Skip to main content
Top
Published in: European Spine Journal 6/2014

01-10-2014 | Original Article

Pelvic parameters and global spine balance for spine degenerative disease: the importance of containing for the well being of content

Authors: Diego Garbossa, Matteo Pejrona, Marco Damilano, Valerio Sansone, Alessandro Ducati, Pedro Berjano

Published in: European Spine Journal | Special Issue 6/2014

Login to get access

Abstract

Purpose

Spinal deformities and pathologies of the spinopelvic junction are conditions affecting up to 60–70 % of the general aging population. In this review, we discuss the more recent knowledge on sagittal balance and its clinical implications.

Methods

Review of the literature regarding global spine balance.

Results

Global spinal balance and its relationship to the pelvis correlate closely with disability and quality of life. It has been demonstrated that extensive surgery, previously considered to have poor balance between risks and outcomes, causes great improvements in health-related quality of life in the oldest age groups.

Conclusion

Failure to restore normal sagittal alignment in patients primarily operated for other than deformity results in unacceptable rates of poor results and revision surgery.
Literature
2.
go back to reference Bernhardt M, Bridwell KH (1989) Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine 14:717–721PubMedCrossRef Bernhardt M, Bridwell KH (1989) Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine 14:717–721PubMedCrossRef
3.
go back to reference Berven SH, Deviren V, Smith JA, Hu SH, Bradford DS (2003) Management of fixed sagittal plane deformity: outcome of combined anterior and posterior surgery. Spine 28(15):1710–1715PubMed Berven SH, Deviren V, Smith JA, Hu SH, Bradford DS (2003) Management of fixed sagittal plane deformity: outcome of combined anterior and posterior surgery. Spine 28(15):1710–1715PubMed
4.
go back to reference Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM (1999) Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine 24(16):1712–1720PubMedCrossRef Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM (1999) Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine 24(16):1712–1720PubMedCrossRef
5.
go back to reference Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupère G, Pélissier J (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422PubMedCrossRefPubMedCentral Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupère G, Pélissier J (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422PubMedCrossRefPubMedCentral
6.
go back to reference Bourghli A, Guérin P, Vital JM, Aurouer N, Luc S, Gille O, Pointillart V, Obeid I (2012) Posterior spinal fusion from T2 to the sacrum for the management of major deformities in patients with Parkinson disease: a retrospective review with analysis of complications. J Spinal Disord Tech 25(3):53–60CrossRef Bourghli A, Guérin P, Vital JM, Aurouer N, Luc S, Gille O, Pointillart V, Obeid I (2012) Posterior spinal fusion from T2 to the sacrum for the management of major deformities in patients with Parkinson disease: a retrospective review with analysis of complications. J Spinal Disord Tech 25(3):53–60CrossRef
7.
go back to reference Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K (2003) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85(3):454–463PubMed Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K (2003) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85(3):454–463PubMed
8.
go back to reference Cho KJ, Bridwell KH, Lenke LG, Berra A, Baldus C (2005) Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine 30(18):2030–2037PubMedCrossRef Cho KJ, Bridwell KH, Lenke LG, Berra A, Baldus C (2005) Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine 30(18):2030–2037PubMedCrossRef
9.
go back to reference Cho KJ, Lenke LG, Bridwell KH, Kamiya M, Sides B (2009) Selection of the optimal distal fusion level in posterior instrumentation and fusion for thoracic hyperkyphosis: the sagittal stable vertebra concept. Spine 34:765–770PubMedCrossRef Cho KJ, Lenke LG, Bridwell KH, Kamiya M, Sides B (2009) Selection of the optimal distal fusion level in posterior instrumentation and fusion for thoracic hyperkyphosis: the sagittal stable vertebra concept. Spine 34:765–770PubMedCrossRef
10.
