Iliopectineal line: A valuable radiological reference for spino-pelvic parameters

Objectives: Spinopelvic parameters are crucial to address sagittal spinal imbalance; such measurements require standardized lateral radiographs that include spine and hips, which are neither always available, nor readily feasible intra-operatively. The aim of this study was to describe pelvic radiological reference points that could provide reliable sagittal balance estimates from conventional lumbosacral lateral radiographs. Methods: A descriptive, cross-sectional, radiological-based study was conducted. Readings were taken from institute’s digital radiology library, blinded to personal and clinical data. The correlation was made to conventional pelvic incidence (CPI), conventional pelvic tilt (CPT), and sacral slope (SS), measured for the same patients, and from the same standardized standing radiographs that included femoral heads. Results: Radiological images for 140 adult subjects, with suspected or established spine problems were studied. The average lumbar lordosis (LL) of 3 readers was 47 ± 13 (13–81) with an interclass agreement of 0.9, SS was 41 ± 9 with an interclass agreement of 0.9, CPI was 53 ± 10 with an interclass agreement of 0.8, CPT was 14 ± 8 with an interclass agreement of 0.9, iliopectineal inclination (IPI) of 4 readers was 64 ± 8 with an interclass agreement of 0.7 and iliopectineal tilt (IPT) was 24 ± 8 with an interclass agreement of 0.8 LL was with 6° of CPI and 16° of IPI. The CPI was equal to (CPI = SS + [CPT + 1.2]) and (IPI = SS + [IPT + 0.6]). The IPI was negatively correlated with CPI –0.2 P = 0.006, and IPI was negatively correlated with CPT –0.333 P < 0.001. Conclusion: Iliopectineal line provides reproducible readings, closer values to LL, and addresses the center of mass displacement.

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Postoperative Changes in Pelvic Parameters and Sagittal Balance in Adult Isthmic Spondylolisthesis

Operative Neurosurgery ◽

10.1227/neu.0b013e3182117249 ◽

2011 ◽

Vol 68 (suppl_2) ◽

pp. ons355-ons363 ◽

Cited By ~ 3

Author(s):

Se Jun Park ◽

Chong Suh Lee ◽

Sung Soo Chung ◽

Kyung Chung Kang ◽

Seong Kee Shin

Keyword(s):

Sagittal Balance ◽

Interbody Fusion ◽

Pelvic Tilt ◽

Posterior Instrumentation ◽

Posterior Lumbar Interbody Fusion ◽

Surgical Correction ◽

Slip Angle ◽

Sacral Slope ◽

Isthmic Spondylolisthesis ◽

Pelvic Parameters

Abstract Background: Correction of deformity in adult isthmic spondylolisthesis can affect the pelvic parameters and sagittal balance. Objective: To evaluate the correlation with the amount of deformity correction and the subsequent change in pelvic parameters after surgical correction of adult isthmic spondylolisthesis and to determine which deformity parameter most affects the postoperative restoration of spinopelvic sagittal alignment. Methods: Fifty-eight patients with 1-level isthmic spondylolisthesis were included. Their average age was 55 years (range, 24–76 years). All patients underwent operation by posterior lumbar interbody fusion and posterior instrumentation. The pre- and postoperative sacral slope, pelvic tilt, lumbar lordosis (LL), and sagittal balance were measured, and then the correlation between these parameters and deformity parameters such as slip degree, slip angle, and height of the intervertebral disc (HOD) was evaluated. Results: The slip degree, slip angle, and HOD were significantly recovered after surgery. Pelvic parameters and sagittal balance changed subsequently. Sacral slope was increased by 4.4 degrees, and pelvic tilt was decreased by 4.4 degrees. LL was increased by 5.2 degrees and sagittal balance was displaced 5.6 mm posteriorly. Only the restoration of the HOD showed a significant correlation with the change in LL (r = 0.305, P = .02) and sagittal balance (r = 0.377, P = .004). Conclusion: Surgical correction of adult isthmic spondylolisthesis with posterior lumbar interbody fusion and posterior instrumentation resulted in improvement of sacral slope, pelvic tilt, LL, and sagittal balance. Only restoration of the HOD was significantly correlated with improvement of LL and sagittal balance. Therefore we presume it is important to restore the HOD in surgical correction of adult isthmic spondylolisthesis.

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Synchronous imaging of pelvic geometry and muscle morphometry: a pilot study of pelvic retroversion using upright MRI

Scientific Reports ◽

10.1038/s41598-021-99305-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Noor Shaikh ◽

Honglin Zhang ◽

Stephen H. M. Brown ◽

Hamza Lari ◽

Oliver Lasry ◽

...

