Natural history of spinopelvic alignment differs from symptomatic deformity of the spine

Sergio Mendoza-Lattes; Zachary Ries; Yubo Gao; Stuart L Weinstein

doi:10.1097/BRS.0b013e3181d35ca9

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Natural history of spinopelvic alignment differs from symptomatic deformity of the spine

Journal article

Peer reviewed

Natural history of spinopelvic alignment differs from symptomatic deformity of the spine

Sergio Mendoza-Lattes, Zachary Ries, Yubo Gao and Stuart L Weinstein

Spine (Philadelphia, Pa. 1976), Vol.35(16), pp.E792-E798

07/15/2010

DOI: 10.1097/BRS.0b013e3181d35ca9

PMID: 20581754

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Abstract

Cross-sectional study and systematic review of the literature. Describe the natural history of spinopelvic alignment parameters and their behavior in patients with degenerative spinal deformity. Normal stance and gait requires congruence between the spine-sacrum and pelvis-lower extremities. This is determined by the pelvic incidence (PI), and 2 positional parameters, the pelvic tilt, and sacral slope (SS). The PI also affects lumbar lordosis (LL), a positional parameter. The final goal is to position the body's axis of gravity to minimize muscle activity and energy consumption. Two study cohorts were recruited: 32 healthy teenagers (Risser IV-V) and 54 adult patients with symptomatic spinal deformity. Standing radiographs were used to measure spinopelvic alignment and positional parameters (SS, PI, sacral-femoral distance [SFD], C7-plumbline [C7P], LL, and thoracic kyphosis). Data from comparable groups of asymptomatic individuals were obtained from the literature. PI increases linearly with age (r2 = 0.8646) and is paralleled by increasing SFD (r2 = 0.8531) but not by SS. Patients with symptomatic deformity have higher SFD (42 +/- 13.6 mm vs. 63.6 +/- 21.6 mm; P < 0.001) and lower SS (42 degrees +/- 9.6 degrees vs. 30.7 degrees +/- 13.6 degrees; P < 0.001) but unchanged PI. The C7P also presents a linear increase throughout life (r2 = 0.8931), and is significantly increased in patients with symptomatic deformity (40 +/- 37 mm vs. 70.3 +/- 59.5 mm; P < 0.001). First, Gradual increase in PI is described throughout the lifespan that is paralleled by an increase in SFD, and is not by an increase in the SS. This represents a morphologic change of the pelvis. Second, Patients with symptomatic deformity of the spine present an increased C7P, thoracic hypokyphosis, reduced LL, and signs of pelvic retroversion (decreased LL and SS; increased SFD).

Diagnosis, Differential

Cross-Sectional Studies

Humans

Spine - physiopathology

Male

Spinal Curvatures - physiopathology

Kyphosis - diagnosis

Pelvis - diagnostic imaging

Radiography

Spine - diagnostic imaging

Kyphosis - physiopathology

Pelvis - physiopathology

Spinal Curvatures - diagnosis

Adolescent

Adult

Female

Kyphosis - etiology

Postural Balance - physiology

Retrospective Studies

Pelvis - pathology

Spine - pathology

Lower Extremity - blood supply

Spinal Curvatures - etiology

Cohort Studies

Details

Title: Subtitle: Natural history of spinopelvic alignment differs from symptomatic deformity of the spine
Creators: Sergio Mendoza-Lattes - Department of Orthopaedic Surgery and Rehabilitation, The University of Iowa Hospitals & Clinics, Hawkins Drive, Iowa City, IA 52242, USA. Sergio-mendoza@uiowa.edu
Zachary Ries
Yubo Gao
Stuart L Weinstein
Resource Type: Journal article
Publication Details: Spine (Philadelphia, Pa. 1976), Vol.35(16), pp.E792-E798
DOI: 10.1097/BRS.0b013e3181d35ca9
PMID: 20581754
NLM abbreviation: Spine (Phila Pa 1976)
ISSN: 0362-2436
eISSN: 1528-1159
Publisher: Lippincott Williams & Wilkins; United States
Language: English
Date published: 07/15/2010
Academic Unit: Stead Family Department of Pediatrics; Orthopedics and Rehabilitation; Internal Medicine
Record Identifier: 9984040595902771

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