Radiologic Findings of Pelvic Parameters Related to Sagittal Balance

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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Sagittal balance and pelvic parameters–a paradigm shift in spinal surgery

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2012.05.023 ◽

2013 ◽

Vol 20 (2) ◽

pp. 191-196 ◽

Cited By ~ 26

Author(s):

R.D. Johnson ◽

A. Valore ◽

A. Villaminar ◽

M. Comisso ◽

M. Balsano

Keyword(s):

Sagittal Balance ◽

Spinal Surgery ◽

Paradigm Shift ◽

Pelvic Parameters

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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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Extended L5 pedicle subtraction osteotomy for neglected sacropelvic dissociation injury: case report

Journal of Neurosurgery Spine ◽

10.3171/2019.1.spine181271 ◽

2019 ◽

Vol 31 (1) ◽

pp. 35-39 ◽

Cited By ~ 1

Author(s):

Vishwajeet Singh ◽

Tarush Rustagi ◽

Robert Hart

Keyword(s):

Case Report ◽

Sagittal Balance ◽

Pedicle Subtraction Osteotomy ◽

Significant Alteration ◽

Sagittal Imbalance ◽

Pelvic Parameters ◽

Lumbar Osteotomy ◽

Pelvis Fractures

The sacrum forms the distal end of the spine and communicates with the pelvis. Fractures involving the sacrum are complex and may disrupt this vital communication. Neglecting these fractures may result in malunion, which often causes significant alteration in the pelvic parameters and sagittal balance. Management of ensuing deformities is complex and poorly described. The authors present a case of sacral malunion with sagittal imbalance treated with a low lumbar osteotomy.

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P26. Pre-Operative Pelvic Parameters Must be Considered to Achieve Adequate Sagittal Balance after Lumbar Osteotomy

The Spine Journal ◽

10.1016/j.spinee.2009.08.284 ◽

2009 ◽

Vol 9 (10) ◽

pp. 129S ◽

Cited By ~ 2

Author(s):

Frank Schwab ◽

Virginie Lafage ◽

Christopher Shaffrey ◽

Jean-Pierre Farcy ◽

Oheneba Boachie-Adjei ◽

...

Keyword(s):

Sagittal Balance ◽

Pelvic Parameters ◽

Lumbar Osteotomy

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Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance

European Spine Journal ◽

10.1007/s00586-011-2124-8 ◽

2011 ◽

Vol 21 (6) ◽

pp. 1200-1206 ◽

Cited By ~ 34

Author(s):

Mourad Ould-Slimane ◽

Thibaut Lenoir ◽

Cyril Dauzac ◽

Ludovic Rillardon ◽

Etienne Hoffmann ◽

...

Keyword(s):

Sagittal Balance ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Pelvic Parameters

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The compensatory mechanisms for global sagittal balance in degenerative spinal kyphosis patients: a radiological analysis of muscle-skeletal associations

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04621-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Weiwei Xia ◽

Weiyan Wang ◽

Zhenqi Zhu ◽

Chenjun Liu ◽

Shuai Xu ◽

...

Keyword(s):

Sagittal Balance ◽

Psoas Muscle ◽

Head Position ◽

Erector Spinae ◽

Vertical Line ◽

Sacral Slope ◽

Compensatory Mechanisms ◽

Sagittal Vertical Axis ◽

Pelvic Parameters ◽

Positive Correlations

Abstract Background The position of the head relative to the spine can be used to evaluate the true global balance in patients with degenerative spinal kyphosis (DSK). However, it is still not clear how the position of the head is related to the spinal-pelvic parameters and lumbar muscles, which are most commonly considered. Methods Sixty-seven patients with DSK admitted in the hospital from January 2017 to January 2019 were retrospectively analyzed. All patients had whole spine X-ray and lumbar MRI. The head position parameters include: the angles of both lines joining the center of acoustic meati (CAM) to the center of the bi-coxofemoral axis (BA) (CAM-BA) and the most superior point of dentiform apophyse of C2 odontoid (OD) to BA (OD-BA) with the vertical line; the distance between the vertical line passing CAM and the posterior upper edge of the S1 (CAM-SVA). The spinal parameters include: C7 sagittal vertical axis (C7-SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), and lumbar lordosis (LL). The pelvic parameters include: pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The relative cross-sectional area (RCSA) of bilateral multifidus, erector spinae and psoas muscle at L3/4 and L4/5 segments were measured. The correlations between head position parameters and the spinal-pelvic parameters and RCSA of lumbar muscles were analyzed, respectively. Results Significant positive correlations were found between each two of CAM-SVA, C7-SVA, CAM-BA and OD-BA (p < 0.001). SS was found to be significantly positively correlated with CAM-BA (r = 0.377, p = 0.034) and OD-BA (r = 0.402, p = 0.023). CAM-BA was found to be significantly negatively correlated with TK (r = − 0.367, p = 0.039). Significant positive correlations were found between RCSA of multifidus at L3/4 level and CAM-SVA (r = 0.413, p = 0.021), CAM-BA (r = 0.412, p = 0.019) and OD-BA (r = 0.366, p = 0.04). Conclusions Our study showed that the head position relative to the spine were significantly correlated to some spinal-pelvic parameters, and the lower lumbar multifidus muscle. The compensatory mechanisms of the global sagittal balance status should also involve the head position area.

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