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 < 0.0005). After matching according to the pelvic incidence, the DSPL population was characterized by an anterior translation of the C7 plumb line (P < 0.05), a loss of lumbar lordosis (P < 0.0005), and a decrease of the sacral slope (P < 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.

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 Increasing pelvic incidence is associated with more global sagittal imbalance in ankylosing spondylitis with thoracolumbar kyphosis

2019 ◽  
Author(s):  
Diyu Song ◽  
Guoquan Zheng ◽  
Tianhao Wang ◽  
Dengbin Qi ◽  
Yan Wang
Keyword(s):  
Ankylosing Spondylitis ◽  
Pelvic Incidence ◽  
Vertical Axis ◽  
Control Group ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Thoracolumbar Kyphosis ◽  
Spinopelvic Parameters ◽  
Sagittal Vertical Axis ◽  
The Relationship

Abstract Background: Ankylosing spondylitis (AS) patients with kyphosis have an abnormal spinopelvic alignment and pelvic morphology. Most of them focus on the relationship of pelvic tilt (PT) or sacral slope (SS) and deformity, and relatively few studies have addressed the relationship between pelvic incidence (PI) and kyphosis in AS patients. The purpose of this study is to analyze the correlation between pelvic incidence (PI) and the spinopelvic parameters describing local deformity or global sagittal balance in AS patients with thoracolumbar kyphosis. Methods: A total of 94 patients with AS (91 males and 3 females) and 30 controls were reviewed. Sagittal spinopelvic parameters, including PI, PT, SS, thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis(LL), sagittal vertical axis(SVA), T1 pelvic angle(TPA), spinosacral angle(SSA) and spinopelvic angle(SPA) were measured. Statistical analysis was performed to identify the correlation of PI with other parameters. Results: Compared with the control group, the AS patients had significantly higher PI(47.4˚ vs. 43.2˚, P<0.001). PI in AS patients was found to be significantly positively correlated with TPA(r=0.533, R 2 =0.284, P<0.001), and negatively correlated with SPA(r=-0.504, R 2 =0.254, P<0.001). However, no correlations were found between PI and SVA, SSA, TK, TLK or LL in AS patients. Conclusion: The value of PI in AS patients with kyphosis was significantly higher than that of controls. Correlation analysis revealed that increasing PI was significantly correlated with more global sagittal imbalance, not with the local deformity in AS patients with thoracolumbar kyphosis.

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.

scholarly journals Increasing pelvic incidence is associated with more global sagittal imbalance in ankylosing spondylitis with thoracolumbar kyphosis

2019 ◽  
Author(s):  
Diyu Song ◽  
Guoquan Zheng ◽  
Tianhao Wang ◽  
Dengbin Qi ◽  
Yan Wang
Keyword(s):  
Ankylosing Spondylitis ◽  
Sagittal Balance ◽  
Pelvic Incidence ◽  
Pearson Correlation ◽  
Control Group ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Thoracolumbar Kyphosis ◽  
Spinopelvic Parameters ◽  
The Relationship

Abstract Background: Ankylosing spondylitis (AS) patients with kyphosis have an abnormal spinopelvic alignment and pelvic morphology. Most studies focus on the relationship of pelvic tilt (PT) or sacral slope (SS) and deformity, and relatively few studies have addressed the relationship between pelvic incidence (PI) and kyphosis in AS patients. The purpose of this study is to analyze the correlation between pelvic incidence (PI) and the spinopelvic parameters describing local deformity or global sagittal balance in AS patients with thoracolumbar kyphosis. Methods: A total of 94 patients with AS (91 males and 3 females) and 30 controls were reviewed. Sagittal spinopelvic parameters, including PI, PT, SS, thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis(LL), sagittal vertical axis(SVA), the first thoracic vertebra pelvic angle(TPA), spinosacral angle(SSA) and spinopelvic angle(SPA) were measured. Pearson correlation (r) and unary linear regression model were used to analysis the relationship between PI and other spinopelvic parameters. Results: Compared with the control group, the AS patients had significantly higher PI(47.4˚ vs. 43.2˚, P<0.001). PI in AS patients was found to be significantly positively correlated with TPA(r=0.533, R2=0.284, P<0.001), and negatively correlated with SPA(r=-0.504, R2=0.254, P<0.001). However, no correlations were found between PI and SVA, SSA, TK, TLK or LL in AS patients. Conclusion: This study revealed that increasing PI was significantly correlated with more global sagittal imbalance, not with the local deformity in AS patients with thoracolumbar kyphosis. Key Words: ankylosing spondylitis, pelvic incidence, sagittal spinopelvic parameters, global sagittal balance

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 Prognostic Importance of Spinopelvic Parameters in the Assessment of Conservative Treatment in Patients with Spondylolisthesis

2018 ◽  
Vol 12 (2) ◽  
pp. 277-284
Author(s):  
Sai Krishna M L V ◽  
Deep Sharma ◽  
Jagdish Menon
Keyword(s):  
New York ◽  
Conservative Treatment ◽  
Postgraduate Medical Education ◽  
Causative Factor ◽  
Control Group ◽  
Sacral Slope ◽  
Low Grade ◽  
Spinopelvic Parameters ◽  
Asymptomatic Volunteers ◽  
Jawaharlal Institute

