between our study and these studies are unclear.…”

Section: Discussionsupporting

confidence: 88%

Evaluation of anatomical pelvic parameters between normal, healthy men and women using three-dimensional computed tomography: a cross-sectional study of sex-specific and age-specific differences

et al. 2019

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Background Sagittal spinal balance and standing posture are affected by pelvic morphology, especially pelvic incidence (PI). However, it is not difficult to identify the hip center because of overlap of the pelvis, image contrast, and soft tissue artifacts. Measurements of PI are not always suitable in all patients, especially those with osteoarthritis of the hip joint whose femoral head is nonspherical, subluxed, or dislocated. We measured PI, pelvic tilt (PT), and sacral slope (SS) as anatomical parameters using a novel three-dimensional measurement in order to compare the pelvic morphology between normal, healthy men and women. Methods In this cross-sectional study, we evaluated 108 Japanese subjects (55 men, 53 women) without low back or knee pain. We used the three-dimensional pelvis model adjusted to the anterior pelvic plane and measured the pelvic parameters. The subjects were stratified by age (< 50 versus ≥ 50 years) and sex. Intraobserver and interobserver reliabilities were calculated with intraclass correlation coefficients. Results There was no significant difference in PI, anatomical-PT, and anatomical-SS between sexes. There was a strong correlation between PI and anatomical-SS in men and women ( R = 0.790 and 0.715, respectively). Values of anatomical-PT were lower, and values of anatomical-SS were greater among older subjects than among younger subjects; the value of PI was similar between younger and older subjects. Intraobserver and interobserver mean absolute differences were about 2 mm and 2°, respectively; the intraclass correlation coefficient was > 0.87. Conclusions We found a strong correlation between PI and anatomical-SS in men and women. This novel measurement concept may be useful to estimate PI from anatomical-SS because the measurements of PI are not always suitable in all patients, especially those with osteoarthritis of the hip joint whose femoral head is not spherical or whose femoral head is subluxed or dislocated. This is the first report to describe the relationship between PI, anatomical-PT, and anatomical-SS as morphologic parameters with a high interclass correlation coefficient for intraobserver and interobserver reliabilities.

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Section: Discussionsupporting

confidence: 88%

Evaluation of anatomical pelvic parameters between normal, healthy men and women using three-dimensional computed tomography: a cross-sectional study of sex-specific and age-specific differences

et al. 2019

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“…A small pelvic incidence angle corresponds to a narrow pelvis (small anteroposterior dimension), while a large angle indicates a broad one (large anteroposterior dimension). In elderly over 75 years old, or some specific long fusion constructs, ligament loosening can produce some degrees of variations [6][7][8].…”

Section: Definition Of the Pelvic Parameters (Fig 3a-c)mentioning

confidence: 99%

Sagittal balance of the spine

et al. 2019

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The static sagittal balance of the normal spine is a physiological alignment of the spine in the most efficient manner by the muscular forces. During gait, this balance is constantly thwarted by single-foot support. This analysis involves the study of parameters which are now well defined. The pelvic incidence is constant, and the sacral slope and the pelvic tilt are positional. The cervical parameters are the upper (O-C2) and lower cervical curvatures (C2-C7), the C7 slope, the spinocranial angle and the vertical cervical offset. At the thoracic and lumbar level, they are, respectively, kyphosis and lordosis. The OD-HA (odontoid hip axis) angle is the most efficient parameter to analyse the global balance. The average values of these parameters are reported with the new 3D measurements by Le Huec et al. The relationship between these different parameters was analysed, and Roussouly proposed his classification of the different spine shape. Ageing makes it possible to show compensation mechanisms at three levels: spinal, pelvic and lower limbs. Understanding these different data allows for better planning of the surgical management of the patients. Global evaluation of the entire spine and the measurement of the aforementioned parameters allow to determine the extent of the correction to be performed during surgery. Taking these parameters into account also enables us to understand the complications involved in this type of surgery: transitional syndromes or junctional syndromes. Integration of these parameters into the study of gait is an area still under investigation.

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“… 17 Nevertheless, some changes can be found due to sacroiliac joint movement (nutation and contra-nutation) caused by ageing or surgical lumbar fusion, usually not exceeding 5°. 18 , 19 PI is closely considered a fixed parameter, characteristic of each patient’s individuality, and clinically determines spino-pelvic interactions. 20 Furthermore, LL angle ( Fig.…”

Section: Spino-pelvic Interactionsmentioning

confidence: 99%

Pelvic motion the key to understanding spine–hip interaction

Pizones

García-Rey

2020

EFORT Open Reviews

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Pelvic motion acting as a hinge between the spine and hips is essential to maintain proper balance during bipedalism. Pelvic rotation is recruited as a compensation mechanism when spinal malalignment occurs. This pelvic rotation can affect functional acetabular orientation, and consequently functional cup positioning if a total hip arthroplasty (THA) is needed. Pelvic retroversion, frequently associated with degenerative spinal changes, implies an increase of acetabular version. Patients with flexible lumbar spines (spine users) protect the hip joint. Patients with stiff, degenerated or fused lumbar spines (hip users) demand higher hip mobility, placing the THA at risk. Pelvises in retroversion place the THA at risk for anterior dislocation when standing. In contrast, pelvises in anteversion or with low pelvic incidence (PI) can place THA at risk for posterior dislocation when sitting. Try to set the cup in an anatomic position. However, bear in mind that low PI pelvises may need more acetabular ante-inclination, and high PI pelvises more acetabular retroversion. If surgery is needed, start first by addressing the hip, except in patients with compensation (high pelvic retroversion), who may need spine surgery first to place the pelvis, and consequently the acetabulum, in a proper position. Cite this article: EFORT Open Rev 2020;5:522-533. DOI: 10.1302/2058-5241.5.200032

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Lumbosacral stress and age may contribute to increased pelvic incidence: an analysis of 1625 adults

Abstract: PI is higher in female patients and in older patients, especially those over 45 years old. Spinal malalignment also may have a role in increased PI due to increased L5-S1 bending moment.

Cited by 32 publications

References 23 publications

Evaluation of anatomical pelvic parameters between normal, healthy men and women using three-dimensional computed tomography: a cross-sectional study of sex-specific and age-specific differences

Evaluation of anatomical pelvic parameters between normal, healthy men and women using three-dimensional computed tomography: a cross-sectional study of sex-specific and age-specific differences

Sagittal balance of the spine

Pelvic motion the key to understanding spine–hip interaction

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