Understanding sagittal compensation in adult spinal deformity patients: relationship between pelvic tilt and lower-extremity position

2021 ◽  
pp. 1-8
Author(s):  
Takayoshi Shimizu ◽  
Meghan Cerpa ◽  
Lawrence G. Lenke
Keyword(s):  
Lower Extremity ◽  
Spinal Deformity ◽  
Knee Flexion ◽  
Pelvic Tilt ◽  
Adult Spinal Deformity ◽  
The Other ◽  
Whole Body ◽  
Shift Group ◽  
Posterior Shift ◽  
Full Body

OBJECTIVE In adult spinal deformity (ASD), quantifying preoperative lower-extremity (LE) compensation is important in formulating an operative plan to achieve optimal global sagittal alignment. Whole-body radiographs are not always available. This study evaluated the possibility of estimating LE compensation without whole-body radiographs. METHODS In total, 200 consecutive ASD patients with full-body radiographic assessment were categorized into the following three groups according to their cranio-hip balance (distance from the cranial sagittal vertical axis to the hip axis [CrSVA-H]): group 1, anterior-shift (A-shift) group (CrSVA-H > 40 mm); group 2, balanced group, −40 mm < CrSVA-H < 40 mm; and group 3, posterior-shift (P-shift) group, CrSVA-H < −40 mm. After analyzing the correlation between CrSVA-H, pelvic tilt (PT), and LE parameters, the cutoff PT and PT/pelvic incidence (PI) values that correlated with the presence of LE compensation were determined. Previously published data from asymptomatic volunteers were used as a baseline threshold (sacrofemoral angle [SFA] > 217.0° and knee flexion angle [KA] > 11.0°). RESULTS Among the hip, knee, and ankle, only KA showed a significant increase in the A-shift group compared to the other two groups (p < 0.01). With a wide threshold (SFA > 208.0° and KA > 5.0°), 84.9% of the A-shift group showed LE compensation (hip or knee or both), which was a significantly greater percentage than those in the balanced and P-shift groups (48.4% and 51.9%, p < 0.01). With a narrow threshold (SFA > 217.0° and KA > 11.0°), 62.2% of the A-shift group showed any LE compensation, which was also a higher percentage than the other two groups. The CrSVA-H was moderately correlated with KA (r = 0.502), but had no correlation with PT, SFA, and ankle dorsiflexion angle (AA). PT showed a moderate/strong correlation with SFA, KA, and AA (r = 0.846, 0.624, and 0.622, respectively). With receiver operating characteristic curves, the authors determined that a 23.0° PT with PT/PI > 0.46 predicts the presence of any type of LE compensation with use of the wide threshold. CONCLUSIONS ASD patients with increased CrSVA-H, which represents cranio-hip anterior imbalance, demonstrated a higher prevalence of LE compensation, especially knee flexion, compared to those with neutral and posterior shift of CrSVA. PT represents the extent of LE compensation in patients with spinal sagittal malalignment. Using the cutoff value of PT determined in this study, surgeons can preoperatively estimate the extent of LE compensation without obtaining a full-body radiograph.

scholarly journals Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity

2016 ◽  
Vol 24 (3) ◽  
pp. 436-446 ◽  
Author(s):  
Emmanuelle Ferrero ◽  
Barthelemy Liabaud ◽  
Vincent Challier ◽  
Renaud Lafage ◽  
Bassel G. Diebo ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Spinal Deformity ◽  
Lower Limb ◽  
Knee Flexion ◽  
Large Population ◽  
Compensatory Mechanisms ◽  
The Impact ◽  
Hip Extension ◽  
Full Body

