Measurements of lumbopelvic lordosis using the pelvic radius technique as it correlates with sagittal spinal balance and sacral translation

Gardocki, Raymond J.; Watkins, Robert G.; Williams, Lytton

doi:10.1016/s1529-9430(02)00426-6

Cited by 48 publications

(35 citation statements)

References 26 publications

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“…A value for PA was allowed as normal from 0°to 35°. The sacral inclination SI was valued as normal between 40 and 50° [2,[8][9][10][11][12]. The mean values observed for our normal population were so similar to those published.…”

Section: Resultssupporting

confidence: 87%

The femoro-sacral posterior angle: an anatomical sagittal pelvic parameter usable with dome-shaped sacrum

Legaye

2006

Eur Spine J

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IntroductionThe interdependence between the pelvis and the sagittal spinal curvatures is obvious. The leading part of the pelvic sagittal anatomy in this orientation was well established by Duval-Beaupe`re thanks to the description of the angle 'Pelvic Incidence' (PI) [14]. It is the angle between the line perpendicular to the superior plate of the first sacral vertebra (S1) at its midpoint and the line connecting this point to the middle axis of the femoral heads. It is own for every individual and independent of the position of pelvis. A strict relation was described between this anatomical parameter and the sagittal tilt of the superior plate of the sacrum, and between this sacral tilt and the amount of lumbar lordosis. So the pelvic morphology modulates the sagittal spinal alignment. During and Itoi [1,7] described also these relations using an angle complementary of the incidence. As well Jackson observed this relation between the pelvic morphology, the sacral inclination and the lumbar curvature. He expressed the pelvic sagittal shape by the 'Pelvic Lordosis' (PR-S1) [8][9][10][11][12]. The measurement of these angles is easy in most of the cases. Their reliability and their reproducibility were established. Each author agrees to use as femoral axis the middle point of the line connecting the centers of the two femoral heads.However, the exact assessment of the upper plate of the sacrum (and consequently the values of the anatomical Jean LegayeThe femoro-sacral posterior angle: an anatomical sagittal pelvic parameter usable with dome-shaped sacrum Abstract The sagittal pelvic morphology modulates the individual alignment of the spine.

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Section: Resultssupporting

confidence: 87%

The femoro-sacral posterior angle: an anatomical sagittal pelvic parameter usable with dome-shaped sacrum

Legaye

2006

Eur Spine J

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“…The two observers also measured the lumbar lordosis angle between the tangent lines along the vertebral body superior endplates of L1 and S1 (Fig. 2) [15].…”

Section: Biplanar Imaging and Spine Parametersmentioning

confidence: 99%

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Esposito

Miller

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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177

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Background Sitting pelvic tilt dictates the proximity of the rim of the acetabulum to the proximal femur and, therefore, the risk of impingement in patients undergoing total hip arthroplasty (THA). Sitting position is achieved through a combination of lumbar spine segmental motions and/or femoroacetabular articular motion in the lumbarpelvic-femoral complex. Multilevel degenerative disc disease (DDD) may limit spine flexion and therefore increase femoroacetabular flexion in patients having THAs, but this has not been well characterized. Therefore, we measured standing and sitting lumbar-pelvic-femoral alignment in patients with radiographic signs of DDD and in patients with no radiographic signs of spine arthrosis.Questions/purposes We asked: (1) Is there a difference in standing and sitting lumbar-pelvic-femoral alignment before surgery among patients undergoing THA who have no radiographic signs of spine arthrosis compared with those with preexisting lumbar DDD? (2) Do patients with lumbar DDD experience less spine flexion moving from a standing to a sitting position and therefore compensate with more femoroacetabular flexion compared with patients who have no radiographic signs of arthrosis? Methods Three hundred twenty-five patients undergoing primary THA had preoperative low-dose EOS spine-toankle lateral radiographs in standing and sitting positions. Eighty-three patients were excluded from this study for scoliosis (39 patients), spondylolysis (15 patients), not having five lumbar vertebrae (7 patients), surgical or disease fusion (11 patients), or poor image quality attributable to high BMI (11 patients). In the remaining 242 of 325 patients (75%), two observers categorized the lumbar spine as either without radiographic arthrosis or having DDD based on defined radiographic criteria. Sacral slope, lumbar lordosis, and proximal femur angles were measured, and these angles were used to calculate lumbar spine flexion and femoroacetabular flexion in standing and sitting positions. Patients were aligned in a standardized sitting position so that their femurs were parallel to the floor to achieve approximately 90°of apparent hip flexion. Results After controlling for age, sex, and BMI, we found patients with DDD spines had a mean of 5°more posterior pelvic tilt (95% CI, À2°to À8°lower sacral slope angles; p \0.01) and 7°less lumbar lordosis (95% CI, À10°to À3°; p \ 0.01) in the standing position compared with patients without radiographic arthrosis. However, in the sitting position, patients with DDD spines had 4°less posterior pelvic tilt (95% CI, 1°-7°higher sacral slope angles; p = 0.02). From standing to sitting position, patients with DDD

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“…Strong correlations between spinopelvic and sagittal balance measurements have been found by other authors using the PR technique [11]. This methodology of Jackson will, for the purposes of this paper, be defined as the 'pelvic radius' or PR technique.…”

Section: S592mentioning

confidence: 72%

Lumbo-pelvic lordosis and the pelvic radius technique in the assessment of spinal sagittal balance: strengths and caveats

et al. 2011

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Introduction The two main methodologies described for the assessment of spinal sagittal alignment are the pelvic radius (PR) technique and that based on measures of the Pelvic Incidence (PI) and Spino-Sacral Angle (SSA). Both methods stress the fundamental relationship between the anatomical position and orientation of the sacrum within the pelvis and the spinal curves above. The aim of the current study was to assess the strengths and potential weaknesses of the PR technique. The PR technique uses measures based on a line (the PR), drawn between the hip axis and the posterior corner of the S1 endplate. The angle formed between the PR line and the sacral endplate, PRS1, is a developmental measure of sacropelvic morphology. Geometrically, PI and PRS1 are approximately complementary angles and both reflect reciprocal alterations in pelvic tilt (for PI) or angulation (for PRS1) and the slope of the S1 endplate. The angle formed between PR and T12, the PR-T12, reflects a combined measure of pelvic morphology and lumbar lordosis. It appears to be a useful measure, which provides a simple and rapid assessment of lumbopelvic sagittal balance, but only in the presence of a congruent thoracic curvature. Materials and methods After reviewing the literature, published measures made using the PR technique were compared to measures taken from a substantial patient population (479 adult patients). Conclusions Errors can occur using the PR technique if the PRT12 is viewed in isolation from the thoracic kyphosis. We found the ratio of the thoracic kyphosis to lumbar lordosis (T4-T12/T12-S1) to be a useful predictor of congruent sagittal alignment, which may alert the clinician to situations where use of the PR-T12 in isolation may be misleading.

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Measurements of lumbopelvic lordosis using the pelvic radius technique as it correlates with sagittal spinal balance and sacral translation

Cited by 48 publications

References 26 publications

The femoro-sacral posterior angle: an anatomical sagittal pelvic parameter usable with dome-shaped sacrum

The femoro-sacral posterior angle: an anatomical sagittal pelvic parameter usable with dome-shaped sacrum

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Lumbo-pelvic lordosis and the pelvic radius technique in the assessment of spinal sagittal balance: strengths and caveats

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