Lumbar lordosis does not correlate with pelvic incidence in the cases with the lordosis apex located at L3 or above

Tono, Osamu; Hara, Kazuhiro; Okamoto, Masashi; Hatsushikano, Shun; Shimoda, Haruka; Watanabe, Kei; Harimaya, Katsumi

doi:10.1007/s00586-018-5695-9

Cited by 18 publications

(20 citation statements)

References 26 publications

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“…However, the data concerning the number of patients with large PIs is small may be a characteristic of Korean elderly patients. Recent study showed similar results [38]. Finally, included people in this study were the current elderly patients in Korea and the fit BMI was a characteristic of the patients.…”

Section: Agesupporting

confidence: 68%

Predictive formula of ideal lumbar lordosis and lower lumbar lordosis determined by individual pelvic incidence in asymptomatic elderly population

et al. 2019

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Purpose This study aimed to obtain reference values of lumbar lordosis (LL) and lower LL (LLL) from normal asymptomatic groups, determine the relationship between them and pelvic incidence (PI), and establish the predictive formula for ideal LLL in the elderly Korean population. Methods Standing plain lateral radiographs of the whole spine, including the pelvis, were analyzed in asymptomatic adult male volunteers without back pain or prior surgery involving the spine or lower extremity. Volunteers with scoliosis, spondylolisthesis, segmental disk space narrowing, and/or compression fractures in the radiographs were excluded. The following parameters were measured: LL, LLL, and pelvic parameters including PI. The values of PILL and PI-LLL were calculated, and the formula using stepwise multiple regression analysis was made. A P value of < 0.05 was considered statistically significant. Results The study participants included 150 volunteers. All were male participants with an average age of 64.1 ± 6.4. The average value of height, weight, and body mass index was 167.

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Section: Agesupporting

confidence: 68%

Predictive formula of ideal lumbar lordosis and lower lumbar lordosis determined by individual pelvic incidence in asymptomatic elderly population

et al. 2019

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“…In fact, in our study, the balanced group maintained optimal alignment until the last follow-up, with an average postoperative LDI of 39.5%, which is much lower than the ideal LDI of 50–80% according to the GAP score. Further, the postoperative apex was at the L2–L3 level, which is relatively more proximal compared to that in other studies [ 31 , 32 ]. Patients with LDK have a large PI [ 40 ], and the mean PI of the patients in our study was 55°.…”

Section: Discussionmentioning

confidence: 87%

“…We measured SVA, thoracic kyphosis angle (TK; T4–T10), LL angle (L1–S1), lower LL angle (LS; L4–S1), PI, PT, and sacral slope (SS) at the period of preoperative, postoperative, and at the last follow-up [ 29 , 30 ]. In order to evaluate the postoperative lordosis morphology, we measured the postoperative lordosis apex level (Apex) [ 31 ]. We measured the postoperative upper lordosis arc angle (UA) and lower lordosis arc angle (LA = SS) by dividing LL by the reference of the horizontal axis.…”

Section: Methodsmentioning

confidence: 99%

Optimized Surgical Strategy for Adult Spinal Deformity: Quantitative Lordosis Correction versus Lordosis Morphology

Lee

Lim

et al. 2021

JCM

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Background: In surgical correction of adult spinal deformity (ASD), pelvic incidence (PI)-lumbar lordosis (LL) plays a key role to restore normal sagittal alignment. Recently, it has been found that postoperative lordosis morphology act as an important factor in preventing mechanical complications. However, there have been no studies on the effect of postoperative lordosis morphology on the restoration of sagittal alignment. The primary objective of this study was to evaluate the effect of postoperative lordosis morphology on achievement of optimal sagittal alignment. The secondary objective was to find out which radiographic or morphologic parameter affects sagittal alignment in surgical correction of ASD. Methods: 228 consecutive patients with lumbar degenerative kyphosis who underwent deformity correction and long-segment fixation from T10 to S1 with sacropelvic fixation and follow-up over 2 years were enrolled. Patients were divided according to whether optimal alignment was achieved (balanced group) or not (non-balanced group) at last follow-up. We analyzed the differences of postoperative radiographic parameters and morphologic parameters between two groups. Correlation analysis and stepwise multiple linear regression analysis was performed to predict the effect of PI-LL and morphologic parameters on the sagittal vertical axis (SVA). Results: Of 228 patients, 195 (85.5%) achieved optimal alignment at last follow-up. Two groups significantly differed in postoperative and last follow-up LL (p < 0.001 and p = 0.028, respectively) and postoperative and last follow-up PI-LL (p < 0.001 and p = 0.001, respectively). Morphologic parameters did not significantly differ between the two groups except lower lordosis arc angle (=postoperative sacral slope). In correlation analysis and stepwise multiple linear regression analysis, postoperative PI-LL was the only parameter which had significant association with last follow-up SVA (R2 = 0.134, p < 0.001). Morphologic parameters did not have any association with last follow-up SVA. Conclusions: When planning spine reconstruction surgery, although considering postoperative lordosis morphology is necessary, it is still very important considering proportional lordosis correction based on individual spinopelvic alignment (PI-LL) to achieve optimal sagittal alignment.

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“…A number of distance and angular parameters were all measured twice by the same trained spine surgeon, and the average value was used as the final result. First, the location of the LLA, defined as the most anterior lumbar vertebra or disc in the sagittal plane [9], was measured. Vertebrae from L1 to L5 were assigned numbers ranging from 1 to 5 to simplify data collection as well as to facilitate correlation analysis.…”

Section: Radiographic Measurementsmentioning

confidence: 99%

“…PI has a direct effect on the lumbar curvature of a specific individual [3,8]. Several data sets have been reported, suggesting there is a strong correlation between lumbar lordosis (LL) and PI in both normal and pathologic situations [9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Correlation between the apex of lumbar lordosis and pelvic incidence in asymptomatic adult

2019

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Purpose The objective of this study was to test the correlation between the apex of lumbar lordosis (LLA) and pelvic incidence (PI) in asymptomatic adults, and to establish predictive formulae based on the PI to obtain the reference values of lumbar sagittal parameters. Methods A cohort of 183 asymptomatic volunteers older than 18 years was enrolled in this study between April 2017 and May 2019. A full-spine, standing X-ray was taken for each subject. The following parameters in the sagittal plane were measured: the LLA, the distance between the plumb line of the lumbar apex (LAPL) and gravity plumb line, lumbar lordosis (LL), the upper arc of lumbar lordosis (LLUA), the lower arc of lumbar lordosis (LLLA) and the PI. The correlations between lumbar parameters and PI were analysed, and simple linear regressions were simultaneously constructed. The statistical significance level was P < 0.05. Results The PI was statistically correlated with the LLA

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Lumbar lordosis does not correlate with pelvic incidence in the cases with the lordosis apex located at L3 or above

Cited by 18 publications

References 26 publications

Predictive formula of ideal lumbar lordosis and lower lumbar lordosis determined by individual pelvic incidence in asymptomatic elderly population

Predictive formula of ideal lumbar lordosis and lower lumbar lordosis determined by individual pelvic incidence in asymptomatic elderly population

Optimized Surgical Strategy for Adult Spinal Deformity: Quantitative Lordosis Correction versus Lordosis Morphology

Correlation between the apex of lumbar lordosis and pelvic incidence in asymptomatic adult

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