OBJECT Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pelvic parameters have demonstrated the compensatory mechanisms of pelvis translation in addition to rotation. However, the mechanisms recruited for this pelvic rotation were not assessed. This study aims to analyze the relationship between spinopelvic and lower-extremity parameters and clarify the role of pelvic translation. METHODS This is a retrospective study of patients with spinal deformity and full-body EOS images. Patients with only stenosis or low-back pain were excluded. Patients were grouped according to T-1 spinopelvic inclination (T1SPi): sagittal forward (forward, > 0.5°), neutral (−6.3° to 0.5°), or backward (< −6.3°). Pelvic translation was quantified by pelvic shift (sagittal offset between the posterosuperior corner of the sacrum and anterior cortex of the distal tibia), hip extension was measured using the sacrofemoral angle (SFA; the angle formed by the middle of the sacral endplate and the bicoxofemoral axis and the line between the bicoxofemoral axis and the femoral axis), and chin-brow vertical angle (CBVA). Univariate and multivariate analyses were used to compare the parameters and correlation with the Oswestry Disability Index (ODI). RESULTS In total, 336 patients (71% female; mean age 57 years; mean body mass index 27 kg/m2) had mean T1SPi values of −8.8°, −3.5°, and 5.9° in the backward, neutral, and forward groups, respectively. There were significant differences in the lower-extremity and spinopelvic parameters between T1SPi groups. The backward group had a normal lumbar lordosis (LL), negative SVA and pelvic shift, and the largest hip extension. Forward patients had a small LL and an increased SVA, with a large pelvic shift creating compensatory knee flexion. Significant correlations existed between lower-limb parameter and pelvic shift, pelvic tilt, T-1 pelvic angle, T1SPi, and sagittal vertical axis (0.3 < r < 0.8; p < 0.001). ODI was significantly correlated with knee flexion and pelvic shift. CONCLUSIONS This is the first study to describe full-body alignment in a large population of patients with spinal pathologies. Furthermore, patients categorized based on T1SPi were found to have significant differences in the pelvic shift and lower-limb compensatory mechanisms. Correlations between lower-limb angles, pelvic shift, and ODI were identified. These differences in compensatory mechanisms should be considered when evaluating and planning surgical intervention for adult patients with spinal deformity.

scholarly journals Influence of comorbid knee osteoarthritis on surgical outcome and sagittal spinopelvic/lower-extremity alignment in elderly patients with degenerative lumbar spondylolisthesis undergoing transforaminal lumbar interbody fusion

2020 ◽  
Vol 32 (6) ◽  
pp. 850-858
Author(s):  
Motonori Kohno ◽  
Yuichi Iwamura ◽  
Riki Inasaka ◽  
Gosuke Akiyama ◽  
Shota Higashihira ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Elderly Patients ◽  
Knee Osteoarthritis ◽  
Surgical Outcome ◽  
Knee Flexion ◽  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
The Other ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis

OBJECTIVEThis retrospective study aimed to clarify the influence of comorbid severe knee osteoarthritis (KOA) on surgical outcome in terms of sagittal spinopelvic/lower-extremity alignment in elderly patients with degenerative lumbar spondylolisthesis (DLS).METHODSIn total, 110 patients aged at least 65 years (27 men, 83 women; mean age 74.0 years) who underwent short-segment lumbar fusion were included in the present study. Using the Kellgren-Lawrence (KL) grading system, patients were categorized into those with no to mild KOA (the mild-OA group: KL grades 0–2), moderate KOA (moderate-OA group: KL grade 3), or severe KOA (severe-OA group: KL grade 4). Surgical results were assessed using the Japanese Orthopaedic Association (JOA) scoring system, and spinopelvic/lower-extremity parameters were compared among the 3 groups. Adjacent-segment disease (ASD) was assessed over a mean follow-up period of 4.7 years (range 2–8.1 years).RESULTSThe study cohort was split into the mild-OA group (42 patients), the moderate-OA group (28 patients), and the severe-OA group (40 patients). The severe-OA group contained significantly more women (p = 0.037) and patients with double-level listhesis (p = 0.012) compared with the other groups. No significant differences were found in mean postoperative JOA scores or recovery rate among the 3 groups. The mean postoperative JOA subscore for restriction of activities of daily living was only significantly lower in the severe-OA group compared with the other groups (p = 0.010). The severe-OA group exhibited significantly greater pelvic incidence, pelvic tilt, and knee flexion angle (KFA), along with a smaller degree of lumbar lordosis than the mild-OA group both pre- and postoperatively (all p < 0.05). Overall, the rate of radiographic ASD was observed to be higher in the severe-OA group than in the mild-OA group (p = 0.015). Patients with ASD in the severe-OA group exhibited significantly greater pelvic tilt, pre- and postoperatively, along with less lumbar lordosis, than the patients without ASD postoperatively (all p < 0.05).CONCLUSIONSA lack of lumbar lordosis caused by double-level listhesis and knee flexion contracture compensated for by far greater pelvic retroversion is experienced by elderly patients with DLS and severe KOA. Therefore, corrective lumbar surgery and knee arthroplasty may be considered to improve sagittal alignment, which may contribute to the prevention of ASD, resulting in favorable long-term surgical outcomes.

