Analysis of spinal alignment and pelvic parameters on upright radiographs: implications for acetabular development

Pytiak, Andrew V; Bomar, James D.; Peterson, Jonathan B.; Schmitz, Matthew R.; Pennock, Andrew T.; Wenger, Dennis R.; Upasani, Vidyadhar V.

doi:10.1093/jhps/hnw008

Cited by 11 publications

(6 citation statements)

References 32 publications

(32 reference statements)

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“…Thus, the overall rate of high-normal lordosis and hyperlordotic curves was 55.1% ( n = 27/49), which is consistent with previous studies demonstrating increased lordosis in AIS and SK patients [ 9–11 , 13 , 14 , 21 , 22 ]. Previous studies have postulated a correlation between lumbar lordosis and acetabular coverage [ 1 , 4 , 6 ], but our study failed to find any significant relationship between these measures (right: r = 0.01, P = 0.52, left: r = 0.02, P = 0.45).…”

Section: Discussioncontrasting

confidence: 92%

“…This discrepancy may be due to varying parameters used to diagnose and define pincer deformity across studies, and actual incidence in the general population may be lower [ 16 ]. A separate study of 99 asymptomatic adolescents found a 14% incidence of abnormal LCEA [ 6 ]. Despite this discrepancy, the incidence of acetabular overcoverage in the AIS and SK populations in the current study was still higher than in the general population.…”

Section: Discussionmentioning

confidence: 99%

“…While this phenomenon has been well documented in adults, little is known about the incidence of hip morbidities associated with spinal deformity in the pediatric population. One study of healthy adolescents by Pytiak et al showed a correlation between lumbar lordosis and pelvic tilt, but no correlation between pelvic tilt and measures of acetabular coverage [ 6 ]. Clinically, surgeons at our institution have observed that patients with adolescent idiopathic scoliosis (AIS) and Scheuermann’s kyphosis (SK) seem to have an unusually high incidence of acetabular overcoverage but actual rates are unknown.…”

Section: Introductionmentioning

confidence: 99%

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Adolescent spine patients have an increased incidence of acetabular overcoverage

Nielsen

Goldstein

2018

Journal of Hip Preservation Surgery

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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.

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Section: Discussioncontrasting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adolescent spine patients have an increased incidence of acetabular overcoverage

Nielsen

Goldstein

2018

Journal of Hip Preservation Surgery

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“…In another study on the relationship between spinopelvic alignment and acetabular coverage, the measures of LCEA were found to have weak inverse correlation with LL but poor correlation with PI and PT. [ 17 ] Moreover, they added TA was not correlated with any of sagittal spinopelvic measurements [ 17 ]. According to the recent research by McQuivey et al, higher TA (> 10 degrees) portended a higher risk for revision surgery after arthroscopic surgery on mild hip dysplasia [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical correction for adult spinal deformity increases acetabular lateral coverage of femoral heads

Luo

Kim

et al. 2021

BMC Musculoskelet Disord

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Background Studies explaining the relationship between hip and spine reported that spinal corrective surgery affected acetabular orientation and changes in pelvic tilt were capable of influencing radiographic measures of acetabular coverage. This study aimed to assess the change in coronal parameters for acetabular coverage as a result of adult spinal deformity (ASD) correction and to analyze the relationship between the postoperative changes in sagittal spinopelvic parameters and coronal acetabular coverage parameters. Methods Fifty-two consecutive patients who had undergone multilevel spinal surgical correction were enrolled and evaluated. Coronal acetabular coverage parameters included Tönnis angle (TA), lateral center edge angle (LCEA), and the angle of Sharp (SA). All radiographic parameters were evaluated at the preoperative and the postoperative 1 year. Paired t test was used to determine whether there were significant changes between the time points. Bivariate correlation and linear regression analysis were used to assess the relationship between the postoperative changes of spinal alignment and acetabular orientation. Results The surgical correction resulted in significant decrease of TA, increase of LCEA and SA, respectively (p < 0.001). The changes in pelvic tilt (PT) demonstrated weak correlation on TA (β = 0.117, p < 0.001 for right; β = 0.111, p < 0.001 for left). Conclusions Although the surgical correction of ASD significantly changed PT resulting in increased acetabular lateral coverage parameters, the correlation between the changes of PT following sagittal correction of ASD and acetabular coverage parameters was low. Trial registration This study was retrospectively registered with approval by the institutional review board (IRB) of our institution (approval number: KHNMC-2020-10-010).

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“…Recent studies by Mac-Thiong, Labelle, and Roussouly 8 have shown that there is a strong relationship between pelvic configuration and lumbar lordosis, also corroborated by studies by Upasani, Xi-Ming Xu, and Kerim and Sariyilmaza. [9][10][11] Parameters such as PI, PV, SS, and SVA (sagittal vertical axis) (Table 1) may undergo modifications that allow the patient to maintain or reestablish sagittal balance, even with changes in the physiological curvatures, such as lumbar lordosis and thoracic kyphosis resulting from surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

Pre- And Postoperative Comparative Analysis of the Spinopelvic and Global Sagittal Parameters of Patients With Adolescent Idiopathic Scoliosis

Souza¹,

Avila²,

Aguiar³

et al. 2022

Coluna/Columna

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Objective: To analyze the pre- and postoperative spinopelvic parameters and global sagittal balance of patients with adolescent idiopathic scoliosis (AIS) divided into 3 groups (Group 1 – thoracic arthrodesis, Group 2 - thoracolumbar arthrodesis, and Group 3 – lumbar arthrodesis), observing differences in these two moments and whether the parameter values are maintained or not over a period of up to 2 years following surgery. Methods: We analyzed the radiographs from a single-center database of 99 patients who underwent arthrodesis with posterior instrumentation. Pelvic incidence, pelvic version, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis values were measured in the pre- and postoperative radiographies of each patient. Results: The parameters of pelvic incidence, pelvic version, sacral slope, and sagittal vertical axis did not show statistically significant differences among the 3 groups. There was a difference in preoperative lumbar lordosis between the 3 groups (p = 0.049). Thoracic kyphosis showed differences both in the pre- (p = 0.015) and postoperative (p = 0.042) values, in addition to demonstrating a relationship of dependence between the pre- and postoperative values in the final statistical analysis. Conclusion: The evaluation of the parameters analyzed shows that the study groups have similar values of individual balance, with the exception of thoracic kyphosis and lumbar lordosis, which are measurements that depend on the surgical technique and compensatory mechanisms, but remained within normal ranges. These factors allow the surgeon to be attentive to both the coronal and sagittal planes when planning the correction in order to achieve the equilibrium of the trunk in addition to correction of the deformity. Level of Evidence IIIA: Comparative retrospective study.

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Analysis of spinal alignment and pelvic parameters on upright radiographs: implications for acetabular development

Cited by 11 publications

References 32 publications

Adolescent spine patients have an increased incidence of acetabular overcoverage

Adolescent spine patients have an increased incidence of acetabular overcoverage

Surgical correction for adult spinal deformity increases acetabular lateral coverage of femoral heads

Pre- And Postoperative Comparative Analysis of the Spinopelvic and Global Sagittal Parameters of Patients With Adolescent Idiopathic Scoliosis

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