Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Spine Journal
Published in: European Spine Journal 5/2011

01-09-2011 | Original Article

Lumbo-pelvic lordosis and the pelvic radius technique in the assessment of spinal sagittal balance: strengths and caveats

Authors: I. G. Sergides, Peter F. McCombe, G. White, Sabarul Mokhtar, William R. Sears

Published in: European Spine Journal | Special Issue 5/2011

Login to get access

Abstract

Introduction

The two main methodologies described for the assessment of spinal sagittal alignment are the pelvic radius (PR) technique and that based on measures of the Pelvic Incidence (PI) and Spino-Sacral Angle (SSA). Both methods stress the fundamental relationship between the anatomical position and orientation of the sacrum within the pelvis and the spinal curves above. The aim of the current study was to assess the strengths and potential weaknesses of the PR technique. The PR technique uses measures based on a line (the PR), drawn between the hip axis and the posterior corner of the S1 endplate. The angle formed between the PR line and the sacral endplate, PRS1, is a developmental measure of sacropelvic morphology. Geometrically, PI and PRS1 are approximately complementary angles and both reflect reciprocal alterations in pelvic tilt (for PI) or angulation (for PRS1) and the slope of the S1 endplate. The angle formed between PR and T12, the PR-T12, reflects a combined measure of pelvic morphology and lumbar lordosis. It appears to be a useful measure, which provides a simple and rapid assessment of lumbopelvic sagittal balance, but only in the presence of a congruent thoracic curvature.

Materials and methods

After reviewing the literature, published measures made using the PR technique were compared to measures taken from a substantial patient population (479 adult patients).

Conclusions

Errors can occur using the PR technique if the PRT12 is viewed in isolation from the thoracic kyphosis. We found the ratio of the thoracic kyphosis to lumbar lordosis (T4-T12/T12-S1) to be a useful predictor of congruent sagittal alignment, which may alert the clinician to situations where use of the PR-T12 in isolation may be misleading.
Literature
1.
Aurouer N, Obeid I, Gille O, Pointillart V, Vital JM (2009) Computerized preoperative planning for correction of sagittal deformity of the spine. Surg Radiol Anat, Jul 14 [Epub ahead of print]
2.
Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 16(9):1459–1467PubMedCrossRef
3.
Barrey C, Jund J, Perrin G, Roussouly P (2007) Spinopelvic alignment of patients with degenerative spondylolisthesis. Neurosurgery 61(5):981–986 discussion 986PubMedCrossRef
4.
Berthonnaud E, Labelle H, Roussouly P, Grimard G, Vaz G, Dimnet J (2005) A variability study of computerized sagittal spinopelvic radiologic measurements of trunk balance. J Spinal Disord Tech 18(1):66–71PubMedCrossRef
5.
Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18(1):40–47PubMedCrossRef
6.
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(4):415–422PubMedCrossRef
7.
Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd ed. Lawrence Erlbaum associates, New Jersey
8.
Dubousset J (1996) Pelvic obliquity correction. In: Marguiles JY, Floman Y, Farcy JP, Neuwirth M (eds) Lumbosacral and spinopelvic fixation. Lippincot-Raven, New York, pp 39–49
9.
Dimar JR, Carreon LY, Labelle H, Djurasovic M, Weidenbaum M, Brown C, Roussouly P (2008) Intra- and inter-observer reliability of determining radiographic sagittal parameters of the spine and pelvis using a manual and a computer-assisted methods. Eur Spine J 17(10):1373–1379PubMedCrossRef
10.
During J, Goudfrooij H, Keessen W, Beeker TW, Crowe A (1985) Toward standards for posture. Postural characteristics of the lower back system in normal and pathologic conditions. Spine (Phila Pa 1976) 10(1):83–87CrossRef
11.
Gardocki RJ, Watkins RG, Williams LA (2002) Measurements of lumbopelvic lordosis using the pelvic radius technique as it correlates with sagittal spinal balance and sacral translation. Spine J 2(6):421–429PubMedCrossRef
12.
DE Gelb, Lenke LG, Bridwell KH, Blanke K, McEnery KW (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976) 20(12):1351–1358
13.
Hresko MT, Labelle H, Roussouly P, Berthonnaud E (2007) Classification of high-grade spondylolistheses based on pelvic version and spine balance: possible rationale for reduction. Spine (Phila Pa 1976) 32(20):2208–2213CrossRef
14.
Jackson RP, Hales C (2000) Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine (Phila Pa 1976) 25(21):2808–2815CrossRef
15.
Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine (Phila Pa 1976) 25(5):575–586CrossRef
16.
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 (Phila Pa 1976) 19(14):1611–1618CrossRef
17.
Jackson RP, Peterson MD, McManus MC, Hales C (1998) Compensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients. Spine (Phila Pa 1976) 23(16):1750–1767CrossRef
18.
Jackson RP, Phipps T, Hales C, Surber J (2003) Pelvic lordosis and alignment in spondylolisthesis. Spine (Phila Pa 1976) 28(2):151–160CrossRef
19.
Jackson RP (1997) Spinal balance, lumbopelvic alignments around the “hip axis” and positioning for surgery. Spine State Art Rev 11:33–58
20.
McManus AC, Jackson RP (2004) Pelvic lordosis and pelvic incidence: the relationship of pelvic parameters to sagittal spinal profile. Curr Opin Orthop 15:150–153CrossRef
21.
22.
Labelle H, Roussouly P, Berthonnaud E, Dimnet J, O’Brien M (2005) The importance of spino-pelvic balance in L5-S1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine (Phila Pa 1976) 30(6 Suppl):S27–S34CrossRef
23.
Labelle H, Roussouly P, Berthonnaud E, Transfeldt E, O’Brien M, Chopin D, Hresko T, Dimnet J (2004) Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine (Phila Pa 1976) 29(18):2049–2054CrossRef
24.
Labelle H, Roussouly P, Chopin D, Berthonnaud E, Hresko T, O’Brien M (2008) Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J 17(9):1170–1176PubMedCrossRef
25.
Legaye J, Duval-Beaupère G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7(2):99–103PubMedCrossRef
26.
Mac-Thiong JM, Labelle H, Berthonnaud E, Betz RR, Roussouly P (2007) Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J 16(2):227–234PubMedCrossRef
27.
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(3):346–353CrossRef
28.
Roussouly P, Gollogly S, Noseda O, Berthonnaud E, Dimnet J (2006) The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine (Phila Pa 1976) 31(11):E320–E325CrossRef
29.
Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11(1):80–87PubMedCrossRef
30.
Vedantam R, Lenke LG, Keeney JA, Bridwell KH (1998) Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults. Spine (Phila Pa 1976) 23(2):211–215CrossRef
Metadata
Title
Lumbo-pelvic lordosis and the pelvic radius technique in the assessment of spinal sagittal balance: strengths and caveats
Authors
I. G. Sergides
Peter F. McCombe
G. White
Sabarul Mokhtar
William R. Sears
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue Special Issue 5/2011
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-011-1926-z

Other articles of this Special Issue 5/2011

European Spine Journal 5/2011 Go to the issue

Review Article

Standardized way for imaging of the sagittal spinal balance

Review Article

Sagittal imbalance cascade for simple degenerative spine and consequences: algorithm of decision for appropriate treatment

Review Article

Biomechanical analysis of the spino-pelvic organization and adaptation in pathology

Original Article

Sagittal spino-pelvic alignment in chronic low back pain

Editor's Preface

Sagittal balance of the spine: consequences for the treatment of the degenerative spine

Original Article

Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults