Fixed Pelvic Obliquity After Poliomyelitis: Classification And Management

Lee, Duk Yong; Choi, In Ho; Chung, Chin Youb; Cho, Tae-Joon; Lee, Jae Chul

doi:10.1302/0301-620x.79b2.7052

Cited by 19 publications

(13 citation statements)

References 19 publications

(30 reference statements)

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“…Because compensation for imbalance of the pelvis could be done by not only the lumbar spine (L1-5), but also the lumbosacral junction or whole spine including thoracic spine, conventional X-ray evaluation using “lumbar scoliosis (L1-5 angle)” is not suitable for evaluating coronal balance in patients have tilted pelvis. Furthermore, Lee et al [ 7 ] classified fixed pelvic obliquity after poliomyelitis into 8 patterns, and elucidated that lumbar scoliosis could develop in each side regardless of the direction of pelvic obliquity. The results of our study showed that the direction of lumbar scoliosis was not always coincident with the direction of pelvic obliquity, and the magnitude of lumbar curve did not correlate with degree of pelvic obliquity.…”

Section: Discussionmentioning

confidence: 99%

The impact of the leg-lengthening total hip arthroplasty on the coronal alignment of the spine

et al. 2015

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BackgroundCoronal imbalance of the pelvis is recognized to lead to the development of degenerative lumbar scoliosis. We hypothesized that an abrupt change of pelvic obliquity may show a reproducible trend of coronal compensation in the lumbosacral spine. The aim of the study was to classify the change of coronal alignment of spine after THA.MethodsThis is a retrospective study based on the radiological analysis of 195 patients who underwent THA between 2009 and 2010. The mean age at surgery was 61.5 years old, and minimum follow up period was 24 months. Pelvic obliquity (POb) and Cobb’s angle of lumbar scoliosis (LS) in coronal plane were measured. Over 3.5 degrees of change in POb was regarded as ΔPOb(+) and over 10 degrees of lumbar scoliosis was regarded as LS(+). The change of LS were classified into 3 subtypes; ΔLS(+), over 5 degrees of progress in LS, ΔLS(-), over 5 degrees of improvement in LS, and ΔLS(n), changes in LS within 5 degrees.ResultsOver 3.5 degrees of change in POb was significantly correlated with the change in LS. Among195 patients, 120 patients improved their pelvic obliquity (ΔPOb(+)), and 75 patients did not have an improved pelvic obliquity (ΔPOb(-)). 99 patients out of 120 ΔPOb(+) patients did not show changes (54, ΔLS(n)) or improvement in scoliosis (45, ΔLS(-)).The remaining 21 patients showed progress or development of de novo scoliosis. Patients who failed to compensate for the POb change at lumbosacral area developed de novo lumbar scoliosis (7 cases), showed progression in lumbar scoliosis (7 cases) or developed coronal trunk shift over 20mm (7 cases)ConclusionsThe patterns of compensation in lumbar or lumbosacral spine in coronal plane after leg lengthening THA were classified with regards to pelvic obliquity and Cobb’s angle. 89.2% of 195 patients showed acceptable compensation in lumbar spine, 21 patients developed coronal imbalance. THA therefore is considered to be safe, as regards to spinal balance in coronal plane. However we have to keep in mind that preoperative rigid scoliosis could have a risk in progress for spinal imbalance.

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Section: Discussionmentioning

confidence: 99%

The impact of the leg-lengthening total hip arthroplasty on the coronal alignment of the spine

et al. 2015

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“…Eberle et al 7 reported a 40% rate of pseudarthrosis and a 94% curve progression rate following long spinal fusion without arthrodesis in 1988. Most recently, Lee et al 22 reported an average 48% curve correction with satisfactory clinical improvement in 5 post-polio patients with scoliosis.…”

Section: Discussionmentioning

confidence: 99%

Complications and Outcomes of Complex Spine Reconstructions in Poliomyelitis-Associated Spinal Deformities

