C7 sacral tilt (C7ST): a novel spinopelvic parameter reveals the relationship between pelvic parameters and global spinal sagittal balance and converts pelvic parameters into spinal parameters

Background: This study aimed to evaluate the effect of total hip arthroplasty (THA) on sagittal pelvic parameters and to evaluate the effect of sagittal pelvic parameters on acetabular cup orientation. Methods: The study included 86 patients who underwent THA for a diagnosis of unilateral coxarthrosis between 2011 and 2015. Measurements were taken of the preoperative and postoperative acetabular cup inclination (ACI), anteversion, and sagittal pelvic parameters. The effect of THA on sagittal pelvic parameters and the effects of the sagittal pelvic parameters on acetabular cup orientation were investigated. Results: The sagittal pelvic tilt values calculated were mean 9.7° ± 6.3° (2°; 23°) preoperatively and 11.0° ± 6.1° (2°; 25°) postoperatively. The increase in postoperative pelvic incidence (PI) values was determined to be statistically significant ( p < 0.05). The preoperative PI values had no significant effect on ACI, but in cases with high preoperative PI values, a tendency to high anteversion values was determined. The mean inclination values were found to be 40.2° ± 11.0° in the low PI group, 41.7° ± 7.4° in the normal PI group, and 44.1° ± 8.3° in the high PI group. As no increase in inclination values was observed with an increase in PI values, no statistical correlation was determined ( p = 0.343). Average of anteversion values in the low PI group was 9.2° ± 13.7°, in the normal PI group 19.3° ± 10.5°, and in the high PI group 21.1° ± 12.5°. The difference between the groups was statistically significant ( p = 0.001). Conclusion: Evaluating the results of this study, it can be concluded that varying PI values do affect the acetabular cup anterversion in THA. So, preoperative assessment of PI values is important in preventing postoperative acetabular cup malposition.

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Conflicting calculations of pelvic incidence and pelvic tilt secondary to transitional lumbosacral anatomy (lumbarization of S-1): case report

Journal of Neurosurgery Spine ◽

10.3171/2016.5.spine16196 ◽

2017 ◽

Vol 26 (1) ◽

pp. 45-49 ◽

Cited By ~ 4

Author(s):

Charles H. Crawford ◽

Steven D. Glassman ◽

Jeffrey L. Gum ◽

Leah Y. Carreon

Keyword(s):

Sagittal Balance ◽

Lumbar Lordosis ◽

Pelvic Incidence ◽

Adult Spinal Deformity ◽

Accurate Identification ◽

Current Case ◽

Pelvic Parameters ◽

Radiology Reports ◽

Sagittal Malalignment

Advancements in the understanding of adult spinal deformity have led to a greater awareness of the role of the pelvis in maintaining sagittal balance and alignment. Pelvic incidence has emerged as a key radiographic measure and should closely match lumbar lordosis. As proper measurement of the pelvic incidence requires accurate identification of the S-1 endplate, lumbosacral transitional anatomy may lead to errors. The purpose of this study is to demonstrate how lumbosacral transitional anatomy may lead to errors in the measurement of pelvic parameters. The current case highlights one of the potential complications that can be avoided with awareness. The authors report the case of a 61-year-old man who had undergone prior lumbar surgeries and then presented with symptomatic lumbar stenosis and sagittal malalignment. Radiographs showed a lumbarized S-1. Prior numbering of the segments in previous surgical and radiology reports led to a pelvic incidence calculation of 61°. Corrected numbering of the segments using the lumbarized S-1 endplate led to a pelvic incidence calculation of 48°. Without recognition of the lumbosacral anatomy, overcorrection of the lumbar lordosis might have led to negative sagittal balance and the propensity to develop proximal junction failure. This case illustrates that improper identification of lumbosacral transitional anatomy may lead to errors that could affect clinical outcome. Awareness of this potential error may help improve patient outcomes.

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Discriminant analysis of the relationship between estimated spinal level of posterior superior iliac spine (PSIS) and spinal-pelvic parameters

10.21203/rs.2.14213/v1 ◽

2019 ◽

Author(s):

Xi Luo ◽

Yuan Wang ◽

Ximing Xu ◽

Kaiqiang Sun ◽

Jian Zhu ◽

...

Keyword(s):

Discriminant Analysis ◽

Sacral Slope ◽

Posterior Superior Iliac Spine ◽

Spinal Level ◽

Linear Discriminant ◽

Factors Affecting ◽

Pelvic Parameters ◽

Imaging Characteristics ◽

Different Populations ◽

The Relationship

Abstract Background: The spinal level determined by reference of posterior superior iliac spine (PSIS) will be different because of the various sagittal posture of spine-pelvis complex. The study aimed at investigating the anatomical factors affecting the estimated spinal level of PSIS from the standpoint of spine-pelvis paraments, and provided a basis for improving the accuracy of positioning. Methods: The lumbar X-ray images of 76 patients were retrospectively analyzed. The population was classified according to the estimated level of PSIS. lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT) and other parameters were measured. Then, the latent factors affecting the estimated level were filtered and obtained by One-way ANOVA and Fisher linear discriminant analysis to further summarize the imaging characteristics of different populations. Results: Three different levels of L5 (10 cases), S1 (46 cases) and S2 (20 cases) were observed. ANOVA analysis showed that LL, SS, PT, PI, SS-PT, LL-SS and lordosis of L1-L5 (LL L1-L5 ) were significantly different among the three groups ( P < 0.05). Discriminant analysis showed that LL, SS, SS-PT and LL L1-L5 were the main factors affecting the estimated level of PSIS (P < 0.05). Conclusions: The variations of morphological parameters such as LL, SS, SS-PT and LL L1-L5 can affect the estimated level of PSIS, and the level can be predicted by the discriminant function. In the study, the function is D=-4.458+0.13×LL-0.115×SS+0.45× （SS-PT）+0.39×LL L1-L5 , which proved 71.1％ of the discriminant accuracy rate.

