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Journal ArticleDOI

Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves

01 Jan 1998-European Spine Journal (Springer-Verlag)-Vol. 7, Iss: 2, pp 99-103
TL;DR: An anatomical parameter, the pelvic incidence, appears to be the main axis of the sagittal balance of the spine, which controls spinal curves in accordance with the adaptability of the other parameters.
Abstract: This paper proposes an anatomical parameter, the pelvic incidence, as the key factor for managing the spinal balance. Pelvic and spinal sagittal parameters were investigated for normal and scoliotic adult subjects. The relation between pelvic orientation, and spinal sagittal balance was examined by statistical analysis. A close relationship was observed, for both normal and scoliotic subjects, between the anatomical parameter of pelvic incidence and the sacral slope, which strongly determines lumbar lordosis. Taking into account the Cobb angle and the apical vertebral rotation confers a three-dimensional aspect to this chain of relations between pelvis and spine. A predictive equation of lordosis is postulated. The pelvic incidence appears to be the main axis of the sagittal balance of the spine. It controls spinal curves in accordance with the adaptability of the other parameters.
Citations
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Journal ArticleDOI
01 Feb 2005-Spine
TL;DR: To describe, quantify, and classify common variations in the sagittal alignment of the spine, sacrum, and pelvis may help to discover the association between spinal balance and the development of degenerative changes in the spine.
Abstract: Study design A prospective radiographic study of 160 volunteers without symptoms of spinal disease was conducted. Objectives The objective of this study was to describe, quantify, and classify common variations in the sagittal alignment of the spine, sacrum, and pelvis. Summary of background data Previous publications have documented the high degree of variability in the sagittal alignment of the spine. Other studies have suggested that specific changes in alignment and the characteristics of the lumbar lordosis are responsible for degenerative changes and symptomatic back pain. Methods In the course of this study, anteroposterior and lateral radiographs of 160 volunteers in a standardized standing position were taken. A custom computer application was used to analyze the alignment of the spine and pelvis on the lateral radiographs. A four-part classification scheme of sagittal morphology was used to classify each patient. Results Reciprocal relationships between the orientation of the sacrum, the sacral slope, the pelvic incidence, and the characteristics of the lumbar lordosis were evident. The global lordotic curvature, lordosis tilt angle, position of the apex, and number or lordotic vertebrae were determined by the angle of the superior endplate of S1 with respect to the horizontal axis. Conclusions Understanding the patterns of variation in sagittal alignment may help to discover the association between spinal balance and the development of degenerative changes in the spine.

1,103 citations


Cites background from "Pelvic incidence: a fundamental pel..."

  • ...Legaye et al have described three angles between these radiographic landmarks that regulate spinal sagittal curves.(6) These angles are called pelvic incidence, pelvic tilt, and sacral slope....

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Journal ArticleDOI
01 Aug 2009-Spine
TL;DR: This study confirms that pelvic position measured via PT correlates withHRQOL in the setting of adult deformity and demonstrates significant T1–SPI correlation with HRQOL measures and outperforms SVA.
Abstract: STUDY DESIGN Prospective radiographic and clinical analysis. OBJECTIVE Investigate the relationship between spino-pelvic parameters and patient self reported outcomes on adult subjects with spinal deformities. SUMMARY OF BACKGROUND DATA It is becoming increasingly recognized that the study of spinal alignment should include pelvic position. While pelvic incidence determines lumbar lordosis, pelvic tilt (PT) is a positional parameter reflecting compensation to spinal deformity. Correlation between plumbline offset (sagittal vertical axis [SVA]) and Health Related Quality of Life (HRQOL) measures has been demonstrated, but such a study is lacking for PT. METHODS This prospective study was carried out on 125 adult patients suffering from spinal deformity (mean age: 57 years). Full-length free-standing radiographs including the spine and pelvis were available for all patients. HRQOL instruments included: Oswestry Disability Index, Short Form-12, Scoliosis Research Society. Correlation analysis between radiographic spinopelvic parameters and HRQOL measures was pursued. RESULTS Correlation analysis revealed no significance pertaining to coronal plane parameters. Significant sagittal plane correlations were identified. SVA and truncal inclination measured by T1 spinopelvic inclination (T1-SPI) (angle between T1-hip axis and vertical) correlated with: Scoliosis Research Society (appearance, activity, total score), Oswestry Disability Index, and Short Form-12 (physical component score). Correlation coefficients ranged from 0.42 < r < 0.55 (P < 0.0001). T1-SPI revealed greater correlation with HRQOL compared to SVA. PT showed correlation with HRQOL (0.28 < r < 0.42) and with SVA (r = 0.64, P < 0.0001). CONCLUSION This study confirms that pelvic position measured via PT correlates with HRQOL in the setting of adult deformity. High values of PT express compensatory pelvic retroversion for sagittal spinal malalignment. This study also demonstrates significant T1-SPI correlation with HRQOL measures and outperforms SVA. This parameter carries the advantage of being an angular measurement which avoids the error inherent in measuring offsets in noncalibrated radiographs.

