Radiological severity of hip osteoarthritis in patients with adult spinal deformity: the effect on spinopelvic and lower extremity compensatory mechanisms

ABSTRACT This study presents details about the applicability of the new image acquisition system, called the biplanar imaging system, with three-dimensional capabilities (EOS®) to the treatment of spinal deformities. This system allows radiographic acquisition of the entire body, with a great reduction in the dose of radiation absorbed by the patient and three-dimensional (3D) stereoradiographic image reconstruction of bone structures, including the spine. In the case of adolescent idiopathic scoliosis, the analysis of the spinal deformity with 3D reconstruction allows better understanding of the deformity and surgical planning. In the case of adult spinal deformity, full-body analysis allows an evaluation of the spinopelvic deformity, including loss of sagittal alignment, in addition to an evaluation of compensatory mechanisms recruited by the individual in an attempt to maintain the sagittal balance. Level of evidence III; Descriptive Review.

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Lower Extremity Motor Function Following Complex Adult Spinal Deformity Surgery

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.17.00575 ◽

2018 ◽

Vol 100 (8) ◽

pp. 656-665 ◽

Cited By ~ 6

Author(s):

Lawrence G. Lenke ◽

Christopher I. Shaffrey ◽

Leah Y. Carreon ◽

Kenneth M.C. Cheung ◽

Benny T. Dahl ◽

...

Keyword(s):

Lower Extremity ◽

Motor Function ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Spinal Deformity Surgery

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Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity

Journal of Neurosurgery Spine ◽

10.3171/2015.5.spine14989 ◽

2016 ◽

Vol 24 (3) ◽

pp. 436-446 ◽

Cited By ~ 43

Author(s):

Emmanuelle Ferrero ◽

Barthelemy Liabaud ◽

Vincent Challier ◽

Renaud Lafage ◽

Bassel G. Diebo ◽

...

Keyword(s):

Lower Extremity ◽

Spinal Deformity ◽

Lower Limb ◽

Knee Flexion ◽

Large Population ◽

Compensatory Mechanisms ◽

The Impact ◽

Hip Extension ◽

Full Body

OBJECT Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pelvic parameters have demonstrated the compensatory mechanisms of pelvis translation in addition to rotation. However, the mechanisms recruited for this pelvic rotation were not assessed. This study aims to analyze the relationship between spinopelvic and lower-extremity parameters and clarify the role of pelvic translation. METHODS This is a retrospective study of patients with spinal deformity and full-body EOS images. Patients with only stenosis or low-back pain were excluded. Patients were grouped according to T-1 spinopelvic inclination (T1SPi): sagittal forward (forward, > 0.5°), neutral (−6.3° to 0.5°), or backward (< −6.3°). Pelvic translation was quantified by pelvic shift (sagittal offset between the posterosuperior corner of the sacrum and anterior cortex of the distal tibia), hip extension was measured using the sacrofemoral angle (SFA; the angle formed by the middle of the sacral endplate and the bicoxofemoral axis and the line between the bicoxofemoral axis and the femoral axis), and chin-brow vertical angle (CBVA). Univariate and multivariate analyses were used to compare the parameters and correlation with the Oswestry Disability Index (ODI). RESULTS In total, 336 patients (71% female; mean age 57 years; mean body mass index 27 kg/m2) had mean T1SPi values of −8.8°, −3.5°, and 5.9° in the backward, neutral, and forward groups, respectively. There were significant differences in the lower-extremity and spinopelvic parameters between T1SPi groups. The backward group had a normal lumbar lordosis (LL), negative SVA and pelvic shift, and the largest hip extension. Forward patients had a small LL and an increased SVA, with a large pelvic shift creating compensatory knee flexion. Significant correlations existed between lower-limb parameter and pelvic shift, pelvic tilt, T-1 pelvic angle, T1SPi, and sagittal vertical axis (0.3 < r < 0.8; p < 0.001). ODI was significantly correlated with knee flexion and pelvic shift. CONCLUSIONS This is the first study to describe full-body alignment in a large population of patients with spinal pathologies. Furthermore, patients categorized based on T1SPi were found to have significant differences in the pelvic shift and lower-limb compensatory mechanisms. Correlations between lower-limb angles, pelvic shift, and ODI were identified. These differences in compensatory mechanisms should be considered when evaluating and planning surgical intervention for adult patients with spinal deformity.

