scholarly journals Reliability of pelvic parameters measurement with sterEOS: preliminary results

10.29007/1rd2 ◽  
2019 ◽  
Author(s):  
Aziliz Guezou-Philippe ◽  
Guillaume Dardenne ◽  
Morgane Dorniol ◽  
Hoel Letissier ◽  
Christian Lefèvre ◽  
...  
Keyword(s):  
Pelvic Incidence ◽  
Sacral Slope ◽  
Anterior Pelvic Plane ◽  
Femur Length ◽  
Pelvic Parameters ◽  
Eos Imaging ◽  
Observer Experience ◽  
Preliminary Study ◽  
Parameters Measurement ◽  
The Impact

SterEOS is a software developed by EOS Imaging® allowing the measurement of 3D orthopaedic parameters on two bi-planar radiographs. The goal of this preliminary study was to assess the reliability of the pelvic measurements. Two observers, a novice and an intermediate user, measured three times these parameters on pre and postoperative EOS images coming from ten patients. Intra- and inter-observer precision have been evaluated with intra-class coefficient (ICC) and Bland-Altman graphs. On preoperative EOS images, a high intra- and inter-observer precision (ICC>0.8) was obtained for the measurement of the femoral head diameter, the femur length, the pelvic version and the pelvic obliquity. The offset, the femoral neck length, the pelvic incidence and the sacral slope measurement had a high intra-observer precision but a lower inter-observer precision. The measurement of the acetabulum inclination and anteversion, the CCD angle, the femur torsion, the pelvic rotation and the anterior pelvic plane inclination had a low intra- and inter-observer precision. Similar results were found on postoperative EOS images. Our results are partially consistent with the literature since authors found high intra- and inter-observer precision for all pelvic parameters. Further studies are therefore needed to evaluate the impact of the observer experience on the reliability of those measurements.

scholarly journals Anterior Pelvic Plane: A Potentially Useful Pelvic Anatomical Reference Plane in Assessing the Patients’ Ideal Pelvic Parameters Without the Influence of Spinal Sagittal Deformity

2020 ◽  
pp. 219256822095867
Author(s):  
Chao Liu ◽  
Fanqi Hu ◽  
Zhizhong Li ◽  
Yan Wang ◽  
Xuesong Zhang
Keyword(s):  
Pelvic Incidence ◽  
Full Length ◽  
Reference Plane ◽  
Sacral Slope ◽  
Anterior Pelvic Plane ◽  
Spine Radiography ◽  
Pelvic Parameters ◽  
Equivalent Effect ◽  
Significant Difference ◽  
Sagittal Deformity

Study Design: Observational study. Objective: This study was aimed at investigating the reliability of anterior pelvic plane (APP) as an anatomical reference plane for assessing the patients’ pelvic incidence in patients with ankylosing spondylitis kyphosis deformity. Methods: The globe kyphosis (GK), lumber lordosis (LL), thoracolumbar kyphosis (TLK), thoracic kyphosis (TK), anatomical cervical 7 sacrum angle (aC7SA), and cervical 7 sacrum angle (C7SA) were measured on full-length spine radiography imagines. The pelvic incidence (PI), anatomical pelvic tilt (aPT), and anatomical sacral slope (aSS) were measured on the pelvic synthesized 2D lateral radiography imagines. Because the angle between APP and vertical line was about 4°, Angle1 and tPT were calculated using the following formulas: Angle1 = aC7SA − 4; PT = aPT + 4. According to the study conducted by Vialle, traditional PT (tPT) was calculated using the following widely accepted formula: tPT = PI * 0.37 − 7. Measured PT (mPT) was also measured on the full-length spine radiography imagines. Results: The data analysis showed that PI, mPT, aSS, aPT, and APPA were 50.83 ± 13.44°, 32.52 ± 4.64°, 41.36 ± 9.46°, 8.56 ± 6.80°, and 23.95 ± 5.17°, respectively. There was no significant difference between the PT and tPT (12.56 ± 6.80, 11.49 ± 4.73; P = .152). So, the results demonstrated that the PT could play the equivalent effect as tPT did for making surgical plans in patients with kyphosis deformity. Conclusion: The pelvic anatomical reference plane had potential to be used in assessing the patients’ ideal pelvic incident without the influence of spinal sagittal deformity. The aPT+4 may represent patients’ postoperative ideal PT.

scholarly journals The Impact of Spinopelvic Mobility on Arthroplasty: Implications for Hip and Spine Surgeons

