A new sagittal parameter to estimate pelvic tilt using the iliac cortical density line and iliac tilt: a retrospective X-ray measurement study

Journal of Orthopaedic Surgery and Research

Yukihide Iwamoto¹  Seiji Okada¹  Mitsumasa Hayashida¹  Yoshihiro Matsumoto¹  Katsumi Harimaya¹  Kiyoshi Tarukado²  Osamu Tono²  Toshio Doi² 

[1] Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka 812-8582, Higashi-ku, Japan;Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumi, Beppu 874-0838, Oita, Japan

关键词: Sagittal alignment;    Pelvis;    Iliac bone;    Kyphosis;   

Others  :  1226935
DOI  :  10.1186/s13018-015-0262-0

 received in 2015-03-04, accepted in 2015-07-12,  发布年份 2015

【 摘 要 】

Background

When spinal kyphosis increases, the compensatory mechanism activates and the pelvic position changes. Increasing the pelvic tilt, which is the orientation of the pelvis with respect to the femoral head, is known to associate with the clinical symptoms in kyphosis in the aging population. It is often difficult to detect the femoral head on radiographs, limiting the ability to determine the pelvic tilt. Therefore, there is a need to establish another parameter independent of the femoral head which closely correlates with the pelvic tilt.

Methods

Eighty-two adult patients with full-length lateral standing spine radiographs were recruited (mean age: 73.0 years). A new parameter, the iliac cortical density line (a component of the arcuate line of the ilium) and the iliac tilt (defined as the angle between the iliac cortical density line and the vertical), was analyzed to determine the correlation with the pelvic tilt.

Results

Both the pelvic tilt (PT) and iliac tilt (IT) could be identified in 67 patients, and a significant correlation was observed between the PT and IT (r = 0.86, P < 0.0001). The PT could be estimated using the following formula: PT = IT − 12.9 (in females), PT = IT − 16.7 (in males).

Conclusions

The iliac tilt, which can be easily and directly measured using the iliac cortical density line, is a new parameter that can reliably estimate the pelvic tilt even when the femoral head is not detectable on the radiograph.

【 授权许可】

   
2015 Doi et al.

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【 参考文献 】

• [1]Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupère G, Pélissier J. Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J. 2006; 15(4):415-22.
• [2]Duval-Beaupère G, Schmidt C, Cosson P. A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng. 1992; 20(4):451-62.
• [3]Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998; 7(2):99-103.
• [4]Schwab F, Lafage V, Patel A, Farcy JP. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976). 2009; 34(17):1828-33.
• [5]Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976). 2009; 34(17):E599-606.
• [6]Blondel B, Schwab F, Patel A, Demakakos J, Moal B, Farcy JP, Lafage V. Sacro-femoral-pubic angle: a coronal parameter to estimate pelvic tilt. Eur Spine J. 2012; 21(4):719-24.
• [7]Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005; 30(18):2024-9.
• [8]Kawakami M, Tamaki T, Ando M, Yamada H, Hashizume H, Yoshida M. Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976). 2002; 27(1):59-64.
• [9]Lazennec JY, Ramaré S, Arafati N, Laudet CG, Gorin M, Roger B, Hansen S, Saillant G, Maurs L, Trabelsi R. Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J. 2000; 9(1):47-55.
• [10]Ross LM, Lamperti ED, Schuenke M, Schulte E, Schumacher U. Atlas of anatomy. In: General Anatomy and Musculoskeletal System. edn. Edited by Lawrence MR, Edward DL. Stuttgart, Germany: Thieme; 2006:116