Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity

Emmanuelle Ferrero, Barthelemy Liabaud, Vincent Challier, Renaud Lafage, Bassel G. Diebo, Shaleen Vira, Shian Liu, Jean Marc Vital, Brice Ilharreborde, Themistocles S. Protopsaltis, Thomas J. Errico, Frank J. Schwab, Virginie Lafage

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

OBJECT: Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pelvic parameters have demonstrated the compensatory mechanisms of pelvis translation in addition to rotation. However, the mechanisms recruited for this pelvic rotation were not assessed. This study aims to analyze the relationship between spinopelvic and lower-extremity parameters and clarify the role of pelvic translation. METHODS: This is a retrospective study of patients with spinal deformity and full-body EOS images. Patients with only stenosis or low-back pain were excluded. Patients were grouped according to T-1 spinopelvic inclination (T1SPi): sagittal forward (forward, > 0.5°), neutral (-6.3° to 0.5°), or backward (< -6.3°). Pelvic translation was quantified by pelvic shift (sagittal offset between the posterosuperior corner of the sacrum and anterior cortex of the distal tibia), hip extension was measured using the sacrofemoral angle (SFA; the angle formed by the middle of the sacral endplate and the bicoxofemoral axis and the line between the bicoxofemoral axis and the femoral axis), and chin-brow vertical angle (CBVA). Univariate and multivariate analyses were used to compare the parameters and correlation with the Oswestry Disability Index (ODI). RESULTS: In total, 336 patients (71% female; mean age 57 years; mean body mass index 27 kg/m2) had mean T1SPi values of -8.8°, -3.5°, and 5.9° in the backward, neutral, and forward groups, respectively. There were significant differences in the lower-extremity and spinopelvic parameters between T1SPi groups. The backward group had a normal lumbar lordosis (LL), negative SVA and pelvic shift, and the largest hip extension. Forward patients had a small LL and an increased SVA, with a large pelvic shift creating compensatory knee flexion. Significant correlations existed between lower-limb parameter and pelvic shift, pelvic tilt, T-1 pelvic angle, T1SPi, and sagittal vertical axis (0.3 < r < 0.8; p < 0.001). ODI was significantly correlated with knee flexion and pelvic shift. CONCLUSIONS: This is the first study to describe full-body alignment in a large population of patients with spinal pathologies. Furthermore, patients categorized based on T1SPi were found to have significant differences in the pelvic shift and lower-limb compensatory mechanisms. Correlations between lower-limb angles, pelvic shift, and ODI were identified. These differences in compensatory mechanisms should be considered when evaluating and planning surgical intervention for adult patients with spinal deformity.

Original languageEnglish (US)
Pages (from-to)436-446
Number of pages11
JournalJournal of Neurosurgery: Spine
Volume24
Issue number3
DOIs
StatePublished - Mar 2016
Externally publishedYes

Fingerprint

Gravitation
Lower Extremity
Lordosis
Hip
Knee
Sacrum
Chin
Body Image
Low Back Pain
Thigh
Pelvis
Tibia
Pathologic Constriction
Body Mass Index
Multivariate Analysis
Retrospective Studies
Pathology
Population

Keywords

  • Compensatory mechanisms
  • Full-body radiography
  • Pelvic shift
  • Pelvic tilt
  • Sagittal alignment
  • Spine deformity
  • T-1 spinopelvic inclination

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity. / Ferrero, Emmanuelle; Liabaud, Barthelemy; Challier, Vincent; Lafage, Renaud; Diebo, Bassel G.; Vira, Shaleen; Liu, Shian; Vital, Jean Marc; Ilharreborde, Brice; Protopsaltis, Themistocles S.; Errico, Thomas J.; Schwab, Frank J.; Lafage, Virginie.

In: Journal of Neurosurgery: Spine, Vol. 24, No. 3, 03.2016, p. 436-446.

Research output: Contribution to journalArticle

Ferrero, E, Liabaud, B, Challier, V, Lafage, R, Diebo, BG, Vira, S, Liu, S, Vital, JM, Ilharreborde, B, Protopsaltis, TS, Errico, TJ, Schwab, FJ & Lafage, V 2016, 'Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity', Journal of Neurosurgery: Spine, vol. 24, no. 3, pp. 436-446. https://doi.org/10.3171/2015.5.SPINE14989
Ferrero, Emmanuelle ; Liabaud, Barthelemy ; Challier, Vincent ; Lafage, Renaud ; Diebo, Bassel G. ; Vira, Shaleen ; Liu, Shian ; Vital, Jean Marc ; Ilharreborde, Brice ; Protopsaltis, Themistocles S. ; Errico, Thomas J. ; Schwab, Frank J. ; Lafage, Virginie. / Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity. In: Journal of Neurosurgery: Spine. 2016 ; Vol. 24, No. 3. pp. 436-446.
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author = "Emmanuelle Ferrero and Barthelemy Liabaud and Vincent Challier and Renaud Lafage and Diebo, {Bassel G.} and Shaleen Vira and Shian Liu and Vital, {Jean Marc} and Brice Ilharreborde and Protopsaltis, {Themistocles S.} and Errico, {Thomas J.} and Schwab, {Frank J.} and Virginie Lafage",
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TY - JOUR

T1 - Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity

AU - Ferrero, Emmanuelle

AU - Liabaud, Barthelemy

AU - Challier, Vincent

AU - Lafage, Renaud

AU - Diebo, Bassel G.

