Predictive Value of Pelvic Incidence in Progression of Spondylolisthesis

Huang, Robert P.; Bohlman, Henry H.; Thompson, George H.; Poe-Kochert, Connie

doi:10.1097/01.brs.0000085325.42542.38

Cited by 85 publications

(41 citation statements)

References 15 publications

(23 reference statements)

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“…In order to measure pelvic radius, Jackson et al [7] placed round plastic jar caps with a small hole in their centers just under the superior domes of both acetabula visualized on the lateral radiographs, to mark the centers for the femoral heads. However, subsequent studies specifying normative values of PI and PT as well as their deviations in spinal pathologies used the centers of the femoral heads to define the bicoxofemoral axis [16][17][18][19][20][21][22][23]. The use of acetabula for PI and PT measurements could also be found in the literature [8,9,11].…”

Section: Discussionmentioning

confidence: 94%

Pelvic incidence and pelvic tilt measurements using femoral heads or acetabular domes to identify centers of the hips: comparison of two methods

Tyrakowski

Siemionow

2014

Eur Spine J

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Purpose The aim of the study was to compare pelvic incidence (PI) and pelvic tilt (PT) measurements using the bicoxofemoral axis obtained from either femoral heads or acetabular domes on lateral digital radiographs of the spine. Methods Standing lateral radiographs of the spine of patients without hip pathologies were analyzed. PI and PT were measured on 50 radiographs using the femoral heads first followed by measurements performed with the acetabular domes to define the bicoxofemoral axis. Agreement between the methods was quantified by intraclass correlation coefficient (ICC) and median error for a single measurement (SEM). Intraobserver reproducibility and interobserver reliability of both methods of identification of bicoxofemoral axis and its impact on PI and PT measurements were tested on 31 radiographs and quantified by ICC and SEM. Results There was an excellent agreement in PI as well as in PT between measurements performed using whether the femoral heads or the acetabular domes (ICC: 0.99; SEM: 0.56°for PI and ICC: 0.99; SEM: 0.2°for PT). Excellent intraobserver reproducibility was revealed for both methods (ICC: 0.99 and SEM: B0.17°for PI and ICC: 0.99; SEM: B0.18°for PT). Both methods presented excellent interobserver reliability (ICC: 0.99 and SEM: B0.54°for PI and ICC: C0.98; SEM: B0.9°for PT). Conclusions We suggest that either the femoral heads or the acetabular domes may be used for reliable PI and PT measurements on the lateral standing long-cassette digital radiographs of the spine.

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Section: Discussionmentioning

confidence: 94%

Pelvic incidence and pelvic tilt measurements using femoral heads or acetabular domes to identify centers of the hips: comparison of two methods

Tyrakowski

Siemionow

2014

Eur Spine J

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“…Some authors consider an important pelvic incidence as a pejorative factor for the progression of the vertebral listhesis [4,11,17]. But others did not observe it as significant [5]. This anatomic alteration permits, however, to suspect a disruption of the growth affecting the first sacral vertebra, leading to a dome-shaped upper sacral plate concomitant to the vertebral listhesis.…”

Section: Discussionmentioning

confidence: 99%

The femoro-sacral posterior angle: an anatomical sagittal pelvic parameter usable with dome-shaped sacrum

Legaye

2006

Eur Spine J

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IntroductionThe interdependence between the pelvis and the sagittal spinal curvatures is obvious. The leading part of the pelvic sagittal anatomy in this orientation was well established by Duval-Beaupe`re thanks to the description of the angle 'Pelvic Incidence' (PI) [14]. It is the angle between the line perpendicular to the superior plate of the first sacral vertebra (S1) at its midpoint and the line connecting this point to the middle axis of the femoral heads. It is own for every individual and independent of the position of pelvis. A strict relation was described between this anatomical parameter and the sagittal tilt of the superior plate of the sacrum, and between this sacral tilt and the amount of lumbar lordosis. So the pelvic morphology modulates the sagittal spinal alignment. During and Itoi [1,7] described also these relations using an angle complementary of the incidence. As well Jackson observed this relation between the pelvic morphology, the sacral inclination and the lumbar curvature. He expressed the pelvic sagittal shape by the 'Pelvic Lordosis' (PR-S1) [8][9][10][11][12]. The measurement of these angles is easy in most of the cases. Their reliability and their reproducibility were established. Each author agrees to use as femoral axis the middle point of the line connecting the centers of the two femoral heads.However, the exact assessment of the upper plate of the sacrum (and consequently the values of the anatomical Jean LegayeThe femoro-sacral posterior angle: an anatomical sagittal pelvic parameter usable with dome-shaped sacrum Abstract The sagittal pelvic morphology modulates the individual alignment of the spine.

