Skip to main content

Advertisement

SpringerLink
Log in

Head to pelvis alignment of adolescent idiopathic scoliosis patients both in and out of brace

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To determine the short-term effect of bracing of adolescent idiopathic scoliotic (AIS) patients on the relationships between spinopelvic parameters related to balance, by comparing their in and out-of-brace geometry and versus healthy subjects.

Methods

Forty-two AIS patients (Cobb angle 29° ± 12°, ranging from 16° to 61°) with a prescription of orthotic treatment were included retrospectively and prospectively. They all underwent biplanar radiography and 3D reconstruction of the spine and pelvis before bracing as well as less than 9 months after bracing. Eighty-three age-matched healthy adolescents were also included as control group and underwent biplanar radiography and 3D reconstruction.

Results

Sacral slope was higher in AIS than healthy patients (p = 0.005). Bracing induced large changes of pelvic tilt (between − 9° and 9°), although patients’ sagittal spinopelvic alignment tended to remain within the normality corridors defined by the healthy patients. Patients had flatter backs compared to healthy subjects and bracing further reduced their spinal curves. The head tended to remain above the pelvis in-brace.

Conclusion

Analysis of sagittal alignment from head to pelvis showed that bracing further flattened the patients’ backs and induced large compensating reorientations of the pelvis. Sagittal balance should be included in the planning and evaluation of brace treatment, since it could play a role in its outcome.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Dubousset J (2018) Definition of adolescent idiopathic scoliosis—pathogenesis of idiopathic scoliosis. In: Weinstein SL, Dubousset J (eds) Machida M. Springer, Tokyo, pp 1–25

    Google Scholar 

  2. Le Huec JC, Gille O, Fabre T (2018) Sagittal balance and spine-pelvis relation: a French speciality? Orthop Traumatol Surg Res 104:551–554. https://doi.org/10.1016/j.otsr.2018.06.001

    Article  PubMed  Google Scholar 

  3. Barrey C, Roussouly P, Le Huec JC et al (2013) Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 22:834–841. https://doi.org/10.1007/s00586-013-3030-z

    Article  PubMed Central  Google Scholar 

  4. Vedantam R, Lenke LG, Keeney JA, Bridwell KH (1998) Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults. Spine (Phila Pa 1976) 23:211–215

    Article  CAS  Google Scholar 

  5. Le Huec JC, Hasegawa K (2016) Normative values for the spine shape parameters using 3D standing analysis from a database of 268 asymptomatic Caucasian and Japanese subjects. Eur Spine J 25:3630–3637. https://doi.org/10.1007/s00586-016-4485-5

    Article  PubMed  Google Scholar 

  6. Schwab F, Lafage V, Patel A, Farcy JP (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine 34:1828–1833. https://doi.org/10.1097/BRS.0b013e3181a13c08

    Article  PubMed  Google Scholar 

  7. Legaye J, Duval-Beaupère G (2005) Sagittal plane alignment of the spine and gravity a radiological and clinical evaluation. Acta Orthop Belg 71:213–220. https://doi.org/10.1016/j.nec.2007.02.008

    Article  PubMed  Google Scholar 

  8. Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–87. https://doi.org/10.1007/s005860000224

    Article  CAS  PubMed  Google Scholar 

  9. Vialle R, Levassor N, Rillardon L et al (2005) Radiographic Analysis of the Sagittal Alignment and Balance of the Spine in Asymptomatic Subjects. J Bone Jt Surg 87:260–267. https://doi.org/10.2106/JBJS.D.02043

    Article  Google Scholar 

  10. Lafage V, Schwab F, Vira S et al (2011) Spino-pelvic parameters after surgery can be predicted: a preliminary formula and validation of standing alignment. Spine (Phila Pa 1976) 36:1037–1045

    Article  Google Scholar 

  11. Roussouly P, Labelle H, Rouissi J, Bodin A (2013) Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults. Eur Spine J 22:203–215. https://doi.org/10.1007/s00586-012-2571-x

    Article  Google Scholar 

  12. Alzakri A, Vergar C, Van den Abbeele M, Gille O, Skalli W, Obeid I (2019) Global sagittal alignment and proximal junctional kyphosis in adolescent idiopathic scoliosis. Spine Deform 7(2):236–244. https://doi.org/10.1016/j.jspd.2018.06.014

    Article  PubMed  Google Scholar 

  13. Glassman SD, Bridwell K, Dimar JR et al (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029

    Article  PubMed  Google Scholar 

  14. Lazennec J-Y, Ramaré S, Arafati N et al (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9:47–55. https://doi.org/10.1007/s005860050008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kumar M, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319. https://doi.org/10.1007/s005860000239

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Dubousset J, Charpak G, Dorion I et al (2005) A new 2D and 3D imaging approach to musculoskeletal physiology and pathology with low-dose radiation and the standing position: the EOS system. Bull Acad Natl Med 189:287–300

    PubMed  Google Scholar 

  17. Courvoisier A, Drevelle X, Vialle R et al (2013) 3D analysis of brace treatment in idiopathic scoliosis. Eur Spine J 22:2449–2455. https://doi.org/10.1007/s00586-013-2881-7

