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01-09-2020 | Original Article

C7 sacral tilt (C7ST): a novel spinopelvic parameter reveals the relationship between pelvic parameters and global spinal sagittal balance and converts pelvic parameters into spinal parameters

Authors: Wen Zhang, Tao Li, Mengmeng Xu, Xiaoyang Liu, Guodong Wang, Bingxiang Wang, Jianmin Sun, Xingang Cui, Zhensong Jiang

Published in: European Spine Journal | Issue 9/2020

Abstract

Purpose

The aim is to propose a novel spinopelvic parameter C7 sacral tilt (C7ST), of which its sum with global tilt (GT) is equal to pelvic incidence (PI), from a geometrical point of view.

Methods

A cohort of 198 patients was recruited and the whole lateral spine and pelvic radiographs were performed. The following sagittal parameters were measured: sagittal vertical axis (SVA), C7 vertical tilt (C7VT), sacral slope (SS), pelvic tilt (PT), PI, GT and C7ST. The correlations between them were analyzed using the Pearson or Spearman correlation coefficient, and simple linear regressions were simultaneously conducted. P < 0.05 was set as the level of significance.

Results

Geometric construction by complementary angles revealed that PI = C7ST + GT, GT = PT + C7VT, and C7ST = SS − C7VT. Both C7ST and GT were moderately correlated with PI (R = 0.52 and 0.596, respectively), strongly correlated with SS and PT, respectively (SS = 0.9 * C7ST + 1.15, R = 0.955; PT = 0.87 * GT + 3.86, R = 0.96). The correlation coefficients of the SVA and C7VT, SVA and SS − C7ST, and SVA and GT − PT were 0.935, 0.925 and 0.863, respectively.

Conclusion

The novel proposed spinopelvic parameter C7ST has the advantages of convenient measurement, reduced error, and extrapolation of other parameters. The greatest significance of proposing C7ST is that pelvic parameters (PI, PT and SS) are converted into spinal parameters (C7ST and GT), which is very helpful for a more intuitive understanding of the progression of spinal sagittal imbalance.

Mehta VA, Amin A, Omeis I, Gokaslan ZL, Gottfried ON (2015) Implications of spinopelvic alignment for the spine surgeon. Neurosurgery 76(Suppl 1):S42–S56. https://doi.org/10.1227/01.neu.0000462077.50830.1a(discussion S56)CrossRefPubMed

Van Royen BJ, Toussaint HM, Kingma I, Bot SD, Caspers M, Harlaar J, Wuisman PI (1998) Accuracy of the sagittal vertical axis in a standing lateral radiograph as a measurement of balance in spinal deformities. Eur Spine J 7:408–412. https://doi.org/10.1007/s005860050098CrossRefPubMedPubMedCentral

Legaye J, Duval-Beaupere G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103. https://doi.org/10.1007/s005860050038CrossRefPubMedPubMedCentral

Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, DeWald C, Mehdian H, Shaffrey C, Tribus C, Lafage V (2012) Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 37:1077–1082. https://doi.org/10.1097/BRS.0b013e31823e15e2CrossRef

Terran J, Schwab F, Shaffrey CI, Smith JS, Devos P, Ames CP, Fu KM, Burton D, Hostin R, Klineberg E, Gupta M, Deviren V, Mundis G, Hart R, Bess S, Lafage V, International Spine Study G (2013) The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 73:559–568. https://doi.org/10.1227/NEU.0000000000000012CrossRefPubMed

Obeid I, Hauger O, Aunoble S, Bourghli A, Pellet N, Vital JM (2011) Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee. Eur Spine J 20(Suppl 5):681–685. https://doi.org/10.1007/s00586-011-1936-xCrossRefPubMedPubMedCentral

Ryan DJ, Protopsaltis TS, Ames CP, Hostin R, Klineberg E, Mundis GM, Obeid I, Kebaish K, Smith JS, Boachie-Adjei O, Burton DC, Hart RA, Gupta M, Schwab FJ, Lafage V, International Spine Study G (2014) T1 pelvic angle (TPA) effectively evaluates sagittal deformity and assesses radiographical surgical outcomes longitudinally. Spine (Phila Pa 1976) 39:1203–1210. https://doi.org/10.1097/BRS.0000000000000382CrossRef

Protopsaltis T, Schwab F, Bronsard N, Smith JS, Klineberg E, Mundis G, Ryan DJ, Hostin R, Hart R, Burton D, Ames C, Shaffrey C, Bess S, Errico T, Lafage V, International Spine Study G (2014) TheT1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life. J Bone Joint Surg Am 96:1631–1640. https://doi.org/10.2106/JBJS.M.01459CrossRefPubMed

Obeid I, Boissiere L, Yilgor C, Larrieu D, Pellise F, Alanay A, Acaroglu E, Perez-Grueso FJ, Kleinstuck F, Vital JM, Bourghli A (2016) Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J 25:3644–3649. https://doi.org/10.1007/s00586-016-4649-3CrossRefPubMed

10.