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“…14,21,23 Ten patients underwent fusion of L4 -S1 and 6 underwent fusion of L5-S1. Six patients underwent placement of transsacral screws alone (Fig.…”

Section: Resultsmentioning

confidence: 99%

High-grade spondylolisthesis treated using a modified Bohlman technique: results among multiple surgeons

Hart

Domes

Goodwin

et al. 2014

SPI

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Object The ideal surgical management of high-grade spondylolisthesis remains unclear. Concerns regarding the original Bohlman transsacral interbody fusion technique with stand-alone autologous fibular strut include late graft fracture and incomplete reduction of lumbosacral kyphosis. The authors' goal was to evaluate the radiographic and surgical outcomes of patients treated for high-grade spondylolisthesis with either transsacral S-1 screws or standard pedicle screw fixation augmenting the Bohlman posterior transsacral interbody fusion technique. Methods A retrospective review of patients who underwent fusion for high-grade spondylolisthesis in which a Bohlman oblique posterior interbody fusion augmented with either transsacral or standard pedicle screw fixation was performed by 4 spine surgeons was completed. Estimated blood loss, operating time, perioperative complications, and need for revision surgery were evaluated. Upright pre- and postsurgical lumbar spine radiographs were compared for slip percent and slip angle. Results Sixteen patients (12 female and 4 male) with an average age of 29 years (range 9–66 years) were evaluated. The average clinical follow-up was 78 months (range 5–137 months) and the average radiographic follow-up was 48 months (range 5–108 months). Ten L4–S1 and 6 L5–S1 fusions were performed. Five fibular struts and 11 titanium mesh cages were used for interbody fusion. Six patients had isolated transsacral screws placed, with 2 (33%) of the 6 requiring revision surgery for nonunion. No nonunions were observed in patients undergoing spanning pedicle screw fixation augmenting the interbody graft. Six patients experienced perioperative complications including 3 iliac crest site infections, 1 L-5 radiculopathy without motor involvement, 1 deep vein thrombosis, and 1 epidural hematoma requiring irrigation and debridement. The average estimated blood loss and operating times were 763 ml and 360 minutes, respectively. Slip percent improved from an average of 62% to 37% (n = 16; p < 0.01) and slip angle improved from an average of 18° to 8° (n = 16; p < 0.01). No patient experienced L-5 or other motor deficit postoperatively. Conclusions The modified Bohlman technique for treatment of high-grade spondylolisthesis has reproducible outcomes among multiple surgeons and results in significant improvements in slip percent and slip angle. Fusion rates were high (14 of 16; 88%), especially with spanning instrumentation augmenting the oblique interbody fusion. Rates of L-5 motor deficit were low in comparison with techniques involving reduction of the anterolisthesis.

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Predictive Value of Pelvic Incidence in Progression of Spondylolisthesis

Abstract: Pelvic incidence cannot adequately predict the probability of spondylolisthetic progression. Analysis of the other clinical and radiographic parameters revealed that slip percentage and high-grade spondylolisthesis remain the most positive predictors of progression.

Cited by 85 publications

References 15 publications

Pelvic incidence and pelvic tilt measurements using femoral heads or acetabular domes to identify centers of the hips: comparison of two methods

Pelvic incidence and pelvic tilt measurements using femoral heads or acetabular domes to identify centers of the hips: comparison of two methods

The femoro-sacral posterior angle: an anatomical sagittal pelvic parameter usable with dome-shaped sacrum

High-grade spondylolisthesis treated using a modified Bohlman technique: results among multiple surgeons

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