Tag: Pelvic incidence

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Can pelvic incidence affect changes in sagittal spino‑pelvic parameters between standing and sitting positions in individuals with lumbar degenerative disease?

European Spine Journal (2024) 33:4598–4604

The aim of this study was to explore the correlation between PI and standing-to-sitting changes of the sagittal alignment in patients with lumbar degenerative diseases, and investigate the differences in posture changes among Roussouly types.

Methods A total of 209 patients with lumbar degenerative disease were retrospectively included in this study. All the patients received lateral full body imaging in both standing and sitting positions. Sagittal parameters including SVA, OD-HA, PT, PI, PT/PI, SS, LL, TK, Upper LL (L1-L4) and Lower LL (L4-S1) were measured in both standing and sitting position, and the parameters were compared between two positions. The correlations between PI and lumbo-pelvic changes were analyzed. The postural changes were compared among different Roussouly types.

Results From standing to sitting, all the parameters except PI significantly changed, including SVA, OD-HA, PT, PT/PI, SS, LL, TK, Upper LL and Lower LL. The contribution of lower LL was greater to global LL than upper LL. PI had a significant correlation with ΔPT, ΔSS, ΔLL, ΔUpper LL and ΔLower LL. From standing to sitting, type 4 patients had the most pronounced ΔPT, ΔSS and ΔLL, and ΔLower LL of types 3 and 4 were greater than that of types 1 and 2.

Conclusions In patients with degenerative disease, PI plays an important role in determining the extent of lumbo-pelvic changes from standing to sitting. Among different Roussouly types, type 4 patients have the most pronounced changes of PT, SS and LL, suggesting the relatively greater flexibility of pelvis and lumbar spine.

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Relationship between the pelvic incidence and the modified Oxford Hip score: a computed tomographic analysis

Acta Neurochirurgica (2024) 166:503

There is scant data on the relationship between skeletal maturity and pelvic parameters such as the pelvic incidence (PI). The aim of this study was to report on the relationship between PI and the modified Oxford Hip Score (mOHS) as a measure of skeletal maturity. We hypothesised a significant correlation would be determined between the mOHS and PI.

Methods CT performed for major trauma or abdominal pathology was assessed. The PI and segmental vertebral body angles, L1-L5, were obtained. The mOHS was used to assess maturity with total scores ranging from 16 to 25 (least-most mature). 193 scans were analysed. The mean age 9.7 years (range 4.0 – 15.7); 62 female (32%).

Results There were significant positive correlations between age and all components of the mOHS: FH (r = 0.765; p < 0.001), GT (r = 0.749; p < 0.001), LT (r = 0.704; p < 0.001), TC (r = 0.775; p < 0.001), IL (r = 0.642; p < 0.001) and mOHS (r = 0.811; p < 0.001). Mean PI for the cohort was 40.8 (s.d. 9.1; range 19.3–69.4). There were significant albeit weak correlations with FH (r = 0.213; p = 0.003), GT (r = 0.209; p = 0.004), LT (r = 0.247; p < 0.001), TC (r = 0.263; p = < 0.001), IL (r = 0.221; p = 0.002) and total mOHS (r = 0.255; p < 0.001). Multivariable linear regression indicated TC and LT the best predictors of PI. Significant correlations noted between L1 segmental lordosis and all components of the mOHS, strongest with triradiate (r=-0.406; p < 0.001).

Conclusions In this CT-based study, the mOHS correlated weakly with PI and proximal vertebral body lordosis. Of the mOHS components, triradiate and lesser trochanter cartilage status appeared to be best correlated with PI and may be anatomic variables to focus on in future research.

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Risk Factors for Adjacent Segment Disease in Short Segment Lumbar Interbody Fusion

Operative Neurosurgery 25:136–141, 2023

Adjacent segment disease (ASD) is a common problem after lumbar spinal fusions. Ways to reduce the rates of ASD are highly sought after to reduce the need for reoperation.

OBJECTIVE: To find predisposing factors of ASD after lumbar interbody fusions, especially in mismatch of pelvic incidence and lumbar lordosis (PI-LL).

METHODS: We conducted a retrospective cohort study of all patients undergoing lumbar interbody fusions of less than 4 levels from June 2015 to July 2020 with at least 1 year of follow-up and in those who had obtained postoperative standing X-rays.

