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

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.

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Implications of Spinopelvic Alignment for the Spine Surgeon

Neurosurgery ◽

10.1227/neu.0b013e31823262ea ◽

2011 ◽

Vol 70 (3) ◽

pp. 707-721 ◽

Cited By ~ 55

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.

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Implications of Spinopelvic Alignment for the Spine Surgeon

Neurosurgery ◽

10.1227/01.neu.0000462077.50830.1a ◽

2011 ◽

Vol 76 (suppl_1) ◽

pp. S42-S56 ◽

Cited By ~ 29

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

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

10.21203/rs.2.16543/v2 ◽

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

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SPINOPELVIC ALIGNMENT OF PATIENTS WITH DEGENERATIVE SPONDYLOLISTHESIS

Neurosurgery ◽

10.1227/01.neu.0000303194.02921.30 ◽

2007 ◽

Vol 61 (5) ◽

pp. 981-986 ◽

Cited By ~ 102

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.

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Characteristics of the spinopelvic parameters of patients with sacroiliac joint pain

Scientific Reports ◽

10.1038/s41598-021-84737-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Juichi Tonosu ◽

Hiroyuki Oka ◽

Kenichi Watanabe ◽

Hiroaki Abe ◽

Akiro Higashikawa ◽

...

Keyword(s):

Sacroiliac Joint ◽

Joint Pain ◽

Pelvic Incidence ◽

Demographic Characteristics ◽

Sacral Slope ◽

Low Back ◽

Spinopelvic Parameters ◽

Sacroiliac Joint Pain ◽

Physical Findings ◽

Univariate Analyses

AbstractTo evaluate the characteristics of the spinopelvic parameters on radiography in patients with sacroiliac joint pain (SIJP). Two hundred fifty patients were included and divided into the SIJP group (those diagnosed with SIJP based on physical findings and response to analgesic periarticular injections; n = 53) and the non-SIJP group (those with low back pain [LBP] because of other reasons; n = 197). We compared their demographic characteristics and spinopelvic parameters using radiography. All differences found in the patients’ demographic characteristics and spinopelvic parameters were analyzed. More female participants experienced SIJP than male participants (P = 0.0179). Univariate analyses revealed significant differences in pelvic incidence (PI) (P = 0.0122), sacral slope (SS) (P = 0.0034), and lumbar lordosis (LL) (P = 0.0078) between the groups. The detection powers for PI, SS, and LL were 0.71, 0.84, and 0.66, respectively. Logistic regression analyses, after adjustment for age and sex, revealed significant differences in PI (P = 0.0308) and SS (P = 0.0153) between the groups, with odds ratios of 1.03 and 1.05, respectively. More female participants experienced SIJP than male participants. Higher PI and SS values were related to SIJP among LBP patients.

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Spinopelvic Parameters Do Not Predict the Sagittal Orientation of the Acetabulum

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120957420 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095742

Author(s):

Munif Hatem ◽

Scott J. Nimmons ◽

Anthony Nicholas Khoury ◽

Hal David Martin

Keyword(s):

