Leg length discrepancy and adolescent idiopathic scoliosis: clinical and radiological characteristics

Büyükaslan, Ahsen; Abul, Kadir; Berk, Haluk; Yilmaz, Hürriyet Gürsel

doi:10.1007/s43390-021-00417-0

Cited by 7 publications

(7 citation statements)

References 30 publications

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“…The lower limb may appear to be overly long if the Achilles tendon is contracted, thus causing the heel to lift. A level pelvis can be verified indirectly using a scoliometer to evaluate the sacral hump or directly on the posterosuperior iliac spine (PSIS) during the trunk flexion portion of Adam's test (Figure 8 ) [ 25 ].…”

Section: Reviewmentioning

confidence: 99%

“…LLI causes pelvic obliquity, precisely the non-horizontality of the axis that passes through the tip of the superior iliac crest, in the frontal plane [ 14 , 23 , 50 , 52 , 68 , 78 ] and an inclination of the sacral base [ 25 ], which is defined as sacral slanting [ 79 ] or sacral shelf inclination [ 75 ]. A rather rigid junction of the L5 vertebra with the sacral bone is often observed in lumbar scoliosis, with convexity directed toward the shorter leg [ 35 ].…”

Section: Reviewmentioning

confidence: 99%

“…For scoliosis, a scoliometer is simple tool to verify the usefulness of compensating for an LLI (see Figure 7 ). Additionally, a scoliometer can be used to check whether a rise positioned under the foot of the shorter limb reduces the asymmetry of the pelvis [ 25 ] and the degree of the lumbar hump.…”

Section: Reviewmentioning

confidence: 99%

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Scoliosis and Lower Limb Inequality: To Lift or Not to Lift, That Is the Question

Colonna,

Casacci,

Borghi

2024

Cureus

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In subjects with scoliotic alterations of the spine, asymmetrical lengths of the lower limbs are frequently observed, a condition commonly referred to as leg length inequality (LLI) or discrepancy (LLD). This asymmetry can induce pelvic misalignments, manifested by an asymmetric height of the iliac crests, and consequently an alteration of the spine's axis. Although correcting this discrepancy might appear to be a straightforward solution, further investigation may reveal other indications. The purpose of this article is to aid clinicians confronted with the decision of whether to compensate for an LLI in individuals with scoliosis, encompassing both adolescents and adults. It presents a literature review on the incidence of LLIs in the general population, distinguishing between structural LLI (sLLI) and functional LLI (fLLI) types of LLIs, and quantifying their magnitude with clinical and instrumental evaluation. Additionally, it links these two types of LLIs to the type of scoliosis (structural or functional). From a clinical perspective, it also examines the compensatory mechanisms employed by the pelvis in the presence of structural or functional LLIs in order to draw useful indications for therapeutic decisions. Moreover, it proposes an additional evaluation parameter in the coronal plane, namely the central sacral vertical line (CSVL), to aid in the decision-making process regarding LLI compensation. Although this parameter has been documented in the literature, it has been little associated with LLIs. The findings indicate that scoliotic discrepancies should be compensated (conservatively or surgically) only when the imbalance of the femoral heads is on the same side as the imbalance of the sacrum and the iliac crests; this corrective action should result in a reduction of the overhang in the coronal plane.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

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Scoliosis and Lower Limb Inequality: To Lift or Not to Lift, That Is the Question

Colonna,

Casacci,

Borghi

2024

Cureus

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“…Another accompanied factor is lower extremity length discrepancy, which was significantly correlated with PO 8 . Especially the functional subtype of lower extremity length discrepancy ≥10 mm was found to be significantly correlated with PO 8,9 . However, in adolescent patients with thoracic or thoracolumbar scoliosis, the lower extremity length discrepancy or anisomelia remains stable with growth while both the scoliotic deformity and PO progress 2 …”

mentioning

confidence: 99%

“…8 Especially the functional subtype of lower extremity length discrepancy ≥ 10 mm was found to be significantly correlated with PO. 8,9 However, in adolescent patients with thoracic or thoracolumbar scoliosis, the lower extremity length discrepancy or anisomelia remains stable with growth while both the scoliotic deformity and PO progress. 2 The validity of diagnostic assessment for scoliosisrelated deformities such as PO is still up for debate, even though it is a topic that has received a lot of attention in the literature recently.…”

