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Pelvic Incidence Changes Between Flexion and Extension

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Abstract

Study Design

Retrospective single-center.

Objectives

To investigate changes in pelvic incidence from flexion to extension. To assess interobserver error in the measurement of pelvic incidence.

Background

Pelvic incidence (PI) has been considered a static parameter since it was originally described. But recent studies have shown that PI can change with age and after spinal procedures. Changes in PI based on position have not been investigated.

Methods

Seventy-two patients who had obtained flexion and extension radiographs of the lumbar spine were identified using strict inclusion and exclusion criteria. PI along with pelvic tilt (PT), sacral slope (SS), and lumbar lordosis were measured in both flexion and extension by two independent measurers. Variations in all parameters and interobserver measurement reliability were analyzed for the entire group.

Results

PI changed significantly from flexion to extension with a general tendency to decrease: mean (–0.94°), p <.044. However, these changes might have had opposite vectors, and exceeded | 6°| (measurement error) in 20% of cases, with a maximum of 12°. Inconsistencies in changes of SS, as opposed to PT from flexion to extension, were found to be the major factor determining changes in PI (p >.001). Obesity significantly contributed to differences in PI between flexion and extension (p = .003).

Conclusions

PI is a dynamic parameter that changes between flexion and extension. Changes in SS are the main factor involved in these changes, implicating movement through the sacroiliac joints as the cause. Obese patients have greater changes in PI from flexion to extension.

Level of Evidence

Level II.

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Authors and Affiliations

  1. Department of Orthopedics, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave., Mail Stop B202, 80045, Aurora, CO, USA

    Nicholas Schroeder MD, Andriy Noschenko PhD, Evalina Burger MD, Vikas Patel MD, Christopher Cain MD, David Ou-Yang MD & Christopher Kleck MD

Authors
  1. Nicholas Schroeder MD
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  2. Andriy Noschenko PhD
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  3. Evalina Burger MD
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  4. Vikas Patel MD
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  5. Christopher Cain MD
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  6. David Ou-Yang MD
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  7. Christopher Kleck MD
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Corresponding author

Correspondence to Christopher Kleck MD.

Additional information

Author disclosures: NS (none), AN (none), EB (grants from OMeGA, Globus, Aesculap, SI Bone, VertiFlex, Medicrea, Medtronic, Orthofix, Integra LifeSciences Corporation, Pfizer, Spinal Kinetics, Synthes, Anschutz Foundation, and from Mainstay, outside the submitted work), VP (grants and personal fees from Aesculap and Medtronic; grants from Stryker, SI Bone, Musculoskeletal Transplant Foundation, and National Institutes of Health; personal fees from Biomet, Baxter; grants from Synthes, Orthofix, Orthopaedic Research and Education Foundation [OREF], and Anschutz Foundation, outside the submitted work), CC (grants from Medtronic Sofamor-Danek, Aesculap, SI Bone, VertiFlex, Medicrea, Orthofix, Integra Life Sciences Corporation, Pfizer, Spinal Kinetics, DePuy Synthes, Musculoskeletal Transplant Foundation, National Institutes of Health, and Medacta; personal fees from DePuy Synthes, DePuy Synthes, Globus Medical, and NuVasive, outside the submitted work), DOY (grants from Medtronic Sofamor-Danek, Aesculap, SI Bone, VertiFlex, Medicrea, Orthofix, Integra Life Sciences Corporation, Pfizer, Spinal Kinetics, DePuy Synthes, Musculoskeletal Transplant Foundation, National Institutes of Health, and Medacta, outside the submitted work), CK (grants from Medtronic Sofamor-Danek, Aesculap, SI Bone, VertiFlex, Medicrea, Orthofix, Integra Life Sciences Corporation, Pfizer, Spinal Kinetics, DePuy Synthes, Musculoskeletal Transplant Foundation, and National Institutes of Health; other from Medacta; grants from Fellowship Funding, outside the submitted work).

Institutional review board approval was obtained from the Colorado Multiple Institutional Review Board, protocol number 16-2150.

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Schroeder, N., Noschenko, A., Burger, E. et al. Pelvic Incidence Changes Between Flexion and Extension. Spine Deform 6, 753–761 (2018). https://doi.org/10.1016/j.jspd.2018.03.008

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  • DOI: https://doi.org/10.1016/j.jspd.2018.03.008

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