scholarly journals Coronal T1 Pelvic Tilt, a Novel Predictive Index for Global Coronal Alignment in Adult Spinal Deformity

Spine ◽  
2020 ◽  
Vol 45 (19) ◽  
pp. 1335-1340
Author(s):  
Jiandang Zhang ◽  
Zheng Wang ◽  
Pengfei Chi ◽  
Cheng Chi
Keyword(s):  
Spinal Deformity ◽  
Pelvic Tilt ◽  
Adult Spinal Deformity ◽  
Coronal Alignment ◽  
Predictive Index

scholarly journals Lower Extremity Motor Function Following Complex Adult Spinal Deformity Surgery

2018 ◽  
Vol 100 (8) ◽  
pp. 656-665 ◽  
Author(s):  
Lawrence G. Lenke ◽  
Christopher I. Shaffrey ◽  
Leah Y. Carreon ◽  
Kenneth M.C. Cheung ◽  
Benny T. Dahl ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Motor Function ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Spinal Deformity Surgery

Radiological severity of hip osteoarthritis in patients with adult spinal deformity: the effect on spinopelvic and lower extremity compensatory mechanisms

2018 ◽  
Vol 27 (9) ◽  
pp. 2294-2302 ◽  
Author(s):  
Louis M. Day ◽  
Edward M. DelSole ◽  
Bryan M. Beaubrun ◽  
Peter L. Zhou ◽  
John Y. Moon ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Hip Osteoarthritis ◽  
Compensatory Mechanisms

The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery

2021 ◽  
Author(s):  
Lawrence G. Lenke ◽  
Scott L. Zuckerman ◽  
Meghan Cerpa ◽  
Christopher I. Shaffrey ◽  
Leah Y. Carreon ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Motor Function ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Spinal Deformity Surgery

Calculation of the Target Lumbar Lordosis Angle for Restoring an Optimal Pelvic Tilt in Elderly Patients With Adult Spinal Deformity

Spine ◽  
2016 ◽  
Vol 41 (4) ◽  
pp. E211-E217 ◽  
Author(s):  
Yu Yamato ◽  
Tomohiko Hasegawa ◽  
Sho Kobayashi ◽  
Tatsuya Yasuda ◽  
Daisuke Togawa ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
Adult Spinal Deformity

Evolution of Sagittal Imbalance Following Corrective Surgery for Sagittal Plane Deformity

Neurosurgery ◽  
2017 ◽  
Vol 81 (1) ◽  
pp. 129-134 ◽  
Author(s):  
Michael M. McDowell ◽  
Zachary J. Tempel ◽  
Gurpreet S. Gandhoke ◽  
Nicholas K. Khattar ◽  
D. Kojo Hamilton ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Deformity ◽  
Sagittal Balance ◽  
Pelvic Tilt ◽  
Short Form ◽  
Adult Spinal Deformity ◽  
Sagittal Imbalance ◽  
Consecutive Series ◽  
Adult Deformity ◽  
Global Sagittal Alignment

