Spinopelvic Parameters: Lumbar Lordosis, Pelvic Incidence, Pelvic Tilt, and Sacral Slope

2018 ◽  
Vol 29 (3) ◽  
pp. 323-329 ◽  
Author(s):  
Paul C. Celestre ◽  
John R. Dimar ◽  
Steven D. Glassman
Keyword(s):  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Sacral Slope ◽  
Spinopelvic Parameters

scholarly journals ASSOCIATION OF SPINOPELVIC PARAMETERS WITH THE LOCATION OF LUMBAR DISC HERNIATION

2015 ◽  
Vol 14 (3) ◽  
pp. 205-209
Author(s):  
Jefferson Coelho de Léo ◽  
Álvaro Coelho de Léo ◽  
Igor Machado Cardoso ◽  
Charbel Jacob Júnior ◽  
José Lucas Batista Júnior
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Lumbar Disc ◽  
Sacral Slope ◽  
Spinopelvic Parameters ◽  
Lateral Recess ◽  
Central Disc

Objective:To associate spinopelvic parameters, pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with the axial location of lumbar disc herniation.Methods:Retrospective study, which evaluated imaging and medical records of 61 patients with lumbar disc herniation, who underwent surgery with decompression and instrumented lumbar fusion in only one level. Pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with simple lumbopelvic lateral radiographs, which included the lumbar spine, the sacrum and the proximal femur. The affected segment was identified as the level and location of lumbar disc herniation in the axial plane with MRI scans.Results:Of 61 patients, 29 (47.5%) had low lumbar lordosis; in this group 24 (82.8%) had central disc herniation, 4 (13.8%) had lateral recess disc herniation and 1 (3.4%) had extraforaminal disc herniation (p<0.05). Of the 61 patients, 18 (29.5%) had low sacral slope; of this group 15 (83.3%) had central disc herniation and 3 (16.7%) had disc herniation in lateral recess (p<0.05).Conclusions:There is a trend towards greater load distribution in the anterior region of the spine when the spine has hypolordotic curve. This study found an association between low lordosis and central disc herniation, as well as low sacral slope and central disc herniation.

Implications of Spinopelvic Alignment for the Spine Surgeon

Neurosurgery ◽  
2011 ◽  
Vol 70 (3) ◽  
pp. 707-721 ◽  
Author(s):  
Vivek A. Mehta ◽  
Anubhav Amin ◽  
Ibrahim Omeis ◽  
Ziya L. Gokaslan ◽  
Oren N. Gottfried
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Degenerative Spondylolisthesis ◽  
Disease Process ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Spinopelvic Parameters ◽  
Spinopelvic Alignment ◽  
Spinopelvic Balance

Abstract The relation of the pelvis to the spine has previously been overlooked as a contributor to sagittal balance. However, it is now recognized that spinopelvic alignment is important to maintain an energy-efficient posture in normal and disease states. The pelvis is characterized by an important anatomic landmark, the pelvic incidence (PI). The PI does not change after adolescence, and it directly influences pelvic alignment, including the parameters of pelvic tilt (PT) and sacral slope (SS) (PI = PT 1 SS), overall sagittal spinal balance, and lumbar lordosis. In the setting of an elevated PI, the spineadapts with increased lumbar lordosis. To prevent or limit sagittal imbalance, the spine may also compensate with increased PT or pelvic retroversion to attempt to maintain anupright posture. Abnormal spinopelvic parameters contribute to multiple spinal conditions including isthmic spondylolysis, degenerative spondylolisthesis, deformity, and impact outcome after spinal fusion. Sagittal balance, pelvic incidence, and all spinopelvic parameters are easily and reliably measured on standing, full-spine (lateral) radiographs, and it is essential to accurately assess and measure these sagittal values to understand their potential role in the disease process, and to promote spinopelvic balance at surgery. In this article, we provide a comprehensive review of the literature regarding the implications of abnormal spinopelvic parameters and discuss surgical strategies for correction of sagittal balance. Additionally, the authors rate and critique the quality of the literature cited in a systematic review approach to give the reader an estimate of the veracity of the conclusions reached from these reports.

