Skip to main content
SpringerLink
Log in

Is pelvic incidence a constant, as everyone knows? Changes of pelvic incidence in surgically corrected adult sagittal deformity

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Previous investigations have recognized the critical role of pelvic parameters in the setting of a fixed sagittal deformity. Pelvic incidence (PI) is a constant, as everyone knows. However, PI might change reciprocally because of increased shear force on the sacroiliac joint, following surgical correction of fixed lumbar lordosis (LL). The disparity in PI after surgery according to the surgical method, and its impact on final follow-up, has not been reported. This study was undertaken to analyze the disparity of PI before and after surgery, and to evaluate its impact on final sagittal alignment in surgically corrected lordosis when there is immediate postoperative normal alignment following correction of adult sagittal deformity.

Methods

A prospective study of 29 subjects with adult spinal deformity (average age: 67.9 years) was conducted. At final evaluation after a minimum 2-year follow-up, normal sagittal alignment was achieved following consecutive sagittal correction. Surgical changes were measured by serial, pelvic standing, lateral, and whole spine radiographs, spinopelvic parameters measured included PI, sacral slope (SS), pelvic tilt (PT), LL, thoracic kyphosis (TK), and sagittal alignment.

Results

The mean LL was 0.2° before surgery; −59.3° after surgery with pedicle subtraction osteotomy (PSO) (n = 20), anterior lumbar interbody fusion (ALIF) (n = 20, 33 segments), and posterior lumbar interbody fusion (PLIF) (n = 21, 36 segments); and −57.5° at last follow-up. The sagittal vertical axis was +14.8 cm before surgery, −0.7 cm after surgery, and 2.2 cm at last follow-up. The mean PI was 49.4° before surgery, and increased to 55.2° after surgery, 57.5° at 1-year follow-up, and 58.8° at last follow-up (P = 0.02). The mean disparity in PI preoperatively and at last follow-up was 11.4° without sacropelvic fixation (n = 18), and 5.9° with sacropelvic fixation (n = 11) (P = 0.002). Analysis revealed the disparity of PI to be significantly greater in non-sacropelvic fixation, and correlated with the follow-up period (R = 0.442, P = 0.016), but not with age, bone mineral density (BMD), number of fused segments, correction methods, corrected LL, or sagittal alignment.

Conclusions

PI increased in all patients with surgically corrected, adult sagittal deformity, following surgical correction of fixed LL. The disparity of PI after surgery was significantly higher in non-sacropelvic fixation, and showed a significant correlation with follow-up period without influence on sagittal alignment at last follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kumar MN, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G (2006) An analysis of sagittal spinal alignment following long adult lumbar instrumentation and fusion to L5 or S1: can we predict ideal lumbar lordosis? Spine 31:2343–2352

    Article  PubMed  Google Scholar 

  3. Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM (1999) Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine 24:1712–1720

    Article  CAS  PubMed  Google Scholar 

  4. Farcy JP, Schwab FJ (1997) Management of flatback and related kyphotic decompensation syndromes. Spine 22:2452–2457

    Article  CAS  PubMed  Google Scholar 

  5. Rothenfluh DA, Mueller DA, Rothenfluh E, Min K (2015) Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion. Eur Spine J 24:1251–1258

    Article  PubMed  Google Scholar 

  6. Farfan HF, Huberdeau RM, Dubow HI (1972) Lumbar intervertebral disc degeneration: the influence of geometrical features on the pattern of disc degeneration–a post mortem study. J Bone Joint Surg Am 54:492–510

    CAS  PubMed  Google Scholar 

  7. Bernhardt M, Bridwell KH (1989) Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine 14:717–721

    Article  CAS  PubMed  Google Scholar 

  8. Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine 19:1611–1618

    Article  CAS  PubMed  Google Scholar 

  9. Jang JS, Lee SH, Min JH, Han KM (2007) Lumbar degenerative kyphosis: radiologic analysis and classifications. Spine 32:2694–2699

    Article  PubMed  Google Scholar 

  10. Lee JH, Kim KT, Suk KS, Lee SH, Jeong BO, Kim JS, Eoh JH, Kim YJ (2010) Analysis of spinopelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine 35:E1386–E1391

    Article  PubMed  Google Scholar 

  11. Legaye J, Duval-Beaupere G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Lee CS, Chung SS, Park SJ, Kim DM, Shin SK (2014) Simple prediction method of lumbar lordosis for planning of lumbar corrective surgery: radiological analysis in a Korean population. Eur Spine J 23:192–197

    Article  PubMed  Google Scholar 

  13. Schwab F, Patel A, Ungar B, Farcy JP, Lafage V (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 35:2224–2231

    Article  PubMed  Google Scholar 

  14. Legaye J, Duval-Beaupere G (2005) Sagittal plane alignment of the spine and gravity: a radiological and clinical evaluation. Acta Orthop Belg 71:213–220

