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Archives of Orthopaedic and Trauma Surgery

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01-06-2019 | Ankylosing Spondylitis | Orthopaedic Surgery

The relationship between global spinal alignment and pelvic orientation from standing to sitting following pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis

Authors: Shi-zhou Zhao, Bang-ping Qian, Yong Qiu, Mu Qiao, Zhuo-jie Liu, Ji-chen Huang

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2019

Abstract

Introduction

To investigate the relationship between the spinal sagittal alignment and arc of pelvic motion from standing to sitting in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis following pedicle subtraction osteotomy (PSO).

Materials and Methods

AS patients who underwent PSO for thoracolumbar kyphosis from January 2016 to July 2018 were recruited. EOS standing and sitting images were obtained pre- and postoperatively. Radiographic parameters were measured on the sagittal radiographs, including lumbar lordosis, thoracic kyphosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA), spinosacral angle, anterior pelvic plane angle (APPA) and knee flexion angle.

Results

Thirty-six patients were enrolled. From standing to sitting, APPA was increased by a mean of 14.7° (P < 0.001) and 3.0° (P = 0.083) before and after surgery, respectively. The increase in APPA from standing to sitting was correlated with the standing SVA (R = 0.592, P < 0.001) preoperatively. After PSO, the change in APPA was correlated with the change in SSA in both the standing and sitting position (R = 0.381, P = 0.022 and R = 0.667, P < 0.001, respectively). The APPA from standing to sitting was decreased in 11 patients with standing C7 plumb line posterior to the femoral head postoperatively.

Conclusions

In AS patients, pelvic orientation was adjusted by the global spinal alignment. When planning total hip arthroplasty for AS patients, global spinal alignment should be considered to improve the joint stability.

Ranganathan V, Gracey E, Brown MA et al (2017) Pathogenesis of ankylosing spondylitis-recent advances and future directions. Nat Rev Rheumatol 13:359–367. https://doi.org/10.1038/nrrheum CrossRefPubMed

Qian BP, Jiang J, Qiu Y et al (2014) The presence of a negative sacral slope in patients with ankylosing spondylitis with severe thoracolumbar kyphosis. J Bone Joint Surg Am 96:e188CrossRefPubMed

Barrey C, Roussouly P, Perrin G et al (2011) Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 20:626–633. https://doi.org/10.1007/s00586-011-1930-3 CrossRefPubMedCentralPubMed

Lazennec JY, Brusson A, Rousseau MA (2011) Hip–spine relations and sagittal balance clinical consequences. Eur Spine J 20:686–698. https://doi.org/10.1007/s00586-011-1937-9 CrossRefPubMedCentralPubMed

Lazennec JY, Brusson A, Rousseau MA (2013) Lumbar-pelvic-femoral balance on sitting and standing lateral radiographs. Orthop Traumatol Surg Res 99:S87–S103. https://doi.org/10.1016/j.otsr.2012.12.003 CrossRefPubMed

Qian BP, Mao SH, Jiang J et al (2017) Mechanisms, predisposing factors, and prognosis of intraoperative vertebral subluxation during pedicle subtraction osteotomy in surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis. Spine (Phila Pa 1976) 42:E983–E990. https://doi.org/10.1097/BRS.0000000000002015 CrossRef

Buckland AJ, Vigdorchik J, Schwab FJ et al (2015) Acetabular anteversion changes due to spinal deformity correction: bridging the gap between hip and spine surgeons. J Bone Joint Surg Am 97:1913–1920. https://doi.org/10.2106/JBJS.O.00276 CrossRefPubMed

Masquefa T, Verdier N, Gille O et al (2015) Change in acetabular version after lumbar pedicle subtraction osteotomy to correct post-operative flat back: EOS® measurements of 38 acetabula. Orthop Traumatol Surg Res 101:655–659. https://doi.org/10.1016/j.otsr.2015.07.013 CrossRefPubMed

Gu M, Zhang Z, Kang Y et al (2015) Roles of sagittal anatomical parameters of the pelvis in primary total hip replacement for patients with ankylosing spondylitis. J Arthroplasty 30(12):2219–2223. https://doi.org/10.1016/j.arth.2015.06.027 CrossRefPubMed

10.

