Correlation between the sagittal spinopelvic alignment and degenerative lumbar spondylolisthesis: a retrospective study.
ABSTRACT: BACKGROUND:Pain and disability associated with degenerative lumbar spondylolisthesis (DLS) results in significant burden on both the patients' quality of life and healthcare costs. Currently, there is controversy regarding the specificity of spinopelvic measures of sagittal plane alignment with respect to DLS. Moreover, the correlation among spinopelvic parameters of sagittal plane alignment remains to be clarified. Our aim in this study was to compare these measurements between patients with single-segment DLS at L5 and a control group with no history of DLS. METHODS:Our study group was formed of 132 patients who underwent full length lateral view radiographs of the spine in a relaxed standing posture. Among these, DLS at L5 was identified in 72 patients, forming the DLS group, with no radiographic evidence of lumbar spine disease in the remaining 60 patients, forming the control group. The patient and control groups were balanced with regard to age and sex distribution. The following spinopelvic parameters of sagittal plane alignment were measured: angle of incidence (PI) and tilt (PT) of the pelvis; sacral slope (SS); thoracic kyphosis (TK); lumbar lordosis (LL); and the spinal sagittal vertical axis (SVA). The Meyerding grade of L5 slippage was quantified for each patient in the DLS group. RESULTS:Measures of TK, PI, SS, and LL were significantly greater in the DLS than control group (P < 0.05), with no between-group difference in SVA and PT. In the DLS group, the grade of L5 slippage correlated with SS (r = 0.873, P < 0.0001), PI (r = 0.791, P < 0.0001) and LL (r = 0.790, P < 0.0001). Moreover, the measurement for SS correlated more strongly with the PI (r = 0.94, P < 0.01) than the LL (r = 0.69, P < 0.01). CONCLUSION:Measurements of SS, PI, and LL were specifically associated with DLS, with measurements correlating positively with the grade of slippage.
Project description:Fat infiltration and atrophy of lumbar muscles are related to spinal degenerative conditions and may cause functional deficits. Spinal alignment exerts biomechanical influence on lumbar intervertebral discs and joints. Our objective was to evaluate if spinopelvic parameters correlate with the lumbar muscle volume and fat infiltration. This is an observational, prospective and cross-sectional study. Ninety-three asymptomatic adult aged 20-40 years were included. Lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracolumbar alignment (TL), sagittal vertical axis (SVA), C2-pelvic angle (CPA), spinosacral angle (SSA), lack of lordosis (PI-LL), L1S1 and T1S1 length were measured on panoramic spine radiographs. Lumbar axial T1-weighted and In- and Out-Phase images were obtained on 1.5T MRI scanner and were used to extract the muscle volumes and fat fractions of multifidus, erector spinae, and psoas. All muscle volumes were higher in men than women (p<0.05). The fat fraction was higher in the multifidus and erector spinae in women (p<0.05). Multifidus volume was weakly correlated with PT (R = 0.22), PI (R = 0.22), LL (R = 0.34) and CPA (R = 0.29). Erectors spinae volume were correlated with CPA (R = 0.21). Psoas volume correlated with TK (R = 0.21), TL (R = 0.27) and SVA (R = -0.23). The lumbar muscle volumes showed a moderated correlation with T1S1 length (R = 0.55 to 0.62). Spinopelvic parameters showed correlation with lumbar muscle volumes but not with muscle fat infiltration on asymptomatic young adults.