944 citations

Journal ArticleDOI
TL;DR: The T9 sagittal offset, reflecting the sagittal balance of the spine, was dependent on three separate factors: a linear combination of the pelvic incidence, maximum lumbar lordosis, and sacral slope; the pelvic tilt; and the thoracic kyphosis.
Abstract: Background: There is an increasing recognition of the clinical importance of the sagittal plane alignment of the spine. A prospective study of several radiographic parameters of the sagittal profile of the spine was conducted to determine the physiological values of these parameters, to calculate th

943 citations


Cites background from "Pelvic incidence: a fundamental pel..."

  • ..., Legaye et al.(10), and Korovessis et al....

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  • ..., Legaye et al.(10), and Duval-Beaupère et al....

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  • ...Legaye et al.(10) defined the spatial position of the pelvis by means of the pelvic incidence and the pelvic tilt....

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  • ...According to Legaye et al.(10), the pelvic incidence is the key anatomical parameter for determining the spinal balance....

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Journal ArticleDOI
01 Dec 2010-Spine
TL;DR: Good clinical outcome requires achieving proper spinopelvic alignment in the treatment of adult spinal deformity, and restoring low sagittal vertical axis and pelvic tilt values are critical goals, and should be combined with proportional lumbar lordosis to pelvic incidence.
Abstract: Study design Current concepts review. Objective Outline the basic principles in the evaluation and treatment of adult spinal deformity patients with a focus on goals to achieve during surgical realignment surgery. Summary of background data Proper global alignment of the spine is critical in maintaining standing posture and balance in an efficient and pain-free manner. Outcomes data demonstrate the clinical effect of spinopelvic malalignment and form a basis for realignment strategies. Methods Correlation between certain radiographic parameters and patient self-reported pain and disability has been established. Using normative values for several important spinopelvic parameters (including sagittal vertical axis, pelvic tilt, and lumbar lordosis), spinopelvic radiographic realignment objectives were identified as a tool for clinical application. Because of the complex relationship between the spine and the pelvis in maintaining posture and the wide range of "normal" values for the associated parameters, a focus on global alignment, with proportionality of individual parameters to each other, was pursued to provide clinical relevance to planning realignment for deformity across a range of clinical cases. Conclusion Good clinical outcome requires achieving proper spinopelvic alignment in the treatment of adult spinal deformity. Although variations in pelvic morphology exist, a framework has been established to determine ideal values for regional and global parameter in an individualized patient approach. When planning realignment surgery for adult spinal deformity, restoring low sagittal vertical axis and pelvic tilt values are critical goals, and should be combined with proportional lumbar lordosis to pelvic incidence.

874 citations

Journal ArticleDOI
01 Jun 2013-Spine
TL;DR: In this article, the authors evaluated correlations between spinopelvic parameters and health-related quality of life (HRQOL) scores in patients with spinal deformity and found that spinopels can provide a more complete assessment of the sagittal plane.
Abstract: Study design Prospective multicenter study evaluating operative (OP) versus nonoperative (NONOP) treatment for adult spinal deformity (ASD). Objective Evaluate correlations between spinopelvic parameters and health-related quality of life (HRQOL) scores in patients with ASD. Summary of background data Sagittal spinal deformity is commonly defined by an increased sagittal vertical axis (SVA); however, SVA alone may underestimate the severity of the deformity. Spinopelvic parameters provide a more complete assessment of the sagittal plane but only limited data are available that correlate spinopelvic parameters with disability. METHODS.: Baseline demographic, radiographical, and HRQOL data were obtained for all patients enrolled in a multicenter consecutive database. Inclusion criteria were: age more than 18 years and radiographical diagnosis of ASD. Radiographical evaluation was conducted on the frontal and lateral planes and HRQOL questionnaires (Oswestry Disability Index [ODI], Scoliosis Research Society-22r and Short Form [SF]-12) were completed. Radiographical parameters demonstrating highest correlation with HRQOL values were evaluated to determine thresholds predictive of ODI more than 40. Results Four hundred ninety-two consecutive patients with ASD (mean age, 51.9 yr) were enrolled. Patients from the OP group (n = 178) were older (55 vs. 50.1 yr, P Conclusion ASD is a disabling condition. Prospective analysis of consecutively enrolled patients with ASD demonstrated that PT and PI-LL combined with SVA can predict patient disability and provide a guide for patient assessment for appropriate therapeutic decision making. Threshold values for severe disability (ODI > 40) included: PT 22° or more, SVA 47 mm or more, and PI - LL 11° or more.