2020 ◽  
Vol 9 (8) ◽  
pp. 2569 ◽  
Author(s):  
Henryk Haffer ◽  
Dominik Adl Amini ◽  
Carsten Perka ◽  
Matthias Pumberger
Keyword(s):  
Lumbar Lordosis ◽  
Flexion Contracture ◽  
Sacral Slope ◽  
Eos Imaging ◽  
Appropriate Treatment ◽  
Number Of Patients ◽  
Increased Risk ◽  
Sagittal Spinal Balance ◽  
Hip Flexion ◽  
The Impact

Spinopelvic mobility represents the complex interaction of hip, pelvis, and spine. Understanding this interaction is relevant for both arthroplasty and spine surgeons, as a predicted increasing number of patients will suffer from hip and spinal pathologies simultaneously. We conducted a comprehensive literature review, defined the nomenclature, summarized the various classifications of spinopelvic mobility, and outlined the corresponding treatment algorithms. In addition, we developed a step-by-step workup for spinopelvic mobility and total hip arthroplasty (THA). Normal spinopelvic mobility changes from standing to sitting; the hip flexes, and the posterior pelvic tilt increases with a concomitant increase in acetabular anteversion and decreasing lumbar lordosis. Most classifications are based on a division of spinopelvic mobility based on ΔSS (sacral slope) into stiff, normal, and hypermobile, and a categorization of the sagittal spinal balance regarding pelvic incidence (PI) and lumbar lordosis (LL) mismatch (PI–LL = ± 10° balanced versus PI–LL > 10° unbalanced) and corresponding adjustment of the acetabular component implantation. When performing THA, patients with suspected pathologic spinopelvic mobility should be identified by medical history and examination, and a radiological evaluation (a.p. pelvis standing and lateral femur to L1 or C7 (if EOS (EOS imaging, Paris, France) is available), respectively, for standing and sitting radiographs) of spinopelvic parameters should be conducted in order to classify the patient and determine the appropriate treatment strategy. Spine surgeons, before planned spinal fusion in the presence of osteoarthritis of the hip, should consider a hip flexion contracture and inform the patient of an increased risk of complications with existing or planned THA.

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 Correlation of tilt of the anterior pelvic plane angle with anatomical pelvic tilt and morphological configuration of the acetabulum in patients with developmental dysplasia of the hip: a cross-sectional study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Norio Imai ◽  
Hayato Suzuki ◽  
Asami Nozaki ◽  
Yuki Hirano ◽  
Naoto Endo
Keyword(s):  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Developmental Dysplasia ◽  
Morphological Parameters ◽  
Plane Angle ◽  
Acetabular Anteversion ◽  
Anterior Pelvic Plane ◽  
Functional Parameters ◽  
Pelvic Parameters ◽  
Dysplasia Of The Hip

Abstract Background It was previously reported that pelvises with developmental dysplasia of the hip are tilted anteriorly, which increases bony coverage of the femoral head. This study aimed to investigate the correlation between anatomical parameters of the pelvis such as pelvic incidence and anatomical pelvic tilt and functional parameters of the spine and pelvis such as tilt of the anterior pelvic plane. Methods We examined 84 female patients with bilateral developmental dysplasia of the hip who had undergone curved periacetabular osteotomy at author’s institution. Radiographs of the thoracic to lumbar spines and the pelvis were obtained in the standing position to measure spino-pelvic parameters before surgery. Morphological parameters of the acetabulum such as the anterior center-edge (CE) angle, posterior CE angle, lateral CE angle, and acetabular anteversion were measured using a preoperative three-dimensional pelvic model reconstructed from computed tomography images. Pearson’s correlation analysis was conducted to evaluate the relationship of these parameters. Results With regard to correlations between pelvic incidence (PI) and other parameters, the sacral slope (SS) value (r = 0.666) was the highest among functional parameters and the anatomical-SS value (r = 0.789) was the highest among morphological parameters. There were moderate correlations of the anterior pelvic plane angle (APPA) with pelvic tilt (PT) (r = − 0.594) and anatomical-PT (r = 0.646). With regard to correlations between spino-pelvic parameters and bony morphological parameters of the acetabulum, there was a moderate correlation between anatomical-PT and acetabular anteversion (AA) (r = 0.424). There were moderate correlations of APPA with the anterior CE angle (r = − 0.478), posterior CE angle (r = 0.432), and AA (r = 0.565). APPA had a stronger correlation with anatomical-PT (r = 0.646) than with AA. Conclusions The tilt of the pelvis may be more dependent on anatomical-PT, a morphological parameter of the pelvis, than the lateral CE angle, anterior CE angle, posterior CE angle, and acetabular anteversion on bony coverage of the acetabulum. This study is the first to investigate the correlation between functional parameters of the pelvis and spine and morphological parameters of the pelvis and acetabulum besides PI.

