European Spine Journal

, Volume 25, Issue 10, pp 3162–3169 | Cite as

Sagittal spino-pelvic adjustment in severe Lenke 1 hypokyphotic adolescent idiopathic scoliosis patients

  • Christophe VidalEmail author
  • Keyvan Mazda
  • Brice Ilharreborde
Original Article



The human standing position requires permanent reciprocal spino-pelvic adjustments to obtain a dynamic and economic posture. This study focuses on a hypokyphotic Lenke 1 adolescent idiopathic scoliosis (AIS) patients cohort and points out their particular lumbo-pelvic adaptive mechanisms to maintain a neutral sagittal balance.


Preoperative retrospective analysis of prospectively collected data on a monocentric cohort of 455 AIS patients planned for corrective surgery. Radiological low-dose system coupled with a validated clinical routine software allowed to obtain data from eighty-four hypokyphotic [thoracic kyphosis (TK) <20°] Lenke 1 patients and were separately analyzed. Bilateral Student and one-way ANOVAs were conducted for statistical analysis.


Mean Cobb angle was 46.3° (±7.2), TK was 11° (±7.1), sagittal vertical axis (SVA) was −10.1 mm (±30.9), pelvic incidence (PI) was 55.7° (±12.9). Fifty percents of patients were posteriorly imbalanced. Among them, patients with a low PI used an anteversion of their pelvis [indicated by a high pelvic tilt (PT) angle] but were not able to increase their lumbar lordosis (LL) to minimize the posterior spinal shift.


Hypokyphotic Lenke 1 AIS patients use lumbo-pelvic compensatory mechanisms to maintain their global balance with a poor effectiveness. Subjects with a low PI have a restricted range of LL adaptation. Attention should be paid during surgical planning not to overcorrect lordosis in the instrumented levels in case of non-selective fusion, that may induce posterior shift of the fusion mass and expose to junctional syndromes and poor functional outcomes in this particular patients.


Sagittal balance Pelvic incidence Thoracic scoliosis Adolescent idiopathic scoliosis 


Compliance with ethical standards

This work has been approved by the Institution’s Ethics Committee.

Conflict of interest

No direct or indirect benefits consecutive to this work have been or will be received by any of the authors. No author received or will receive any form of financial or material support consecutive to the present work.


