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European Spine Journal

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01-11-2016 | Original Article

Optimum pelvic incidence minus lumbar lordosis value can be determined by individual pelvic incidence

Authors: Satoshi Inami, Hiroshi Moridaira, Daisaku Takeuchi, Yo Shiba, Yutaka Nohara, Hiroshi Taneichi

Published in: European Spine Journal | Issue 11/2016

Abstract

Purpose

Adult spinal deformity (ASD) classification showing that ideal pelvic incidence minus lumbar lordosis (PI-LL) value is within 10° has been received widely. But no study has focused on the optimum level of PI-LL value that reflects wide variety in PI among patients. This study was conducted to determine the optimum PI-LL value specific to an individual’s PI in postoperative ASD patients.

Methods

48 postoperative ASD patients were recruited. Spino-pelvic parameters and Oswestry Disability Index (ODI) were measured at the final follow-up. Factors associated with good clinical results were determined by stepwise multiple regression model using the ODI. The patients with ODI under the 75th percentile cutoff were designated into the “good” health related quality of life (HRQOL) group. In this group, the relationship between the PI-LL and PI was assessed by regression analysis.

Results

Multiple regression analysis revealed PI-LL as significant parameters associated with ODI. Thirty-six patients with an ODI <22 points (75th percentile cutoff) were categorized into a good HRQOL group, and linear regression models demonstrated the following equation: PI-LL = 0.41PI–11.12 (r = 0.45, P = 0.0059).

Conclusions

On the basis of this equation, in the patients with a PI = 50°, the PI-LL is 9°. Whereas in those with a PI = 30°, the optimum PI-LL is calculated to be as low as 1°. In those with a PI = 80°, PI-LL is estimated at 22°. Consequently, an optimum PI-LL is inconsistent in that it depends on the individual PI.

Schwab F, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine 27:387–392CrossRefPubMed

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 20:1351–1358CrossRefPubMed

Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029CrossRefPubMed

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:E599–E606CrossRefPubMed

Protopsaltis T, Schwab F, Bronsard N, Smith JS, Klineberg E, Mundis G et al (2014) The T1 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 96:1631–1640CrossRefPubMed

Schwab F, Farcy JP, Bridwell K, Berven S, Glassman S, Harrast J et al (2006) A clinical impact classification of scoliosis in the adult. Spine 31:2109–2114CrossRefPubMed

Duval-Beaupère G, Schmidt C, Cosson P (1992) A barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann of Biomed Eng 20:451–462CrossRef

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 7:99–103CrossRefPubMedPubMedCentral

Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C et al (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422CrossRefPubMed

10.

Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D et al (2012) Scoliosis research society-Schwab adult spinal deformity classification: a validation study. Spine 37:1077–1082CrossRefPubMed

11.

Rothenfluh DA, Mueller DA, Rothenfluh E, Min K (2015) Pelvic incidence-lumbar lordosis mismatch predispose to adjacent segment disease after lumbar spinal fusion. Eur Spine J 24:1251–1258CrossRefPubMed

12.

Cho W, Mason JR, Smith JS, Shimer AL, Wilson AS, Shaffrey CI (2013) Failure of lumbopelvic fixation after long construct fusion in patients with adult spinal deformity: clinical and radiographic risk factors. J Neurosurg Spine 19:445–453CrossRefPubMed

13.

Le Huec JC, Aunoble S, Philippe L, Nicolas P (2011) Pelvic parameters: origin and significance. Eur Spine J 20:S564–S571CrossRef

14.

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 the 153 asymptomatic volunteers. Spine 31:E320–E325CrossRefPubMed

15.

Berthonnaud E, Dimnet J, Roussouly P, Labella H (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18:40–47CrossRefPubMed

16.

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 35:2224–2231CrossRefPubMed

17.

Yamada K, Abe Y, Yanagibashi Y, Hyakumachi T, Satoh S (2015) Mid- and long-term clinical outcomes of corrective fusion surgery which did not achieve sufficient pelvic incidence minus lumbar lordosis value for adult spinal deformity. Scoliosis 10:S17CrossRefPubMedPubMedCentral

18.

Horton WC, Brown CW, Bridwell KH, Glassman SD, Suk SI, Cha CW (2005) Is there an optimal patient stance for obtaining a lateral 36″ radiograph? Acritical comparison of three techniques. Spine 30:427–433CrossRefPubMed

19.

Schwab F, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity. Spine 38:E803–E812CrossRefPubMed

20.

Boissiere L, Bourghli A, Vital JM, Gille O, Obeid I (2013) The lumbar lordosis index: a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery. Eur Spine 22:1339–1345CrossRef

21.

Lafage V, Schwab F, Vira S, Patel A, Ungar B, Farcy JP (2011) Spino-pelvic parameter after surgery can be predicted. Spine 36:1037–1045CrossRefPubMed

22.

Rose PS, Bridwell KH, Lenke LG, Cronen GA, Mulconrey DS, Buchowski JM et al (2009) Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine 34:785–791CrossRefPubMed

23.

Roussouly P, Pinherio-Franco JL (2011) Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J 20:S609–S618CrossRef

24.

Legaye J, Duval-Beauere G (2005) Sagittal plane alignment of the spine and gravity: a radiological and clinical evaluation. Acta Orthop Belg 71:213–220PubMed

25.

Lafage V, Ames C, Schwab F, Klineberg E, Akbania B, Smith J et al (2012) Change in thoracic kyphosis negatively impact sagittal alignment after lumbar pedicle subtraction osteotomy. Spine 37:E180–E187CrossRefPubMed

26.

Berjano P, Langella F, Ismael M-F, Damilano M, Scopetta S, Lamertina C (2014) Successful correction of sagittal imbalance can be calculated on the basis of pelvic incidence and age. Eur Spine J 23:S587–S596CrossRef

Title: Optimum pelvic incidence minus lumbar lordosis value can be determined by individual pelvic incidence
Authors: Satoshi Inami
Hiroshi Moridaira
Daisaku Takeuchi
Yo Shiba
Yutaka Nohara
Hiroshi Taneichi
Publication date: 01-11-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 11/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-016-4563-8

At a glance: The STEP trials

Springer Medicine

Optimum pelvic incidence minus lumbar lordosis value can be determined by individual pelvic incidence

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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