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L1-pelvic angle: a convenient measurement to attain optimal deformity correction

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Abstract

Purpose

(1) Evaluate the associations between L1-pelvic angle (L1PA) and both sagittal vertical axis (SVA) and T1-pelvic angle (T1PA), and (2) assess the clinical impact of L1PA.

Methods

A single-institution retrospective cohort study was undertaken for patients undergoing adult spinal deformity (ASD) surgery from 2013 to 2017. Ideal L1PA was defined as (0.5xPelvic Incidence)-21. Pearson correlation was performed to compare L1PA, SVA, and T1PA. Univariate/multivariate regression was performed to assess the effect of L1PA on mechanical complications, controlling for age, BMI, and postoperative pelvic incidence-lumbar lordosis mismatch (PI/LL). Due to the overlapping nature of patients with pseudarthrosis and rod fracture, these patients were analyzed together.

Results

A total of 145 patients were included. Mean preoperative L1PA, SVA, and T1PA were 15.5 ± 8.9°, 90.7 ± 66.8 mm, and 27.1 ± 13.0°, respectively. Mean postoperative L1PA, SVA, and T1PA were 15.0 ± 8.9°, 66.7 ± 52.8 mm, and 22.3 ± 11.1°, respectively. Thirty-six (24.8%) patients achieved ideal L1PA. Though the correlation was modest, preoperative L1PA was linearly correlated with preoperative SVA (r2 = 0.16, r = 0.40, 95%CI = 0.22–0.60, p < 0.001) and T1PA (r2 = 0.41, r = 0.62, 95%CI = 0.46–0.76, p < 0.001). Postoperative L1PA was linearly correlated with postoperative SVA (r2 = 0.12, r = 0.37, 95%CI = 0.18–0.56, p < 0.001) and T1PA (r2 = 0.40, r = 0.62, 95%CI = 0.45–0.74, p < 0.001). Achieving ideal L1PA ± 5° was associated with a decreased risk of rod fracture/pseudarthrosis on univariate and multivariate regression (OR = 0.33, 95%CI = 0.12–0.86, p = 0.024). No association between achieving ideal L1PA and patient-reported outcomes was observed.

Conclusion

L1PA was modestly correlated with SVA and T1PA, and achieving ideal L1PA was associated with lower rates of rod fracture/pseudarthrosis. Future studies are warranted to better define the clinical implications of achieving a normal L1PA.

Level of evidence

III.

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Acknowledgements

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Funding

This study did not receive funding from any institution or grant.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA

    Hani Chanbour, Michael Longo, Steven G. Roth, Amir M. Abtahi, Scott L. Zuckerman & Byron F. Stephens

  2. Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    William Hunter Waddell, Justin Vickery, Matthew E. LaBarge, Andrew J. Croft, Amir M. Abtahi, Scott L. Zuckerman & Byron F. Stephens

  3. Department of Orthopedic Surgery, University of Texas, San Antonio, TX, USA

    Jeffrey M. Hills

Authors
  1. Hani Chanbour
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  2. William Hunter Waddell
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  3. Justin Vickery
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  4. Matthew E. LaBarge
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  5. Andrew J. Croft
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  6. Michael Longo
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  7. Steven G. Roth
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  11. Byron F. Stephens
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Corresponding author

Correspondence to Byron F. Stephens.

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Conflict of interest

Dr. Stephens is a consultant for Nuvasive and Carbofix and receives institutional research support from Nuvasive and Stryker Spine. Dr. Zuckerman reports being an unaffiliated neurotrauma consultant for the National Football League. Dr. Abtahi receives an institutional research support from Stryker Spine. No other perceived conflict of interest by any of the listed authors.

Ethical approval

This study was approved by the IRB committee at Vanderbilt University Medical Center (IRB#211290). We certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Chanbour, H., Waddell, W.H., Vickery, J. et al. L1-pelvic angle: a convenient measurement to attain optimal deformity correction. Eur Spine J 32, 4003–4011 (2023). https://doi.org/10.1007/s00586-023-07920-0

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  • DOI: https://doi.org/10.1007/s00586-023-07920-0

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