scholarly journals SAGITTAL BALANCE AFTER POSTERIOR INSTRUMENTATION IN LUMBAR FRACTURES

2018 ◽  
Vol 17 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Luis Muñiz Luna ◽  
Fernando Guevara Villazón ◽  
José Enrique Salcedo Oviedo ◽  
Iván Omar Cáliz Castorena
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Posterior Instrumentation ◽  
Case Series ◽  
Sacral Slope ◽  
Level Of Evidence ◽  
Spinopelvic Balance ◽  
Clinical Consequences ◽  
Lumbar Fractures

ABSTRACT Objective: When a lumbar fractures developes a significant deformity, the sagittal balance is altered which can lead to clinical consequences. The aim of this study was to measure and analyze the sagittal balance in patients with lumbar fractures operated with posterior instrumentation after three months and analyze their correlation with the different variables of the patient and the fracture. Methods: Sixty-three medical records of patients with lumbar fracture operated with posterior instrumentation were analyzed, excluding those with previous spinal pathology, or inability to stand upright. The parameters of pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, lumbar lordosis/pelvic incidence (LL/ PI) ratio, as well as the pre and postoperative status of segmental kyphosis and residual pain were measured. Results: Eighteen women, 44 men, with mean age of 42 years, with lumbar fractures: 29 in L1, 19 in L2, 10 in L3, 3 in L4 and 1 in L5. AOSpine Clasification: 2 type A1, 2 type A2, 37 type A3, 19 type A4, 2 type B. All patients were operated with a transpedicular polyaxial system. More than 80% of patients with spinopelvic balance within parameters considered normal. More than 70% with lumbar lordosis and LL/PI ratio within parameters. All with improvement of segmental kyphosis (average correction of 8.5°, p<.000). Final mean VAS of 1.85. Conclusions: The posterior instrumentation with a polyaxial system allows acceptable corrections of the segmental kyphosis of lumbar fractures. No statistically significant correlation was found between sagittal balance parameters, and characteristics of the patient and fracture. Level of Evidence IV; Case series.

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.

Spinopelvic Characteristics in Acetabular Retroversion: Does Pelvic Tilt Change After Periacetabular Osteotomy?

2019 ◽  
Vol 48 (1) ◽  
pp. 181-187 ◽  
Author(s):  
George Grammatopoulos ◽  
Saif Salih ◽  
Paul E. Beaule ◽  
Johan Witt
Keyword(s):  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Pelvic Ring ◽  
Periacetabular Osteotomy ◽  
Case Series ◽  
Acetabular Retroversion ◽  
Sacral Slope ◽  
Anterior Pelvic Plane ◽  
Level Of Evidence ◽  
Pelvic Position

Background: Acetabular retroversion may lead to impingement and pain, which can be treated with an anteverting periacetabular osteotomy (aPAO). Pelvic tilt influences acetabular orientation; as pelvic tilt angle reduces, acetabular version reduces. Thus, acetabular retroversion may be a deformity secondary to abnormal pelvic tilt (functional retroversion) or an anatomic deformity of the acetabulum and the innominate bone (pelvic ring). Purpose: To (1) measure the spinopelvic morphology in patients with acetabular retroversion and (2) assess whether pelvic tilt changes after successful anteverting PAO (aPAO), thus testing whether preoperative pelvic tilt was compensatory. Study Design: Case series; Level of evidence, 4. Methods: A consecutive cohort of 48 hips (42 patients; 30 ± 7 years [mean ± SD]) with acetabular retroversion that underwent successful aPAO was studied. Spinopelvic morphology (pelvic tilt, pelvic incidence, anterior pelvic plane, and sacral slope) was measured from computed tomography scans including the sacral end plate in 21 patients, with adequate images. In addition, the change in pelvic tilt with aPAO was measured via the sacrofemoral-pubic angle with supine pelvic radiographs at an interval of 2.5 ± 2 years. Results: The spinopelvic characteristics included a pelvic tilt of 4° ± 4°, a sacral slope of 39° ± 9°, an anterior pelvic plane angle of 11° ± 5°, and a pelvic incidence of 42° ± 10°. Preoperative pelvic tilt was 4° ± 4° and did not change postoperatively (4° ± 4°) ( P = .676). Conclusion: Pelvic tilt in acetabular retroversion was within normal parameters, illustrating “normal” sagittal pelvic balance and values similar to those reported in the literature in healthy subjects. In addition, it did not change after aPAO. Thus, acetabular retroversion was not secondary to a maladaptive pelvic tilt (functional retroversion). Further work is required to assess whether retroversion is a reflection of a pelvic morphological abnormality rather than an isolated acetabular abnormality. Treatment of acetabular retroversion should focus on correcting the deformity rather than attempting to change the functional pelvic position.