AU - Vira, Shaleen

AU - Liu, Shian

AU - Vital, Jean Marc

AU - Ilharreborde, Brice

AU - Protopsaltis, Themistocles S.

AU - Errico, Thomas J.

AU - Schwab, Frank J.

AU - Lafage, Virginie

PY - 2016/3

Y1 - 2016/3

N2 - OBJECT: Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pelvic parameters have demonstrated the compensatory mechanisms of pelvis translation in addition to rotation. However, the mechanisms recruited for this pelvic rotation were not assessed. This study aims to analyze the relationship between spinopelvic and lower-extremity parameters and clarify the role of pelvic translation. METHODS: This is a retrospective study of patients with spinal deformity and full-body EOS images. Patients with only stenosis or low-back pain were excluded. Patients were grouped according to T-1 spinopelvic inclination (T1SPi): sagittal forward (forward, > 0.5°), neutral (-6.3° to 0.5°), or backward (< -6.3°). Pelvic translation was quantified by pelvic shift (sagittal offset between the posterosuperior corner of the sacrum and anterior cortex of the distal tibia), hip extension was measured using the sacrofemoral angle (SFA; the angle formed by the middle of the sacral endplate and the bicoxofemoral axis and the line between the bicoxofemoral axis and the femoral axis), and chin-brow vertical angle (CBVA). Univariate and multivariate analyses were used to compare the parameters and correlation with the Oswestry Disability Index (ODI). RESULTS: In total, 336 patients (71% female; mean age 57 years; mean body mass index 27 kg/m2) had mean T1SPi values of -8.8°, -3.5°, and 5.9° in the backward, neutral, and forward groups, respectively. There were significant differences in the lower-extremity and spinopelvic parameters between T1SPi groups. The backward group had a normal lumbar lordosis (LL), negative SVA and pelvic shift, and the largest hip extension. Forward patients had a small LL and an increased SVA, with a large pelvic shift creating compensatory knee flexion. Significant correlations existed between lower-limb parameter and pelvic shift, pelvic tilt, T-1 pelvic angle, T1SPi, and sagittal vertical axis (0.3 < r < 0.8; p < 0.001). ODI was significantly correlated with knee flexion and pelvic shift. CONCLUSIONS: This is the first study to describe full-body alignment in a large population of patients with spinal pathologies. Furthermore, patients categorized based on T1SPi were found to have significant differences in the pelvic shift and lower-limb compensatory mechanisms. Correlations between lower-limb angles, pelvic shift, and ODI were identified. These differences in compensatory mechanisms should be considered when evaluating and planning surgical intervention for adult patients with spinal deformity.

AB - OBJECT: Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pelvic parameters have demonstrated the compensatory mechanisms of pelvis translation in addition to rotation. However, the mechanisms recruited for this pelvic rotation were not assessed. This study aims to analyze the relationship between spinopelvic and lower-extremity parameters and clarify the role of pelvic translation. METHODS: This is a retrospective study of patients with spinal deformity and full-body EOS images. Patients with only stenosis or low-back pain were excluded. Patients were grouped according to T-1 spinopelvic inclination (T1SPi): sagittal forward (forward, > 0.5°), neutral (-6.3° to 0.5°), or backward (< -6.3°). Pelvic translation was quantified by pelvic shift (sagittal offset between the posterosuperior corner of the sacrum and anterior cortex of the distal tibia), hip extension was measured using the sacrofemoral angle (SFA; the angle formed by the middle of the sacral endplate and the bicoxofemoral axis and the line between the bicoxofemoral axis and the femoral axis), and chin-brow vertical angle (CBVA). Univariate and multivariate analyses were used to compare the parameters and correlation with the Oswestry Disability Index (ODI). RESULTS: In total, 336 patients (71% female; mean age 57 years; mean body mass index 27 kg/m2) had mean T1SPi values of -8.8°, -3.5°, and 5.9° in the backward, neutral, and forward groups, respectively. There were significant differences in the lower-extremity and spinopelvic parameters between T1SPi groups. The backward group had a normal lumbar lordosis (LL), negative SVA and pelvic shift, and the largest hip extension. Forward patients had a small LL and an increased SVA, with a large pelvic shift creating compensatory knee flexion. Significant correlations existed between lower-limb parameter and pelvic shift, pelvic tilt, T-1 pelvic angle, T1SPi, and sagittal vertical axis (0.3 < r < 0.8; p < 0.001). ODI was significantly correlated with knee flexion and pelvic shift. CONCLUSIONS: This is the first study to describe full-body alignment in a large population of patients with spinal pathologies. Furthermore, patients categorized based on T1SPi were found to have significant differences in the pelvic shift and lower-limb compensatory mechanisms. Correlations between lower-limb angles, pelvic shift, and ODI were identified. These differences in compensatory mechanisms should be considered when evaluating and planning surgical intervention for adult patients with spinal deformity.

KW - Compensatory mechanisms

KW - Full-body radiography

KW - Pelvic shift

KW - Pelvic tilt

KW - Sagittal alignment

KW - Spine deformity

KW - T-1 spinopelvic inclination

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