The relationship between global spinal alignment and pelvic orientation from standing to sitting following pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis

  • Shi-zhou Zhao
  • Bang-ping QianEmail author
  • Yong Qiu
  • Mu Qiao
  • Zhuo-jie Liu
  • Ji-chen Huang
Orthopaedic Surgery



To investigate the relationship between the spinal sagittal alignment and arc of pelvic motion from standing to sitting in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis following pedicle subtraction osteotomy (PSO).

Materials and Methods

AS patients who underwent PSO for thoracolumbar kyphosis from January 2016 to July 2018 were recruited. EOS standing and sitting images were obtained pre- and postoperatively. Radiographic parameters were measured on the sagittal radiographs, including lumbar lordosis, thoracic kyphosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA), spinosacral angle, anterior pelvic plane angle (APPA) and knee flexion angle.


Thirty-six patients were enrolled. From standing to sitting, APPA was increased by a mean of 14.7° (P < 0.001) and 3.0° (P = 0.083) before and after surgery, respectively. The increase in APPA from standing to sitting was correlated with the standing SVA (R = 0.592, P < 0.001) preoperatively. After PSO, the change in APPA was correlated with the change in SSA in both the standing and sitting position (R = 0.381, P = 0.022 and R = 0.667, P < 0.001, respectively). The APPA from standing to sitting was decreased in 11 patients with standing C7 plumb line posterior to the femoral head postoperatively.


In AS patients, pelvic orientation was adjusted by the global spinal alignment. When planning total hip arthroplasty for AS patients, global spinal alignment should be considered to improve the joint stability.


Ankylosing spondylitis Thoracolumbar kyphosis Osteotomy Anterior pelvic plane Standing Sitting 



This study was funded by the “Six One” Advanced Health Professionals Project of the Key Talents Program of Jiangsu Province (LGY2017001), Jiangsu Provincial Medical Talent (RC2011147) and the Jiangsu Provincial Key Medical Center (YXZXA2016009).

Compliance with ethical standards

Ethical approval

All methods were performed in accordance with the relevant guidelines and regulations.

Conflict of interest

Shi-zhou Zhao, Bang-ping Qian, Yong Qiu, Mu Qiao, Zhuo-jie Liu, and Ji-chen Huang declare that they have no conflict of interest.