<sec><title>Study Design</title><p>This was a prospective, two-group comparative study.</p></sec><sec><title>Purpose</title><p>The present study aimed to determine the importance of the spinopelvic parameters in the causation and progression of spondylolisthesis.</p></sec><sec><title>Overview of Literature</title><p>Spondylolisthesis is slippage of one vertebra over the vertebra below. Since the discovery of pelvic incidence (PI) in 1998 in addition to documentation of other parameters in spinopelvic balance, slippage in spondylolisthesis has been attributed to these parameters. Many studies on the Caucasian population have implicated high PI as a causative factor of spondylolisthesis. To the best of our knowledge, no study has described the role of these parameters in the progression of spondylolisthesis.</p></sec><sec><title>Methods</title><p>The study was conducted in Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. Seventy-nine patients with spondylolisthesis consented to participate in the study. All patients were advised to undergo conservative treatment and were regularly followed up according to the protocol. Seventy-five asymptomatic volunteers were recruited as a control group. Of the total of 79 patients, 54 were followed up for 6 months, during which 46 improved, eight showed no improvement, and 25 were lost to follow-up. Sagittal spinopelvic parameters were measured by a single observer using the Surgimap spine software ver. 2.1.2 (Nemaris, New York, NY, USA). Parameters measured were PI, pelvic tilt (PT), sacral slope (SS), thoracic kyphosis, and lumbar lordosis. The results from patients and controls were compared using appropriate statistical methods.</p></sec><sec><title>Results</title><p>The normal and spondylolisthesis groups significantly differed with respect to PI, SS, and PT (<italic>p</italic>&lt;0.001). There were no significant differences in the measured spinopelvic parameters between patients with high- and low-grade spondylolisthesis or between those whose condition improved and those whose condition worsened.</p></sec><sec><title>Conclusions</title><p>PI, the most important of all spinopelvic parameters, is responsible for the slip in spondylolisthesis, but not for its progression.</p></sec>

scholarly journals Analysis of sagittal balance and spinopelvic parameters in a brazilian population sample

2014 ◽  
Vol 13 (2) ◽  
pp. 108-111 ◽  
Author(s):  
Raphael De Rezende Pratali ◽  
Charlles De Oliveira Luz ◽  
Carlos Eduardo Gonçales Barsotti ◽  
Francisco Prado Eugenio Dos Santos ◽  
Carlos Eduardo Algaves Soares De Oliveira
Keyword(s):  
Sagittal Balance ◽  
Pelvic Incidence ◽  
Population Sample ◽  
Total Sample ◽  
Brazilian Population ◽  
Sacral Slope ◽  
Spinopelvic Parameters ◽  
Significant Difference ◽  
Asymptomatic Volunteers ◽  
European Populations

Objective: To define the sagittal balance and spinopelvic parameters in a Brazilian population sample composed of asymptomatic volunteers. Methods: Fifty healthy adult individuals volunteered to participate in this study. The exclusion criteria included spinal deformity or improper radiograph study. In each radiograph exam in profile view, the sagittal balance and spinopelvic parameters were evaluated, including vertical sagittal axis, sacral slope, pelvic tilt and pelvic incidence. Results: The data obtained in this study are according to the values presented in the worldwide literature. None of the radiographic parameters showed any differences between the genders. Comparing the values presented in this study with those of other reports, with different populations, it was observed that: there was no significant difference in any of the pelvic parameters between Brazilian and Korean populations; there was a significant difference in pelvic incidence between Brazilian and European populations in a total sample (p=0.0001), in males (p=0.02), and in females (p=0.0007); there was a difference in sacral slope between Brazilian and European populations in a total sample (p=0.0140), and in females (p=0.005). Conclusion: There were no differences in any parameter in terms of gender. There were no differences in pelvic incidence between Brazilian and Korean populations. There was a difference in pelvic incidence between Brazilian and European populations, in the total sample and in males and females. There was a difference in sacral slope between Brazilian and European populations in a total sample, and in females.

The Influence of Pelvic Incidence and Lumbar Lordosis Mismatch on Development of Symptomatic Adjacent Level Disease Following Single-Level Transforaminal Lumbar Interbody Fusion

Neurosurgery ◽  
2017 ◽  
Vol 80 (6) ◽  
pp. 880-886 ◽  
Author(s):  
Zachary J. Tempel ◽  
Gurpreet S. Gandhoke ◽  
Bryan D. Bolinger ◽  
Nicolas K. Khattar ◽  
Philip V. Parry ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Revision Surgery ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Pelvic Incidence ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Adjacent Level ◽  
Spinopelvic Parameters ◽  
Single Level

Abstract BACKGROUND: Annual incidence of symptomatic adjacent level disease (ALD) following lumbar fusion surgery ranges from 0.6% to 3.9% per year. Sagittal malalignment may contribute to the development of ALD. OBJECTIVE: To describe the relationship between pelvic incidence-lumbar lordosis (PI-LL) mismatch and the development of symptomatic ALD requiring revision surgery following single-level transforaminal lumbar interbody fusion for degenerative lumbar spondylosis and/or low-grade spondylolisthesis. METHODS: All patients who underwent a single-level transforaminal lumbar interbody fusion at either L4/5 or L5/S1 between July 2006 and December 2012 were analyzed for pre- and postoperative spinopelvic parameters. Using univariate and logistic regression analysis, we compared the spinopelvic parameters of those patients who required revision surgery against those patients who did not develop symptomatic ALD. We calculated the predictive value of PI-LL mismatch. RESULTS: One hundred fifty-nine patients met the inclusion criteria. The results noted that, for a 1° increase in PI-LL mismatch (preop and postop), the odds of developing ALD requiring surgery increased by 1.3 and 1.4 fold, respectively, which were statistically significant increases. Based on our analysis, a PI-LL mismatch of &gt;11° had a positive predictive value of 75% for the development of symptomatic ALD requiring revision surgery. CONCLUSIONS: A high PI-LL mismatch is strongly associated with the development of symptomatic ALD requiring revision lumbar spine surgery. The development of ALD may represent a global disease process as opposed to a focal condition. Spine surgeons may wish to consider assessment of spinopelvic parameters in the evaluation of degenerative lumbar spine pathology.

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