Godzik

Lenke²,

Holekamp³

et al. 2014

Spine

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Study Design Retrospective case-series Objective Share our institutional experience with spinal reconstruction for deformity correction in patients with a history of poliomyelitis. Background Data Polio and post-polio syndrome are not uncommonly related to a paralytic spinal deformity. Limited modern data exists regarding outcomes and complications following spinal reconstruction in this population. Methods A clinical database was reviewed for patients undergoing spinal reconstruction for polio-associated spinal deformity at our institution from 1985 to 2012. Relevant demographic, medical, surgical and postoperative information were collected from medical records and analyzed. Preoperative and last follow-up SRS-22 scores were recorded. Results A total of 22 patients with polio who underwent surgical deformity correction were identified. Mean age was 49 years (Range, 12–74), and 15 patients (68%) were female. Preoperative motor deficit was present in 14/22 (64%). All patients underwent instrumented spinal fusion (Mean 13 vertebral levels, Range, 3–18). Ten (10/22, 45%) patients developed major complications, and four patients (4/22, 18%) developed new postoperative neurological deficits. Neurological monitoring yielded a 13% false negative rate. At 2-year follow-up (20/22), patients maintained an average coronal correction of 25 degrees (33%, p = 0.001) and sagittal correction of 25 degrees (34%, p = 0.003). Minimum 2-year follow-up data were available for 11/22 (50%) of patients. At an average of 72 months of follow-up (Range, 28 – 134 months), the mean SRS22 pain subscore improved from a mean of 2.75 to 3.6 (p = 0.012); self-image from 2.8 to 3.7 (p = 0.041); function from 3.1 to 3.8 (p = 0.036); satisfaction from 2.1 to 3.9 (p = 0.08); mental health from 3.7 to 4.5 (p = 0.115). Conclusion Spine reconstruction for poliomyelitis-associated deformity was associated with high complication rates (54%) and sometimes unreliable neurologic monitoring data. Despite this, patients undergoing spine reconstructions had significantly improved outcomes scores. These data may help surgeons appropriately counsel this complicated patient population.

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“…PO was classified into two major deformity types: I ( Fig 1A ) and II ( Fig 1B ). The direction of pelvic inclination was used relative to the short leg as the basis for classification, with modifications based on the purpose of the present and previous studies [ 8 , 12 ], i.e. based on the inclination of preoperative and postoperative PO, each deformity type was further classified into six subtypes depending on the severity of the PO angle of inclination: 0°–3° (types IA and IIA), 3°–6° (types IB and IIB), and >6° (types IC and IIC) [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…PO angles were measured as described in previous studies, with modifications ( Fig 1A and 1B ) [ 8 , 12 ]. One line was drawn on the AP radiograph of the pelvis with respect to the lower lumbar spine; this line connected the apices of both iliac crests, and another line was drawn along the bottom of the fourth lumbar vertebra [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…Theoretically, the type I PO deformity is characterized by an abduction contracture deformity in the affected hip, as well as a pelvis that is inclined forward to the affected side and lower on the side of the shorter leg ( Fig 1A ). Conversely, the type II deformity is characterized by an adduction contracture deformity in the affected hip and a higher pelvis that is inclined forward to the healthy side ( Fig 1B ) [ 12 ]. We hypothesize that PO with a fixed abduction/adduction contracture deformity of the hip may intraoperatively affect the release of soft tissues, ultimately resulting in LLI.…”

Section: Introductionmentioning

confidence: 99%

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Severe Pelvic Obliquity Affects Femoral Offset in Patients with Total Hip Arthroplasty but Not Leg-Length Inequality

et al. 2015

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Leg-length inequality is an extensively studied complication of total hip arthroplasty in normal patients. However, few studies have focused on the pelvic obliquity of coronal pelvic malrotation. We hypothesized that pelvic obliquity with a fixed abduction/adduction contracture deformity of the hip may intraoperatively affect the release of soft tissues, ultimately resulting in a leg-length inequality. This study also investigated whether the femoral and vertical offsets of total hip arthroplasty were correlated with pelvic obliquity. This prospective study divided 98 patients into six groups based on the inclination of pelvic obliquity before total hip arthroplasty. Leg-length inequality, variation of pelvic obliquity, offset, and vertical offset were measured after total hip arthroplasty. Leg-length inequality and vertical offset were not significantly different among groups, whereas the variation of pelvic obliquity was significantly higher in type IIC pelvic obliquity than in other groups. Type IC pelvic obliquity had a significantly shorter offset than did the other groups, which may have been an important factor leading to type IC pelvic obliquity. Pelvic obliquity exhibited no significant effect on leg-length inequality in patients with total hip arthroplasty. A shorter offset may be caused by the higher tension of the abductor in the operated hip, which may result in the formation of type IC pelvic obliquity. Releasing the abductor contracture and restoring femoral offset are important for increasing hip stability and maintaining pelvic balance following total hip arthroplasty.

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Fixed Pelvic Obliquity After Poliomyelitis: Classification And Management

Cited by 19 publications

References 19 publications

The impact of the leg-lengthening total hip arthroplasty on the coronal alignment of the spine

The impact of the leg-lengthening total hip arthroplasty on the coronal alignment of the spine

Complications and Outcomes of Complex Spine Reconstructions in Poliomyelitis-Associated Spinal Deformities

Severe Pelvic Obliquity Affects Femoral Offset in Patients with Total Hip Arthroplasty but Not Leg-Length Inequality

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