Abstract BACKGROUND: Sagittal balance in adult spinal deformity is a major predictor of quality of life. A temporary loss of paraspinal muscle force and somatic pain following spine surgery may limit a patient's ability to maintain posture. OBJECTIVE: To assess the evolution of sagittal balance and clinical outcomes during recovery from adult spinal deformity surgery. METHODS: Retrospective review of a prospective observational database identified a consecutive series of patients with sagittal vertical axis (SVA) &gt; 40 mm undergoing adult deformity surgery. Radiographic parameters and clinical outcomes were measured out to 2 yr after surgery. RESULTS: A total of 113 consecutive patients met inclusion criteria. Mean preoperative SVA was 90.3 mm, increased to 104.6 mm in the first week, then gradually reduced at each follow-up interval to 59.2 mm at 6 wk, 45.0 mm at 3 mo, 38.6 mm at 6 mo, and 34.1 mm at 1 yr (all P &lt; .05). SVA did not change between 1 and 2 yr. Pelvic incidence-lumbar lordosis (PI-LL) corrected immediately from 25.3° to 8.5° (16.8° change; P &lt; .01) and a decreased pelvic tilt from 27.6° to 17.6° (10° change; P &lt; .01). No further change was noted in PI-LL. Pelvic tilt increased to 20.2° (P = .01) at 6 wk and held steady through 2 yr. Mean Visual Analog Scale, Oswestry Disability Index, and Short Form-36 scores all improved; pain rapidly improved, whereas disability measures improved as SVA improved. CONCLUSION: Radiographic assessment of global sagittal alignment did not fully reflect surgical correction of sagittal balance until 6 mo after adult deformity surgery. Sagittal balance initially worsened then steadily improved at each interval over the first year postoperatively. At 1 yr, all clinical and radiographic measures outcomes were significantly improved.

scholarly journals Effect of Whole-Body Vibration Training on Muscle Activation for Individuals with Knee Osteoarthritis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Juan Zhang ◽  
Rui Wang ◽  
Yili Zheng ◽  
Jiao Xu ◽  
Ya Wu ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Knee Osteoarthritis ◽  
Vibration Frequency ◽  
Knee Flexion ◽  
Muscle Activation ◽  
Whole Body Vibration ◽  
Whole Body ◽  
Vibration Frequencies ◽  
Activation Rate ◽  
Vibration Parameters

Whole-body vibration (WBV) training may improve the strength of lower extremity muscles in patients with knee osteoarthritis (KOA), but the inconsistency in vibration parameters leads to differences in findings. This cross-sectional study is aimed at observing the effects of different vibration frequencies and knee flexion angles on the activation of lower extremity muscles in patients with KOA. Enrolled participants received WBV training at 0, 30, and 60° knee flexion angles with vibration frequencies of 0, 5, 10, and 20 Hz. Activation rates for vastus medialis, vastus lateralis, rectus femoris, biceps femoris, and semitendinosus in different combinations were collected through surface electromyography. The effects of frequency and angle on muscle activation rate were quantified by repeated measures ANOVA. Individual and synergistic effects of frequency and angle were also analysed. Twenty-six participants with KOA were included. Muscle activation increased with the vibration frequency in 0–20 Hz range and with knee flexion angle in 0–60° range. WBV training at 20 Hz was the most effective for knee muscle activation, and static squatting at 60° was the most suitable for WBV training. Therefore, WBV training can increase the activation rate of knee flexor and extensor muscles in patients with KOA, and the most efficient combination was 20 Hz vibration frequency and 60° knee flexion. When applying WBV to patients with KOA, individual differences and rehabilitation purposes should be considered in selecting vibration parameters and knee angle to effectively increase neuromuscular activity.

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