Project description:Background:This study aims to determine if (1) loss of lumbar lordosis (LL), often associated with degenerative scoliosis (DS), is structural or rather largely due to positional factors secondary to spinal stenosis; (2) only addressing the symptomatic levels with a decompression and posterolateral fusion in carefully selected patients will result in improvement of sagittal malalignment; and (3) degree of sagittal plane correction achieved with such a local fusion could be predicted by routine pre-operative imaging. Methods:A retrospective study design with prospectively collected imaging data of a consecutive series of surgically treated DS patients who underwent decompression and instrumented fusion at only symptomatic levels was performed. Pre- and post-operative plain radiographs and pre-operative magnetic resonance imaging (MRIs) of the spinopelvic region were analyzed. LL, pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were assessed in all patients. As a requirement for the surgical strategy, all patients presented with a pre-operative PI-LL mismatch greater than 10°. Post-operative complications were assessed. Results:Pre-operative MRIs and lumbar extension radiographs revealed a mean LL of 42° (range 10-66°) and 48° (range 20-74°), respectively, in 68 patients (mean follow-up 29?months). LL post-operatively was corrected to a mean PI-LL of 10°. Of patients who achieved PI-LL mismatch within 10o on their pre-operative extension lateral lumbar radiographs, 62.5% were able to maintain a PI-LL mismatch within 10° on their initial post-operative films. Only 37.5% were not able to achieve that mismatch on extension radiographs (p?=?0.001, OR?=?9.58). Similarly, 54.2% were able to achieve a PI-LL?<?10° on initial post-operative radiographs, when pre-operative MRI revealed a PI-LL mismatch within 10°. In contrast, only 20.5% achieved that goal post-operatively if their mismatch was greater than 10o on their MRI (p?=?0.003, OR?=?4.25). Conclusion:With a decompression and instrumented fusion of only the symptomatic levels in symptomatic DS patients, we were able to achieve a PI-LL mismatch to within 10°. The loss of LL observed pre-operatively may be largely positional rather than structural. The amount of LL correction observed immediately after surgery can be predicted from pre-operative lumbar extension radiographs and supine sagittal MRI.
Project description:<h4>Background</h4>The prevalence of an abnormal spinopelvic relationship in patients presenting for primary total hip arthroplasty (THA) is not well known. The purpose of this study was to identify the prevalence of abnormal spinopelvic relationships in patients presenting for primary THA.<h4>Methods</h4>A retrospective chart review of 338 consecutive, nonselected patients undergoing primary THA from the practice of 2 fellowship-trained adult reconstruction surgeons was performed (J.E.O. and T.S.B.). Sitting and standing radiographs were measured for lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS<sub>stand</sub>), and pelvic tilt; the sacral slope was also measured on sitting radiographs (SS<sub>sit</sub>). Patients were assessed for the presence of spinopelvic imbalance, defined as PI-LL>10°, and decreased spinopelvic motion, defined as SS<sub>stand</sub>-SS<sub>sit</sub>< 10°. Descriptive statistics were reported.<h4>Results</h4>A cohort of 338 patients was identified; 110 were excluded. In total, 228 unique patients underwent measurement. One hundred one of 228 patients (44.3%) in the cohort were female. The mean age of the cohort was 60.0 ± 13 years, with the mean body mass index of 31 ± 7 mg/kg<sup>2</sup>. Spinopelvic imbalance (PI-LL > 10°) was present in 142 of 228 patients (62.3%). Decreased motion at the spinopelvic junction (SS<sub>stand</sub>-SS<sub>sit</sub> < 10°) was present in 78 of 228 patients (34.2%). Fifty (21.9%) patients had both spinopelvic imbalance and decreased spinopelvic motion.<h4>Conclusions</h4>In a cohort of 228 patients presenting for primary THA, the prevalence of spinopelvic imbalance was 62.3%, the prevalence of decreased spinopelvic motion was 34.2%, and the prevalence of both spinopelvic imbalance and decreased spinopelvic motion was 22%. Hip surgeons are likely to encounter patients with abnormal spinopelvic relationships.