Implications of Spinopelvic Alignment for the Spine Surgeon

Neurosurgery ◽  
2011 ◽  
Vol 76 (suppl_1) ◽  
pp. S42-S56 ◽  
Author(s):  
Vivek A. Mehta ◽  
Anubhav Amin ◽  
Ibrahim Omeis ◽  
Ziya L. Gokaslan ◽  
Oren N. Gottfried
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Degenerative Spondylolisthesis ◽  
Disease Process ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Spinopelvic Parameters ◽  
Spinopelvic Alignment ◽  
Spinopelvic Balance

Abstract The relation of the pelvis to the spine has previously been overlooked as a contributor to sagittal balance. However, it is now recognized that spinopelvic alignment is important to maintain an energy-efficient posture in normal and disease states. The pelvis is characterized by an important anatomic landmark, the pelvic incidence (PI). The PI does not change after adolescence, and it directly influences pelvic alignment, including the parameters of pelvic tilt (PT) and sacral slope (SS) (PI = PT 1 SS), overall sagittal spinal balance, and lumbar lordosis. In the setting of an elevated PI, the spineadapts with increased lumbar lordosis. To prevent or limit sagittal imbalance, the spine may also compensate with increased PT or pelvic retroversion to attempt to maintain anupright posture. Abnormal spinopelvic parameters contribute to multiple spinal conditions including isthmic spondylolysis, degenerative spondylolisthesis, deformity, and impact outcome after spinal fusion. Sagittal balance, pelvic incidence, and all spinopelvic parameters are easily and reliably measured on standing, full-spine (lateral) radiographs, and it is essential to accurately assess and measure these sagittal values to understand their potential role in the disease process, and to promote spinopelvic balance at surgery. In this article, we provide a comprehensive review of the literature regarding the implications of abnormal spinopelvic parameters and discuss surgical strategies for correction of sagittal balance. Additionally, the authors rate and critique the quality of the literature cited in a systematic review approach to give the reader an estimate of the veracity of the conclusions reached from these reports.

scholarly journals EFFECTS OF SAGITTAL BALANCE DIFFERENCES ON SPONDYLOLISTHESIS

2019 ◽  
Vol 27 (2) ◽  
pp. 120-123
Author(s):  
Zeliha Cosgun ◽  
Emine Dagistan ◽  
Yasar Dagistan
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
Normal Population ◽  
Sacral Slope ◽  
Routine Practice ◽  
Compensatory Mechanism ◽  
Spinopelvic Parameters ◽  
Level Of Evidence ◽  
Stage 1

ABSTRACT Objectives: This study aimed to compare the lumbar lordosis (LL) and spinopelvic parameters of patients with stage 1–2 spondylolisthesis to those of the normal population and demonstrate the importance of these parameters in sagittal balance. Methods: The lumbosacral parameters on the lateral radiographs of a total of 125 patients were retrospectively compared. Lumbosacral parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LLA), L5 incidence (L5I), L5 slope (L5S), and sacral table angle (STA) were compared between groups. Results: Comparison of the parameters between groups revealed no sex-based differences (p > 0.05). Conclusions: Abnormal sagittal spinopelvic parameters are commonly examined for their effects on the development of spondylolisthesis and should be used in routine practice. We found that the low SS values in our study, unlike those of other similar studies, may be a compensatory mechanism developed to reduce pain and maintain sagittal balance. Level of Evidence II; retrospective study.