Keyword(s):

Pelvic Tilt ◽

Pelvic Incidence ◽

Sacral Slope ◽

Resonance Imaging ◽

Cross Sectional ◽

Future Studies ◽

Upright Mri ◽

Asymptomatic Volunteers ◽

Good Repeatability ◽

Magnetic Resonance Imaging Mri

AbstractThis study investigated feasibility of imaging lumbopelvic musculature and geometry in tandem using upright magnetic resonance imaging (MRI) in asymptomatic adults, and explored the effect of pelvic retroversion on lumbopelvic musculature and geometry. Six asymptomatic volunteers were imaged (0.5 T upright MRI) in 4 postures: standing, standing pelvic retroversion, standing 30° flexion, and supine. Measures included muscle morphometry [cross-sectional area (CSA), circularity, radius, and angle] of the gluteus and iliopsoas, and pelvic geometry [pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), L3–S1 lumbar lordosis (LL)] L3-coccyx. With four volunteers repeating postures, and three raters assessing repeatability, there was generally good repeatability [ICC(3,1) 0.80–0.97]. Retroversion had level dependent effects on muscle measures, for example gluteus CSA and circularity increased (up to 22%). Retroversion increased PT, decreased SS, and decreased L3–S1 LL, but did not affect PI. Gluteus CSA and circularity also had level-specific correlations with PT, SS, and L3–S1 LL. Overall, upright MRI of the lumbopelvic musculature is feasible with good reproducibility, and the morphometry of the involved muscles significantly changes with posture. This finding has the potential to be used for clinical consideration in designing and performing future studies with greater number of healthy subjects and patients.

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

Coluna/Columna ◽

10.1590/s1808-185120201902224026 ◽

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.

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Anatomical sacral slope, a new pelvic parameter, is associated with lumbar lordosis and pelvic incidence in healthy Japanese women: A retrospective cross-sectional study

Journal of Orthopaedic Surgery ◽

10.1177/2309499019888809 ◽

2019 ◽

Vol 28 (1) ◽

pp. 230949901988880

Author(s):

Hayato Suzuki ◽

Norio Imai ◽

Asami Nozaki ◽

Yuki Hirano ◽

Naoto Endo

Keyword(s):

Lumbar Lordosis ◽

Pelvic Incidence ◽

Intraclass Correlation ◽

Three Dimensional ◽

Correlation Coefficients ◽

Normal Subjects ◽

Cross Sectional Study ◽

Sacral Slope ◽

Cross Sectional ◽

Pelvic Parameters

Purpose: Anatomical sacral slope (a-SS), a pelvic anatomical parameter that does not require the center of the femoral head, strongly correlates with pelvic incidence (PI) during three-dimensional measurements in normal subjects. Sagittal alignment of spinal and pelvic parameters is typically evaluated using two-dimensional radiographs; however, the relationship between a-SS and PI has not been evaluated using radiographs. This study aimed to evaluate the correlation between a-SS and other spinal and pelvic parameters using radiographs. Methods: We evaluated 144 healthy women. Using sagittal radiographs, we measured lumbar lordosis (LL), thoracic kyphosis, PI, SS, pelvic tilt, and a-SS, which were defined as the angle between the superior end plate of S1 and a line perpendicular to the anterior pelvic plane. Pearson coefficients were used to determine correlations, and intraobserver and interobserver intraclass correlation coefficients (ICCs) were used for validation. Results: There was a strong correlation between PI and a-SS ( r = 0.756). Moreover, correlations between a-SS and LL and between PI and LL were similar ( r = 0.661 and r = 0.554, respectively). The intraobserver ICCs were 0.884 for a-SS and 0.840 for PI. The interobserver ICCs were 0.856 for a-SS and 0.653 for PI. Conclusion: a-SS was strongly correlated with PI. The correlation between a-SS and LL was equivalent to the correlation between PI and LL. Moreover, the ICC for a-SS was larger than that of PI. This study suggests that a-SS is a useful new pelvic anatomical parameter that can be used instead of PI.

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Pelvic Rotation and Inclination Affect Reliability of Sagittal Pelvic Alignment and Anterior Pelvic Plane Angle Measured by EOS System

10.29007/98fd ◽

2018 ◽

Author(s):

Masashi Okamoto ◽

Kunihiko Tokunaga

Keyword(s):