RESULTS: We found 243 patients who fit inclusion and exclusion criteria. Fourteen patients (5.8%) developed ASD, at a median of 24 months. Postoperative lumbar lordosis was significantly higher in the non-ASD cohort (median 46.4°± 1.4°vs 36.9°± 3.6°, P < .001), pelvic tilt was significantly lower in the non-ASD cohort (16.0°± 0.66°vs 20.3°± 2.4°, P = .002), PI-LL mismatch was significantly lower in the non-ASD cohort (5.28°± 1.0°vs 17.1°± 2.0°, P < .001), and age-appropriate PI-LL mismatch was less common in the non-ASD cohort (34 patients [14.8%] vs 13 [92.9%] of patients with high mismatch, P < .001). Using multivariate analysis, greater PI-LL mismatch was predictive of ASD (95% odds ratio CI = 1.393-2.458, P < .001) and age-appropriate PI-LL mismatch was predictive of ASD (95% odds ratio CI = 10.8-970.4, P < .001).

CONCLUSION: Higher PI-LL mismatch, both age-independent and when adjusted for age, after lumbar interbody fusion was predictive for developing ASD. In lumbar degenerative disease, correction of spinopelvic parameters should be a main goal of surgical correction.

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The influence of spinopelvic parameters on adjacent-segment degeneration after short spinal fusion for degenerative spondylolisthesis

J Neurosurg Spine 29:407–413, 2018

Spinopelvic parameters, such as the pelvic incidence (PI) angle, sacral slope angle, and pelvic tilt angle, are important anatomical indices for determining the sagittal curvature of the spine and the individual variability of the lumbar lordosis (LL) curve. The aim of this study was to investigate the influence of spinopelvic parameters and LL on adjacent-segment degeneration (ASD) after short lumbar and lumbosacral fusion for single-level degenerative spondylolisthesis.

METHODS The authors retrospectively reviewed the records of all short lumbar and lumbosacral fusion surgeries performed between August 2003 and July 2010 for single-level degenerative spondylolisthesis in their orthopedic department.

RESULTS A total of 30 patients (21 women and 9 men, mean age 64 years) with ASD after lower lumbar or lumbosacral fusion surgery comprised the study group. Thirty matched patients (21 women and 9 men, mean age 63 years) without ASD comprised the control group, according to the following matching criteria: same diagnosis on admission, similar pathologic level (≤ 1 level difference), similar sex, and age. The average follow-up was 6.8 years (range 5–8 years). The spinopelvic parameters had no significant influence on ASD after short spinal fusion.

CONCLUSIONS Neither the spinopelvic parameters nor a mismatch of PI and LL were significant factors responsible for ASD after short spinal fusion due to single-level degenerative spondylolisthesis.

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The Influence of Pelvic Incidence and Lumbar Lordosis Mismatch on Development of Symptomatic Adjacent Level Disease Following Single-Level Transforaminal Lumbar Interbody Fusion

Neurosurgery 80:880–886, 2017

Annual incidence of symptomatic adjacent level disease (ALD) following lumbar fusion surgery ranges from 0.6% to 3.9% per year. Sagittal malalignment may contribute to the development of ALD.

OBJECTIVE: To describe the relationship between pelvic incidence-lumbar lordosis (PI-LL) mismatch and the development of symptomatic ALD requiring revision surgery following single-level transforaminal lumbar interbody fusion for degenerative lumbar spondylosis and/or low-grade spondylolisthesis.

METHODS: All patients who underwent a single-level transforaminal lumbar interbody fusion at either L4/5 or L5/S1 between July 2006 and December 2012 were analyzed for pre- and postoperative spinopelvic parameters. Using univariate and logistic regression analysis,we compared the spinopelvic parameters of those patients who required revision surgery against those patients who did not develop symptomatic ALD. We calculated the predictive value of PI-LL mismatch.

RESULTS: One hundred fifty-nine patients met the inclusion criteria. The results noted that, for a 1◦ increase in PI-LL mismatch (preop and postop), the odds of developing ALD requiring surgery increased by 1.3 and 1.4 fold, respectively, which were statistically significant increases. Based on our analysis, a PI-LL mismatch of >11◦ had a positive predictive value of 75% for the development of symptomatic ALD requiring revision surgery.

CONCLUSIONS: A high PI-LL mismatch is strongly associated with the development of symptomatic ALD requiring revision lumbar spine surgery. The development of ALD may represent a global disease process as opposed to a focal condition. Spine surgeons may wish to consider assessment of spinopelvic parameters in the evaluation of degenerative lumbar spine pathology.

 

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