The effect of direct vertebral rotation on the spine parameters (coronal and sagittal) in adolescent idiopathic scoliosis

2021 ◽  
pp. 1-8
Author(s):  
Carlos Eduardo Gonçales Barsotti ◽  
Carlos Augusto Belchior B. Junior ◽  
Rodrigo Mantelatto Andrade ◽  
Alexandre Penna Torini ◽  
Ana Paula Ribeiro
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Vertebral Rotation ◽  
Sacral Slope ◽  
Post Surgery ◽  
Radiographic Parameters

BACKGROUND: Idiopathic scoliosis is accompanied by postural alterations, instability of gait, and functional disabilities. The objective was to verify radiographic parameters (coronal and sagittal) of adolescents with idiopathic scoliosis (AIS) pre- and post-surgery with direct vertebral rotation (DVR), associated with type 1 osteotomies in all segments (except the most proximal) and type 2 in the periapical vertebrae of the curves. METHODS: A prospective study design was employed in which 41 AIS were evaluated and compared pre- and post-surgery. Scoliosis was confirmed by a spine X-ray exam (Cobb angle). Eight radiographic parameters were measured: Cobb angles (thoracic proximal and distal), segmental kyphosis, total kyphosis, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. RESULTS: The Cobb angle averaged 51.3∘± 14.9∘. Post-surgery, there were significant reductions for the following spine measurement parameters: Cobb angle thoracic proximal (p= 0.003); Cobb angle thoracic distal (p= 0.001); Cobb angle lumbar (p= 0.001); kyphosis (T5-T12, p= 0.012); and kyphosis (T1-T12, p= 0.002). These reductions showed the effectiveness of surgical correction to reduce Cobb angles and improve thoracic kyphosis. The values obtained for lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt were not significantly different pre- and post-surgery. CONCLUSION: The surgical technique of DVR in AIS proved to be effective in the coronal and sagittal parameters directed at Cobb angles and thoracic kyphosis in order to favor the rehabilitation process.

scholarly journals IMPACT OF THE MIS-TLIF TECHNIQUE ON THE SPINOPELVIC PARAMETERS OF PATIENTS WITH LUMBAR ARTHRODESIS

2019 ◽  
Vol 18 (1) ◽  
pp. 47-50
Author(s):  
Cristiano Magalhães Menezes ◽  
Leonardo Fernandes Aguiar ◽  
André de Oliveira Arruda ◽  
Rodrigo Vieira Cardoso ◽  
Germano Senna Oliveira do Valle ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Mean Value ◽  
Radiographic Evaluation ◽  
Spinopelvic Parameters ◽  
Level Of Evidence ◽  
Lumbar Arthrodesis ◽  
Retrospective Comparative Study ◽  
Segmental Lordosis

ABSTRACT Objective: To evaluate the influence of the MIS-TLIF technique on the spinopelvic parameters of patients submitted to lumbar arthrodesis up to three levels for the treatment of vertebral degenerative conditions without deformity. Methods: Retrospective radiographic evaluation of 52 patients submitted to the surgical treatment of lumbar arthrodesis using the MIS-TLIF technique in up to three levels. The spinopelvic parameters – pelvic incidence (PI), pelvic tilt(PT), lumbar lordosis (LL), segmental lordosis (Lseg), and the difference between lumbar lordosis and pelvic incidence (LL-PI mismatch) were analyzed in orthostatic lateral radiographs in the pre- and postoperative periods, with a minimum follow-up of 1 year. The patients were divided into three groups: PI <45°, PI between 45° and 55° and PI >55°. Results: Sixty-nine operated levels were evaluated in 15 patients with PI <45°, 19 with PI between 45° and 55° and 18 with PI >55°. The mean value of the pelvic incidence was 52.3° (± 11.5), lumbar lordosis 46.1° (pre)/45.6° (post); segmental lordosis 20.3° (pre)/20.6° (post); pelvic tilt 18.5° (pre)/18.2° (post); “mismatch” (PI-LL) 7° (pre)/ 6.6° (post), with no statistical difference among all parameters (p>0.05). Conclusions: The MIS-TLIF technique had no influence on postoperative spinopelvic parameters of patients undergoing lumbar arthrodesis surgery. Level of evidence: III. Retrospective comparative study.