Pelvic Incidence ◽

Sagittal Plane ◽

Cross Sectional Study ◽

Sacral Slope ◽

Spinopelvic Parameters ◽

Level Of Evidence ◽

Cross Sectional ◽

Spinopelvic Parameter ◽

Magnetic Resonance Arthrogram ◽

Sagittal Orientation

Background: The orientation of the acetabulum has a fundamental role in impingement and instability of the hip, and the spinopelvic parameters are thought to predict the sagittal orientation of the acetabulum (SOA). However, similar to the acetabular version (axial orientation) and inclination (coronal orientation), the cephalic or caudal orientation of the acetabulum in the sagittal plane, or SOA, may primarily be an intrinsic feature of the acetabulum itself. Purpose: To determine whether the spinopelvic parameters predict the sagittal orientation of the acetabulum in individuals without lumbar deformity. Study Design: Cross-sectional study; Level of evidence, 4. Methods: A retrospective analysis was performed in 89 patients (94 hips; 62 female, 27 male; mean ± SD age, 45.9 ± 15.4 years) without lumbosacral deformity who underwent magnetic resonance arthrogram (MRA) for assessment of hip pain. The SOA was determined in the sagittal cut MRA. A line was drawn at the distal limit of the anterior and posterior acetabular horns longitudinally to the transverse ligament, and the angle between this line and the axial plane represented the SOA. The sacral slope, pelvic incidence, and spinopelvic tilt were determined using a 3-dimensional cursor and the axial, sagittal, and coronal cuts. All MRA studies were performed with the patient in the supine position. Results: The SOA had a mean ± SD cephalic orientation of 18° ± 6.6°. No significant correlation was observed between the SOA and the sacral slope ( r = –0.03; P = .77). A weak correlation was observed between the SOA and the pelvic incidence ( r = 0.22; P = .03) and between the SOA and the spinopelvic tilt ( r = 0.41; P < .01). Conclusion: The SOA cannot be presumed based on the spinopelvic parameter. Similar to the well-known parameters to assess the axial and coronal orientation of the acetabulum, the assessment of the SOA demands acetabular-specific parameters. Additional studies are necessary to assess the SOA in asymptomatic hips, including disparities between genders. Clinically significant values for abnormal SOA of the acetabulum remain to be defined.

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Incidence of spinal deformity in adults and its distribution according SRS-Schwab classification

Coluna/Columna ◽

10.1590/s1808-185120151402147624 ◽

2015 ◽

Vol 14 (2) ◽

pp. 93-96 ◽

Cited By ~ 5

Author(s):

Marcus Vinicius Amaral Barreto ◽

Raphael de Rezende Pratali ◽

Carlos Eduardo Gonçales Barsotti ◽

Francisco Prado Eugenio dos Santos ◽

Carlos Eduardo Algaves Soares de Oliveira ◽

...

Keyword(s):

Spinal Deformity ◽

Total Population ◽

Vertebral Deformity ◽

Demographic Data ◽

Population Sample ◽

Brazilian Population ◽

Age Group ◽

Curve Type ◽

Radiographic Parameters ◽

Significant Difference

<sec><title>OBJECTIVE:</title> To evaluate the incidence of spinal deformity in adults, as well as its distribution according the curve type and the occurrence of sagittal modifiers of the SRS-Schwab classification..</sec><sec><title>METHODS:</title> Radiographs in frontal and lateral views of the entire column were performed and radiographic parameters were used to diagnose the vertebral deformity for the classification according to the SRS-Schwab system.</sec><sec><title>RESULTS:</title> We included 302 patients in the study, 236 (78.1%) women and 66 (21.9%) men. Fifty-six of the participants were diagnosed with ASD, 50 women and 6 men. The incidence of ASD was 18.5% in the total population, ranging from 9.1% in males and 21.2% in females (p=0.04). As to age group, the incidence was 11.9% in patients between 18 and 39 years, 12% between 40 and 59 years and 28.8% in patients with 60 years of age or older, significantly higher in the oldest group (p=0.002). When analyzing the correlation between age and progression of sagittal modifiers, there was no significant difference in the PI-LL and PT modifiers, but there was significant difference of SVA modifier (p=0.008), with a higher age in individuals "++".</sec><sec><title>CONCLUSION:</title> This study presented demographic data on ASD in a Brazilian population sample. There was a higher incidence of ASD in females and individuals aged ≥ 60 years. As for the sagittal modifiers of SRS-Schwab classification, there was a correlation between increasing age and degree of progression of SVA.</sec>

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

10.21203/rs.2.16543/v1 ◽

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.

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EFFECTS OF SAGITTAL BALANCE DIFFERENCES ON SPONDYLOLISTHESIS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220192702205665 ◽

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.

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ASSOCIATION OF SPINOPELVIC PARAMETERS WITH THE LOCATION OF LUMBAR DISC HERNIATION

Coluna/Columna ◽

10.1590/s1808-185120151403145172 ◽

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.

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