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The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery

European Spine Journal ◽

10.1007/s00586-021-06969-z ◽

2021 ◽

Author(s):

Lawrence G. Lenke ◽

Scott L. Zuckerman ◽

Meghan Cerpa ◽

Christopher I. Shaffrey ◽

Leah Y. Carreon ◽

...

Keyword(s):

Lower Extremity ◽

Motor Function ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Spinal Deformity Surgery

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Understanding sagittal compensation in adult spinal deformity patients: relationship between pelvic tilt and lower-extremity position

Journal of Neurosurgery Spine ◽

10.3171/2021.1.spine201660 ◽

2021 ◽

pp. 1-8

Author(s):

Takayoshi Shimizu ◽

Meghan Cerpa ◽

Lawrence G. Lenke

Keyword(s):

Lower Extremity ◽

Spinal Deformity ◽

Knee Flexion ◽

Pelvic Tilt ◽

Adult Spinal Deformity ◽

The Other ◽

Whole Body ◽

Shift Group ◽

Posterior Shift ◽

Full Body

OBJECTIVE In adult spinal deformity (ASD), quantifying preoperative lower-extremity (LE) compensation is important in formulating an operative plan to achieve optimal global sagittal alignment. Whole-body radiographs are not always available. This study evaluated the possibility of estimating LE compensation without whole-body radiographs. METHODS In total, 200 consecutive ASD patients with full-body radiographic assessment were categorized into the following three groups according to their cranio-hip balance (distance from the cranial sagittal vertical axis to the hip axis [CrSVA-H]): group 1, anterior-shift (A-shift) group (CrSVA-H > 40 mm); group 2, balanced group, −40 mm < CrSVA-H < 40 mm; and group 3, posterior-shift (P-shift) group, CrSVA-H < −40 mm. After analyzing the correlation between CrSVA-H, pelvic tilt (PT), and LE parameters, the cutoff PT and PT/pelvic incidence (PI) values that correlated with the presence of LE compensation were determined. Previously published data from asymptomatic volunteers were used as a baseline threshold (sacrofemoral angle [SFA] > 217.0° and knee flexion angle [KA] > 11.0°). RESULTS Among the hip, knee, and ankle, only KA showed a significant increase in the A-shift group compared to the other two groups (p < 0.01). With a wide threshold (SFA > 208.0° and KA > 5.0°), 84.9% of the A-shift group showed LE compensation (hip or knee or both), which was a significantly greater percentage than those in the balanced and P-shift groups (48.4% and 51.9%, p < 0.01). With a narrow threshold (SFA > 217.0° and KA > 11.0°), 62.2% of the A-shift group showed any LE compensation, which was also a higher percentage than the other two groups. The CrSVA-H was moderately correlated with KA (r = 0.502), but had no correlation with PT, SFA, and ankle dorsiflexion angle (AA). PT showed a moderate/strong correlation with SFA, KA, and AA (r = 0.846, 0.624, and 0.622, respectively). With receiver operating characteristic curves, the authors determined that a 23.0° PT with PT/PI > 0.46 predicts the presence of any type of LE compensation with use of the wide threshold. CONCLUSIONS ASD patients with increased CrSVA-H, which represents cranio-hip anterior imbalance, demonstrated a higher prevalence of LE compensation, especially knee flexion, compared to those with neutral and posterior shift of CrSVA. PT represents the extent of LE compensation in patients with spinal sagittal malalignment. Using the cutoff value of PT determined in this study, surgeons can preoperatively estimate the extent of LE compensation without obtaining a full-body radiograph.

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