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confidence: 99%

Intraobserver and Interobserver Reliability of Pelvic Obliquity Measurement Methods in Patients With Idiopathic Scoliosis

Kisacik,

Bazancir-Apaydin,

Apaydin

2024

Journal of Pediatric Orthopaedics

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Background: Despite the importance of the assessment of pelvic obliquity, especially in the planning of surgery, there is no consensus on the pelvic obliquity measurements. The purpose of this study is to assess the intraobserver and interobserver reliability of 4 different pelvic obliquity measuring methods in patients with idiopathic scoliosis (IS): the Osebold, O’Brien, Maloney, and Allen&Ferguson methods. Methods: A retrospective cohort of 85 posteroanterior full-spine radiographs in the standing position of patients with IS involving the pelvic obliquity was evaluated by a team of 3 raters. The same researcher recorded the curve magnitude, apical vertebral rotation, Risser grade, curve pattern, and femoral head height difference. The pelvic obliquity angle was measured using the Osebold, O’Brien, Maloney, and Allen&Ferguson methods. The same graders were asked to regrade the same radiographs after at least 1 month. Results: The Osebold method showed the highest interobserver reliability with an ICC of 0.994 and 0.983. The Allen&Ferguson method had the lowest reliability with an ICC of 0.911 and 0.934, but all of the methods were considered having excellent reliability. The Osebold method also showed the highest intraobserver reliability, ranging from 0.909 to 0.997. The Allen&Ferguson method had the lowest intraobserver reliability, with a range of 0.741 to 0.960. Also, all observers preferred the Osebold Method. The observers reported that the Allen&Ferguson method was considered the most time-consuming method, while the least time-consuming method was specified as the Osebold method. Conclusions: To the best of our knowledge, this study is the first to evaluate the intraobserver and interobserver reliability of pelvic obliquity among common measurement methods in patients with idiopathic scoliosis. All methods were evaluated as having excellent to good reliability in this study, but the Osebold method is the most reliable method of measuring pelvic obliquity on a frontal view radiograph in idiopathic scoliosis. The Osebold method is easier to use as it requires only the iliac crests to be visualized. Level of Evidence: Level III—Retrospective cohort study.

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Effect of spinal fusion on joint space narrowing of the hip: comparison among non-fusion, short fusion, and middle or long fusion

et al. 2023

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Background Lumbar fusion corrects spinal deformities and improves spinal complications. Hip osteoarthritis (OA) is strongly correlated with spinal mobility, and joint space narrowing of the hip after spinal fusion has gained attention. This study aimed to elucidate the effect of spinal fusion on hip joint space narrowing. Materials and methods We retrospectively examined 530 hips of 270 patients who underwent spinal surgery. All the patients underwent whole-spine radiography before and at the final follow-up. Patients were divided into three groups (N group: non-spinal fusion, S group: up to three interbody fusions, and L group: more than four interbody fusions). The rates of joint space narrowing, spinal parameters (sagittal vertical axis, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence), and limb length discrepancy at the final follow-up were compared. A multilinear regression analysis was performed to identify the risk factors for the rate of joint space narrowing. Results The rate of joint space narrowing was significantly higher in the L group than in the N and S groups (P < 0.001). No significant difference in the rate of joint space narrowing was observed between the N and S groups. Multiple linear regression analysis revealed that the number of fusion levels (p < 0.05) and follow-up period (p < 0.001) were independent risk factors for joint space narrowing. Spinal parameters at the final follow-up were not independent risk factors. Conclusions Long spinal fusion (more than four levels) led to significantly greater joint space narrowing of the hip than short (up to three levels) or no fusion. Spinal alignment did not affect joint space narrowing of the hip. Surgeons should be aware that more than four interbody fusions may result in worse joint space narrowing of the hip. Level of evidence IV, retrospective study

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Leg length discrepancy and adolescent idiopathic scoliosis: clinical and radiological characteristics

Cited by 7 publications

References 30 publications

Scoliosis and Lower Limb Inequality: To Lift or Not to Lift, That Is the Question

Scoliosis and Lower Limb Inequality: To Lift or Not to Lift, That Is the Question

Intraobserver and Interobserver Reliability of Pelvic Obliquity Measurement Methods in Patients With Idiopathic Scoliosis

Effect of spinal fusion on joint space narrowing of the hip: comparison among non-fusion, short fusion, and middle or long fusion

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