scholarly journals Validity of the EOS-determined pelvic parameters and orientation with pelvic positional variation: a phantom study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jung-Taek Kim ◽  
Dong hoon Lee ◽  
Han-Dong Lee ◽  
Han-Bit Shin ◽  
Bumhee Park ◽  
...  
Keyword(s):  
Measurement Errors ◽  
Imaging System ◽  
Three Dimensional ◽  
Sacral Slope ◽  
Geometric Means ◽  
Pelvic Parameters ◽  
Positional Variation ◽  
Eos Imaging ◽  
Custom Made ◽  
True Values

AbstractThe EOS is a medical imaging system that incorporates simultaneous orthogonal images, producing three-dimensional (3D) reconstructions of the whole skeletal system in various functional positions. Despite growing interest in the pelvic 3D position, the validity of the EOS has not yet been well studied. We investigated the trueness and precision of EOS imaging for pelvic parameters and orientation and assessed whether the measurement using the EOS was affected by the pelvic orientation itself. The orientation of the anterior pelvic plane and pelvic parameters of a custom-made pelvic phantom were measured by three raters using the EOS, and the measurements obtained were compared with the true values. The standard deviations of the measurement errors were 3.23°, 0.26°, 0.23°, 2.98°, 0.88°, and 3.22° for flexion, obliquity, rotation, pelvic incidence, spinopelvic tilt, and sacral slope, respectively. The root-mean square averages of the standard deviation of each measurement were 4.05°, 0.41°, 0.28°, 4.80°, 0.99°, and 5.13°, respectively. The measurement errors for sacral slope correlated significantly with geometric means of flexion, obliquity, and rotation (r = 0.364, p = 2.67 × 10–11). The EOS rendered accurate and reliable measurements regarding pelvic 3D position, even with positional variation, but positional variation could affect measurements of sacral slope.

scholarly journals Relationship between pelvic morphology and functional parameters in standing position for patient-specific cup planning in THA

10.29007/41f9 ◽  
2018 ◽  
Author(s):  
Maximilian Fischer ◽  
Stephanie Schörner ◽  
Stefan Rohde ◽  
Christian Lüring ◽  
Klaus Radermacher
Keyword(s):  
Pelvic Tilt ◽  
Planning Process ◽  
Pelvic Incidence ◽  
Pubic Symphysis ◽  
Standing Position ◽  
Patient Specific ◽  
Automatic Process ◽  
Sacral Slope ◽  
Functional Parameters ◽  
Eos Imaging

The sagittal orientation of the pelvis commonly called pelvic tilt has an effect on the orientation of the cup in total hip arthroplasty (THA). Pelvic tilt is different between individuals and changes during activities of daily living. In particular, the pelvic tilt in standing position should be considered during the planning of THA to adapt the target angles of the cup patient-specifically to minimize wear and the risk of dislocation. Methods to measure pelvic tilt require an additional step in the planning process, may be time consuming and additional devices or x-ray imaging are necessary.In this study, the relationship between three functional parameters describing the sagittal pelvic orientation in standing position and seven morphological parameters of the pelvis was investigated. Correlations might be used to estimate the pelvic tilt in standing position by the morphology of the pelvis in order to avoid additional measuring techniques of pelvic tilt in the planning process of THA. For 18 subjects a semi-automatic process was established to match a 3D-reconstruction of the pelvis from CT scans to orthogonal EOS imaging in standing position and to calculate the morphological and functional parameters of the pelvis subsequently.The two strongest correlations of the linear correlation analysis were observed between morphological pelvic incidence and functional sacral slope (r = 0.78; p = 0.0001) and between morphological pubic symphysis-posterior superior iliac spines- ratio and functional tilt of anterior pelvic plane (r = -0.59; p = 0.0098). The results of this study suggest that patient-specific adjustments to the orientation of the cup in planning of THA without additional measurement of the sagittal pelvic orientation in standing position should be based on the correlation between morphological pelvic incidence and functional sacral slope.

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

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.