Project description:<h4>Purpose</h4>This article examines if longer posterior spinal fusions with instrumentation (PSFI) into the lumbar spine (L3/4) alter spinopelvic parameters compared with selective fusions to T12/L1/L2 in adolescent idiopathic scoliosis (AIS) patients.<h4>Methods</h4>We analysed radiographs of 84 AIS patients, 58 (69%) females and 26 (31%) males, who underwent PSFI at an mean age of 15 years ± 2.5 years, range 10 years to 21 years, between 1st January 2007 and 31st December 2014. Radiographic parameters were measured pre- and post-operatively at most recent follow-up (range 2 years to 8.2 years): pelvic incidence (PI), lumbar lordosis (LL, L1-S1 and L4-S1), sagittal vertical alignment (SVA), scoliosis angle and proximal junctional kyphosis (PJK). PI-LL was calculated. Data was analysed using t-tests or Wilcoxon rank-sum tests.<h4>Results</h4>In total, 32 patients underwent a selective fusion with lowest instrumented vertebra (LIV) T12-L2, and 52 patients underwent a fusion with LIV L3-L4. In both groups, scoliosis angle was significantly corrected at follow-up (p < 0.005).Pre-operatively, both groups had similar LL (L1-S1) and PI-LL. Post-operatively, LL increased in the L3-4 fusion group (p < 0.005) but did not change in the selective fusion group (p = 0.116). This change in LL in the L3-4 fusion group affected the post-operative PI-LL (T12-L2 fusion -4.9° <i>versus</i> L3-4 fusion -13.6°, p = 0.002). No differences were seen in PI, SVA or LL L4-S1 between groups. Radiographic PJK occurred in seven of the L3-4 patients with and without PJK (noPJK -8.8° <i>versus</i> PJK -25.8°, p = 0.026).<h4>Conclusions</h4>In patients who underwent a fusion ending at L3 or L4, LL was increased. This altered the PI-LL relationship, and appeared to increase the risk of PJK.<h4>Level of evidence</h4>III.
Project description:Prospective, cross-sectional study.The aim of the study was to determine which radiographic parameters drive patient-reported outcomes (PROs) in primary presentation adult symptomatic lumbar scoliosis (ASLS).Previous literature suggests correlations between PROs and sagittal plane deformity (sagittal vertical axis [SVA], pelvic incidence-lumbar lordosis [PI-LL] mismatch, pelvic tilt [PT]). Prior work included revision and primary adult spinal deformity patients. The present study addresses only primary presentation ASLS.Prospective baseline data were analyzed on 286 patients enrolled in an NIH RO1 clinical trial by nine centers from 2010 to 2014.40 to 80 years old, lumbar Cobb (LC) 30° or higher and Scoliosis Research Society-23 score 4.0 or less in Pain, Function or Self-Image domains, or Oswestry Disability Index (ODI) 20 or higher. Patients were primary presentation (no prior spinal deformity surgery) and had complete baseline data: standing coronal/sagittal 36" radiographs and PROs (ODI, Scoliosis Research Society-23, Short Form-12). Correlation coefficients were calculated to evaluate relations between radiographic parameters and PROs for the study population and a subset of patients with ODI 40 or higher. Analysis of variance was used to identify differences in PROs for radiographic modifier groups.Mean age was 60.3 years. Mean spinopelvic parameters were: LL?=?-39.2°; SVA?=?3.1 cm; sacral slope?=?32.5°; PT?=?23.9°; PI-LL mismatch?=?16.8°. Only weak correlations (0.2-0.4) were identified between population sacral slope, SVA and SVA modifiers, and SRS function. SVA and SVA modifiers were weakly associated with ODI. Although there were more correlations in subset analysis of high-symptom patients, all were weak. Analysis of variance identified significant differences in ODI reported by SVA modifier groups.In primary presentation patients with ASLS and a subset of "high-symptom" patients (ODI???40), only weak associations between baseline PROs and radiographic parameters were identified. For this patient population, these results suggest regional radiographic parameters (LC, LL, PT, PI-LL mismatch) are not drivers of PROs and cannot be used to extrapolate effect on patient-perceived pathology.2.