go back to reference Finocchiaro FM, Nena U, Lo Scalzo V, Monterumici DA (2012) Treatment of kyphotic deformities in adults: our experience. Eur Spine J 21(1):S100–S107PubMedCrossRef Finocchiaro FM, Nena U, Lo Scalzo V, Monterumici DA (2012) Treatment of kyphotic deformities in adults: our experience. Eur Spine J 21(1):S100–S107PubMedCrossRef
11.
go back to reference Gelb DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358PubMedCrossRef Gelb DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358PubMedCrossRef
12.
go back to reference Gill JB, Levin A, Burd T, Longley M (2008) Corrective osteotomies in spine surgery. J Bone Joint Surg Am 90(11):2509–2520PubMedCrossRef Gill JB, Levin A, Burd T, Longley M (2008) Corrective osteotomies in spine surgery. J Bone Joint Surg Am 90(11):2509–2520PubMedCrossRef
13.
go back to reference Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 30:682–688PubMedCrossRef Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 30:682–688PubMedCrossRef
14.
15.
go back to reference Jackson RP, Hales C (2000) Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine 25:2808–2815PubMedCrossRef Jackson RP, Hales C (2000) Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine 25:2808–2815PubMedCrossRef
16.
go back to reference Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine 19:1611–1618PubMedCrossRef Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine 19:1611–1618PubMedCrossRef
17.
go back to reference Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34:599–606CrossRef Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34:599–606CrossRef
18.
go back to reference Lafage V, Schwab F, Vira S, Patel A, Ungar B, Farcy JP (2011) Spinopelvic parameters after surgery can be predicted: a preliminary formula and validation of standing alignment. Spine 36:1037–1045PubMedCrossRef Lafage V, Schwab F, Vira S, Patel A, Ungar B, Farcy JP (2011) Spinopelvic parameters after surgery can be predicted: a preliminary formula and validation of standing alignment. Spine 36:1037–1045PubMedCrossRef
19.
go back to reference Lamartina C, Berjano P, Petruzzi M, Sinigaglia A, Casero G, Cecchinato R, Damilano M, Bassani R (2012) Criteria to restore sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J 21:27–31CrossRefPubMedCentral Lamartina C, Berjano P, Petruzzi M, Sinigaglia A, Casero G, Cecchinato R, Damilano M, Bassani R (2012) Criteria to restore sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J 21:27–31CrossRefPubMedCentral
20.
go back to reference Lamartina C, Berjano P (2014) Classification of sagittal imbalance based on spinal alignment and compensatory mechanism. Eur Spine J 23(6):1177–1189PubMedCrossRef Lamartina C, Berjano P (2014) Classification of sagittal imbalance based on spinal alignment and compensatory mechanism. Eur Spine J 23(6):1177–1189PubMedCrossRef
21.
go back to reference Lazennec JY, Ramaré S, Arafati N, Laudet CG, Gorin M, Roger B, Hansen S, Saillant G, Maurs L, Trabelsi R (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9:47–55PubMedCrossRefPubMedCentral Lazennec JY, Ramaré S, Arafati N, Laudet CG, Gorin M, Roger B, Hansen S, Saillant G, Maurs L, Trabelsi R (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9:47–55PubMedCrossRefPubMedCentral
22.
go back to reference Le Huec JC, Leijssen P, Duarte M, Aunoble S (2011) Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique. Eur Spine J 20(5):669–680PubMedCrossRefPubMedCentral Le Huec JC, Leijssen P, Duarte M, Aunoble S (2011) Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique. Eur Spine J 20(5):669–680PubMedCrossRefPubMedCentral
23.
go back to reference Mac-Thiong JM, Roussouly P, Berthonnaud E, Guigui P (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine 35:1193–1198CrossRef Mac-Thiong JM, Roussouly P, Berthonnaud E, Guigui P (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine 35:1193–1198CrossRef
24.
go back to reference Mac-Thiong JM, Transfeldt EE, Mehbod AA, Perra JH, Denis F, Garvey TA, Lonstein JE, Wu C, Dorman CW, Winter RB (2009) Can C7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine 34(15):519–527CrossRef Mac-Thiong JM, Transfeldt EE, Mehbod AA, Perra JH, Denis F, Garvey TA, Lonstein JE, Wu C, Dorman CW, Winter RB (2009) Can C7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine 34(15):519–527CrossRef
25.