scholarly journals RADIOGRAPHIC ANALYSIS OF THE RESULTS OF ANTERIOR INTERNODY ARTHRODESIS ON THE SAGITTAL LUMBOPELVIC PARAMETERS

2020 ◽  
Vol 19 (2) ◽  
pp. 104-107
Author(s):  
FELIPE DE NEGREIROS NANNI ◽  
EMILIANO NEVES VIALLE ◽  
MARVIN DURANTE BRUNET
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Degenerative Spondylolisthesis ◽  
Anterior Lumbar Interbody Fusion ◽  
Sacral Slope ◽  
Lumbar Interbody Fusion ◽  
Pelvic Parameters ◽  
Segmental Lordosis

ABSTRACT Objective The objective of this study is to analyze the radiographs of patients who underwent anterior lumbar interbody fusion (ALIF), to compare the values of the lumbopelvic measurements, and to quantify improvements in these parameters achieved through this technique. Methods The radiographs of 42 patients, all submitted to ALIF with a 12° interbody device, were evaluated from a database at a single center. The pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, segmental lordosis, and regional lordosis angles of each patient were measured in pre- and postoperative radiographs. Results We observed a discreet change in the pelvic parameters and a marked increase in regional lordosis with a mean increase of 5.8° (p>0.001). Segmental lordosis also showed a mean increase of 2.43°. The gain in segmental lordosis was even higher in patients with degenerative spondylolisthesis and when the operated level was L5-S1. Conclusions The ALIF technique in the lumbar spine is capable of significantly increase the lordosis of a segment, whether at one or two levels. Greater improvement in the lumbopelvic parameters was observed it the procedures performed in level L5-S1 and in cases that presented spondylolisthesis.

scholarly journals Effect of Direct Vertebral Rotation on the Spine Parameters (Coronal and Sagittal) in Adolescent Idiopathic Scoliosis

2020 ◽  
Author(s):  
Carlos Eduardo Gonçales Barsotti ◽  
Carlos Augusto Belchior B Junior ◽  
Rodrigo Mantelatto Andrade ◽  
Alexandre Penna Torini ◽  
Ana Paula Ribeiro
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Vertebral Rotation ◽  
Sacral Slope ◽  
Post Surgery ◽  
Radiographic Parameters

Abstract Background: Idiopathic scoliosis is accompanied by postural alterations, instability of gait, and functional disabilities. The objective was to verify radiographic parameters (coronal and sagittal) of adolescents with idiopathic scoliosis (AIS) pre- and post-surgery with direct vertebral rotation (DVR), associated with type 1 osteotomies in all segments (except the most proximal) and type 2 in the periapical vertebrae of the curves. Methods: A prospective study design was employed in which 41 AIS were evaluated and compared pre- and post-surgery. Scoliosis was confirmed by a spine X-ray exam (Cobb angle). Eight radiographic parameters were measured: Cobb angles (thoracic proximal and distal), segmental kyphosis, total kyphosis, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. Results: The Cobb angle averaged 51.3° ± 14.9°. Post-surgery, there were significant reductions for the following spine measurement parameters: Cobb angle thoracic proximal (p = 0.003); Cobb angle thoracic distal (p=0.001); Cobb angle lumbar (p=0.001); kyphosis (T5-T12, p=0.012); and kyphosis (T1-T12, p=0.002). These reductions showed the effectiveness of surgical correction to reduce Cobb angles and improve thoracic kyphosis. The values obtained for lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt were not significantly different pre- and post-surgery. Conclusion: The surgical technique of DVR in AIS proved to be effective in the coronal and sagittal parameters directed at Cobb angles and thoracic kyphosis.