Project description:Background Changes in spinopelvic and lower extremity alignment between standing and relaxed sitting have important clinical implications with regard to stability of total hip arthroplasty. This study aimed to analyze the effect of body mass index (BMI) on lumbopelvic alignment and motion at the hip joint. Methods A retrospective review of patients who underwent full-body stereoradiographs in standing and relaxed sitting for total hip arthroplasty planning was conducted. Spinopelvic parameters measured included spinopelvic tilt (SPT), pelvic incidence (PI), lumbar lordosis (LL), PI minus LL (PI-LL), proximal femoral shaft angle (PFSA), and standing-to-sitting hip range of motion. Propensity score matching controlled for age, gender, PI, and hip ostoarthritis grade. Patients were stratified into normal (NORMAL; BMI, 18.5-24.9), overweight (OW; 25.0-29.9), and obese (OB; 30.0-34.9) groups. Alignment parameters were compared using one-way analysis of variance. Results There were 84 patients in each group after propensity score matching. Standing alignment between BMI groups was similar for all parameters (P > .05) except for PFSA (P < .001). Significant differences were noted for sitting alignment between patients who are NORMAL, OW, and OB in: SPT (P = .007), PI-LL (P = .018), and LL (P = .029). PFSA between groups was not significantly different (P > .05). Significant differences were found for sitting-to-standing alignment across groups in PFSA change (P < .001), SPT change (P = .006), PI-LL change (P = .005), LL change (P = .037), and hip flexion (P < .001). Conclusions Significant differences in sitting and standing-to-sitting change in lumbopelvic alignment based on BMI suggest obese patients recruit more posterior spinopelvic tilt when sitting to compensate for soft-tissue impingement that occurs anterior to the hip joint and limiting hip flexion.
Project description:Study Design Cross-sectional study. Objective Sacropelvic parameters in various spine and hip disorders have been published in various studies. We aimed to study the normal sacropelvic parameters and curvatures of the spine and their correlation in asymptomatic Indian adults in relation to variations in sex and age. Methods The study included 101 asymptomatic adults (50 men and 51 women with an average age of 47.16 and 48.59 years, respectively). For each subject, the thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured from standing lateral radiographs. After stratification of the group by sex and age with a cutoff of 50 years, descriptive, correlation, and regression analysis were performed using SPSS software. Results The average PI, SS, PT, LL, and TK values were 55.48 (±5.31), 35.99 (±7.53), 17.97 (±7.16), 48.84 (±9.82), and 32.55 (±10.92), respectively. No statistically significant difference was observed in these values with regards to sex and age < 50 years and > 50 years but the pelvic incidence was found to be higher in women. A positive correlation between the PI and SS and a negative correlation between the SS and PT was observed. A positive correlation between the TK and LL was found in subjects > 50 years. Simple and multiple regression analyses were also performed for different groups. Conclusion The current study is the first of asymptomatic Indian adults and provides invaluable information to the clinicians about the normal range of sacropelvic and spinopelvic parameters, which is useful to plan spinal deformity corrections and to evaluate pathologic conditions associated with abnormal angular values.
Project description:<h4>Purpose</h4>A retrospective study that aims to report Adjacent Segment Degeneration (ASD) incidence and spinopelvic balance in short lumbosacral instrumentation for degenerative lumbar spinal stenosis. Although ASD is a common complication following lumbar fusion, the effect of an interspinous spacer (IS) in the supradjacent segment in short lumbosacral instrumented fusion and its interaction with spinopelvic balance has not been studied adequately.<h4>Methods</h4>From 55 consecutive age-, diagnosis-, and gender-matched patients aged 60±11 years, 17 (Group R) received PEEK IS; 18 (Group S) received Silicon IS compared with 20 controls (Group C) without receiving any IS. The functional outcome was evaluated with VAS and ODI. Spinopelvic balance was evaluated using SVA, T<sub>12</sub>-S<sub>1</sub> LL, SS, PT, PI, and supradjacent segment disc heights. All spines were preoperatively balanced (SVA<40 mm).<h4>Results</h4>The follow-up averaged out to 56±11 months. VAS and ODI scores improved postoperatively in all 3 groups. SS and anterior disc height in the supradjacent free segment increased postoperatively compensatory to spinal alterations. Although 6, 4, and 5 patients from Groups R, S, and C, respectively, showed radiological progression of the preoperative degeneration grade in the supradjacent disc, only 2, 1, and 2 patients in Groups R, S, and C, respectively, developed symptomatic ASD in the 1<sup>st</sup> supradjacent segment solely. No additional surgery was required in any patient.<h4>Conclusion</h4>ASD incidence in the supradjacent segment following short lumbar fusion did not statistically significantly differ between PEEK and Silicon IS. There was a trend towards lower ASD incidence in Silicon IS. IS reduced ASD in both 1<sup>st</sup> and 2<sup>nd</sup> supradjacent segments. The authors speculate that soft stabilization provided by IS may be more advantageous for preventing ASD. This trial is registered with <i>ClinicalTrials.gov</i>NCT03477955.