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.

scholarly journals TORACOLOMBAR BURST FRACTURES AND SPINOPELVIC BALANCE

2020 ◽  
Vol 19 (2) ◽  
pp. 133-136
Author(s):  
DANIEL COSTA ◽  
OSMAR AVANZI ◽  
MARIA FERNANDA SILBER CAFFARO ◽  
ALBERTO GOTFRYD ◽  
NELSON ASTUR ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Sacral Slope ◽  
Spinopelvic Parameters ◽  
Level Of Evidence ◽  
Thoracolumbar Burst Fractures ◽  
Spinopelvic Alignment ◽  
Burst Fractures ◽  
Spinopelvic Balance ◽  
Sagittal Parameters

ABSTRACT Objective To describe the spinopelvic parameters in patients with conservatively treated thoracolumbar burst fractures. Methods Twenty-six patients with thoracolumbar burst fractures treated conservatively between 2008 and 2017 participated in the study. Inclusion criteria were acute burst-type fractures, located between T11 and L2, which compromised a single vertebral segment, did not present a neurological deficit, and had a minimum of 6 months of follow-up, excluding injuries that presented distraction or rotation, pathological fractures, and surgically treated cases. The sagittal and spinopelvic alignment parameters, including vertical sagittal axis, sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, and regional kyphosis, were analyzed. Results The values obtained for the sample showed that there was an increase in regional kyphosis and that the mean sagittal parameters and lumbar lordosis were within the values considered normal in the literature. Conclusion Patients with thoracolumbar burst fractures treated conservatively had no alterations in the spinopelvic parameters. Level of Evidence II; Retrospective study.

scholarly journals SAGITTAL BALANCE IN ADOLESCENT IDIOPATHIC SCOLIOSIS

2019 ◽  
Vol 18 (3) ◽  
pp. 182-186 ◽  
Author(s):  
EDUARDO MOREIRA PINTO ◽  
JORGE ALVES ◽  
ARTUR TEIXEIRA ◽  
ANTÓNIO MIRANDA
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Case Series ◽  
Level Of Evidence ◽  
Thoracic Curvature ◽  
Upper Thoracic ◽  
Cervical Spine Alignment

ABSTRACT Objective The objective of this study is to achieve a better understanding of the parameters that influence sagittal balance in a population with adolescent idiopathic scoliosis (AIS). Methods A retrospective study of 80 patients with adolescent idiopathic scoliosis (AIS) was conducted. The parameters evaluated were: age, sex, pelvic incidence (PI), sacral slop (SS), pelvic tilt (PT), sagittal balance (SB), coronal balance (CB), lumbar lordosis (LL), thoracic kyphosis (TK) divided into upper (between T1 and T5) and lower (between T5 and T12), cervical spine alignment (CSA), and Cobb’s coronal angle (CCA) of primary scoliotic curvature. Results Regarding the sagittal balance, this study demonstrated a significant statistical positive correlation with cervical shape (p<0.01) and upper thoracic kyphosis (from T1 to T5) (p<0.05), but not with the other variables. LL had a strong influence on lower thoracic curvature (from T5 to T12) and was strongly influenced by the PI and SS. Conclusions Sagittal balance is a parameter that is influenced by multiple factors. In fact, it is closely related to cervical shape and the upper thoracic curvature (from T1 to T5), which in turn, is closely linked to the severity of the scoliotic kyphosis. The Cobb angle of the lower thoracic spine (from T5 to T12) is more closely correlated with the angle of lumbar lordosis than with the upper thoracic kyphosis (from T1 to T5). Level of evidence IV; Case Series.

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.

scholarly journals Posterior-Only Approach with Pedicle Screws for the Correction of Scheuermann's Kyphosis

2017 ◽  
Vol 11 (4) ◽  
pp. 513-519 ◽  
Author(s):  
Adem Cobden ◽  
Akif Albayrak ◽  
Yalkin Camurcu ◽  
Hakan Sofu ◽  
Temel Tacal ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pedicle Screws ◽  
Definitive Treatment ◽  
Sacral Slope ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Radiological Results ◽  
Lower Complication ◽  
Clinical And Radiological Results

<sec><title>Study Design</title><p>Retrospective study (level of evidence: level 3).</p></sec><sec><title>Purpose</title><p>The purpose of this study was to evaluate the clinical and radiological results of the posterior-only approach with pedicle screws for the treatment of Scheuermann's kyphosis (SK).</p></sec><sec><title>Overview of Literature</title><p>The correction of SK with instrumentation can be performed using posterior-only or combined anterior-posterior procedures. With the use of all-pedicle screw constructs in spine surgery, the posterior-only approach has become a popular option for the definitive treatment of SK. In a nationwide study involving 2,796 patients, a trend toward posterior-only fusion with lower complication rates was reported.</p></sec><sec><title>Methods</title><p>We retrospectively reviewed the data of patients who underwent posterior-only correction for SK between January 2005 and May 2013. Patients with a definite diagnosis of SK who fulfilled the minimum follow-up criterion of 24 months were included. The thoracic kyphosis (T5–T12), lumbar lordosis (L1–S1), and thoracolumbar junction (T10–L2) angles were measured from preoperative, postoperative, and last control radiographs. Sagittal balance, thoracic length, thoracic diameter, Voutsinas index and the sacral slope, pelvic tilt, proximal junction kyphosis, and distal junction kyphosis angles were also measured.</p></sec><sec><title>Results</title><p>Forty-five patients underwent surgery for the treatment of SK between 2005 and 2013. After applying the exclusion criteria, 20 patients (18 males and 2 females) with a mean age of 19 years were included. The mean thoracic kyphosis angle was 79.8 degrees preoperatively, 44.6 degrees postoperatively, and 44.9 degrees at the last control. There were statistically significant differences between preoperative and postoperative values in the thoracic kyphosis and lumbar lordosis angles, thoracic length, thoracic diameter, and Voutsinas index (<italic>p</italic>&lt;0.05).</p></sec><sec><title>Conclusions</title><p>The clinical and radiological results of the current study suggest that posterior-only fusion is an efficient technique for the treatment of SK.</p></sec>

scholarly journals Spinopelvic Parameters Do Not Predict the Sagittal Orientation of the Acetabulum

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.

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

2017 ◽  
Vol 26 (1) ◽  
pp. 45-49 ◽  
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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