232. Optimal lumbar lordosis correction for adult spinal deformity with severe sagittal imbalance in patients over age 65: role of pelvic tilt and pelvic tilt ratio

Lee, Jung‐Hee; Lee, Ki Young; Im, Sang Kyu; Lim, Hae-Seong; Jang, Taesu; Cho, Seong Jin

doi:10.1016/j.spinee.2020.05.643

Cited by 1 publication

(2 citation statements)

References 30 publications

(41 reference statements)

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“…46,47 This is substantiated by the ideal discrepancy between PI and LL (i.e., PI-LL), initially quoted as ± 10 degrees, 48 which is lately found to be able to accept a much lower LL in the elderly. 49 In fact, age-adjusted values of PI-LL now guide the target LL in spinal realignment surgery with slightly reduced mechanical complications, and stems from our understanding that aged adults have forward sagittal spinal imbalance which can be considered 'physiological' and hence acceptable. 50 Overzealous correction of LL will lead to increase stress at junctional areas of the spine leading to PJF.…”

Section: Discussionmentioning

confidence: 99%

“…Lumbar lordosis is mandatory in bipeds to be able to stand upright, and it is often closer to PI in the young, healthy adults and much less than PI in the elderly or in diseased spines with loss of sagittal profile 46,47 . This is substantiated by the ideal discrepancy between PI and LL (i.e., PI-LL), initially quoted as ±10 degrees, 48 which is lately found to be able to accept a much lower LL in the elderly 49 . In fact, age-adjusted values of PI-LL now guide the target LL in spinal realignment surgery with slightly reduced mechanical complications, and stems from our understanding that aged adults have forward sagittal spinal imbalance which can be considered ‘physiological’ and hence acceptable 50 .…”

Section: Discussionmentioning

confidence: 99%

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Changes in Spinopelvic Parameters Between Standing and Sitting Postures

Tan

Hey

2023

Clinical Spine Surgery: A Spine Publication

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Study Design: Systematic review and meta-analysis. Objective: To report the ratio-of-differences between standing and sitting. To understand how sex and age influence these differences. Summary of Background Data: Currently, spinal deformity surgery aims to realign the sagittal profile of the spine with-reference-to the standing posture resulting in overcorrection. New studies report significant disparities between standing and sitting spinal alignment. Methods: A comprehensive search and review of the published literature was performed on 4 platforms in accordance with the PRISMA 2009 checklist by 2 authors independently. Results: From 753 abstracts extracted from the databases, 38 papers involving 5423 patients were identified. sagittal vertical axis was more positive in sitting, with a pooled mean difference of 29.5 mm (95% CI: 17.9–41.0). Pelvic tilt (PT) was larger in sitting, with a pooled mean difference of 16.7 degrees (95% CI: 12.5–20.9), and a pooled odds ratio of 1.2(95% CI:1.1–1.3. P=0.001). Sacral Slope (SS) was smaller and lumbar lordosis (LL) was less lordotic in sitting, with a pooled mean difference of 15.0 degrees (95% CI: 11.918.1) and 21.1 degrees (95% CI:14.5–27.8), respectively, and a pooled odds ratio of 0.7 (95% CI: 0.6–0.8. P<0.001) and 0.7 (95% CI:0.6–0.7, P<0.001), respectively. Pelvic incidence and thoracic kyphosis was similar in sitting. Subgroup meta-analysis comparing odd ratio of standing to sitting showed: Among younger patients (age younger than 50), the PT and LL pooled odds-ratios were 1.4 and 0.7, respectively. Among older patients (age older than or equal to 50), the PT and LL pooled odds-ratios were 1.1 and 0.8, respectively. Among female patients, the SS pooled odds ratio was 0.6. Among male patients, the SS pooled odds ratio was 0.7. Conclusion: When comparing sitting to standing, it gives a more positive sagittal vertical axis, a smaller SS and LL, and a larger PT. pelvic incidence and thoracic kyphosis remained similar. Younger and female patients have pronounced differences in SS, PT, and LL, suggesting the existence of age and sex variations, and its role to be considered when planning for spinal realignment surgeries. Clinical outcome studies are required to ascertain the impact of these findings.

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