Project description:BACKGROUND:Osteoporotic vertebral compression fractures (OVCFs) often cause local kyphosis. Percutaneous kyphoplasty (PKP) is a common method for the treatment of local kyphosis. However, the influence of kyphoplasty on spino-pelvic alignment and global sagittal balance when performed at specific treatment sites in the spine remains unclear. The purpose of the study is to investigate the influence of different fracture sites and PKP treatment on the spino-pelvic alignment and global sagittal balance in patients with OVCFs. METHODS:90 patients with OVCF who underwent PKP were included in the retrospective study. According to the site of the fractured vertebrae, all the cases were divided into 3 groups: Main thoracic (MT) group (T1 to T9), Thoracolumbar (TL) group (T10 to L2) and Lumbar (LU) group (L3 to L5). 26 healthy elderly volunteers (aged over 59) were enrolled as the control group. Sagittal spino-pelvic parameters were measured on the full-spine radiographs preoperatively and postoperatively. Information of sagittal spino-pelvic parameters and global sagittal balance was gathered. RESULTS:Compared with the Control group, TL group showed significant differences in almost all parameters, except pelvic incidence (PI) and lumbar lordosis (LL). While only local sagittal parameters (Thoracic kyphosis (TK), Thoracolumbar kyphosis (TLK), LL) were significantly different in MT group. There was no significant difference in almost all of the parameters except for PT and TPA in LU group. Correspondingly, the sagittal parameters of TL group improved best after PKP, except for thoracic kyphosis (TK) and sagittal vertical axis (SVA). In MT group, only TLK was significantly decreased, while in LU group, only local kyphosis Cobb angle and SSA were improved. CONCLUSIONS:OVCF mainly occurs in the thoracolumbar region. Compared with MT group and LU group, OVCF occurred in the thoracolumbar region had greater influence on the spino-pelvic alignment and global sagittal balance. When PKP was performed, the improvement of sagittal balance parameters of TL group was the best in the three groups.
Project description:<h4>Background</h4>Few reports to date have evaluated the effects of different pedicle screw insertion depths on sagittal balance and prognosis after posterior lumbar interbody and fusion (PLIF) in patients with lumbar degenerative spondylolisthesis (LDS).<h4>Methods</h4>A total of 88 patients with single-level PLIF for LDS from January 2018 to December 2019 were enrolled. Long screw group (Group L): 52 patients underwent long pedicle screw fixation (the leading edge of the screw exceeded 80% of the anteroposterior diameter of vertebral body). Short screw group (Group S): 36 patients underwent short pedicle screw fixation (the leading edge of the screw was less than 60% of the anteroposterior diameter of vertebral body). Local deformity parameters of spondylolisthesis including slip degree (SD) and segment lordosis (SL), spino-pelvic sagittal plane parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL), Oswestry Disability Index (ODI), and Visual Analog Scale (VAS) for back pain of both groups were compared. Postoperative complications, including vertebral fusion rate and screw loosening rate, were recorded.<h4>Results</h4>Except that PI in Group S at the final follow-up was not statistically different from the preoperative value (P > 0.05), other parameters were significantly improved compared with preoperative values one month after surgery and at the final follow-up (P < 0.05). There was no significant difference in parameters between Group L and Group S before and one month after surgery (P > 0.05). At the final follow-up, SD, SL, LL, PT and PI-LL differed significantly between the two groups (P < 0.05). Compared with the preoperative results, ODI and VAS in both groups decreased significantly one month after surgery and at the final follow-up (P < 0.05). Significant differences of ODI and VAS were found between the two groups at the final follow-up (P < 0.05). Postoperative complications were not statistically significant between the two groups (P > 0.05).<h4>Conclusions</h4>PLIF can significantly improve the prognosis of patients with LDS. In terms of outcomes with an average follow-up time of 2 years, the deeper the screw depth is within the safe range, the better the spino-pelvic sagittal balance may be restored and the better the quality of life may be.