To evaluate the 3D deformity of the acetabula and lower limbs in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with spino-pelvic alignment.
Two hundred and seventy-four subjects with AIS (frontal Cobb: 33.5° ± 18° [10°–110°]) and 84 controls were enrolled. All subjects underwent full-body biplanar X-rays with subsequent 3D reconstructions. Classic spino-pelvic and lower limb parameters were collected as well as acetabular parameters: acetabular orientation in the 3 planes (tilt, anteversion and abduction), center–edge angle (CEA) and anterior and posterior sector angles. Subjects with AIS were represented by both lower limb sides and classified by elevated (ES) or lowered (LS), depending on the frontal pelvic obliquity. Parameters were then compared between groups. Determinants of acetabular and lower limb alterations were investigated among spino-pelvic parameters.
Acetabular abduction was higher on the ES in AIS (59.2° ± 6°) when compared to both LS (55.6° ± 6°) and controls (57.5° ± 3.9°, p < 0.001). CEA and acetabular anteversion were higher on the LS in AIS (32° ± 6.1°, 20.5° ± 5.7°) when compared to both ES (28.7° ± 5.1°, 19.8° ± 5.1°) and controls (29.8° ± 4.8°, 19.1° ± 4°, respectively, p < 0.001). Anterior sector angle was lower on both ES and LS in AIS when compared to controls. CEA, acetabular abduction and acetabular anteversion were found to be mostly determined (adjusted R2: 0.08–0.32) by pelvic tilt and less by frontal pelvic obliquity, frontal Cobb and T1T12.
Subjects with AIS had a more abducted acetabulum at the lowered side, more anteverted acetabulum and a lack of anterior coverage of both acetabula. These alterations were strongly related to pelvic tilt.
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Alzakri A, Vergari C, Van den Abbeele M et al (2019) Global sagittal alignment and proximal junctional kyphosis in adolescent idiopathic scoliosis. Spine Deform 7:236–244. https://doi.org/10.1016/j.jspd.2018.06.014
Pasha S, Aubin C-E, Sangole AP et al (2014) Three-dimensional spinopelvic relative alignment in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 39:564–570. https://doi.org/10.1097/brs.0000000000000193
Dubousset J (1990) CD instrumentation in pelvic tilt. Orthopade 19:300–308
Burwell RG, Aujla RK, Kirby AS et al (2008) Ultrasound femoral anteversion (FAV) and tibial torsion (TT) after school screening for adolescent idiopathic scoliosis (AIS). Stud Health Technol Inform 140:225–230
Saji MJ, Upadhyay SS, Leong JC (1995) Increased femoral neck-shaft angles in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 20:303–311
Márkus I, Schlégl ÁT, Burkus M et al (2018) The effect of coronal decompensation on the biomechanical parameters in lower limbs in adolescent idiopathic scoliosis. Rev Chir Orthop Traumatol 104:441. https://doi.org/10.1016/j.rcot.2018.06.018
Lazennec J-Y, Brusson A, Rousseau M-A (2011) Hip–spine relations and sagittal balance clinical consequences. Eur Spine J 20:1–13. https://doi.org/10.1007/s00586-011-1937-9
Chaibi Y, Cresson T, Aubert B et al (2012) Fast 3D reconstruction of the lower limb using a parametric model and statistical inferences and clinical measurements calculation from biplanar X-rays. Comput Methods Biomech Biomed Eng 15:457–466. https://doi.org/10.1080/10255842.2010.540758
Massaad A, Assi A, Bakouny Z et al (2016) Three-dimensional evaluation of skeletal deformities of the pelvis and lower limbs in ambulant children with cerebral palsy. Gait Posture. https://doi.org/10.1016/j.gaitpost.2016.06.029
Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83:1169–1181
Lazennec J-Y, Charlot N, Gorin M et al (2004) Hip-spine relationship: a radio-anatomical study for optimization in acetabular cup positioning. Surg Radiol Anat 26:136–144. https://doi.org/10.1007/s00276-003-0195-x
Anda S, Svenningsen S, Grontvedt T, Benum P (1990) Pelvic inclination and spatial orientation of the acetabulum. A radiographic, computed tomographic and clinical investigation. Acta Radiol 31:389–394
Tönnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81:1747–1770. https://doi.org/10.2106/JBJS.L.00710
Anda S, Svenningsen S, Dale LG, Benum P (1986) The acetabular sector angle of the adult hip determined by computed tomography. Acta Radiol Diagn (Stockh) 27:443–447
Assi A, Presedo A, Baudoin A et al (2012) Specific 3D reconstruction for children lower limbs using a low dose biplanar X-ray system. Reproducibility of clinical parameters for cerebral palsy patients. Comput Methods Biomech Biomed Eng. https://doi.org/10.1080/10255840701479065
Rampal V, Rohan P-Y, Assi A et al (2018) Lower-limb lengths and angles in children older than six years: reliability and reference values by EOS® stereoradiography. Orthop Traumatol Surg Res 104:389–395. https://doi.org/10.1016/j.otsr.2017.10.007
Rehm J, Germann T, Akbar M et al (2017) 3D-modeling of the spine using EOS imaging system: inter-reader reproducibility and reliability. PLoS ONE 12:1–13. https://doi.org/10.1371/journal.pone.0171258
Assi A, Chaibi Y, Presedo A et al (2013) Three-dimensional reconstructions for asymptomatic and cerebral palsy children’s lower limbs using a biplanar X-ray system: a feasibility study. Eur J Radiol 82:2359–2364. https://doi.org/10.1016/J.EJRAD.2013.07.006
Stem ESE, O’Connor MIM, Kransdorf MJM et al (2006) Computed tomography analysis of acetabular anteversion and abduction. Skeletal Radiol 35:385–389. https://doi.org/10.1007/s00256-006-0086-4
Tannast M, Hanke MS, Zheng G et al (2015) What are the radiographic reference values for acetabular under- and overcoverage? Clin Orthop Relat Res. https://doi.org/10.1007/s11999-014-4038-3
Nault M, Allard P, Le Blanc R et al (2002) Relations between standing stability and body posture parameters in adolescent idiopathic scoliosis. Spine 27:1911–1917. https://doi.org/10.1097/01.BRS.0000025720.91214.DB
Schmitz MR, Bittersohl B, Zaps D et al (2013) Spectrum of radiographic femoroacetabular impingement morphology in adolescents and young adults: an EOS-based double-cohort study. J Bone Joint Surg Am 95:e90. https://doi.org/10.2106/JBJS.L.01030
Segreto FA, Vasquez-Montes D, Brown AE et al (2018) Incidence, trends, and associated risks of developmental hip dysplasia in patients with Early Onset and Adolescent Idiopathic Scoliosis. J Orthop 15:874–877. https://doi.org/10.1016/j.jor.2018.08.015
Henebry A, Gaskill T (2013) The effect of pelvic tilt on radiographic markers of acetabular coverage. Am J Sports Med 41:2599–2603. https://doi.org/10.1177/0363546513500632
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. https://doi.org/10.2106/JBJS.O.00276
This research was funded by the University of Saint-Joseph (grant FM300). The funding source did not intervene in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
This study was funded by the University of Saint-Joseph (Grant No. FM300).
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Karam, M., Bizdikian, A.J., Khalil, N. et al. Alterations of 3D acetabular and lower limb parameters in adolescent idiopathic scoliosis. Eur Spine J 29, 2010–2017 (2020). https://doi.org/10.1007/s00586-020-06397-5
- Adolescent idiopathic scoliosis
- Lower limbs
- 3D reconstructions