Lewinnek GE, Lewis JL, Tarr R et al (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60(2):217–220CrossRefPubMed

11.

Ochi H, Baba T, Homma Y et al (2016) Importance of the spinopelvic factors on the pelvic inclination from standing to sitting before total hip arthroplasty. Eur Spine J 25(11):3699–3706CrossRefPubMed

12.

Ranawat CS, Ranawat AS, Lipman JD et al (2016) Effect of spinal deformity on pelvic orientation from standing to sitting position. J Arthroplasty 31(6):1222–1227. https://doi.org/10.1016/j.arth.2015.11.035 CrossRef

13.

van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368CrossRefPubMed

14.

MacKay K, Brophy S, Mack C et al (2000) The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the bath ankylosing spondylitis radiology hip index. J Rheumatol 27(12):2866–2872PubMed

15.

Xu H, Zhang Y, Zhao Y et al (2015) Radiologic and clinical outcomes comparison between single- and two-level pedicle subtraction osteotomies in correcting ankylosing spondylitis kyphosis. Spine J 15(2):290–297. https://doi.org/10.1016/j.spinee.2014.09.014 CrossRef

16.

Zhang YP, Qian BP, Qiu Y et al (2017) Sagittal vertical axis, spinosacral angle, spinopelvic angle, and T1 pelvic angle: which parameters may effectively predict the quality of life in ankylosing spondylitis patients with thoracolumbar kyphosis? Clin Spine Surg 30:E871–E876. https://doi.org/10.1097/BSD.0000000000000463 CrossRefPubMed

17.

Jalai CM, Cruz DL, Diebo BG et al (2017) Full-body analysis of age-adjusted alignment in adult spinal deformity patients and lower-limb compensation. Spine (Phila Pa 1976) 42(9):653–661. https://doi.org/10.1097/BRS.0000000000001863 CrossRef

18.

Sankar WN, Laird CT, Baldwin KD (2012) Hip range of motion in children: what is the norm? J Pediatr Orthop 32(4):399–405. https://doi.org/10.1097/BPO.0b013e3182519683 CrossRefPubMed

19.

McGrory BJ, Freiberg AA, Shinar AA et al (1993) Correlation of measured range of hip motion following total hip arthroplasty and responses to a questionnaire. J Arthroplasty 11(5):565–571CrossRef

20.

Zheng GQ, Zhang YG, Chen JY et al (2014) Decision making regarding spinal osteotomy and total hip replacement for ankylosing spondylitis: experience with 28 patients. Bone Joint J 96-B(3):360–365. https://doi.org/10.1302/0301-620X.96B3.32774 CrossRefPubMed

21.

Rousseau MA, Lazennec JY, Tassin JL et al (2014) Sagittal rebalancing of the pelvis and the thoracic spine after pedicle subtraction osteotomy at the lumbar level. J Spinal Disord Tech 27:166–173. https://doi.org/10.1097/BSD.0b013e318272faaf CrossRefPubMed

22.

Hey HWD, Teo AQA, Tan KA et al (2017) How the spine differs in standing and in sitting-important considerations for correction of spinal deformity. Spine J 17:799–806. https://doi.org/10.1016/j.spinee.2016.03.056 CrossRefPubMed

23.

DiGioia AM, Hafez MA, Jaramaz B et al (2006) Functional pelvic orientation measured from lateral standing and sitting radiographs. Clin Orthop Relat Res 453:272–276CrossRefPubMed

24.

Radcliff KE, Orozco F, Molby N et al (2013) Change in spinal alignment after total hip arthroplasty. Orthop Surg 5(4):261–265. https://doi.org/10.1111/os.12076 CrossRefPubMedPubMedCentral

Title: The relationship between global spinal alignment and pelvic orientation from standing to sitting following pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis
Authors: Shi-zhou Zhao
Bang-ping Qian
Yong Qiu
Mu Qiao
Zhuo-jie Liu
Ji-chen Huang
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Keywords: Ankylosing Spondylitis
Hip-TEP
Hip-TEP
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 6/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-03107-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The relationship between global spinal alignment and pelvic orientation from standing to sitting following pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis

Abstract

Introduction

Materials and Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and Methods

Results

Conclusions

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