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Sacro-femoral-pubic angle: a coronal parameter to estimate pelvic tilt

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Abstract

Introduction

Pelvic tilt is an established measure of position which has been tied to sagittal plane spinal deformity. Increased tilt is noted in the setting of the aging spine and sagittal malalignment syndromes such as flatback (compensatory mechanism). However, the femoral heads are often poorly visualized on sagittal films of scoliosis series in adults, limiting the ability to determine pelvic incidence and tilt. There is a need to establish a coronal plane (better visualization) pelvic parameter which correlates closely with pelvic tilt.

Methods

This is a retrospective review of 71 adult patients (47 females and 24 males) with full-length standing spine radiographs. Visualization of all spinal and pelvic landmarks was available coronally and sagittally (including pelvis and acetabuli). Pelvic tilt was calculated through validated digital analysis software (SpineView®). A new parameter, the sacro-femoral-pubic angle (midpoint of S1 endplate to centroid of acetabuli to superior border of the pubic symphysis) was analyzed for correlation (and predictive ability) with sagittal pelvic tilt.

Results

The sacro-femoral-pubic angle (SFP angle) was highly correlated to PT, and according to this analysis, pelvic tilt could be estimated by the formula: PT = 75 − (SFP angle). A Pearson’s correlation coefficient of 0.74 (p < 0.005) and predictive ability of 76% accuracy was obtained (±7.5°). The correlation and predictive ability was greater for males compared to females (male: r = 0.87 and predictive model = 93%; female: r = 0.67 and predictive model = 67%).

Conclusion

The pelvic tilt is an essential measure in the context of radiographic evaluation of spinal deformity and malalignment. Given the routinely excellent visibility of coronal films this study established the SFP as a coronal parameter which can reliably estimate pelvic tilt. The high correlation and predictive ability of the SFP angle should prompt further study and clinical application when lateral radiographs do not permit assessment of pelvic parameters.

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Authors and Affiliations

  1. Spine Division, Hospital for Joint Diseases, New York University, New York, USA

    Benjamin Blondel, Frank Schwab, Ashish Patel, Jason Demakakos, Bertrand Moal & Virginie Lafage

  2. SUNY Downstate Medical Center, Brooklyn, New York, USA

    Ashish Patel

  3. Maimonides Medical Center, Brooklyn, New York, USA

    Jean-Pierre Farcy

Authors
  1. Benjamin Blondel
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  2. Frank Schwab
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  3. Ashish Patel
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  4. Jason Demakakos
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  5. Bertrand Moal
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  6. Jean-Pierre Farcy
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  7. Virginie Lafage
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Corresponding author

Correspondence to Virginie Lafage.

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Blondel, B., Schwab, F., Patel, A. et al. Sacro-femoral-pubic angle: a coronal parameter to estimate pelvic tilt. Eur Spine J 21, 719–724 (2012). https://doi.org/10.1007/s00586-011-2061-6

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  • DOI: https://doi.org/10.1007/s00586-011-2061-6

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