Adolescent spine patients have an increased incidence of acetabular overcoverage

Abstract

Changes in spino-pelvic alignment can lead to changes in acetabular coverage and predispose those with spinal pathologies to hip pathologies. The purpose of this study was to define the incidence of acetabular overcoverage in pediatric spine patients. Retrospective review of charts and EOS radiographs was conducted for patients ≤21 years old with adolescent idiopathic scoliosis (AIS) or Scheuermann’s Kyphosis (SK) who were treated with posterior spinal fusion (PSF) between 12/01/2015–7/26/2016. Radiographs were measured for lateral center edge angles (LCEA), anterior center edge angle (ACEA), and lumbar lordosis pre- and postoperatively. 32 patients met inclusion criteria. Preoperatively, mean LCEA was 44.1 degrees (range: 32–55, SD: 5.1) on the right and 42.8 degrees (range: 33–52, SD: 4.4) on the left. Mean preoperative ACEA was 56.0 degrees (range: 35–90, SD: 10.4). Mean preoperative lordosis was 56.0 degrees (range: −22–105, SD: 19.1) Preoperative LCEA was not associated with lordosis (right: r = 0.002, p = 0.78, left: r = 0.006, p = 0.66). Preoperative ACEA was no associated with lordosis (r = 0.02, p = 0.49). Overall, the mean percent change in LCEA was −3.4% (range: −19.6–21.9, SD: 10.3) on the right and −3.5% (range: −31.0–27.9, SD: 13.3) on the left. Mean percent change in ACEA was 9.1% (range: −20.6–35.7, SD: 15.1). Mean percent change in lordosis was −12.2% (range: −150–33.3, SD: 33.3. The incidence of acetabular overcoverage may be significantly higher in a pediatric spinal population than the general population. Careful monitoring of these patients for signs and symptoms of hip pathology may be warranted.

Incidence, trends, and associated risks of developmental hip dysplasia in patients with Early Onset and Adolescent Idiopathic Scoliosis

“…5,7,14,16 It has been shown that scoliosis patients experience increased rates of acetabular over coverage, which can predispose patients to hip pathology. 11 We found that hip osteoarthritis occurred in 0.6% (EOS: 0.2%; AIS: 0.9%) of patients and 0.3% of patients had developed hip osteonecrosis. AIS patients were also more likely to have recurrent hip dislocations (35.4% vs 17.0%, OR: 2.67, p < 0.001), which was likely a product of the older AIS population having more time to experience a recurrence.…”

Physical Therapy Management of Hip Pain in Adults with Scoliosis: A Case Series

“…There is an abundance of literature that discusses the biomechanical impact of scoliosis on the hip (Gum et al, 2007;Kotwicki et al, 2008;Radcliff et al, 2013;Buckland et al, 2015;Esposito et al, 2016;Márkus et al, 2018Márkus et al, , 2018Nielsen and Goldstein, 2018;Banno et al, 2020;Si et al, 2020;Zhang et al, 2020;Smith et al, 2021;Bortz et al, 2022), yet only one study that discusses the orthopedic extremity disease burden from scoliosis (Smith et al, 2021).…”

“…The complex biomechanical relationship between the hip and spine is well observed (Offierski and MacNab, 1983;Radcliff et al, 2013;Buckland et al, 2015;Esposito et al, 2016;Eguchi et al, 2018;Nielsen and Goldstein, 2018;Rivière et al, 2018;Burkus et al, 2019;Morimoto et al, 2019;Prather and van Dillen, 2019;Banno et al, 2020;Si et al, 2020;Smith et al, 2021;Bortz et al, 2022).…”

“…There is a wide range of studies on the biomechanical impact of AIS on the pelvis and hip in multiple planes both in standing and walking (Chen et al, 1998;Kramers-de Quervain et al, 2004;Mahaudens et al, 2009;Yang et al, 2013;Daryabor et al, 2017;Wu et al, 2019) that show asymmetrical forces through the hip and pelvis as well as abnormalities in acetabular coverage, all with implication for degenerative changes and stress to the hip joint. Burkus, et al (2019) andMarkus, et al (2018) used EOS imaging to show significant differences in proximal femoral parameters in patients with AIS in the coronal plane, while Nielsen and Goldstein, (2018) used EOS imaging to show the impact of sagittal plane changes on acetabular coverage. Gum, et al (2007) looked at patterns of pelvic rotation in the transverse plane in patients with AIS.…”

How Often Do Patients Presenting With Severe Adolescent Idiopathic Scoliosis Have Underlying Hip Dysplasia?

“…1,2 The concurrence of AIS and hip dysplasia may be explained by an uneven distribution of forces through the hips, potentially increasing the likelihood of concomitant hip pathologies. [1][2][3] Coronal imbalance may independently occur due to spinal deformity or hip disorders, and has been correlated with lower mental health, vitality, physical function, and greater lower back pain. [4][5][6][7] Many studies have explored a process where hip dysplasia causes asymmetry of lower limbs-leading to pelvic obliquity, compensation by the sacroiliac joint and spine, and as a result, compensatory scoliosis, and coronal imbalance.…”