801 citations

References
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Journal ArticleDOI
01 Jan 1985-Spine
TL;DR: This study considers some of the criteria for normal posture in the group of spondylolysis patients, especially as they are related to the lumbar spine and pelvis.
Abstract: On theoretic grounds it can be assumed that aberrations of posture may play a role in the generation of low-back pain by creating concentrations of stress. However, this assumption remains speculative because of the absence of criteria for normal posture. This study considers some of these criteria, especially as they are related to the lumbar spine and pelvis. The relations between the angle of declivity of the sacrum and radius and inclination of the lordotic curvature of the lumbar spine show good correlation. Mean values of postural parameters in the group of spondylolysis patients differ significantly from those in the group of healthy volunteers.

287 citations

Journal ArticleDOI
01 Nov 1988-Spine
TL;DR: Weakness of the lumbar extensors was clearly shown by Isoklnetic measurement and a marked atrophy of these muscles with fatty infiltration was demonstrated by CT scanning, and a reversed ratio of extensor/flexors muscle power compared with normal controls and other types of spinal curvatures was found.
Abstract: We suggest that lumbar degenerative kyphosis be included as one of the abnormal sagittal curvatures in which a kyphosis or a marked loss of lordosis is seen in the lumbar spine, caused by degenerative changes in middle-aged and elderly. One hundred and five consecutive patients were investigated, most of whom complained of low-back pain, often with a long history. They all walked in a forward bending posture, either all the time or only when exhausted. In roentgenograms, most cases showed a marked loss of the sacral inclination, as well as multiple disc narrowing and/or vertebral wedging in the lumbar region. These subjects showed a definite weakness of the lumbar extensors compared to the flexors, and therefore a reversed ratio of extensors/flexors muscle power compared with normal controls and other types of spinal curvatures. Weakness of the lumbar extensors was clearly shown by isokinetic measurement and a marked atrophy of these muscles with fatty infiltration was demonstrated by CT scanning.

281 citations

Journal ArticleDOI
Eiji Itoi1
01 Jul 1991-Spine
TL;DR: Investigation of the relationship between postural deformities and clinical symptoms in spinal osteoporotic patients found low-back pain was highly associated with decreased lumbar lordosis and increased sacropelvic angle, suggesting that the sacroiliac joint was one of the causes of low back pain.
Abstract: This study was designed to investigate the relationship between postural deformities--including both the spine and lower extremities--and clinical symptoms in spinal osteoporotics. Lateral roentgenographic films of 100 osteoporotic patients taken in a standing position were analyzed. Thoracic kyphosis, a primary deformity of the osteoporotic spine, appeared compensated by the lumbar spine, sacroiliac joint, hip joint, and knee joint, respectively. Low-back pain was highly associated with decreased lumbar lordosis and increased sacropelvic angle, suggesting that the sacroiliac joint was one of the causes of low-back pain.

223 citations

Journal ArticleDOI
01 Mar 1994-Spine
TL;DR: Results suggest that the lack of relaxation of the ES muscle may be associated with perturbation of movement patterns and the duration of the symptoms, given the small sample size.
Abstract: Profiles of hip-spine movement interaction and muscle activations were characterized in 10 low back pain patients and in 10 normal subjects during trunk forward bending and extension. Electrogoniometric recordings showed that patients performed the movements significantly more slowly than normal sub

167 citations

Journal ArticleDOI
15 Jan 1994-Spine
TL;DR: There was a considerable effect (10-24%) of lumbar curvature on lever arm lengths for the back extensor muscles in lordosis, which will affect the need for extensor muscle force and thus the magnitude of compression in theLumbar spine in loading situations such as lifting.
Abstract: Magnetic resonance imaging was used to study the effect of different curvatures in the lumbar spine on lever arm lengths of the erector spinae musculature. Eleven subjects were instructed to simulate static lifts while lying supine in a magnetic resonance camera with the lumbar spine either in kyphosis or lordosis. A sagittal image of the spine was obtained to analyze the lumbosacral angle and to guide the imaging of transverse sections through each disc (L1/L2 to L5/S1). Images were analyzed for lever arm lengths of the erector spinae muscle (ES) and the erector spinae aponeurosis (ESA), the latter functioning as a tendon for superiorly positioned ES muscle portions. The lumbosacral angle (between superior surfaces of S1 and L4) averaged 44 degrees in the lordosed, 26 degrees in the kyphosed and 41 degrees in a neutral supine position. In lordosis, the lever arm lengths were significantly longer than in kyphosis for all levels, averaging 60-63 mm (ES) and 82-86 mm (ESA). The corresponding values for kyphosis were 49-57 mm (ES) and 67-77 mm (ESA), respectively. Thus, there was a considerable effect (10-24%) of lumbar curvature on lever arm lengths for the back extensor muscles. The change in leverage will affect the need for extensor muscle force and thus the magnitude of compression in the lumbar spine in loading situations such as lifting.

119 citations