New prognostic factors for adjacent-segment degeneration after one-stage 360° fixation for spondylolytic spondylolisthesis: special reference to the usefulness of pelvic incidence angle

2007 ◽  
Vol 7 (2) ◽  
pp. 139-144 ◽  
Author(s):  
Jeong Yoon Park ◽  
Yong Eun Cho ◽  
Sung Uk Kuh ◽  
Jun Hyung Cho ◽  
Dong Kyu Chin ◽  
...  
Keyword(s):  
Pelvic Incidence ◽  
Incidence Angle ◽  
Slope Angle ◽  
Adjacent Segment Degeneration ◽  
Individual Variability ◽  
Sacral Slope ◽  
Adjacent Segment ◽  
One Stage ◽  
Pelvic Parameters ◽  
Spondylolytic Spondylolisthesis

Object. The purpose of this study was to evaluate the correlation between adjacent-segment degeneration (ASD) and pelvic parameters in the patients with spondylolytic spondylolisthesis. Sagittal balance is the most important risk and prognostic factor in the development of ASD. The pelvic incidence angle (PIA) is an important anatomical parameter in determining the sagittal curvature of the spine and in the individual variability of the sacral slope and the lordotic curve. Thus, the authors evaluated the relationship between the pelvic parameters and the ASD. Methods. Among 132 patients with spondylolytic spondylolisthesis who underwent surgery at their institution, the authors selected patients in whom a one-stage, single-level, 360° fixation procedure was performed for Grade I spondylolisthesis and who underwent follow-up for more than 1 year. Parameters in 34 patients satisfied these conditions. Of the 34 patients, seven had ASD (Group 1) and 27 patients did not have ASD (Group 2). The investigators measured degree of spondylolisthesis, lordotic angle, sacral slope angle (SSA), pelvic tilt angle (PTA), PIA, and additional parameters pre-and postoperatively. The radiographic data were reviewed retrospectively. Results. The population consisted of nine men and 25 women whose mean age was 48.9 ± 9 years (± standard deviation) (range 28–65 years). Seven patients developed ASD after undergoing fusion. Of all the parameters, pre-and postoperative degree of spondylolisthesis, segmental lordosis, lordotic angle, SSA, preoperative PTA, and pre-operative PIA did not differ significantly between the two groups; only postoperative PTA and PIA were significantly different. Conclusions. The development of ASD is closely related to postoperative PIA and PTA, not preoperative PIA and PTA. The measurement of postoperative PIA can be used as a new indirect method to predict the ASD.

scholarly journals The Relationship between Sacral Kyphosis and Pelvic Incidence

2018 ◽  
Vol 12 (1) ◽  
pp. 74-79 ◽  
Author(s):  
George McKay ◽  
Peter Alexander Torrie ◽  
Georgina Dempster ◽  
Wendy Bertram ◽  
Ian Harding
Keyword(s):  
Pelvic Incidence ◽  
Clinical Pathology ◽  
Normative Values ◽  
Sacral Slope ◽  
Strong Positive Correlation ◽  
Mean Values ◽  
Pelvic Parameters ◽  
Unpaired Student ◽  
Lumbar Spinal

<sec><title>Study Design</title><p>Retrospective cohort study.</p></sec><sec><title>Purpose</title><p>Evaluate the fixed anatomical parameter of sacral kyphosis (SK) and its relationship with pelvic incidence (PI).</p></sec><sec><title>Overview of Literature</title><p>Pelvic parameters determine pelvic and lumbar spinal position. Studies have defined normative values, and have evaluated the role of these parameters in clinical practice. It has been suggested that a ratio of sacral slope (SS)/PI &lt;0.5 predisposes to spinal pathology. PI=SS+pelvic tilt (PT) and therefore for a given PI, patients with a higher SS due to an elevated SK will potentially predispose to an unfavourable SS/PI ratio.</p></sec><sec><title>Methods</title><p>CT measurements of SS and PI were made in 100 consecutive patients from our database. Imagings without clear landmarks were excluded. PI and SK were measured using standardised techniques. Pearson's correlation was used to assess association between PI and SK, in addition to the correlation between age and the pelvic parameters. Gender specific values for PI and SK were compared using an unpaired Student <italic>t</italic>-test.</p></sec><sec><title>Results</title><p>Ninety-five patients (52 females) with a mean age 51.3 years were available for analysis. A strong positive correlation between the PI and the SK was identified (Pearson's coefficient=0.636, <italic>R<sup>2</sup></italic> value=0.404). Neither PI nor SK had a statistically significant correlation with age (<italic>p</italic>=0.721 and <italic>p</italic>=0.572, respectively). The mean values of both the PI and SK were statistically significantly lower in females when compared to males (<italic>p</italic>=0.0461 and <italic>p</italic>=0.0031, respectively).</p></sec><sec><title>Conclusions</title><p>A strong correlation between PI and SK exists and is a reflection of different pelvic morphologies. SK partially determines SS and a relatively high SK compared to PI will result in less ability to change PT and a potentially unfavourable SS/PI ratio, which could theoretically contribute to clinical pathology.</p></sec>

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