Radiographic Spinopelvic Parameters in Skeletally Mature Patients With Scheuermann Disease

Study Design. Retrospective radiographical analysis of sagittal spinopelvic parameters in skeletally mature patients with Scheuermann disease (SD). Objective. To analyze anatomical and positional parameters of spinopelvic sagittal alignment in mature patients with SD. Summary of Background Data. Sagittal spinopelvic alignment has already been characterized in normal subjects and deviations in sagittal parameters have been reported for various spinal pathologies. No study has investigated spinopelvic parameters in SD. Methods. Standing posteroanterior and lateral radiographs of the skeletally mature patients with SD were analyzed. Immature patients and those with other spinal pathologies were excluded from the study. Pelvic positional and anatomic parameters and spinal parameters were measured. Pelvic incidence (PI) was compared with the values reported for healthy individuals. Correlations between the measured parameters were analyzed. Results. Forty patients met the inclusion criteria. Sixteen females and 24 males (mean age, 25 yr) were analyzed. The mean PI in this group was 40° and was significantly lower than that reported for healthy adults and adolescents (P < 0.0001) and not significantly different than the values reported for healthy children (P = 0.44). Patients with atypical (thoracolumbar) SD had lower PI than those with typical (thoracic) form (41°vs. 38°; P = 0.09). There was no correlation between PI and LL, thoracic kyphosis, or thoracolumbar kyphosis. Conclusion. This study demonstrated that skeletally mature patients with SD have significantly lower PI than healthy adults. There was no correlation between PI and LL in individuals with SD. This challenges the role of PI in predicting the proper values of LL in this group of patients. Further studies are needed to investigate whether impaired spinopelvic alignment is a cause or a result of SD. Level of Evidence: 3

[1]  C. Tardieu,et al.  How is sagittal balance acquired during bipedal gait acquisition? Comparison of neonatal and adult pelves in three dimensions. Evolutionary implications. , 2013, Journal of human evolution.

[2]  Zhongqiang Chen,et al.  Analysis of Spinopelvic Sagittal Alignment in Patients With Thoracic and Thoracolumbar Angular Kyphosis , 2013, Spine.

[3]  S. Kim,et al.  Difference of Sagittal Spinopelvic Alignments between Degenerative Spondylolisthesis and Isthmic Spondylolisthesis , 2013, Journal of Korean Neurosurgical Society.

[4]  Boštjan Likar,et al.  A review of methods for evaluating the quantitative parameters of sagittal pelvic alignment. , 2012, The spine journal : official journal of the North American Spine Society.

[5]  K. Wood,et al.  Adult Scheuermann Kyphosis: Evaluation, Management, and New Developments , 2012, The Journal of the American Academy of Orthopaedic Surgeons.

[6]  J. Mac-Thiong,et al.  Pediatric sagittal alignment , 2011, European Spine Journal.

[7]  F. Schwab,et al.  Spino-Pelvic Parameters After Surgery Can be Predicted: A Preliminary Formula and Validation of Standing Alignment , 2011, Spine.

[8]  Eric Berthonnaud,et al.  Sagittal Parameters of Global Spinal Balance: Normative Values From a Prospective Cohort of Seven Hundred Nine Caucasian Asymptomatic Adults , 2010, Spine.

[9]  Wafa Skalli,et al.  Differences in Male and Female Spino-Pelvic Alignment in Asymptomatic Young Adults: A Three-Dimensional Analysis Using Upright Low-Dose Digital Biplanar X-rays , 2009, Spine.

[10]  J. Buchowski,et al.  Role of Pelvic Incidence, Thoracic Kyphosis, and Patient Factors on Sagittal Plane Correction Following Pedicle Subtraction Osteotomy , 2009, Spine.

[11]  J. Legaye,et al.  Influence of the sagittal anatomy of the pelvis on the intercrestal line position , 2008, European journal of anaesthesiology.

[12]  T. Lowe,et al.  Evidence Based Medicine: Analysis of Scheuermann Kyphosis , 2007, Spine.

[13]  P. Roussouly,et al.  Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases , 2007, European Spine Journal.

[14]  A. van Ooij,et al.  Predictable Correction of the Unfused Lumbar Lordosis After Thoracic Correction and Fusion in Scheuermann Kyphosis , 2006, Spine.

[15]  C. Schmidt,et al.  A barycentremetric study of the sagittal shape of spine and pelvis: The conditions required for an economic standing position , 2006, Annals of Biomedical Engineering.

[16]  J. Pélissier,et al.  Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis , 2006, European Spine Journal.

[17]  H. Labelle,et al.  The Importance of Spino-Pelvic Balance in L5–S1 Developmental Spondylolisthesis: A Review of Pertinent Radiologic Measurements , 2005, Spine.

[18]  Courtney W. Brown,et al.  Is There an Optimal Patient Stance for Obtaining a Lateral 36” Radiograph?: A Critical Comparison of Three Techniques , 2005, Spine.

[19]  Wafa Skalli,et al.  Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. , 2005, The Journal of bone and joint surgery. American volume.

[20]  Paolo Mangione,et al.  Study of the course of the incidence angle during growth , 2005, European Spine Journal.

[21]  P. Newton,et al.  Evaluation of a Functional Position for Lateral Radiograph Acquisition in Adolescent Idiopathic Scoliosis , 2004, Spine.

[22]  Hubert Labelle,et al.  Spondylolisthesis, Pelvic Incidence, and Spinopelvic Balance: A Correlation Study , 2004, Spine.

[23]  Hubert Labelle,et al.  Sagittal Alignment of the Spine and Pelvis During Growth , 2004, Spine.

[24]  Hubert Labelle,et al.  Sagittal Plane Analysis of the Spine and Pelvis in Adolescent Idiopathic Scoliosis According to the Coronal Curve Type , 2003, Spine.

[25]  L. Lenke,et al.  Correlation of Pelvic Incidence With Low- and High-Grade Isthmic Spondylolisthesis , 2002, Spine.

[26]  W. Skalli,et al.  The Association of Sagittal Spinal and Pelvic Parameters in Asymptomatic Persons and Patients with Isthmic Spondylolisthesis , 2002, Journal of spinal disorders & techniques.

[27]  E. Berthonnaud,et al.  Sagittal morphology and equilibrium of pelvis and spine , 2002, European Spine Journal.

[28]  B. Boisaubert,et al.  The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients , 2002, European Spine Journal.

[29]  F Lavaste,et al.  Computer-assisted assessment of spinal sagittal plane radiographs. , 2001, Journal of spinal disorders.

[30]  L. Lenke,et al.  The Effect of Variation in Arm Position on Sagittal Spinal Alignment , 2000, Spine.

[31]  J. Hecquet,et al.  Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves , 1998, European Spine Journal.

[32]  J. Risser,et al.  The Classic: The Iliac Apophysis: An Invaluable Sign in the Management of Scoliosis , 2009, Clinical orthopaedics.