Compensatory mechanisms contributing to keep the sagittal balance of the spine

Barrey, Cédric; Roussouly, Pierre; Huec, Jean-Charles Le; D’Acunzi, Gennaro; Perrin, Gilles

doi:10.1007/s00586-013-3030-z

Cited by 364 publications

(275 citation statements)

References 25 publications

(33 reference statements)

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“…Compensatory mechanisms have been widely described by Barrey et al [20]. Three stages were observed corresponding to the severity of the imbalance: balanced, balanced with PT pelvic tilt, SS sacral slope, PI pelvic incidence compensatory mechanisms and imbalanced.…”

Section: Resultsmentioning

confidence: 99%

Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review

Huec

Faúndez

Dominguez

et al. 2014

International Orthopaedics (SICOT)

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190

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The measure of radiographic pelvic and spinal parameters for sagittal balance analysis has gained importance in reconstructive surgery of the spine and particularly in degenerative spinal diseases (DSD). Fusion in the lumbar spine may result in loss of lumbar lordosis (LL), with possible compensatory mechanisms: decreased sacral slope (SS), increased pelvic tilt (PT) and decreased thoracic kyphosis (TK). An increase in PT after surgery is correlated with postoperative back pain. A decreased SS and/or abnormal sagittal vertical axis (SVA) after fusion have a higher risk of adjacent segment degeneration. High pelvic incidence (PI) increases the risk of sagittal imbalance after spine fusion and is a predictive factor for degenerative spondylolisthesis. Restoration of a normal PT after surgery is correlated with good clinical outcome. Therefore, there is a need for comparative prospective studies that include pre-and postoperative spinopelvic parameters and compare complication rate, degree of disability, pain and quality of life.

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Section: Resultsmentioning

confidence: 99%

Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review

Huec

Faúndez

Dominguez

et al. 2014

International Orthopaedics (SICOT)

Self Cite

190

131

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“…In the case of anterior malalignment, in order to maintain GL position within a narrow range, different compensatory mechanisms occur: thoracic flattening, pelvic retroversion, and lower-limb responses such as hip extension, knee flexion, ankle flexion. 1,25,34 With the recent development of the EOS system, full-body analysis can be performed in a standing position with low-dose irradiation, which has allowed the more thorough analysis of these compensatory mechanisms. Spine surgeons can now use EOS imaging to better understand how each patient utilizes various compensatory mechanisms, which need to be factored into the degree of deformity correction in order to achieve optimal postoperative alignment.…”

Section: Discussionmentioning

confidence: 99%

“…Changes in the hip, knee, and ankle joints, which compensate for sagittal malalignment, have been described but have not been accurately assessed from head to feet. 1,25,26 Using full-body images (EOS imaging), this study aims to clarify the role of pelvic translation and analyze the relationships between spinopelvic parameters and lower-extremity parameters in adults with spinal pathology.…”

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confidence: 99%

Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity

Ferrero

Liabaud

Challier

et al. 2016

SPI

107

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OBJECT Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pelvic parameters have demonstrated the compensatory mechanisms of pelvis translation in addition to rotation. However, the mechanisms recruited for this pelvic rotation were not assessed. This study aims to analyze the relationship between spinopelvic and lower-extremity parameters and clarify the role of pelvic translation. METHODS This is a retrospective study of patients with spinal deformity and full-body EOS images. Patients with only stenosis or low-back pain were excluded. Patients were grouped according to T-1 spinopelvic inclination (T1SPi): sagittal forward (forward, > 0.5°), neutral (−6.3° to 0.5°), or backward (< −6.3°). Pelvic translation was quantified by pelvic shift (sagittal offset between the posterosuperior corner of the sacrum and anterior cortex of the distal tibia), hip extension was measured using the sacrofemoral angle (SFA; the angle formed by the middle of the sacral endplate and the bicoxofemoral axis and the line between the bicoxofemoral axis and the femoral axis), and chin-brow vertical angle (CBVA). Univariate and multivariate analyses were used to compare the parameters and correlation with the Oswestry Disability Index (ODI). RESULTS In total, 336 patients (71% female; mean age 57 years; mean body mass index 27 kg/m2) had mean T1SPi values of −8.8°, −3.5°, and 5.9° in the backward, neutral, and forward groups, respectively. There were significant differences in the lower-extremity and spinopelvic parameters between T1SPi groups. The backward group had a normal lumbar lordosis (LL), negative SVA and pelvic shift, and the largest hip extension. Forward patients had a small LL and an increased SVA, with a large pelvic shift creating compensatory knee flexion. Significant correlations existed between lower-limb parameter and pelvic shift, pelvic tilt, T-1 pelvic angle, T1SPi, and sagittal vertical axis (0.3 < r < 0.8; p < 0.001). ODI was significantly correlated with knee flexion and pelvic shift. CONCLUSIONS This is the first study to describe full-body alignment in a large population of patients with spinal pathologies. Furthermore, patients categorized based on T1SPi were found to have significant differences in the pelvic shift and lower-limb compensatory mechanisms. Correlations between lower-limb angles, pelvic shift, and ODI were identified. These differences in compensatory mechanisms should be considered when evaluating and planning surgical intervention for adult patients with spinal deformity.

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“…Frequently, this mechanism uses muscle force to improve alignment, with a resulting spinal shape that restores the gravity line position and horizontal gaze [22][23][24]. In this stage, the individual is able to meet these alignment goals, but at the price of increased muscle activity.…”

Section: Discussionmentioning

confidence: 99%

Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms

2014

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Introduction Sagittal balance is an independent predictor of clinical outcomes in spinal care. Surgical treatment is challenging and jeopardized by frequent complications. Guidelines for surgical treatment are currently not based on a classification of the disease. A comprehensive classification of sagittal balance based on regional deformities and compensatory mechanisms combined in deformity patterns is proposed. Though the sagittal shape of the spine can change due to degeneration or trauma, correlations between sagittal shape parameters and pelvic incidence (PI) have been described. Pelvic incidence is not changed by degeneration, thus representing a permanent source of information on the original sagittal shape of the spine. Methods One hundred and twenty-eight full-spine lateral standing radiographs of patients with different spinal conditions were evaluated and classified by one rater. One random subseries of 35 patients was evaluated by two raters for calculation of inter-rater agreement. Spinopelvic parameters were measured in all the radiographs. Internal validity of the classification system was evaluated comparing the values of regional sagittal parameters that distinguish one category from the others. Results Eight different patterns were identified regarding the site of the deformity and the presence of compensatory mechanisms: cervical, thoracic, thoracolumbar junction, lumbar, lower lumbar, global and pelvic kyphosis and normal sagittal alignment. Inter-rater agreement was almost perfect (j = 0.963). Statistically significant differences were found comparing the means of selected sagittal spinopelvic parameters that conceptually divide pairs or groups of categories: C2-C7 SVA for cervical kyphosis vs all other patients, TK-PI mismatch for thoracic kyphosis vs all other patients, T11-L2 kyphosis for thoracolumbar kyphosis vs all other patients, global alignment (LL?TK-PI) and SVA for lumbar kyphosis vs global kyphosis and pelvic tilt for pelvic kyphosis vs lumbar, lower lumbar and global kyphosis. Conclusion A comprehensive classification of sagittal imbalance is presented. This classification permits a better interpretation of the deformity and muscle forces acting on the spine, and helps surgical planning. Preliminary validation has been provided.

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Compensatory mechanisms contributing to keep the sagittal balance of the spine

Cited by 364 publications

References 25 publications

Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review

Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review

Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity

Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms

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