Analysis of the Sagittal Balance of the Spine and Pelvis Using Shape and Orientation Parameters

Berthonnaud, Éric; Dimnet, J.; Roussouly, Pierre; Labelle, Hubert

doi:10.1097/01.bsd.0000117542.88865.77

Cited by 498 publications

(349 citation statements)

References 8 publications

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“…Twenty-nine 30 9 90 cm lateral radiographs of the spine and pelvis from a cohort of 160 asymptomatic young adult volunteers from a previous study [1] were randomly selected. These conventional standing lateral X-rays of the spine, pelvis, and femoral heads were obtained at a fixed distance of 228 cm from the X-ray source with the subject in a comfortable standing position, the knees fully extended, and the upper limbs resting on two arm supports.…”

Section: Methodsmentioning

confidence: 99%

“…This program allows the user to measure various data points on the radiograph, manipulating image contrast and size [1]. Two sets of data points are necessary to generate the geometric model of the spine and pelvis.…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies described the pelvic radius technique to determine pelvic orientation, focusing on understanding the relationship of global sagittal alignment to the orientation of the pelvis, as the entire balance of the spine is dependent on its geometric configuration [7][8][9][10]. More recent studies employ a sagittal measurement computer program using a method for calculating the best-fit arcs passing through the spine which are used to calculate thoracic kyphosis and lumbar lordosis, thus eliminating the need for distinctly visualized endplates resulting in significantly improved reproducibility in the measurement of various spinal sagittal and pelvic plane parameters [1,5]. A validation study comparing the Cobb measurement technique to the best-fit arcs methodology demonstrated that both techniques exhibit similar reliability and accuracy [2,3].…”

Section: Introductionmentioning

confidence: 99%

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Intra- and inter-observer reliability of determining radiographic sagittal parameters of the spine and pelvis using a manual and a computer-assisted methods

Dimar¹,

Carreon²,

Labelle

et al. 2008

Eur Spine J

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Sagittal imbalance is a significant factor in determining clinical treatment outcomes in patients with deformity. Measurement of sagittal alignment using the traditional Cobb technique is frequently hampered by difficulty in visualizing landmarks. This report compares traditional manual measurement techniques to a computerassisted sagittal plane measurement program which uses a radius arc methodology. The intra and inter-observer reliability of the computer program has been shown to be 0.92-0.99. Twenty-nine lateral 90 cm radiographs were measured by a computer program for an array of sagittal plane measurements. Ten experienced orthopedic spine surgeons manually measured the same parameters twice, at least 48 h apart, using a digital caliper and a standardized radiographic manual. Intraclass correlations were used to determine intra-and interobserver reliability between different manual measures and between manual measures and computer assisted-measures. The inter-observer reliability between manual measures was poor, ranging from -0.02 to 0.64 for the different sagittal measures. The intra-observer reliability in manual measures was better ranging from 0.40 to 0.93. Comparing manual to computer-assisted measures, the ICC ranged from 0.07 to 0.75. Surgeons agreed more often with each other than with the machine when measuring the lumbar curve, the thoracic curve, and the spinosacral angle. The reliability of the computer program is significantly higher for all measures except for lumbar lordosis. A computer-assisted program produces a reliable measurement of the sagittal profile of the spine by eliminating the need for distinctly visible endplates. The use of a radial arc methodology allows for infinite data points to be used along the spine to determine sagittal measurements. The integration of this technique with digital radiography's ability to adjust image contrast and brightness will enable the superior identification of key anatomical parameters normally not available for measurement on traditional radiographs, improving the consistency of sagittal measurement.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intra- and inter-observer reliability of determining radiographic sagittal parameters of the spine and pelvis using a manual and a computer-assisted methods

Dimar¹,

Carreon²,

Labelle

et al. 2008

Eur Spine J

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“…It is essential to have an optimal congruence between pelvic and spinal parameters to achieve an economic posture placing the axis of gravity in a physiologic position [3,5,14,17].…”

Section: Global Balance Evaluationmentioning

confidence: 99%

Compensatory mechanisms contributing to keep the sagittal balance of the spine

Barrey

Roussouly

Huec³

et al. 2013

Eur Spine J

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361

234

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Introduction Aging spine is characterized by facet joints arthritis, degenerative disc disease, bone remodeling and atrophy of extensor muscles resulting in a progressive kyphosis of the lumbar spine. Objective The aim of this paper is to describe the different compensatory mechanisms for patients with severe degenerative lumbar spine. Material and methods According to the severity of the imbalance, three stages are observed: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permit to limit the consequences of loss of lumbar lordosis on global sagittal alignment and therefore contribute to keep the sagittal balance of the spine. Results The basic concept is to extend adjacent segments of the kyphotic spine allowing for compensation of the sagittal unbalance but potentially inducing adverse effects.Conclusion Finally, we propose a three-step algorithm to analyze the global balance status and take into consideration the presence of the compensatory mechanisms in the spinal, pelvic and lower limb areas.

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“…As a basis for comparison, it is therefore important to document the sacropelvic balance and morphology in the normal population. So far, normal values of sacropelvic parameters have been published for pediatric [25], adult [26][27][28][29][30], and elderly subjects [31].…”

Section: Introductionmentioning

confidence: 99%

Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults

et al. 2011

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Introduction Many studies suggest the importance of the sagittal sacropelvic balance and morphology in spinal and hip disorders. This study describes the normal age-and sex-related changes in sacropelvic morphology and balance in a prospective cohort of asymptomatic adults without spinal disorder. Materials and methods A prospective cohort of 709 asymptomatic adults without spinal pathology was recruited. There were 354 males and 355 females aged 37.9 ± 14.7 and 35.7 ± 13.9 years, respectively. For each subjects, pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured from standing lateral radiographs. Ratios of SS to PI (SS/PI), PT to PI (PT/PI), and PT to SS (PT/SS) were also calculated. Results There was no significant difference in PI (pelvic incidence), SS (sacral slope), PT (pelvic tilt), PT/PI, SS/PI, or PT/SS between males and females. The mean ± 2 standard deviations (SD) range was 32°-74°, 0°-27°, and 24°-55°for PI, PT and SS, respectively. The mean ± 2 SD range was greater than 0.5 for SS/PI and less than 0.5 for PT/PI. PI was not related to age in either sex group. PT, SS, PT/PI, SS/PI, and PT/SS presented only weak correlation coefficients (r B 0.21) with respect to age. Conclusion The current study presents the largest cohort of asymptomatic adults in the literature dedicated to the evaluation of sagittal sacropelvic morphology and balance. The range of values corresponding to the mean ± 2 SD can provide invaluable information to clinicians about the normal range of values expected in 95% of the normal population.

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Analysis of the Sagittal Balance of the Spine and Pelvis Using Shape and Orientation Parameters

Cited by 498 publications

References 8 publications

Intra- and inter-observer reliability of determining radiographic sagittal parameters of the spine and pelvis using a manual and a computer-assisted methods

Intra- and inter-observer reliability of determining radiographic sagittal parameters of the spine and pelvis using a manual and a computer-assisted methods

Compensatory mechanisms contributing to keep the sagittal balance of the spine

Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults

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