Is There a Gender-Specific Full Body Sagittal Profile for Different Spinopelvic Relationships? A Study on Propensity-Matched Cohorts

Shaleen Vira, Bassel G. Diebo, Matthew Adam Spiegel, Barthelemy Liabaud, Jensen K. Henry, Jonathan H. Oren, Renaud Lafage, Elizabeth M. Tanzi, Themistocles S. Protopsaltis, Thomas J. Errico, Frank J. Schwab, Virginie Lafage

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Design Retrospective review. Objective To evaluate gender-related differences in compensatory recruitment to progressive sagittal malalignment. Summary of Background Data Recent research has elucidated compensatory mechanisms recruited in response to sagittal malalignment, but gender-specific differences in compensatory recruitment patterns is unknown. Methods Single-center study of patients with full body x-rays. A female group was propensity matched by age, body mass index (BMI), and pelvic incidence (PI) to a male group. Patients were then stratified into five groups of progressive PI-lumbar lordosis (LL) mismatch (<0°, 0°-10°, 10°-20°, 20°-30°, >30°). Differences between PI-LL groups were assessed with analysis of variance, and between genders by unpaired t test. Knee flexion to pelvic tilt (PT) ratio was computed and compared between genders. Multivariate regression to develop predictive models for PT was performed for each gender, first with spinopelvic parameters and subsequently with inclusion of lower limb parameters. Results A total of 942 patient visits were included: 471 females (mean age 54 years, BMI 27, PI 51°) and 471 males (mean age 52 years, BMI 27, PI 51°). At the lowest level of malalignment, females had greater PT and less knee flexion. With progressive malalignment, females continued to exhibit a pattern of greater pelvic retroversion and less knee flexion compared to males. Hip extension was higher in females with progressive PI-LL mismatch groups. Both genders progressively recruited knee flexion and pelvic retroversion with increased PI-LL mismatch, except that at the higher PI-LL mismatch groups, only males continued to recruit knee flexion (all p <.05). Inclusion of lower limbs in the regression for PT markedly improved correlation coefficients for females but not for males. Conclusions With progressive sagittal malalignment, men recruit more knee flexion and women recruit more pelvic tilt and hip extension. Knee flexion is a possible mechanism to gain pelvic tilt for females whereas for males, knee flexion is an independent compensatory mechanism.

Original languageEnglish (US)
Pages (from-to)104-111
Number of pages8
JournalSpine Deformity
Volume4
Issue number2
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Fingerprint

Knee
Lordosis
Incidence
Body Mass Index
Hip
Lower Extremity
Analysis of Variance
X-Rays
Research

Keywords

  • Adult spinal deformity
  • Compensatory recruitment
  • Full body x-ray
  • PI-LL mismatch
  • Sagittal malalignment

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Is There a Gender-Specific Full Body Sagittal Profile for Different Spinopelvic Relationships? A Study on Propensity-Matched Cohorts. / Vira, Shaleen; Diebo, Bassel G.; Spiegel, Matthew Adam; Liabaud, Barthelemy; Henry, Jensen K.; Oren, Jonathan H.; Lafage, Renaud; Tanzi, Elizabeth M.; Protopsaltis, Themistocles S.; Errico, Thomas J.; Schwab, Frank J.; Lafage, Virginie.

In: Spine Deformity, Vol. 4, No. 2, 01.03.2016, p. 104-111.

Research output: Contribution to journalArticle

Vira, S, Diebo, BG, Spiegel, MA, Liabaud, B, Henry, JK, Oren, JH, Lafage, R, Tanzi, EM, Protopsaltis, TS, Errico, TJ, Schwab, FJ & Lafage, V 2016, 'Is There a Gender-Specific Full Body Sagittal Profile for Different Spinopelvic Relationships? A Study on Propensity-Matched Cohorts', Spine Deformity, vol. 4, no. 2, pp. 104-111. https://doi.org/10.1016/j.jspd.2015.08.004
Vira, Shaleen ; Diebo, Bassel G. ; Spiegel, Matthew Adam ; Liabaud, Barthelemy ; Henry, Jensen K. ; Oren, Jonathan H. ; Lafage, Renaud ; Tanzi, Elizabeth M. ; Protopsaltis, Themistocles S. ; Errico, Thomas J. ; Schwab, Frank J. ; Lafage, Virginie. / Is There a Gender-Specific Full Body Sagittal Profile for Different Spinopelvic Relationships? A Study on Propensity-Matched Cohorts. In: Spine Deformity. 2016 ; Vol. 4, No. 2. pp. 104-111.
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abstract = "Design Retrospective review. Objective To evaluate gender-related differences in compensatory recruitment to progressive sagittal malalignment. Summary of Background Data Recent research has elucidated compensatory mechanisms recruited in response to sagittal malalignment, but gender-specific differences in compensatory recruitment patterns is unknown. Methods Single-center study of patients with full body x-rays. A female group was propensity matched by age, body mass index (BMI), and pelvic incidence (PI) to a male group. Patients were then stratified into five groups of progressive PI-lumbar lordosis (LL) mismatch (<0°, 0°-10°, 10°-20°, 20°-30°, >30°). Differences between PI-LL groups were assessed with analysis of variance, and between genders by unpaired t test. Knee flexion to pelvic tilt (PT) ratio was computed and compared between genders. Multivariate regression to develop predictive models for PT was performed for each gender, first with spinopelvic parameters and subsequently with inclusion of lower limb parameters. Results A total of 942 patient visits were included: 471 females (mean age 54 years, BMI 27, PI 51°) and 471 males (mean age 52 years, BMI 27, PI 51°). At the lowest level of malalignment, females had greater PT and less knee flexion. With progressive malalignment, females continued to exhibit a pattern of greater pelvic retroversion and less knee flexion compared to males. Hip extension was higher in females with progressive PI-LL mismatch groups. Both genders progressively recruited knee flexion and pelvic retroversion with increased PI-LL mismatch, except that at the higher PI-LL mismatch groups, only males continued to recruit knee flexion (all p <.05). Inclusion of lower limbs in the regression for PT markedly improved correlation coefficients for females but not for males. Conclusions With progressive sagittal malalignment, men recruit more knee flexion and women recruit more pelvic tilt and hip extension. Knee flexion is a possible mechanism to gain pelvic tilt for females whereas for males, knee flexion is an independent compensatory mechanism.",
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AU - Diebo, Bassel G.

