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

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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Increasing pelvic incidence is associated with more global sagittal imbalance in ankylosing spondylitis with thoracolumbar kyphosis: an observational retrospective study of 94 cases

10.21203/rs.2.16543/v3 ◽

2020 ◽

Author(s):

Diyu Song ◽

Guoquan Zheng ◽

Tianhao Wang ◽

Dengbin Qi ◽

Yan Wang

Keyword(s):

Ankylosing Spondylitis ◽

Pelvic Incidence ◽

Pearson Correlation ◽

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 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 (27 males and 3 females) were reviewed. The mean age was 36.8 years in AS patients and 34.4 years in controls. Gender ratios and mean age were similar in both group. 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. The same spine surgeons measured all the parameters of the AS and control group. All the sagittal spinopelvic parameters were compared between the groups. The relationship between PI and other spinopelvic parameters was analyzed with Pearson correlation (r) and unary linear regression model.Results: All the sagittal parameters were found to be significantly different between AS patients and controls. Compared with the control group, the AS patients had significantly higher PI(47.4˚ vs. 43.2˚, P<0.001). Correlation analysis revealed that PI in AS patients was 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.

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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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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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Spinopelvic sagittal imbalance is risky for development of proximal instrumented fracture after posterior instrumentation.

10.21203/rs.3.rs-253715/v1 ◽

2021 ◽

Author(s):

Jen-Chung Liao ◽

Wen-Jer Chen

Keyword(s):

Posterior Instrumentation ◽

Control Group ◽

Sacral Slope ◽

Sagittal Imbalance ◽

Study Group ◽

Fracture Type ◽

Mineral Density ◽

Spinopelvic Parameters ◽

T Score ◽

Proximal Junctional Failure

Abstract Backgrounds: Postoperative fracture of the upper instrumented vertebrae (UIV) is thought to be as fracture type of proximal junctional failure (PJF), which usually needs revision surgery for salvage. The purpose of this study was to investigate the influences of spinopelvic parameters, such as the pelvic incidence (PI) angles, sacral slope (SS) angles, and pelvic tilt (PT), sagittal vertical axis (SVA), and proximal local kyphosis (PLK) angle on the development of fracture type of proximal junctional failure after posterior instrumentation. Methods This was a retrospective 1:3 matched case-control cohort study: 24 patients in the study group and 72 patients in the control group. The weighted Charlson Comorbidity Index (CCI) and bone mineral density (BMD) with T score were recorded. In addition to spinopelvic parameters, PI-LL and spinopelvic realignment score were calculated. Results More comorbidities (CCI, p = 0.002), poorer bone density (T score, p = 0.001) were noted in the study group. Before surgery, the study group had significantly lower LL (p = 0.046), SS (p = 0.043), and significantly higher PLK (p < 0.001), PT (p = 0.044) than the control group. Postoperatively, the study group had significantly higher PLK (p < 0.001 ) and lower LL (p = 0.031) than the control group; the degree of PI-LL ( p = 0.007) remained significantly higher in the study group. Both preoperative (p = 0.026) and postoperative (p = 0.045) spinopelvic realignment scores was worse in the study goup. Conclusions Preoperative and postoperative lower LL/spinopelvic realignment score, and higher PLK/PI-LL were significantly associated with instrumented fracture at upper instrumented vertebrae. An appropriate LL and a lower PLK should be obtained at surgery to prevent the development of instrumented fracture.

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

Coluna/Columna ◽

10.1590/s1808-18512014130200399 ◽

2014 ◽

Vol 13 (2) ◽

pp. 108-111 ◽

Cited By ~ 5

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.

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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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Increasing pelvic incidence is associated with more global sagittal imbalance in ankylosing spondylitis with thoracolumbar kyphosis: an observational retrospective study of 94 cases

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03226-0 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Diyu Song ◽

Guoquan Zheng ◽

Tianhao Wang ◽

Dengbin Qi ◽

Yan Wang

Keyword(s):

Retrospective Study ◽

Ankylosing Spondylitis ◽

Pelvic Incidence ◽

Sagittal Imbalance ◽

Thoracolumbar Kyphosis

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Spinal Balance/Alignment—Clinical Relevance and Biomechanics

Journal of Biomechanical Engineering ◽

10.1115/1.4043650 ◽

2019 ◽

Vol 141 (7) ◽

Cited By ~ 4

Author(s):

Anoli Shah ◽

Justin V. C. Lemans ◽

Joseph Zavatsky ◽

Aakash Agarwal ◽

Moyo C. Kruyt ◽

...

Keyword(s):

Social Interaction ◽

Sagittal Balance ◽

Sagittal Plane ◽

The Body ◽

Optimal Configuration ◽

Sacral Slope ◽

Sagittal Imbalance ◽

Compensatory Mechanisms ◽

Spinal Balance ◽

Spinal Imbalance

In the anatomy of a normal spine, due to the curvatures in various regions, the C7 plumb line (C7PL) passes through the sacrum so that the head is centered over the pelvic-ball and socket hip and ankle joints. A failure to recognize malalignment in the sagittal plane can affect the patient's activity as well as social interaction due to deficient forward gaze. The sagittal balance configuration leads to the body undertaking the least muscular activities as possible necessary to maintain spinal balance. Global sagittal imbalance is energy consuming and often results in painful compensatory mechanisms that in turn negatively influence the patient's quality of life, self-image, and social interaction due to inability to maintain a horizontal gaze. Deformity, scoliosis, kyphosis, trauma, and/or surgery are some ways that this optimal configuration can be disturbed, thus requiring higher muscular activity to maintain posture and balance. Several parameters such as the thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and hip and leg positions influence the sagittal balance and thus the optimal configuration of spinal alignment. This review examines the clinical and biomechanical aspects of spinal imbalance, and the biomechanics of spinal balance as dictated by deformities—ankylosing spondylitis (AS), scoliosis and kyphosis; surgical corrections—pedicle subtraction osteotomies (PSO), long segment stabilizations, and consequent postural complications like proximal and distal junctional kyphosis. The study of the biomechanics involved in spinal imbalance is relatively new and thus the literature is rather sparse. This review suggests several potential research topics in the area of spinal biomechanics.

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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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