Should Sagittal Spinal Alignment Targets for Adult Spinal Deformity Correction Depend on Pelvic Incidence and Age?

Abstract

Study Design. Retrospective analysis. Objective. Determine whether deformity corrections should vary by pelvic incidence (PI). Summary of Background Data. Alignment targets for deformity correction have been reported for various radiographic parameters. The T1 pelvic-angle (TPA) has gained in applications for adult spinal deformity (ASD) surgical-planning since it directly measures spinal alignment separate from pelvic- and lower-extremity compensation. Recent studies have demonstrated that ASD corrections should be age specific. Methods. A prospective database of consecutive ASD patients was analyzed in conjunction with a normative spine database. Clinical measures of disability included the Oswestry Disability Index (ODI) and Short Form 36 Survey (SF-36) Physical Component Score (PCS). Baseline relationships between TPA, age, PI, and ODI/SF-36 PCS scores were analyzed in the ASD and asymptomatic patients. Linear regression modeling was used to determine alignment targets based on PI and age-specific normative SF-36-PCS values. Results. Nine hundred three ASD patients (mean 53.7 yr) and 111 normative subjects (mean 50.7 yr) were included. Patients were subanalyzed by PI: low, medium, high (<40, 40–75, >75); and age: elderly (>65 yr, n = 375), middle age (45–65 yr, n = 387), and young (18–45 yr, n = 141). TPA and SRS-Schwab parameters correlated with age and PI in ASD and normative subjects (r = 0.42, P < 0.0001). ODI correlated with PCS (r = 0.71, P < 0.0001). Linear regression analysis using age-normative SF-36-PCS values demonstrated that ideal spinopelvic alignment is less strict with increasing PI and age. Conclusion. Targets for ASD correction should vary by age and PI. This is demonstrated in both asymptomatic and ASD subjects. Using age-normative SF-36 PCS values, alignment targets are described for different age and PI categories. High-PI patients do not require as rigorous realignments to attain age-specific normative levels of health status. As such, sagittal spinal alignment targets increase with increasing age as well as PI. Level of Evidence: 3

Clinical Outcomes of S2 Alar-Iliac (S2AI) Screw Technique in The Treatment of Severe Spinal Sagittal Imbalance: A Retrospective 2-Year Follow-Up Study

“…Patients with a small PI have less sagittal compensation ability, and the requirements for reconstruction of lumbar lordosis are stricter. 24 In our study, mechanical complications were signi cantly correlated with GAP scores. The average GAP scores were 6.9±2.0 and 10.9±2.4 in groups A and B, respectively.…”

Increasing pelvic incidence is associated with more global sagittal imbalance in ankylosing spondylitis with thoracolumbar kyphosis: an observational retrospective study of 94 cases

“…The association between increasing PI and larger TPA in AS patients with thoracolumbar kyphosis might be significant for the surgical design. Protopsaltis et al [28] also found that TPA was significantly correlated with PI in adult spinal deformity and suggested that the targets for sagittal spinal alignment increase with increasing PI.…”

Synchronous imaging of pelvic geometry and muscle morphometry: a pilot study of pelvic retroversion using upright MRI

“…Additionally, the influence of PI on compensation and notably the interplay of PI, PT and SS to achieve pelvic retroversion was also observed in this study. Previous work has shown that the ability to retrovert the pelvis, by increasing PT, is limited by PI, in addition to a minimal value of SS of 0°, a horizontal sacral endplate 10 , 22 . A smaller PI means the pelvis has a more vertical shape, a lower SS and as a result, it is generally observed that these individuals have less capacity to retrovert their pelvis.…”