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lebel DE, Al-Aubaidi Z, Shin E-J et al (2013) Three dimensional analysis of brace biomechanical efficacy for patients with AIS. Eur Spine J 22:2445–2448. https://doi.org/10.1007/s00586-013-2921-3

    Article  PubMed  PubMed Central  Google Scholar 

  19. Clin J, Aubin C-E, Parent S et al (2010) Comparison of the biomechanical 3D efficiency of different brace designs for the treatment of scoliosis using a finite element model. Eur Spine J 19:1169–1178. https://doi.org/10.1007/s00586-009-1268-2

    Article  PubMed  PubMed Central  Google Scholar 

  20. Negrini S, Donzelli S, Aulisa AG et al (2018) 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord 13:3. https://doi.org/10.1186/s13013-017-0145-8

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lonstein JE, Carlson JM (1984) The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Jt Surg Am 66:1061–1071

    Article  CAS  Google Scholar 

  22. Humbert L, De Guise JA, Aubert B et al (2009) 3D reconstruction of the spine from biplanar X-rays using parametric models based on transversal and longitudinal inferences. Med Eng Phys 31:681–687. https://doi.org/10.1016/j.medengphy.2009.01.003

    Article  CAS  PubMed  Google Scholar 

  23. Amabile C, Pillet H, Lafage V et al (2016) A new quasi-invariant parameter characterizing the postural alignment of young asymptomatic adults. Eur Spine J 25:3666–3674. https://doi.org/10.1007/s00586-016-4552-y

    Article  PubMed  Google Scholar 

  24. Coe D (2009) Fisher matrices and confidence ellipses: a quick-start guide and software. arXiv:09064123

  25. Conover WJ, Iman RL (1982) Analysis of covariance using the rank transformation. Biometrics 38:715–724. https://doi.org/10.2307/2530051

    Article  CAS  PubMed  Google Scholar 

  26. Zaina F, Donzelli S, Lusini M, Negrini S (2012) Correlation between in-brace radiographic correction and short time brace results. Scoliosis 7:1. https://doi.org/10.1186/1748-7161-7-s1-o27

    Article  Google Scholar 

  27. Clin J, Aubin C-É, Sangole A et al (2010) Correlation between immediate in-brace correction and biomechanical effectiveness of brace treatment in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 35:1706–1713. https://doi.org/10.1097/BRS.0b013e3181cb46f6

    Article  Google Scholar 

  28. Vital JM, Senegas J (1986) Anatomical bases of the study of the constraints to which the cervical spine is subject in the sagittal plane a study of the center of gravity of the head. Surg Radiol Anat 8:169–173. https://doi.org/10.1007/BF02427845

    Article  CAS  PubMed  Google Scholar 

  29. Dubousset J (2011) Reflections of an orthopaedic surgeon on patient care and research into the condition of scoliosis. J Pediatr Orthop 31:S1–S8. https://doi.org/10.1097/BPO.0b013e3181f73beb

    Article  PubMed  Google Scholar 

  30. Amabile C, Le Huec J-C, Skalli W (2018) Invariance of head-pelvis alignment and compensatory mechanisms for asymptomatic adults older than 49 years. Eur Spine J 27:458–466. https://doi.org/10.1007/s00586-016-4830-8

    Article  PubMed  Google Scholar 

  31. Guo J, Liu Z, Lv F et al (2012) Pelvic tilt and trunk inclination: new predictive factors in curve progression during the Milwaukee bracing for adolescent idiopathic scoliosis. Eur Spine J 21:2050–2058. https://doi.org/10.1007/s00586-012-2409-6

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors are grateful to the BiomecAM chair program on subject-specific musculoskeletal modelling (with the support of ParisTech and Yves Cotrel Foundations, Société Générale, Covea and Proteor) and to the DHU MAMUTH for funding. We are also grateful to Ms Fay Manning for her technical support.

Author information

Authors and Affiliations

  1. LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l’Hôpital, 75013, Paris, France

    Claudio Vergari & Wafa Skalli

  2. Unite Rachis, CHU - Hopital Bellevue, Saint-Étienne, France

    Isabelle Courtois & Eric Ebermeyer

  3. Department of Pediatric Orthopaedics, Armand Trousseau Hospital, Sorbonne University, UPMC Paris 6 University, Paris, France

    Raphael Pietton, Houssam Bouloussa & Raphael Vialle

  4. Spine Surgery Department, Kaiser Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA

    Houssam Bouloussa

Authors
  1. Claudio Vergari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isabelle Courtois
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric Ebermeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raphael Pietton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Houssam Bouloussa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raphael Vialle
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wafa Skalli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claudio Vergari.

Ethics declarations

Conflict of interest

Wafa Skalli holds patents related to the EOS system and associated 3D reconstruction methods, with no personal financial benefit (royalties rewarded for research and education). Raphael Vialle received consulting fees from EOS Imaging unrelated to this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vergari, C., Courtois, I., Ebermeyer, E. et al. Head to pelvis alignment of adolescent idiopathic scoliosis patients both in and out of brace. Eur Spine J 28, 1286–1295 (2019). https://doi.org/10.1007/s00586-019-05981-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-019-05981-8

Keywords

Search

Navigation