    PubMed  Google Scholar 

  15. Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34:E599–E606

    Article  PubMed  Google Scholar 

  16. Rose PS, Bridwell KH, Lenke LG, Cronen GA, Mulconrey DS, Buchowski JM, Kim YJ (2009) Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine 34:785–791

    Article  PubMed  Google Scholar 

  17. Schwab F, Lafage V, Patel A, Farcy JP (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine 34:1828–1833

    Article  PubMed  Google Scholar 

  18. Skalli W, Zeller RD, Miladi L, Bourcereau G, Savidan M, Lavaste F, Dubousset J (2006) Importance of pelvic compensation in posture and motion after posterior spinal fusion using CD instrumentation for idiopathic scoliosis. Spine 31:E359–E366

    Article  PubMed  Google Scholar 

  19. Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y (1988) Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine 13:1317–1326

    Article  CAS  PubMed  Google Scholar 

  20. Horton WC, Brown CW, Bridwell KH, Glassman SD, Suk SI, Cha CW (2005) Is there an optimal patient stance for obtaining a lateral 36″ radiograph? A critical comparison of three techniques. Spine 30:427–433

    Article  PubMed  Google Scholar 

  21. Berjano P, Langella F, Ismael MF, Damilano M, Scopetta S, Lamartina C (2014) Successful correction of sagittal imbalance can be calculated on the basis of pelvic incidence and age. Eur Spine J 23:587–596

    Article  PubMed  Google Scholar 

  22. Lafage V, Smith JS, Bess S, Schwab FJ, Ames CP, Klineberg E, Arlet V, Hostin R, Burton DC, Shaffrey CI (2012) Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity. Eur Spine J 21:698–704

    Article  PubMed  Google Scholar 

  23. Dreyfuss P, Dreyer SJ, Cole A, Mayo K (2004) Sacroiliac joint pain. J Am Acad Orthop Surg 12:255–265

    Article  PubMed  Google Scholar 

  24. Frymoyer JW, Howe J, Kuhlmann D (1978) The long-term effects of spinal fusion on the sacroiliac joints and ilium. Clin Orthop Relat Res 134:196–201

    Google Scholar 

  25. Ha KY, Lee JS, Kim KW (2008) Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion: a prospective cohort study over five-year follow-up. Spine 33:1192–1198

    Article  PubMed  Google Scholar 

  26. Ivanov AA, Kiapour A, Ebraheim NA, Goel V (2009) Lumbar fusion leads to increases in angular motion and stress across sacroiliac joint: a finite element study. Spine 34:E162–E169

    Article  PubMed  Google Scholar 

  27. Jean L (2014) Influence of age and sagittal balance of the spine on the value of the pelvic incidence. Eur Spine J 23:1394–1399

    Article  PubMed  Google Scholar 

  28. Yamada K, Aota Y, Higashi T, Ishida K, Nimura T, Saito T (2015) Accuracies in measuring spinopelvic parameters in full-spine lateral standing radiograph. Spine 40:E640–E646

    Article  PubMed  Google Scholar 

  29. Sturesson B, Selvik G, Uden A (1989) Movements of the sacroiliac joints. A Roentgen stereophotogrammetric analysis. Spine 14:162–165

    Article  CAS  PubMed  Google Scholar 

  30. Jacob HA, Kissling RO (1995) The mobility of the sacroiliac joints in healthy volunteers between 20 and 50 years of age. Clin Biomech 10:352–361

    Article  Google Scholar 

  31. Smidt GL, Wei SH, McQuade K, Barakatt E, Sun T, Stanford W (1997) Sacroiliac motion for extreme hip positions. A fresh cadaver study. Spine 22:2073–2082

    Article  CAS  PubMed  Google Scholar 

  32. Sturesson B, Uden A, Vleeming A (2000) A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine 25:364–368

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by a grant of AOSpine research fund, Korea.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea

    Jung-Hee Lee & Ho-Yeon Jeong

  2. Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea

    Ki-Ho Na

  3. Department of Orthopaedic Surgery, College of Medicine, Sanggye Paik Hospital, Inje University, 1342, Dongil-Ro, Nowon-Gu, Seoul, 139-707, Korea

    Jin-Hyok Kim & Dong-Gune Chang

Authors
  1. Jung-Hee Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ki-Ho Na
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jin-Hyok Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ho-Yeon Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dong-Gune Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dong-Gune Chang.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, JH., Na, KH., Kim, JH. et al. Is pelvic incidence a constant, as everyone knows? Changes of pelvic incidence in surgically corrected adult sagittal deformity. Eur Spine J 25, 3707–3714 (2016). https://doi.org/10.1007/s00586-015-4199-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-015-4199-0

Keywords

Search

Navigation