Radiographic Analysis of the Sagittal Alignment and Balance of the Spine in Asymptomatic Subjects

Vialle, Raphaël; Levassor, N; Rillardon, L.; Templier, Alexandre; Skalli, Wafa; Guigui, P.

doi:10.2106/00004623-200502000-00004

Cited by 378 publications

(373 citation statements)

References 22 publications

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“…We found a strong positive correlation between sacral slope and lumbar lordosis in patients undergoing THA (Fig. 4), which also has been reported in asymptomatic subjects and patients with spinal stenosis [9,43], and we found a negative correlation between spine flexion and femoroacetabular flexion (Fig. 5), because we asked patients to achieve 90°of apparent hip flexion in the sitting position regardless of whether they flexed through their spine or their hips.…”

Section: Discussionsupporting

confidence: 80%

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

201

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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Section: Discussionsupporting

confidence: 80%

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

201

177

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“…Also, sagittal sacropelvic morphology as measured by the PI tends to change slightly during growth and results in a proportionally slight increase in PT in the presence of a stable SS. In adults, previous reports [26,28,30,31] including smaller cohorts have provided conflicting results concerning the sex-and age-related changes in PI, PT, and SS. However, in accordance with those previous reports, the current study confirms that the influence of age and sex on sagittal sacropelvic morphology and orientation is at most modest (Tables 1, 2, 3).…”

Section: Discussionmentioning

confidence: 94%

“…On the contrary, Vialle et al [30] found statistically significant differences in SS and PI--but not PT--between 110 females and 190 males. However, the mean differences (3°or less) were marginal when considering the potential measurement errors.…”

Section: Introductionmentioning

confidence: 86%

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Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults

et al. 2011

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Introduction Many studies suggest the importance of the sagittal sacropelvic balance and morphology in spinal and hip disorders. This study describes the normal age-and sex-related changes in sacropelvic morphology and balance in a prospective cohort of asymptomatic adults without spinal disorder. Materials and methods A prospective cohort of 709 asymptomatic adults without spinal pathology was recruited. There were 354 males and 355 females aged 37.9 ± 14.7 and 35.7 ± 13.9 years, respectively. For each subjects, pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured from standing lateral radiographs. Ratios of SS to PI (SS/PI), PT to PI (PT/PI), and PT to SS (PT/SS) were also calculated. Results There was no significant difference in PI (pelvic incidence), SS (sacral slope), PT (pelvic tilt), PT/PI, SS/PI, or PT/SS between males and females. The mean ± 2 standard deviations (SD) range was 32°-74°, 0°-27°, and 24°-55°for PI, PT and SS, respectively. The mean ± 2 SD range was greater than 0.5 for SS/PI and less than 0.5 for PT/PI. PI was not related to age in either sex group. PT, SS, PT/PI, SS/PI, and PT/SS presented only weak correlation coefficients (r B 0.21) with respect to age. Conclusion The current study presents the largest cohort of asymptomatic adults in the literature dedicated to the evaluation of sagittal sacropelvic morphology and balance. The range of values corresponding to the mean ± 2 SD can provide invaluable information to clinicians about the normal range of values expected in 95% of the normal population.

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“…The following spinopelvic parameters were measured from the radiographs: pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), L4-S1 lordosis (L L4-S1 ), thoracolumbar lordosis (L T11-L2 ), thoracic kyphosis, C7-S1 sagittal vertical axis (SVA) and C2-C7 sagittal vertical axis (C2-C7 SVA). Previously published formulae and data were used to estimate the ideal sagittal parameters based on pelvic incidence [9,14,15]. Two senior spinal surgeons evaluated all the films and after discussion defined eight deformity patterns (including normal sagittal alignment).…”

Section: Subjectsmentioning

confidence: 99%

Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms

2014

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Introduction Sagittal balance is an independent predictor of clinical outcomes in spinal care. Surgical treatment is challenging and jeopardized by frequent complications. Guidelines for surgical treatment are currently not based on a classification of the disease. A comprehensive classification of sagittal balance based on regional deformities and compensatory mechanisms combined in deformity patterns is proposed. Though the sagittal shape of the spine can change due to degeneration or trauma, correlations between sagittal shape parameters and pelvic incidence (PI) have been described. Pelvic incidence is not changed by degeneration, thus representing a permanent source of information on the original sagittal shape of the spine. Methods One hundred and twenty-eight full-spine lateral standing radiographs of patients with different spinal conditions were evaluated and classified by one rater. One random subseries of 35 patients was evaluated by two raters for calculation of inter-rater agreement. Spinopelvic parameters were measured in all the radiographs. Internal validity of the classification system was evaluated comparing the values of regional sagittal parameters that distinguish one category from the others. Results Eight different patterns were identified regarding the site of the deformity and the presence of compensatory mechanisms: cervical, thoracic, thoracolumbar junction, lumbar, lower lumbar, global and pelvic kyphosis and normal sagittal alignment. Inter-rater agreement was almost perfect (j = 0.963). Statistically significant differences were found comparing the means of selected sagittal spinopelvic parameters that conceptually divide pairs or groups of categories: C2-C7 SVA for cervical kyphosis vs all other patients, TK-PI mismatch for thoracic kyphosis vs all other patients, T11-L2 kyphosis for thoracolumbar kyphosis vs all other patients, global alignment (LL?TK-PI) and SVA for lumbar kyphosis vs global kyphosis and pelvic tilt for pelvic kyphosis vs lumbar, lower lumbar and global kyphosis. Conclusion A comprehensive classification of sagittal imbalance is presented. This classification permits a better interpretation of the deformity and muscle forces acting on the spine, and helps surgical planning. Preliminary validation has been provided.

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Radiographic Analysis of the Sagittal Alignment and Balance of the Spine in Asymptomatic Subjects

Cited by 378 publications

References 22 publications

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

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

Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults

Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms

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