Pelvic Tilt ◽

Standing Position ◽

Reference Points ◽

Sacral Slope ◽

Plane Angle ◽

Anterior Pelvic Plane ◽

Pelvic Rotation ◽

X Ray ◽

Axis Rotation ◽

Eos System

The Difficulties to obtain acceptable pelvic reference points on bi- planar X-ray images for EOS measurements change as the patient’s pelvis rotated or inclined. The aim of this study was to clarify the effects of pelvic Z-axis rotation (rotation) and X-axis rotation (inclination) on the measurement values of SS, PT, and APP angle by using of EOS. Methods: We obtained anteroposterior and lateral X-ray images of a trunk phantom which was rotated and inclined in standing position by using of the EOS. Sacral slope (SS) and pelvic tilt (PT) as parameters to judge patient’s pelvic alignments by spinal surgeons, and anterior pelvic (APP) angle as a reference to decide patient’s pelvic alignments by hip surgeons were measured with the EOS software. The values of SS and PT and APP angle were compared in the phantom rotation and inclination. Results: PT showed small changes when the phantom was rotated, however, SS decreased and APP angle increased when the phantom was rotated. The values of SS and PT dispersed at 300 rotation among each inclination. APP angle dispersed at -15o and 30o of rotation among each inclination. Conclusion: Measurement variations of SS and PT were small amount under 15 degrees of rotation and inclination. On the contrary, APP angles showed greater variations when the phantom was rotated and inclined. Proper positioning of subjects, by reducing rotational effects, is important to get constant reproducible measurements, even if we use EOS system.

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Association between back muscle degeneration and spinal-pelvic parameters in patients with degenerative spinal kyphosis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2837-0 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Weiwei Xia ◽

Han Fu ◽

Zhenqi Zhu ◽

Chenjun Liu ◽

Kaifeng Wang ◽

...

Keyword(s):

Erector Spinae ◽

Sacral Slope ◽

Muscle Degeneration ◽

Imaging Data ◽

Spinal Level ◽

Sagittal Vertical Axis ◽

Cross Sectional ◽

Pelvic Parameters ◽

Lumbar Level ◽

Psoas Muscles

Abstract Background The paraspinal and psoas muscles have been considered to be essentially important for stabilizing the spinal column, and the muscle degeneration was found to exist in degenerative spinal kyphosis (DSK) patients. However, it is still not clear the relationship between muscle degeneration and spinal-pelvic alignment. The purpose of this study was to determine the correlations between the individual muscle degeneration at each lumbar spinal level and spinal-pelvic parameters in DSK patients. Methods The imaging data of 32 patients with DSK were retrospectively analyzed. The fat infiltration (FI) and relative cross-sectional area of muscle (RCSA) were quantitatively measured for multifidus (MF), erector spinae (ES) and psoas (PS) at each spinal level from L1/2 to L5/S1. The correlations were analyzed between RCSA and the sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI). Results The FI of MF and ES at L3/4, L4/5 and L5/S1 were higher than that at L1/2 and L2/3. The FI of PS at L4/5 and L5/S1 were lower than that of L1/2, L2/3 and L3/4. The RCSA of ES and PS from L1/2 to L5/S1 gradually increased, whereas the RCSA of ES from L1/2 to S5/S1 gradually decreased. The RCSA of MF at the L1/2 level was negatively correlated SVA (r = − 0.397,p = 0.024); the RCSA at L3/4, L4/5 and L5/S1 levels were negatively correlated with TK (r = − 0.364, p = 0.04; r = − 0.38, p = 0.032; r = − 0.432, p = 0.014); the RCSA at L4/5 level was positively correlated with LL (r = 0.528, p = 0.002). The RCSA of ES at L3/4 and L4/5 levels were positively correlated with PI (r = 0.377, p = 0.037) and SS (r = 0.420, p = 0.019). Conclusions FI of MF and ES at lower lumbar level is higher than that at upper level, but FI of PS at upper lumbar level is higher than that at lower level. MF and ES have different roles for maintaining the sagittal spinal-pelvic balance.

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ALTERATION OF PELVIC PARAMETERS IN ADJACENT SEGMENT DEGENERATION

Coluna/Columna ◽

10.1590/s1808-185120181702189442 ◽

2018 ◽

Vol 17 (2) ◽

pp. 99-102 ◽

Cited By ~ 1

Author(s):

Carla Lisette García Ramos ◽

Alejandro Reyes Sánchez

Keyword(s):

Pelvic Tilt ◽

Pelvic Incidence ◽

Adjacent Segment Degeneration ◽

Lumbar Spine Surgery ◽

Sacral Slope ◽

Adjacent Segment ◽

Level Of Evidence ◽

Pelvic Parameters ◽

Study Results

ABSTRACT Objective: To describe the changes in the spino-pelvic parameters obtained after lumbar spine surgery. Methods: Prospective study. Results: The post-surgical pelvic parameters were found as follows: pelvic incidence of 75.75°, sacral slope 46.18°, pelvic tilt 19.68°. The sagittal balance was 30.93 mm, the postoperative lordosis was 66.06°. The surgery has significant effects on the patient's pain and posture. In our analysis, in a 12-month follow-up, we found: four patients (8.8%, two males and two females) with degeneration of the adjacent segment according to the criteria, and there was no degeneration of the underlying segment, nor any relationship with the spino-pelvic parameters. Conclusions: The degeneration of the adjacent segment does not correlate with the pelvic parameters. Level of Evidence II, Prognostic studies. Investigation of the effect of characteristics of a patient on the outcome of the disease.

