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Evolution of the ischio-iliac lordosis during natural growth and its relation with the pelvic incidence

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Abstract

Purpose

Human fully upright ambulation, with fully extended hips and knees, and the body’s center of gravity directly above the hips, is unique in nature, and distinguishes humans from all other mammalians. This bipedalism is made possible by the development of a lordosis between the ischium and ilium; it allows to ambulate in this unique bipedal manner, without sacrificing forceful extension of the legs. This configuration in space introduces unique biomechanical forces with relevance for a number of spinal conditions. The aim of this study was to quantify the development of this lordosis between ischium and ilium in the normal growing and adult spine and to evaluate its correlation with the well-known clinical parameter, pelvic incidence.

Methods

Consecutive series of three-dimensional computed tomography scans of the abdomen of 189 children and 310 adults without spino-pelvic pathologies were used. Scan indications were trauma screening or acute abdominal pathology. Using previously validated image processing techniques, femoral heads, center of the sacral endplate and the axes of the ischial bones were semi-automatically identified. A true sagittal view of the pelvis was automatically reconstructed, on which ischio-iliac angulation and pelvic incidence were calculated. The ischio-iliac angle was defined as the angle between the axes of the ischial bones and the line from the midpoint of the sacral endplate to the center of the femoral heads.

Results

A wide natural variation of the ischio-iliac angle (3°–46°) and pelvic incidence (14°–77°) was observed. Pearson’s analysis demonstrated a significant correlation between the ischio-iliac angle and pelvic incidence (r = 0.558, P < 0.001). Linear regression analysis revealed that ischio-iliac angle, as well as pelvic incidence, increases during childhood (+7° and +10°, respectively) and becomes constant after adolescence.

Conclusions

The development of the ischio-iliac lordosis is unique in nature, is in harmonious continuity with the highly individual lumbar lordosis and defines the way the human spine is biomechanically loaded. The practical parameter that reflects this is the pelvic incidence; both values increase during growth and remain stable in adulthood.

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Conflict of interest

This authors of this study were supported by the Alexandre Suerman MD/PhD program, an unrestricted Medtronic research grant and by AOSpine, DePuy Synthes Spine and Johnson & Johnson.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands

    Tom P. C. Schlösser, Michiel M. A. Janssen, F. Cumhur Öner & René M. Castelein

  2. Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia

    Tomaž Vrtovec & Franjo Pernuš

  3. Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands

    Max A. Viergever & Koen L. Vincken

Authors
  1. Tom P. C. Schlösser
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  2. Michiel M. A. Janssen
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  3. Tomaž Vrtovec
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  4. Franjo Pernuš
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  7. Koen L. Vincken
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  8. René M. Castelein
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Correspondence to Tom P. C. Schlösser.

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Schlösser, T.P.C., Janssen, M.M.A., Vrtovec, T. et al. Evolution of the ischio-iliac lordosis during natural growth and its relation with the pelvic incidence. Eur Spine J 23, 1433–1441 (2014). https://doi.org/10.1007/s00586-014-3358-z

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  • DOI: https://doi.org/10.1007/s00586-014-3358-z

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