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The relationship between exercise-induced low back pain, the fat infiltration rate of paraspinal muscles, and lumbar sagittal balance

Spine Surgery and Related Research ◽

10.22603/ssrr.2021-0103 ◽

2021 ◽

Author(s):

Masataka Nakamura ◽

Koji Otani ◽

Yota Kaneko ◽

Miho Sekiguchi ◽

Shin-ichi Konno

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Sagittal Balance ◽

Infiltration Rate ◽

Low Back ◽

Paraspinal Muscles ◽

Fat Infiltration ◽

Exercise Induced ◽

The Relationship

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Sagittal balance and pelvic parameters–a paradigm shift in spinal surgery

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2012.05.023 ◽

2013 ◽

Vol 20 (2) ◽

pp. 191-196 ◽

Cited By ~ 26

Author(s):

R.D. Johnson ◽

A. Valore ◽

A. Villaminar ◽

M. Comisso ◽

M. Balsano

Keyword(s):

Sagittal Balance ◽

Spinal Surgery ◽

Paradigm Shift ◽

Pelvic Parameters

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Postoperative Changes in Pelvic Parameters and Sagittal Balance in Adult Isthmic Spondylolisthesis

Operative Neurosurgery ◽

10.1227/neu.0b013e3182117249 ◽

2011 ◽

Vol 68 (suppl_2) ◽

pp. ons355-ons363 ◽

Cited By ~ 3

Author(s):

Se Jun Park ◽

Chong Suh Lee ◽

Sung Soo Chung ◽

Kyung Chung Kang ◽

Seong Kee Shin

Keyword(s):

Sagittal Balance ◽

Interbody Fusion ◽

Pelvic Tilt ◽

Posterior Instrumentation ◽

Posterior Lumbar Interbody Fusion ◽

Surgical Correction ◽

Slip Angle ◽

Sacral Slope ◽

Isthmic Spondylolisthesis ◽

Pelvic Parameters

Abstract Background: Correction of deformity in adult isthmic spondylolisthesis can affect the pelvic parameters and sagittal balance. Objective: To evaluate the correlation with the amount of deformity correction and the subsequent change in pelvic parameters after surgical correction of adult isthmic spondylolisthesis and to determine which deformity parameter most affects the postoperative restoration of spinopelvic sagittal alignment. Methods: Fifty-eight patients with 1-level isthmic spondylolisthesis were included. Their average age was 55 years (range, 24–76 years). All patients underwent operation by posterior lumbar interbody fusion and posterior instrumentation. The pre- and postoperative sacral slope, pelvic tilt, lumbar lordosis (LL), and sagittal balance were measured, and then the correlation between these parameters and deformity parameters such as slip degree, slip angle, and height of the intervertebral disc (HOD) was evaluated. Results: The slip degree, slip angle, and HOD were significantly recovered after surgery. Pelvic parameters and sagittal balance changed subsequently. Sacral slope was increased by 4.4 degrees, and pelvic tilt was decreased by 4.4 degrees. LL was increased by 5.2 degrees and sagittal balance was displaced 5.6 mm posteriorly. Only the restoration of the HOD showed a significant correlation with the change in LL (r = 0.305, P = .02) and sagittal balance (r = 0.377, P = .004). Conclusion: Surgical correction of adult isthmic spondylolisthesis with posterior lumbar interbody fusion and posterior instrumentation resulted in improvement of sacral slope, pelvic tilt, LL, and sagittal balance. Only restoration of the HOD was significantly correlated with improvement of LL and sagittal balance. Therefore we presume it is important to restore the HOD in surgical correction of adult isthmic spondylolisthesis.

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Extended L5 pedicle subtraction osteotomy for neglected sacropelvic dissociation injury: case report

Journal of Neurosurgery Spine ◽

10.3171/2019.1.spine181271 ◽

2019 ◽

Vol 31 (1) ◽

pp. 35-39 ◽

Cited By ~ 1

Author(s):

Vishwajeet Singh ◽

Tarush Rustagi ◽

Robert Hart

Keyword(s):

Case Report ◽

Sagittal Balance ◽

Pedicle Subtraction Osteotomy ◽

Significant Alteration ◽

Sagittal Imbalance ◽

Pelvic Parameters ◽

Lumbar Osteotomy ◽

Pelvis Fractures

The sacrum forms the distal end of the spine and communicates with the pelvis. Fractures involving the sacrum are complex and may disrupt this vital communication. Neglecting these fractures may result in malunion, which often causes significant alteration in the pelvic parameters and sagittal balance. Management of ensuing deformities is complex and poorly described. The authors present a case of sacral malunion with sagittal imbalance treated with a low lumbar osteotomy.

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