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Underarm bracing for adolescent idiopathic scoliosis leads to flatback deformity

The Bone & Joint Journal ◽

10.1302/0301-620x.101b11.bjj-2019-0515.r1 ◽

2019 ◽

Vol 101-B (11) ◽

pp. 1370-1378 ◽

Cited By ~ 5

Author(s):

Jason P. Y. Cheung ◽

Christopher H. W. Chong ◽

Prudence W. H. Cheung

Keyword(s):

Quality Of Life ◽

Lumbar Spine ◽

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Pelvic Tilt ◽

Vertical Axis ◽

Sacral Slope ◽

Sagittal Vertical Axis ◽

Pelvic Parameters

Aims The aim of this study was to determine the influence of pelvic parameters on the tendency of patients with adolescent idiopathic scoliosis (AIS) to develop flatback deformity (thoracic hypokyphosis and lumbar hypolordosis) and its effect on quality-of-life outcomes. Patients and Methods This was a radiological study of 265 patients recruited for Boston bracing between December 2008 and December 2013. Posteroanterior and lateral radiographs were obtained before, immediately after, and two-years after completion of bracing. Measurements of coronal and sagittal Cobb angles, coronal balance, sagittal vertical axis, and pelvic parameters were made. The refined 22-item Scoliosis Research Society (SRS-22r) questionnaire was recorded. Association between independent factors and outcomes of postbracing ≥ 6° kyphotic changes in the thoracic spine and ≥ 6° lordotic changes in the lumbar spine were tested using likelihood ratio chi-squared test and univariable logistic regression. Multivariable logistic regression models were then generated for both outcomes with odds ratios (ORs), and with SRS-22r scores. Results Reduced T5-12 kyphosis (mean -4.3° (sd 8.2); p < 0.001), maximum thoracic kyphosis (mean -4.3° (sd 9.3); p < 0.001), and lumbar lordosis (mean -5.6° (sd 12.0); p < 0.001) were observed after bracing treatment. Increasing prebrace maximum kyphosis (OR 1.133) and lumbar lordosis (OR 0.92) was associated with postbracing hypokyphotic change. Prebrace sagittal vertical axis (OR 0.975), prebrace sacral slope (OR 1.127), prebrace pelvic tilt (OR 0.940), and change in maximum thoracic kyphosis (OR 0.878) were predictors for lumbar hypolordotic changes. There were no relationships between coronal deformity, thoracic kyphosis, or lumbar lordosis with SRS-22r scores. Conclusion Brace treatment leads to flatback deformity with thoracic hypokyphosis and lumbar hypolordosis. Changes in the thoracic spine are associated with similar changes in the lumbar spine. Increased sacral slope, reduced pelvic tilt, and pelvic incidence are associated with reduced lordosis in the lumbar spine after bracing. Nevertheless, these sagittal parameter changes do not appear to be associated with worse quality of life. Cite this article: Bone Joint J 2019;101-B:1370–1378.

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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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Effect of the Mini Nutritional Assessment-Short Form (MNA-SF) in Elderly Burn Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/irab164 ◽

2021 ◽

Author(s):

Jia-Yu Wei ◽

Shu-Ting Shi ◽

Dan Sun ◽

Guo-Zhong Lyu

Keyword(s):

Wound Healing ◽

Nutritional Status ◽

Nutritional Assessment ◽

Short Form ◽

Mini Nutritional Assessment ◽

The Elderly ◽

Reference Points ◽

Nutrition Intervention ◽

Burn Patients ◽

Cross Sectional

Abstract Objective Nutritional assessment can early identify patients who are malnourished and at risk of malnutrition. To examine the effect of nutritional status on wound healing in elderly burn patients, we used the MNA-SF to measure the nutritional status of elderly patients. This study aimed to examine the role of MNA-SF in elderly burn patients through the correlation analysis of wound-healing indicators and MNA-SF score. Design Prospective observational and cross-sectional study. Methods This study used the MNA-SF to investigate the elderly burn patients at the department of burn. According to the score, the patients fell into three groups: good nutritional status (more than 12 points), malnutrition risk (8~11 points), and malnutrition (0~7 points). At the same time, we measured and compared the wound-healing indicators among the three groups of patients, and detected the correlation. Results The statistical analysis found gender had a slight influence on the score of nutritional status. While age was negatively correlated with the MNA-SF score and nutrition-related indicators. There was a low positive linear correlation between the wound healing percent area change or wound healing rate of patients and the score of the MNA-SF. Conclusion This study finds malnutrition is common among hospitalized elderly burn patients. The application of the MNA-SF in elderly burn patients is efficient and accurate to identify malnutrition early and prevent further obstruction of the normal wound healing, which can provide reference points for early nutrition intervention programs.

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