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Relationship Between Lumbar Lordosis and Pelvic Incidence in the Adolescent Patient: Normal Cohort Analysis and Literature Comparison

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Abstract

Study Design

Retrospective review; literature comparison.

Objectives

To review the literature on the relationship between lumbar lordosis (LL) and pelvic incidence (PI) and evaluate this relationship in asymptomatic adolescents while testing the validity of previously reported adult correlation models between LL and PI in an adolescent population.

Summary of Background Data

Accurate understanding of the normal spinopelvic relationship is critical when considering surgical fusion of the lumbar spine. Many studies have reported relationships between pelvic measurements and LL in adult populations, but data in pediatric populations is lacking.

Methods

A literature search was performed to identify previously reported relationships between pelvic parameters and LL in adults and pediatric patients. A cohort of 125 asymptomatic adolescent patients evaluated at our institution was evenly split into two cohorts for model development and validation. Linear regression between LL and PI was performed. The resultant regression model was tested in the validation cohort along with previously reported formulae with LL as a function of PI. Mean absolute error (MAE) was calculated and compared between prior models and the newly developed adolescent model using analysis of variance and post-hoc testing.

Results

In our adolescent cohort (mean age: 13 ± 2), there was a strong correlation between PI and LL (r = 0.53). Regression analysis in the development cohort produced the following predictive model: LL = 0.66(PI) + 24.2. Testing in the validation cohort revealed a good correlation between predicted and actual LL (r = 0.51) and an MAE of 8.3. All but three previously reported models functioned with similar accuracy in the adolescent population, with only two methods having an MAE over 10.

Conclusions

The majority of previously published formulae for predicting LL as a function of PI developed in adults can be extrapolated to adolescent populations. These relationships are important in understanding how to surgically restore the sagittal alignment in adolescents with spinal deformity.

Level of Evidence

Level IV.

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Author information

Authors and Affiliations

  1. University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA

    T. Barrett Sullivan MD & Peter O. Newton MD

  2. Rady Children’s Hospital, San Diego, 3020 Children’s Way, MC 5260, San Diego, CA, 92123, USA

    Nikolas Marino BA, Fredrick G. Reighard MPH & Peter O. Newton MD

Authors
  1. T. Barrett Sullivan MD
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  2. Nikolas Marino BA
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  3. Fredrick G. Reighard MPH
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  4. Peter O. Newton MD
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Corresponding author

Correspondence to Peter O. Newton MD.

Additional information

This study was conducted at Rady Children’s Hospital, San Diego, CA.

Author disclosures: TBS (none), NM (none), FGR (none), PON (grants and other from the Setting Scoliosis Straight Foundation, other from Rady Children’s Specialists, grants and personal fees from DePuy Synthes Spine, personal fees from Law firm of Carroll, Kelly, Trotter, Franzen & McKenna, personal fees from Law firm of Smith, Haughey, Rice & Roegge, grants from NIH, grants from OREF, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, other from NuVasive, personal fees from Ethicon Endosurgery, other from Electrocore, personal fees from Cubist, other from International Orthopedic Think Tank, other from Orthopediatrics Institutional Support, personal fees from K2M, outside of the submitted work; in addition, a patent “Anchoring systems and methods for correcting spinal deformities” (8540754) with royalties paid to DePuy Synthes Spine, a patent “Low profile spinal tethering systems” (8123749) issued to DePuy Spine, Inc., a patent “Screw placement guide” (7981117) issued to DePuy Spine, Inc., and a patent “Compressor for use in minimally invasive surgery” (7189244) issued to DePuy Spine, Inc.).

Research support is gratefully acknowledged from the Rady Children’s Foundation Assaraf Family Research Fund and a Surgical Department grant from Rady Children’s Specialists of San Diego.

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Sullivan, T.B., Marino, N., Reighard, F.G. et al. Relationship Between Lumbar Lordosis and Pelvic Incidence in the Adolescent Patient: Normal Cohort Analysis and Literature Comparison. Spine Deform 6, 529–536 (2018). https://doi.org/10.1016/j.jspd.2018.02.002

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  • DOI: https://doi.org/10.1016/j.jspd.2018.02.002

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