A normal sagittal vertical axis (SVA) after spinal deformity correction can yield mechanical complications of up to 30%. Post-operative compensatory pelvic orientation can produce a normal SVA. We assess relative pelvic version (RPV), an individualised measure, for persistent post-operative compensatory measures.
Adult spinal deformity (ASD) patients who were treated operatively, with a normal SVA (< ± 50 mm) at 6-week follow-up were included, who were then followed-up after 2 years. These only included patients with fusion of > 4 vertebrae extending to L5 or below. Six-week subgroups were made regarding pelvis orientation, relative pelvic version (RPV: anteversion, aligned, moderate or severe retroversion) with analysis of patient-related outcome measures (PROMs), complications and spino-pelvic sagittal parameters.
At 6 weeks, 140 patients met the inclusion criteria, 5 (3.6%) patients had anteversion, 59 (42.1%) were aligned, 60 (42.9%) had moderate retroversion and 16 (11.4%) patients had severe retroversion. Follow-up after 2 years demonstrated increased RPV in all groups except the severe RPV group who were more likely to develop SVA > 50 mm. Complications occurred in all groups. Significant 2-year differences were observed between moderate and severe RPV for back pain and PROMs but not between other RPV groups.
Adult spinal deformity patients with a normal SVA after spino-pelvic instrumentation carry a significant risk of retroversion progression post-operatively, followed by increased positive sagittal balance. Relative pelvic version (RPV) measurements when categorised into anteversion, aligned, moderate retroversion and severe retroversion at 6 weeks were predictive of PROMs at 2 years.
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Depuy-Synthes funds were received by European Spine Study Group in support of this work. Relevant financial activities outside the submitted work: consultancy, royalties, grants. Funding was provided by Spineart, K2M, Medtronic, Zimmer Biomet, Alphatec Spine, Clariance.
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Cawley, D.T., Boissiere, L., Yilgor, C. et al. Relative pelvic version displays persistent compensatory measures with normalised sagittal vertical axis after deformity correction. Spine Deform (2021). https://doi.org/10.1007/s43390-021-00345-z
- Adult spinal deformity
- Relative pelvic version
- Sacral slope
- Pelvic tilt
- Sagittal vertical axis
- Lumbar lordosis