Spinopelvic sagittal balance: what does the radiologist need to know?

Savarese, Leonor Garbin; Reis, Rafael de Menezes; Bonugli, Gustavo Perazzoli; Herrero, Carlos Fernando Pereira da Silva; Defino, Helton Luíz Aparecido; Nogueira-Barbosa, Marcello Henrique

doi:10.1590/0100-3984.2019.0048

Cited by 22 publications

(20 citation statements)

References 51 publications

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“…Patients with lumbar degenerative disease are characterized by anterior sagittal imbalance, loss of LL, and increased PT ( 12 , 15 , 20 , 21 ). Ogon et al ( 16 ) found an association between anterior annulus fibrosus degeneration in all lumbar disc levels and hypolordosis of the lumbar spine, anterior translation of the trunk and posterior inclination of the pelvis in chronic low back pain using quantitative MRI.…”

Section: Discussionmentioning

confidence: 99%

Sagittal balance and intervertebral disc composition in patients with low back pain

Savarese

Reis

Jorge

et al. 2022

Braz J Med Biol Res

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The aim of this study was to verify the relationship between quantitative T2 relaxation measurements of lumbar intervertebral discs (IVDs) and spinopelvic parameters in patients with chronic low back pain. The study was approved by the Clinical Hospital of the Ribeirao Preto Medical School (USP) Ethics Committee, and written consent was obtained from all patients. A total of 455 IVDs from 91 consecutive patients with chronic low back pain were included in this prospective study. All subjects were assessed using the Oswestry Disability Index and visual analogue scale questionnaires and were confirmed to have no other spine diseases except disc degeneration. Spinopelvic parameters including the pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), global tilt (GT), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence minus lumbar lordosis mismatch (PI-LL), and lack of lumbar lordosis (LLL) were measured. The study group was categorized according to the Roussouly classification. Sagittal T2 maps were acquired to extract the IVD relaxation times, and the complete manual segmentation of IVDs at all levels was performed using Display s software. Lumbar IVD T2 relaxation times showed significant correlation with PT (Po0.01), GT (Po0.01), TPA (Po0.01), PI-LL (P=0.01), and LLL (P=0.01). No difference was noted between Roussouly subtypes regarding T2 relaxation times at any disc level. Data from questionnaires showed no correlation with T2 relaxation times. Global tilt and T1 pelvic angle were correlated with IVD composition changes (T2 relaxometry). There was no correlation between clinical symptoms and IVD T2 relaxation times.

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Section: Discussionmentioning

confidence: 99%

Sagittal balance and intervertebral disc composition in patients with low back pain

Savarese

Reis

Jorge

et al. 2022

Braz J Med Biol Res

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“…A number of recent studies conducted in Brazil have highlighted the important role that imaging methods play in the evaluation of the musculoskeletal system (36)(37)(38)(39)(40) . In our study, the prevalence of imaging alterations in the CPN was high (36.8-39.4%), and the levels of interobserver and intraobserver agreement for these abnormalities were excellent (Figure 6).…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging evaluation of common peroneal nerve injury in acute and subacute posterolateral corner lesion: a retrospective study