Banno T, Togawa D, Arima H, Hasegawa T, Yamato Y, Kobayashi S, Yasuda T, Oe S, Hoshino H, Matsuyama Y (2016) The cohort study for the determination of reference values for spinopelvic parameters (T1 pelvic angle and global tilt) in elderly volunteers. Eur Spine J 25:3687–3693. https://doi.org/10.1007/s00586-016-4411-xCrossRefPubMed

11.

Iyer S, Lenke LG, Nemani VM, Albert TJ, Sides BA, Metz LN, Cunningham ME, Kim HJ (2016) Variations in Sagittal Alignment Parameters Based on Age: A Prospective Study of Asymptomatic Volunteers Using Full-Body Radiographs. Spine (Phila Pa 1976) 41:1826-1836. https://doi.org/10.1097/brs.0000000000001642

12.

Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS, Boachie-Adjei O, Burton DC, Akbarnia BA, Mundis GM, Ames CP, Kebaish K, Hart RA, Farcy JP, Lafage V, International Spine Study G (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 38:E803-812. https://doi.org/10.1097/brs.0b013e318292b7b9

13.

Liang C, Sun J, Cui X, Jiang Z, Zhang W, Li T (2016) Spinal sagittal imbalance in patients with lumbar disc herniation: its spinopelvic characteristics, strength changes of the spinal musculature and natural history after lumbar discectomy. BMC Musculoskelet Disord 17:305. https://doi.org/10.1186/s12891-016-1164-yCrossRefPubMedPubMedCentral

14.

Smith JS, Bess S, Shaffrey CI, Burton DC, Hart RA, Hostin R, Klineberg E, International Spine Study G (2012) Dynamic changes of the pelvis and spine are key to predicting postoperative sagittal alignment after pedicle subtraction osteotomy: a critical analysis of preoperative planning techniques. Spine (Phila Pa 1976) 37:845–853. https://doi.org/10.1097/BRS.0b013e31823b0892CrossRef

15.

Akbar M, Terran J, Ames CP, Lafage V, Schwab F (2013) Use of Surgimap Spine in sagittal plane analysis, osteotomy planning, and correction calculation. Neurosurg Clin N Am 24:163–172. https://doi.org/10.1016/j.nec.2012.12.007CrossRefPubMed

16.

Savage JW, Patel AA (2014) Fixed sagittal plane imbalance. Glob Spine J 4:287–296. https://doi.org/10.1055/s-0034-1394126CrossRef

17.

Zhu Z, Xu L, Zhu F, Jiang L, Wang Z, Liu Z, Qian BP, Qiu Y (2014) Sagittal alignment of spine and pelvis in asymptomatic adults: norms in Chinese populations. Spine 39:E1–E6. https://doi.org/10.1097/BRS.0000000000000022CrossRefPubMed

18.

Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupere G, Pelissier J (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422. https://doi.org/10.1007/s00586-005-0984-5CrossRefPubMed

19.

Schwab F, Lafage V, Patel A, Farcy JP (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976) 34:1828–1833. https://doi.org/10.1097/BRS.0b013e3181a13c08CrossRef

20.

Vila-Casademunt A, Pellise F, Acaroglu E, Perez-Grueso FJ, Martin-Buitrago MP, Sanli T, Yakici S, de Frutos AG, Matamalas A, Sanchez-Marquez JM, Obeid I, Yaman O, Bago J, Essg ESSG (2015) The reliability of sagittal pelvic parameters: the effect of lumbosacral instrumentation and measurement experience. Spine (Phila Pa 1976) 40:E253–E258. https://doi.org/10.1097/BRS.0000000000000720CrossRef

21.

Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 87:260–267. https://doi.org/10.2106/JBJS.D.02043CrossRefPubMed

22.

Schwab F, Lafage V, Boyce R, Skalli W, Farcy JP (2006) Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine (Phila Pa 1976) 31:E959–E967. https://doi.org/10.1097/01.brs.0000248126.96737.0fCrossRef

23.

Legaye J, Duval-Beaupere G (2008) Gravitational forces and sagittal shape of the spine: clinical estimation of their relations. Int Orthop 32:809–816. https://doi.org/10.1007/s00264-007-0421-yCrossRefPubMed

24.

Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 30:346–353. https://doi.org/10.1097/01.brs.0000152379.54463.65CrossRef

25.

Schwab F, Patel A, Ungar B, Farcy JP, Lafage V (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35:2224–2231. https://doi.org/10.1097/BRS.0b013e3181ee6bd4CrossRef

Title: C7 sacral tilt (C7ST): a novel spinopelvic parameter reveals the relationship between pelvic parameters and global spinal sagittal balance and converts pelvic parameters into spinal parameters
Authors: Wen Zhang
Tao Li
Mengmeng Xu
Xiaoyang Liu
Guodong Wang
Bingxiang Wang
Jianmin Sun
Xingang Cui
Zhensong Jiang
Publication date: 01-09-2020
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 9/2020
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-020-06548-8

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C7 sacral tilt (C7ST): a novel spinopelvic parameter reveals the relationship between pelvic parameters and global spinal sagittal balance and converts pelvic parameters into spinal parameters

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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