Failure of Pelvic Compensation in Patients with Severe Positive Sagittal Imbalance

Ho Joong Kim; Feng Shen; Kyoung Tak Kang; Heoung Jae Chun; Sung Taeck Kim; Bong Soon Chang; Choon Ki Lee; Jin S. Yeom

doi:10.1097/BRS.0000000000002985

Failure of Pelvic Compensation in Patients with Severe Positive Sagittal Imbalance

Ho Joong Kim, Feng Shen, Kyoung Tak Kang, Heoung Jae Chun, Sung Taeck Kim, Bong Soon Chang, Choon Ki Lee, Jin S. Yeom

Department of Mechanical Engineering

Research output: Contribution to journal › Article › peer-review

13 Citations (Scopus)

Abstract

Objective. To compare spinopelvic parameters using static radiographs with the values obtained using motion analysis during gait between adult spinal deformity (ASD) or lumbar spinal stenosis (LSS). Summary of Background Data. It is still unclear whether measurement of radiological parameters using static radiographs can reflect natural sagittal balance during gait in the patients with severe positive sagittal imbalance. Methods. In this age- and sex-matched case control study, a total of 40 patients, each 20 subjects with either ASD or LSS who were scheduled to undergo surgery were included. Both clinical outcomes and sagittal spinopelvic parameters, including sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI) were measured. In motion analysis during walking, the angle of anterior pelvic tilt and the angles of the pelvis, hip, and knee were estimated. The correlation between variables was analyzed. Results. On standing lateral x-rays, SVA, PT, and PI - LL were significantly higher in the ASD group while SS and LL were significantly lower in the ASD group. However, on motion analysis, the average mean anterior pelvic tilt_SD values in the ASD group were 8.3_10.7 and 8.5_10.7 on the right and left, respectively, and were not different from matched values in the LSS group. A Bland-Altman plot demonstrated a good agreement between the SS in the x-ray and anterior pelvic tilt in the motion analysis. In the ASD group, SS and SVA showed a significant positive correlation with mean anterior pelvic tilt in motion analysis during gait. Conclusion. The present study showed that the failure of pelvic compensation would likely occur in patients with severe positive sagittal imbalance during walking.

Original language	English
Pages (from-to)	E759-E765
Journal	Spine
Volume	44
Issue number	13
DOIs	https://doi.org/10.1097/BRS.0000000000002985
Publication status	Published - 2019 Jul 1

Bibliographical note

Funding Information:
From the *Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Republic of Korea; †Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea; and zDepartment of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea. Acknowledgment date: October 25, 2018. First revision date: December 12, 2018. Acceptance date: December 28, 2018. The manuscript submitted does not contain information about medical device(s)/drug(s). Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2016R1A2B3012850) and the SNUBH Research Fund (grant no 14-2018-005) funds were received in support of this work. No relevant financial activities outside the submitted work. Address correspondence and reprint requests to Jin S. Yeom, MD, Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea; E-mail: highcervi-cal@gmail.com

Publisher Copyright:
© 2019 Lippincott Williams and Wilkins. All rights reserved.

All Science Journal Classification (ASJC) codes

Orthopedics and Sports Medicine
Clinical Neurology

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10.1097/BRS.0000000000002985

Cite this

@article{72bf3cd6d11b4a3fa69c69d9686b3803,

title = "Failure of Pelvic Compensation in Patients with Severe Positive Sagittal Imbalance",

abstract = "Objective. To compare spinopelvic parameters using static radiographs with the values obtained using motion analysis during gait between adult spinal deformity (ASD) or lumbar spinal stenosis (LSS). Summary of Background Data. It is still unclear whether measurement of radiological parameters using static radiographs can reflect natural sagittal balance during gait in the patients with severe positive sagittal imbalance. Methods. In this age- and sex-matched case control study, a total of 40 patients, each 20 subjects with either ASD or LSS who were scheduled to undergo surgery were included. Both clinical outcomes and sagittal spinopelvic parameters, including sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI) were measured. In motion analysis during walking, the angle of anterior pelvic tilt and the angles of the pelvis, hip, and knee were estimated. The correlation between variables was analyzed. Results. On standing lateral x-rays, SVA, PT, and PI - LL were significantly higher in the ASD group while SS and LL were significantly lower in the ASD group. However, on motion analysis, the average mean anterior pelvic tilt_SD values in the ASD group were 8.3_10.7 and 8.5_10.7 on the right and left, respectively, and were not different from matched values in the LSS group. A Bland-Altman plot demonstrated a good agreement between the SS in the x-ray and anterior pelvic tilt in the motion analysis. In the ASD group, SS and SVA showed a significant positive correlation with mean anterior pelvic tilt in motion analysis during gait. Conclusion. The present study showed that the failure of pelvic compensation would likely occur in patients with severe positive sagittal imbalance during walking.",

author = "Kim, {Ho Joong} and Feng Shen and Kang, {Kyoung Tak} and Chun, {Heoung Jae} and Kim, {Sung Taeck} and Chang, {Bong Soon} and Lee, {Choon Ki} and Yeom, {Jin S.}",