Research involving human and/or animal participants

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Ranganathan V, Gracey E, Brown MA et al (2017) Pathogenesis of ankylosing spondylitis-recent advances and future directions. Nat Rev Rheumatol 13:359–367. CrossRefGoogle Scholar
  2. 2.
    Qian BP, Jiang J, Qiu Y et al (2014) The presence of a negative sacral slope in patients with ankylosing spondylitis with severe thoracolumbar kyphosis. J Bone Joint Surg Am 96:e188CrossRefGoogle Scholar
  3. 3.
    Barrey C, Roussouly P, Perrin G et al (2011) Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 20:626–633. CrossRefGoogle Scholar
  4. 4.
    Lazennec JY, Brusson A, Rousseau MA (2011) Hip–spine relations and sagittal balance clinical consequences. Eur Spine J 20:686–698. CrossRefGoogle Scholar
  5. 5.
    Lazennec JY, Brusson A, Rousseau MA (2013) Lumbar-pelvic-femoral balance on sitting and standing lateral radiographs. Orthop Traumatol Surg Res 99:S87–S103. CrossRefGoogle Scholar
  6. 6.
    Qian BP, Mao SH, Jiang J et al (2017) Mechanisms, predisposing factors, and prognosis of intraoperative vertebral subluxation during pedicle subtraction osteotomy in surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis. Spine (Phila Pa 1976) 42:E983–E990. CrossRefGoogle Scholar
  7. 7.
    Buckland AJ, Vigdorchik J, Schwab FJ et al (2015) Acetabular anteversion changes due to spinal deformity correction: bridging the gap between hip and spine surgeons. J Bone Joint Surg Am 97:1913–1920. CrossRefGoogle Scholar
  8. 8.
    Masquefa T, Verdier N, Gille O et al (2015) Change in acetabular version after lumbar pedicle subtraction osteotomy to correct post-operative flat back: EOS® measurements of 38 acetabula. Orthop Traumatol Surg Res 101:655–659. CrossRefGoogle Scholar
  9. 9.
    Gu M, Zhang Z, Kang Y et al (2015) Roles of sagittal anatomical parameters of the pelvis in primary total hip replacement for patients with ankylosing spondylitis. J Arthroplasty 30(12):2219–2223. CrossRefGoogle Scholar
  10. 10.
    Lewinnek GE, Lewis JL, Tarr R et al (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60(2):217–220CrossRefGoogle Scholar
  11. 11.
    Ochi H, Baba T, Homma Y et al (2016) Importance of the spinopelvic factors on the pelvic inclination from standing to sitting before total hip arthroplasty. Eur Spine J 25(11):3699–3706CrossRefGoogle Scholar
  12. 12.
    Ranawat CS, Ranawat AS, Lipman JD et al (2016) Effect of spinal deformity on pelvic orientation from standing to sitting position. J Arthroplasty 31(6):1222–1227. CrossRefGoogle Scholar
  13. 13.
    van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368CrossRefGoogle Scholar
  14. 14.
    MacKay K, Brophy S, Mack C et al (2000) The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the bath ankylosing spondylitis radiology hip index. J Rheumatol 27(12):2866–2872Google Scholar
  15. 15.
    Xu H, Zhang Y, Zhao Y et al (2015) Radiologic and clinical outcomes comparison between single- and two-level pedicle subtraction osteotomies in correcting ankylosing spondylitis kyphosis. Spine J 15(2):290–297. CrossRefGoogle Scholar
  16. 16.
    Zhang YP, Qian BP, Qiu Y et al (2017) Sagittal vertical axis, spinosacral angle, spinopelvic angle, and T1 pelvic angle: which parameters may effectively predict the quality of life in ankylosing spondylitis patients with thoracolumbar kyphosis? Clin Spine Surg 30:E871–E876. CrossRefGoogle Scholar
  17. 17.
    Jalai CM, Cruz DL, Diebo BG et al (2017) Full-body analysis of age-adjusted alignment in adult spinal deformity patients and lower-limb compensation. Spine (Phila Pa 1976) 42(9):653–661. CrossRefGoogle Scholar
  18. 18.
    Sankar WN, Laird CT, Baldwin KD (2012) Hip range of motion in children: what is the norm? J Pediatr Orthop 32(4):399–405. CrossRefGoogle Scholar
  19. 19.
    McGrory BJ, Freiberg AA, Shinar AA et al (1993) Correlation of measured range of hip motion following total hip arthroplasty and responses to a questionnaire. J Arthroplasty 11(5):565–571CrossRefGoogle Scholar
  20. 20.
    Zheng GQ, Zhang YG, Chen JY et al (2014) Decision making regarding spinal osteotomy and total hip replacement for ankylosing spondylitis: experience with 28 patients. Bone Joint J 96-B(3):360–365. CrossRefGoogle Scholar
  21. 21.
    Rousseau MA, Lazennec JY, Tassin JL et al (2014) Sagittal rebalancing of the pelvis and the thoracic spine after pedicle subtraction osteotomy at the lumbar level. J Spinal Disord Tech 27:166–173. CrossRefGoogle Scholar
  22. 22.
    Hey HWD, Teo AQA, Tan KA et al (2017) How the spine differs in standing and in sitting-important considerations for correction of spinal deformity. Spine J 17:799–806. CrossRefGoogle Scholar
  23. 23.
    DiGioia AM, Hafez MA, Jaramaz B et al (2006) Functional pelvic orientation measured from lateral standing and sitting radiographs. Clin Orthop Relat Res 453:272–276CrossRefGoogle Scholar
  24. 24.
    Radcliff KE, Orozco F, Molby N et al (2013) Change in spinal alignment after total hip arthroplasty. Orthop Surg 5(4):261–265. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Spine SurgeryDrum Tower Hospital of Nanjing University Medical SchoolNanjingChina
  2. 2.Medical School of Nanjing UniversityNanjingChina

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