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Wide anatomical variability of PI normative values within an asymptomatic population: a systematic review

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Abstract

Purpose

Studies on sagittal alignment parameters have solely focused on patients with preexisting spinal deformity. Limited data in the literature have analyzed pelvic incidence (PI) values in an asymptomatic patient population. The purpose of this study was to: (1) systematically review the literature to analyze normative PI values in asymptomatic patients; and (2) provide a more definitive geometric measurement guide for determining surgical interventions.

Methods

A systematic review of retrospective studies was performed by searching PubMed to identify studies that analyzed PI measurements in asymptomatic subjects. The following search phrases were used: (pelvic incidence, pelvic tilt, sacral slope, sagittal alignment, radiograph, asymptomatic, normative values, and adults) using Boolean operators AND, OR and NOT. Patients with pathology involving the osseous pelvic anatomy (including fracture, infection, tumor, previous surgery, and lumbosacral fusion) that would prevent measurement of the selected parameters were not included. Pelvic incidence (PI) values were analyzed.

Results

A total of 29 studies met inclusion criteria, including 3629 asymptomatic subjects who underwent standing lateral radiographs (mean age, 41.1 years; range, 24–69 years) for the purposes of analyzing pelvic incidence values. Overall, the mean PI value was 50.0° (range, 24–69) which is consistent with reported values in the literature.

Conclusion

Wide anatomical variability and broad clinical interpretation of PI normative values do little to guide surgical planning for successful outcomes. However, this systematic review has presented PI-stratified normative values in a large sample of asymptomatic subjects which can serve as a grounded geometric reference for spine surgeons when considering surgical intervention approaches.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. The Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA

    Kari Odland, Sharon Yson & David W. Polly Jr.

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  1. Kari Odland
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  2. Sharon Yson
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  3. David W. Polly Jr.
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Contributions

SY and DP contributed to study conception and design. Material preparation, data collection, and analysis were performed by KO & SY. DP & KO commented on previous versions of the manuscript and read and approved the final manuscript. KO: Made substantial contributions to the design of the work, and the acquisition, analysis, and interpretation of data. Drafted the work and revised it critically for important intellectual content. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SY: Made substantial contributions to the conception of the work, and analysis and interpretation of data. Drafted initial work. Approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DWPJr.: Made substantial contributions to the conception of the work and reviewed the work critically for important intellectual content. Approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Kari Odland.

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Conflict of interest

KO, SY, and DP declare no financial conflicts. SY declares grant/research support from SI-BONE, Inc.

Ethical approval/review

Research protocol for this project which relied on de-identified data, did not require University of Minnesota Institutional Review Board approval.

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Odland, K., Yson, S. & Polly Jr., D.W. Wide anatomical variability of PI normative values within an asymptomatic population: a systematic review. Spine Deform 11, 559–566 (2023). https://doi.org/10.1007/s43390-023-00649-2

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  • DOI: https://doi.org/10.1007/s43390-023-00649-2

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