AU - Spiegel, Matthew Adam

AU - Liabaud, Barthelemy

AU - Henry, Jensen K.

AU - Oren, Jonathan H.

AU - Lafage, Renaud

AU - Tanzi, Elizabeth M.

AU - Protopsaltis, Themistocles S.

AU - Errico, Thomas J.

AU - Schwab, Frank J.

AU - Lafage, Virginie

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N2 - Design Retrospective review. Objective To evaluate gender-related differences in compensatory recruitment to progressive sagittal malalignment. Summary of Background Data Recent research has elucidated compensatory mechanisms recruited in response to sagittal malalignment, but gender-specific differences in compensatory recruitment patterns is unknown. Methods Single-center study of patients with full body x-rays. A female group was propensity matched by age, body mass index (BMI), and pelvic incidence (PI) to a male group. Patients were then stratified into five groups of progressive PI-lumbar lordosis (LL) mismatch (<0°, 0°-10°, 10°-20°, 20°-30°, >30°). Differences between PI-LL groups were assessed with analysis of variance, and between genders by unpaired t test. Knee flexion to pelvic tilt (PT) ratio was computed and compared between genders. Multivariate regression to develop predictive models for PT was performed for each gender, first with spinopelvic parameters and subsequently with inclusion of lower limb parameters. Results A total of 942 patient visits were included: 471 females (mean age 54 years, BMI 27, PI 51°) and 471 males (mean age 52 years, BMI 27, PI 51°). At the lowest level of malalignment, females had greater PT and less knee flexion. With progressive malalignment, females continued to exhibit a pattern of greater pelvic retroversion and less knee flexion compared to males. Hip extension was higher in females with progressive PI-LL mismatch groups. Both genders progressively recruited knee flexion and pelvic retroversion with increased PI-LL mismatch, except that at the higher PI-LL mismatch groups, only males continued to recruit knee flexion (all p <.05). Inclusion of lower limbs in the regression for PT markedly improved correlation coefficients for females but not for males. Conclusions With progressive sagittal malalignment, men recruit more knee flexion and women recruit more pelvic tilt and hip extension. Knee flexion is a possible mechanism to gain pelvic tilt for females whereas for males, knee flexion is an independent compensatory mechanism.

AB - Design Retrospective review. Objective To evaluate gender-related differences in compensatory recruitment to progressive sagittal malalignment. Summary of Background Data Recent research has elucidated compensatory mechanisms recruited in response to sagittal malalignment, but gender-specific differences in compensatory recruitment patterns is unknown. Methods Single-center study of patients with full body x-rays. A female group was propensity matched by age, body mass index (BMI), and pelvic incidence (PI) to a male group. Patients were then stratified into five groups of progressive PI-lumbar lordosis (LL) mismatch (<0°, 0°-10°, 10°-20°, 20°-30°, >30°). Differences between PI-LL groups were assessed with analysis of variance, and between genders by unpaired t test. Knee flexion to pelvic tilt (PT) ratio was computed and compared between genders. Multivariate regression to develop predictive models for PT was performed for each gender, first with spinopelvic parameters and subsequently with inclusion of lower limb parameters. Results A total of 942 patient visits were included: 471 females (mean age 54 years, BMI 27, PI 51°) and 471 males (mean age 52 years, BMI 27, PI 51°). At the lowest level of malalignment, females had greater PT and less knee flexion. With progressive malalignment, females continued to exhibit a pattern of greater pelvic retroversion and less knee flexion compared to males. Hip extension was higher in females with progressive PI-LL mismatch groups. Both genders progressively recruited knee flexion and pelvic retroversion with increased PI-LL mismatch, except that at the higher PI-LL mismatch groups, only males continued to recruit knee flexion (all p <.05). Inclusion of lower limbs in the regression for PT markedly improved correlation coefficients for females but not for males. Conclusions With progressive sagittal malalignment, men recruit more knee flexion and women recruit more pelvic tilt and hip extension. Knee flexion is a possible mechanism to gain pelvic tilt for females whereas for males, knee flexion is an independent compensatory mechanism.

KW - Adult spinal deformity

KW - Compensatory recruitment

KW - Full body x-ray

KW - PI-LL mismatch

KW - Sagittal malalignment

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