note = "Funding Information: From the *Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Republic of Korea; †Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea; and zDepartment of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea. Acknowledgment date: October 25, 2018. First revision date: December 12, 2018. Acceptance date: December 28, 2018. The manuscript submitted does not contain information about medical device(s)/drug(s). Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2016R1A2B3012850) and the SNUBH Research Fund (grant no 14-2018-005) funds were received in support of this work. No relevant financial activities outside the submitted work. Address correspondence and reprint requests to Jin S. Yeom, MD, Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea; E-mail: highcervi-cal@gmail.com Publisher Copyright: {\textcopyright} 2019 Lippincott Williams and Wilkins. All rights reserved.",

year = "2019",

month = jul,

day = "1",

doi = "10.1097/BRS.0000000000002985",

language = "English",

volume = "44",

pages = "E759--E765",

journal = "Spine",

issn = "0362-2436",

publisher = "Lippincott Williams and Wilkins",

number = "13",

}

TY - JOUR

T1 - Failure of Pelvic Compensation in Patients with Severe Positive Sagittal Imbalance

AU - Kim, Ho Joong

AU - Shen, Feng

AU - Kang, Kyoung Tak

AU - Chun, Heoung Jae

AU - Kim, Sung Taeck

AU - Chang, Bong Soon

AU - Lee, Choon Ki

AU - Yeom, Jin S.

N1 - Funding Information: From the *Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Republic of Korea; †Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea; and zDepartment of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea. Acknowledgment date: October 25, 2018. First revision date: December 12, 2018. Acceptance date: December 28, 2018. The manuscript submitted does not contain information about medical device(s)/drug(s). Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2016R1A2B3012850) and the SNUBH Research Fund (grant no 14-2018-005) funds were received in support of this work. No relevant financial activities outside the submitted work. Address correspondence and reprint requests to Jin S. Yeom, MD, Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea; E-mail: highcervi-cal@gmail.com Publisher Copyright: © 2019 Lippincott Williams and Wilkins. All rights reserved.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Objective. To compare spinopelvic parameters using static radiographs with the values obtained using motion analysis during gait between adult spinal deformity (ASD) or lumbar spinal stenosis (LSS). Summary of Background Data. It is still unclear whether measurement of radiological parameters using static radiographs can reflect natural sagittal balance during gait in the patients with severe positive sagittal imbalance. Methods. In this age- and sex-matched case control study, a total of 40 patients, each 20 subjects with either ASD or LSS who were scheduled to undergo surgery were included. Both clinical outcomes and sagittal spinopelvic parameters, including sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI) were measured. In motion analysis during walking, the angle of anterior pelvic tilt and the angles of the pelvis, hip, and knee were estimated. The correlation between variables was analyzed. Results. On standing lateral x-rays, SVA, PT, and PI - LL were significantly higher in the ASD group while SS and LL were significantly lower in the ASD group. However, on motion analysis, the average mean anterior pelvic tilt_SD values in the ASD group were 8.3_10.7 and 8.5_10.7 on the right and left, respectively, and were not different from matched values in the LSS group. A Bland-Altman plot demonstrated a good agreement between the SS in the x-ray and anterior pelvic tilt in the motion analysis. In the ASD group, SS and SVA showed a significant positive correlation with mean anterior pelvic tilt in motion analysis during gait. Conclusion. The present study showed that the failure of pelvic compensation would likely occur in patients with severe positive sagittal imbalance during walking.

AB - Objective. To compare spinopelvic parameters using static radiographs with the values obtained using motion analysis during gait between adult spinal deformity (ASD) or lumbar spinal stenosis (LSS). Summary of Background Data. It is still unclear whether measurement of radiological parameters using static radiographs can reflect natural sagittal balance during gait in the patients with severe positive sagittal imbalance. Methods. In this age- and sex-matched case control study, a total of 40 patients, each 20 subjects with either ASD or LSS who were scheduled to undergo surgery were included. Both clinical outcomes and sagittal spinopelvic parameters, including sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI) were measured. In motion analysis during walking, the angle of anterior pelvic tilt and the angles of the pelvis, hip, and knee were estimated. The correlation between variables was analyzed. Results. On standing lateral x-rays, SVA, PT, and PI - LL were significantly higher in the ASD group while SS and LL were significantly lower in the ASD group. However, on motion analysis, the average mean anterior pelvic tilt_SD values in the ASD group were 8.3_10.7 and 8.5_10.7 on the right and left, respectively, and were not different from matched values in the LSS group. A Bland-Altman plot demonstrated a good agreement between the SS in the x-ray and anterior pelvic tilt in the motion analysis. In the ASD group, SS and SVA showed a significant positive correlation with mean anterior pelvic tilt in motion analysis during gait. Conclusion. The present study showed that the failure of pelvic compensation would likely occur in patients with severe positive sagittal imbalance during walking.

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Failure of Pelvic Compensation in Patients with Severe Positive Sagittal Imbalance

Abstract

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