Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms?

Barrey, Cédric; Roussouly, Pierre; Perrin, Gilles; Huec, Jean-Charles Le

doi:10.1007/s00586-011-1930-3

Cited by 357 publications

(262 citation statements)

References 23 publications

(30 reference statements)

Supporting

Mentioning

240

Contrasting

Unclassified

Order By: Relevance

“…Our study is the first, to our knowledge, to stratify patients undergoing THA into those with or without lumbar DDD, and we found that most patients with DDD had flattened backs (mean 7°less lumbar lordosis) and more posterior pelvic tilt (mean 5°more sacral slope) in standing. Decreasing values in lumbar lordosis and sacral slope angles in patients with DDD are consistent with the spine literature, where these sagittal parameters are used to evaluate individual sagittal balance [4,5,28]. Interestingly, similar to a previous study evaluating sagittal balance during standing in patients undergoing THA [24], some patients with DDD in our study had such excessive posterior pelvic tilt and lack of lumbar lordosis that they required knee flexion to adapt, because hip extension was insufficient.…”

Section: Discussionsupporting

confidence: 89%

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Esposito

Miller

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

199

177

View full text Add to dashboard Cite

Background Sitting pelvic tilt dictates the proximity of the rim of the acetabulum to the proximal femur and, therefore, the risk of impingement in patients undergoing total hip arthroplasty (THA). Sitting position is achieved through a combination of lumbar spine segmental motions and/or femoroacetabular articular motion in the lumbarpelvic-femoral complex. Multilevel degenerative disc disease (DDD) may limit spine flexion and therefore increase femoroacetabular flexion in patients having THAs, but this has not been well characterized. Therefore, we measured standing and sitting lumbar-pelvic-femoral alignment in patients with radiographic signs of DDD and in patients with no radiographic signs of spine arthrosis.Questions/purposes We asked: (1) Is there a difference in standing and sitting lumbar-pelvic-femoral alignment before surgery among patients undergoing THA who have no radiographic signs of spine arthrosis compared with those with preexisting lumbar DDD? (2) Do patients with lumbar DDD experience less spine flexion moving from a standing to a sitting position and therefore compensate with more femoroacetabular flexion compared with patients who have no radiographic signs of arthrosis? Methods Three hundred twenty-five patients undergoing primary THA had preoperative low-dose EOS spine-toankle lateral radiographs in standing and sitting positions. Eighty-three patients were excluded from this study for scoliosis (39 patients), spondylolysis (15 patients), not having five lumbar vertebrae (7 patients), surgical or disease fusion (11 patients), or poor image quality attributable to high BMI (11 patients). In the remaining 242 of 325 patients (75%), two observers categorized the lumbar spine as either without radiographic arthrosis or having DDD based on defined radiographic criteria. Sacral slope, lumbar lordosis, and proximal femur angles were measured, and these angles were used to calculate lumbar spine flexion and femoroacetabular flexion in standing and sitting positions. Patients were aligned in a standardized sitting position so that their femurs were parallel to the floor to achieve approximately 90°of apparent hip flexion. Results After controlling for age, sex, and BMI, we found patients with DDD spines had a mean of 5°more posterior pelvic tilt (95% CI, À2°to À8°lower sacral slope angles; p \0.01) and 7°less lumbar lordosis (95% CI, À10°to À3°; p \ 0.01) in the standing position compared with patients without radiographic arthrosis. However, in the sitting position, patients with DDD spines had 4°less posterior pelvic tilt (95% CI, 1°-7°higher sacral slope angles; p = 0.02). From standing to sitting position, patients with DDD

show abstract

Section: Discussionsupporting

confidence: 89%

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Esposito

Miller

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

199

177

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…The LL will structurally reduce as a result of segmental discopathy and loss of disc height [13,25]. Subsequently, the loss of lordosis potentially leads to the anterior translation of the gravity axis (increasing SVA).…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, the loss of lordosis potentially leads to the anterior translation of the gravity axis (increasing SVA). In compensation, pelvic backtilt (PT increasing and SS decreasing and SFD increasing), which is secondary to the action of the hip extensor muscles acts to limit the forward movement of the gravity axis in these patients [2,13,15,16,25].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The characteristics of spinopelvic sagittal alignment in patients with lumbar disc degenerative diseases

et al. 2013

View full text Add to dashboard Cite

Purpose A comparative study of the spinopelvic sagittal alignment in patients with lumbar disc degeneration or herniation (LDD/LDH) in normal population was designed to analyse the role of sagittal anatomical parameter (pelvic incidence, PI) and positional parameters in the pathogenesis and development of the disease. Several comparative studies of these patients with asymptomatic controls have been done. However, in previous studies without lumbar MRI, a certain number of asymptomatic LDD patients should have been included in the control group and then impacted on the results. Methods Based on MRI findings, we divided 60 LDD or LDH patients and 110 asymptomatic volunteers into the normal group (NG) and the degeneration group (DG), which was further subdivided into the symptomatic (SDG) and asymptomatic (ADG) subgroups according to patients' symptoms. Standing full spine radiographs were used to measure sagittal parameters, including PI, sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA), and sacrumbicoxofemoral distance (SFD). Results The PI, SS and LL in DG were significantly lower than NG, while the SVA and SFD were significantly greater (P \ 0.05). PI correlated well with the SS and LL in all subjects. However, the trend lines of SS or LL over PI were downward in DG. PI was similar in SDG and ADG (P = 0.716) but SS and LL were significantly lower and SVA was significantly greater (P \ 0.05).Conclusions PI may play a predisposing role in the pathogenesis of lumbar disc degenerative diseases. The secondary structural and compensatory factors would lead to a straighter spine after disc degenerative change.

show abstract

Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms?

Cited by 357 publications

References 23 publications

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms

The characteristics of spinopelvic sagittal alignment in patients with lumbar disc degenerative diseases

Contact Info

Product

Resources

About