SPINOPELVIC ALIGNMENT OF PATIENTS WITH DEGENERATIVE SPONDYLOLISTHESIS

Neurosurgery ◽  
2007 ◽  
Vol 61 (5) ◽  
pp. 981-986 ◽  
Author(s):  
Cédric Barrey ◽  
Jérôme Jund ◽  
Gilles Perrin ◽  
Pierre Roussouly
Keyword(s):  
Lumbar Spine ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Degenerative Spondylolisthesis ◽  
Plumb Line ◽  
Control Group ◽  
Sacral Slope ◽  
Spinopelvic Parameters ◽  
Spinopelvic Alignment ◽  
Asymptomatic Volunteers

Abstract OBJECTIVE The main objectives of this study were to analyze and compare spinopelvic parameters, including the pelvis shape, in a population of 40 patients with degenerative spondylolisthesis (DSPL) and to compare these patients with a control group of asymptomatic volunteers. METHODS Forty patients with DSPL were included in this study. Spinopelvic parameters were analyzed on preoperative full spine x-rays in a standardized standing position. The following spinopelvic parameters were measured: pelvic incidence (PI), sacral slope, pelvic tilt, lumbar lordosis, thoracic kyphosis, and positioning of the C7 plumb line. The population of patients was compared with a control population of 154 normal and asymptomatic adults who were studied in a recently published study. In order to understand variations of spinopelvic parameters, a control group was matched according to the PI, which is a morphological parameter. RESULTS The PI was significantly greater for patients with DSPL (60.1 ± 10.6 degrees) compared with the control group (52 ± 10.7 degrees) (P &lt; 0.0005). After matching according to the pelvic incidence, the DSPL population was characterized by an anterior translation of the C7 plumb line (P &lt; 0.05), a loss of lumbar lordosis (P &lt; 0.0005), and a decrease of the sacral slope (P &lt; 0.0005). Retrolisthesis and/or segmental intervertebral hyperextension were observed in the upper lumbar spine in 30% of the cases. CONCLUSION Matching according to the PI between the patients in the study and the control group enabled us to understand variations of the spinopelvic parameters in a population of patients with DSPL. DSPL patients were characterized by a greater PI than the asymptomatic population; therefore, we suggest that a high PI may be a predisposing factor in developing DSPL. Finally, we observed significant variations in spinopelvic alignment, such as loss of lordosis and sagittal unbalance, which were partially compensated by pelvis back tilt and hyperextension in the upper lumbar spine.

scholarly journals HIP-SPINE SYNDROME, RADIOGRAPHIC EVALUATION OF THE SAGITTAL BALANCE

2020 ◽  
Vol 19 (3) ◽  
pp. 184-188
Author(s):  
OMAR MOHAMAD MANSOUR ABDALLAH ◽  
XAVIER SOLER GRAELLS ◽  
ÁLYNSON LAROCCA KULCHESKI ◽  
PEDRO GREIN DEL SANTORO ◽  
MARCEL LUIS BENATO ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Lumbar Spine ◽  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Normal Values ◽  
Radiographic Evaluation ◽  
Sacral Slope ◽  
Level Ii

ABSTRACT Objectives The hip-spine syndrome (HSS) is defined as the simultaneous degeneration of the hip and lumbar spine. The objective of this study is to quantify the sagittal balance values in the population with HSS and to compare them with the normal sagittal balance parameters. Methods A retrospective study was conducted in which 30 patients with HSS who were waiting for total hip arthroplasty (THA) were evaluated. The lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI) and spinopelvic harmony (SH) angles and the BMI of these patients were measured. Results Seventeen women and 13 men participated in the study, with a mean LL of 39.55°, a mean SS of 36.92°, a mean PT of 25.77°, a mean PI of 62.72°, a mean SH of 23.17° and a mean BMI of 25.55. Only the SS did not present a changed value when compared to the normal values of the population. Conclusions HSS is increasingly present in our environment due to the aging population. Sagittal balance is gaining more and more attention in studies related to spinal pathologies. All the parameters measured in this study, except for SS, presented altered values when compared to the populational means. Evidence Level II. Observational and retrospective study.

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