et al. 2021

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Objective: To evaluate qualitative and quantitative magnetic resonance imaging (MRI) criteria for injury of the common peroneal nerve (CPN) in patients with acute or subacute injuries in the posterolateral corner (PLC) of the knee, as well as to evaluate the reproducibility of MRI evaluation of CPN alterations. Materials and Methods: This was a retrospective study of 38 consecutive patients submitted to MRI and diagnosed with acute or subacute injury to the PLC of the knee (patient group) and 38 patients with normal MRI results (control group). Two musculoskeletal radiologists (designated radiologist A and radiologist B, respectively) evaluated the images. Nerve injury was classified as neurapraxia, axonotmesis, or neurotmesis. Signal strength was measured at the CPN, the tibial nerve (TN), and a superficial vein (SV). The CPN/TN and CPN/SV signal ratios were calculated. The status of each PLC structure, including the popliteal tendon, arcuate ligament, lateral collateral ligament, and biceps tendon, was classified as normal, partially torn, or completely torn, as was that of the cruciate ligaments. For the semiquantitative analysis of interobserver agreement, the kappa statistic was calculated, whereas a receiver operating characteristic (ROC) curve was used for the quantitative analysis. Results: In the patient group, radiologist A found CPN abnormalities in 15 cases (39.4%)-neurapraxia in eight and axonotmesis in seven-whereas radiologist B found CPN abnormalities in 14 (36.8%)-neurapraxia in nine and axonotmesis in five. The kappa statistic showed excellent interobserver agreement. In the control group, the CPN/TN signal ratio ranged from 0.63 to 1.1 and the CPN/SV signal ratio ranged from 0.16 to 0.41, compared with 1.30-4.02 and 0.27-1.08, respectively, in the patient group. The ROC curve analysis demonstrated that the CPN/TN signal ratio at a cutoff value of 1.39 had high (93.3%) specificity for the identification of nerve damage, compared with 81.3% for the CPN/SV signal ratio at a cutoff value of 0.41. Conclusion: CPN alterations are common in patients with PLC injury detected on MRI, and the level of interobserver agreement for such alterations was excellent. Calculating the CPN/TN and CPN/SV signal ratios may increase diagnostic confidence. We recommend systematic analysis of the CPN in cases of PLC injury.

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“…The published studies on functional outcome and SPA after spinal surgery have offered conflicting results. A number of studies have established a significant relationship between these parameters and outcomes, while others were unable to establish a relationship, even with positive outcomes, while these measurements were abnormal [2,3,7,10,12,[14][15][16]. This inconsistency may be due to other factors contributing to the outcome not being studied or due to the short follow-up procedures.…”

Section: Discussionmentioning

confidence: 99%

“…The sacral slope (SS) is the angle between the horizontal line and the sacral plateau. The pelvic incidence is the sum of the pelvic tilting angles with the sacral slope (PI = PT+SS) [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…LL can be measured using a simple formula (LL= PI ± 10 °) for age-adjusted calculation of a mismatch [2]. In order to optimally plan surgery for spinal instrumentation, the prediction of postoperative alignment is necessary [7]. Le Huec et al showed that lumbar fusion, if not correctly performed, may result in loss of LL, increase in PT, decrease in SS, leading to spinal complications [8].…”

Section: Introductionmentioning

confidence: 99%

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How Do Pelvic Parameters Correlate With Postoperative Outcomes When the Parameters Are Not Measured Preoperatively in Patients Undergoing Instrumented Lumbar Fusion?

Fallatah¹,

Altijani²,

Alharbi³

et al. 2021

Cureus

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Objective: A normal age-adjusted sagittal alignment is an important factor in achieving long-term functional results after lumbar spinal fusion. We aim to determine if the changes in spino-pelvic alignment (SPA) correlate with post-operative functional outcomes in patients who underwent instrumented lumbar spine surgery when the parameters were not measured before.Method: A retrospective review of medical records from 2012 to 2016, and radiographs of the patients who underwent instrumented fusion of the lumbar spine. The X-rays of the available preoperative lumbar spine were reviewed for SPA and compared with the last follow-up postoperative images. The patients were contacted by telephone to complete the EuroQoL 5 Dimensions 5-level questionnaire and visual analog scale for evaluation of their functional outcomes during 2017. Correlation studies were performed using Pearson's coefficient.Results: Forty-six patients were included with a mean age of 53 years and a follow-up of 47 months. There was a significant improvement in the functional outcomes and pain in the whole group. All the patients showed improvement in their SPA, and those who underwent more than two levels of fusion showed a significant improvement (P<0.05). Lumbar lordosis and sacral slope had a significant correlation with postoperative clinical improvement (R=0.8). Conclusion:The study showed that single or double fusion has significant improvement in pain and functional outcome with a significant change in SPA.

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Spinopelvic sagittal balance: what does the radiologist need to know?

Cited by 22 publications

References 51 publications

Sagittal balance and intervertebral disc composition in patients with low back pain

Sagittal balance and intervertebral disc composition in patients with low back pain

Magnetic resonance imaging evaluation of common peroneal nerve injury in acute and subacute posterolateral corner lesion: a retrospective study

How Do Pelvic Parameters Correlate With Postoperative Outcomes When the Parameters Are Not Measured Preoperatively in Patients Undergoing Instrumented Lumbar Fusion?

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