go back to reference Mehta VA, Amin A, Omeis I, Gokaslan ZL, Gottfried ON (2012) Implications of spinopelvic alignment for the spine surgeon. Neurosurgery 70:707–721PubMedCrossRef Mehta VA, Amin A, Omeis I, Gokaslan ZL, Gottfried ON (2012) Implications of spinopelvic alignment for the spine surgeon. Neurosurgery 70:707–721PubMedCrossRef
26.
go back to reference Mi Kyung K, Sun-Ho L, Eun-Sang K, Whan E, Sung-Soo C, Chong-Suh L (2011) The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: a pilot study. BMC Musculoskelet Disord 12:69. doi:10.1186/1471-2474-12-69 CrossRef Mi Kyung K, Sun-Ho L, Eun-Sang K, Whan E, Sung-Soo C, Chong-Suh L (2011) The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: a pilot study. BMC Musculoskelet Disord 12:69. doi:10.​1186/​1471-2474-12-69 CrossRef
27.
go back to reference Neal CJ, McClendon J, Halpin R, Acosta FL, Koski T, Ondra SL (2011) Predicting ideal spinopelvic balance in adult spinal deformity. J Neurosurg Spine 15:82–91PubMedCrossRef Neal CJ, McClendon J, Halpin R, Acosta FL, Koski T, Ondra SL (2011) Predicting ideal spinopelvic balance in adult spinal deformity. J Neurosurg Spine 15:82–91PubMedCrossRef
28.
go back to reference Ondra SL, Marzouk S, Koski T, Silva F, Salehi S (2006) Mathematical calculation of pedicle subtraction osteotomy size to allow precision correction of fixed sagittal deformity. Spine 31:973–979CrossRef Ondra SL, Marzouk S, Koski T, Silva F, Salehi S (2006) Mathematical calculation of pedicle subtraction osteotomy size to allow precision correction of fixed sagittal deformity. Spine 31:973–979CrossRef
29.
go back to reference Rose PS, Bridwell KH, Lenke LG, Cronen GA, Mulconrey DS, Buchowski JM, Kim YJ (2009) Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine 34:785–791PubMedCrossRef Rose PS, Bridwell KH, Lenke LG, Cronen GA, Mulconrey DS, Buchowski JM, Kim YJ (2009) Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine 34:785–791PubMedCrossRef
31.
go back to reference Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M, Farcy JP (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine 30:1082–1085PubMedCrossRef Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M, Farcy JP (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine 30:1082–1085PubMedCrossRef
32.
go back to reference Schwab F, Lafage V, Patel A, Farcy JP (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine 34:1828–1833PubMedCrossRef Schwab F, Lafage V, Patel A, Farcy JP (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine 34:1828–1833PubMedCrossRef
33.
go back to reference 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 35:2224–2231PubMedCrossRef 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 35:2224–2231PubMedCrossRef
34.
go back to reference Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, Ondra S, Schwab F, Shainline M, Fu KM, Bridwell K (2009) Improvement of back pain with operative and non operative in adults with scoliosis. Neurosurgery 65:86–93PubMedCrossRef Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, Ondra S, Schwab F, Shainline M, Fu KM, Bridwell K (2009) Improvement of back pain with operative and non operative in adults with scoliosis. Neurosurgery 65:86–93PubMedCrossRef
35.
go back to reference Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL, Horton WC, Ondra SL, Sansur CA, Bridwell KH (2011) Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine 36:817–824PubMedCrossRef Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL, Horton WC, Ondra SL, Sansur CA, Bridwell KH (2011) Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine 36:817–824PubMedCrossRef
36.
go back to reference Smith-Petersen MN, Larson CB, Aufranc OE (1969) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res 66:6–9PubMed Smith-Petersen MN, Larson CB, Aufranc OE (1969) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res 66:6–9PubMed
38.
go back to reference 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 87:260–267PubMedCrossRef 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 87:260–267PubMedCrossRef
Metadata
Title
Pelvic parameters and global spine balance for spine degenerative disease: the importance of containing for the well being of content
Authors
Diego Garbossa
Matteo Pejrona
Marco Damilano
Valerio Sansone
Alessandro Ducati
Pedro Berjano
Publication date
01-10-2014
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue Special Issue 6/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-014-3558-6

Other articles of this Special Issue 6/2014

European Spine Journal 6/2014 Go to the issue