  1. 1.
    Duval-Beaupère G, Schmidt C, Cosson P (1992) A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng 20:451–462CrossRefPubMedGoogle Scholar
  2. 2.
    Steffen JS, Obeid I, Aurouer N et al (2010) 3D postural balance with regard to gravity line: an evaluation in the transversal plane on 93 patients and 23 asymptomatic volunteers. Eur Spine J 19:760–767CrossRefPubMedGoogle Scholar
  3. 3.
    Roussouly P, Gollogly S, Berthonnaud E et al (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 30:346–353CrossRefGoogle Scholar
  4. 4.
    Mac-Thiong JM, Labelle H, Berthonnaud E et al (2007) Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J 16:227–234CrossRefPubMedGoogle Scholar
  5. 5.
    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 Joint Surg Am 87:260–267CrossRefPubMedGoogle Scholar
  6. 6.
    Lamartina C, Berjano P, Petruzzi M, Sinigaglia A, Casero G, Cecchinato R, Damilano M, Bassani R (2012) Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J 21:27–31CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Schwab F, Patel A, Ungar B, Farcy JP, Lafage V (2010) Adult spinal deformity postoperative standing imbalance: how much can you tolerate? An overview of key parameters assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35:2224–2231CrossRefGoogle Scholar
  8. 8.
    Sanchez-Mariscal F, Gomez-Rice A, Izquierdo E, Pizones J et al (2012) Correlation of radiographic and functional outcomes in patients who underwent primary scoliosis surgery in adult age. Spine (Phila Pa 1976) 37:592–598CrossRefGoogle Scholar
  9. 9.
    Ilharreborde B, Morel E, Mazda K, Dekutoski MB (2009) Adjacent segment disease after instrumented fusion for idiopathic scoliosis: review of current trends and controversies. J Spinal Disord Tech 22:530–539CrossRefPubMedGoogle Scholar
  10. 10.
    Luk KD, Vidyadhara S, Lu DS et al (2010) Coupling between sagittal and frontal plane deformity correction in idiopathic thoracic scoliosis and its relationship with postoperative sagittal alignment. Spine (Phila Pa 1976) 35:1158–1164CrossRefGoogle Scholar
  11. 11.
    Ilharreborde B, Sebag G, Skalli W, Mazda K (2013) Adolescent idiopathic scoliosis treated with posteromedial translation: radiologic evaluation with a 3D low-dose system. Eur Spine J 22:2382–2391CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Vidal C, Ilharreborde B, Azoulay R et al (2013) Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis. Eur Spine J 22:1362–1367CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lamartina C, Berjano P (2014) Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J 23:1177–1189CrossRefPubMedGoogle Scholar
  14. 14.
    Apazidis A, Ricart PA, Diefenbach CM et al (2011) The prevalence of transitional vertebrae in the lumbar spine. Spine J 11:858–862CrossRefPubMedGoogle Scholar
  15. 15.
    Ibrahim DA, Myung KS, Skaggs DL (2013) Ten percent of patients with adolescent idiopathic scoliosis have variations in the number of thoracic or lumbar vertebrae. J Bone Joint Surg Am 95:828–833CrossRefPubMedGoogle Scholar
  16. 16.
    Vaz G, Roussouly P, Berthonnaud E et al (2002) Morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–87CrossRefPubMedGoogle Scholar
  17. 17.
    La Maida GA, Zottarelli L, Mineo GV, Misaggi B (2013) Sagittal balance in adolescent idiopathic scoliosis: radiographic study of spino-pelvic compensation after surgery. Eur Spine J 22:S859–S867CrossRefPubMedGoogle Scholar
  18. 18.
    Clément J, Geoffray A, Yagoubi F et al (2013) Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis. Eur Spine J 22:2414–2420CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Roussouly P, Pinheiro-Franco JL (2011) Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J 20:609–618CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kouwenhoven JW, Castelein RM (2008) The pathogenesis of adolescent idiopathic scoliosis: review of the literature. Spine (Phila Pa 1976) 33:2898–2908CrossRefGoogle Scholar
  21. 21.
    Erdemir C, Musaoglu R, Selek O, Gok U, Sarlak AY (2015) Distal fusion level selection in Lenke 1A curves according to axial plane analyses. Spine J 15:2378–2384CrossRefPubMedGoogle Scholar
  22. 22.
    Blondel B, Lafage V, Schwab F et al (2012) Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis. Eur Spine J 21:1964–1971CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Sucato DJ, Agrawal S, O′Brien MF et al (2008) Restoration of thoracic kyphosis after operative treatment of adolescent idiopathic scoliosis: a multicenter comparison of three surgical approaches. Spine (Phila Pa 1976) 33:2630–2636CrossRefGoogle Scholar
  24. 24.
    Crawford AH, Lykissas MG, Gao X et al (2013) All-pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery: a comparative radiographic study with a minimum 2-year follow-up. Spine (Phila Pa 1976) 38:1199–1208CrossRefGoogle Scholar
  25. 25.
    Abelin-Genevois K, Idjerouidene A, Roussouly P, Vital JM, Garin C (2014) Cervical spine alignment in the pediatric population: a radiographic normative study of 150 asymptomatic patients. Eur Spine J 23:1442–1448CrossRefPubMedGoogle Scholar
  26. 26.
    Dubousset J, Lavaste F, Skalli W, Lafage V (2011) Modeling the spine and spinal cord. Bull Acad Natl Med 195:1831–1842PubMedGoogle Scholar
  27. 27.
    Paul JC, Patel A, Bianco K, Godwin E, Naziri Q, Maier S, Lafage V, Paulino C, Errico TJ (2014) Gait stability improvement after fusion surgery for adolescent idiopathic scoliosis is influenced by corrective measures in coronal and sagittal planes. Gait Posture 40(4):510–515CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Christophe Vidal
    • 1
    Email author
  • Keyvan Mazda
    • 1
  • Brice Ilharreborde
    • 1
  1. 1.Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HPParis Diderot UniversityParisFrance

Personalised recommendations