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Abstract
Study design
A literature review on the radiologic findings of pelvic parameters for treatment of spinal deformity
Objectives
This review examines sagittal spine alignment, pelvic parameters, and methods for assessing alignment, and examines the relationships among all of these parameters to understand spinal deformity.
Summary of Literature Review
Understanding the main pelvic and sagittal spinal parameters and recognizing their correlation is imperative in the diagnosis and treatment of various spinal disorders.
Results
As spinal and pelvic parameters tend to have a strong correlation, it is essential to measure not only spinal parameters but also pelvic parameters in analyzing sagittal balance. Degenerative changes have the potential to greatly disrupt the normal curvature of the spine, leading to sagittal malalignment. Analysis of sagittal balance is crucial to optimizing the management of spinal diseases. Improvement in surgical outcomes may be achieved through better understanding of radiographic spinopelvic parameters and their association with deformity.
Conclusions
Understanding spinal and pelvic parameters raises awareness of the relationship among alignment and balance, the soft tissue envelope, and compensatory mechanisms, which will, in turn, provide a more comprehensive understanding of the nature of spinal deformity and the modalities with which it is treated.
REFERENCES
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Fig. 1.
Method of measurement of pelvic parameters on radiography. Three pelvic parameters on a lateral radiograph. The sacral slope is the angle between the horizontal line and the cranial sacral endplate tan-gent. The pelvic tilt is the angle between the vertical line and the line joining the middle of the sacral plate and the center of the bicoxofemoral axis (the line between the geometric center of both femoral heads). The pelvic incidence is the angle between the line perpendicular to the middle of the cranial sacral end plate and the line joining the middle of the cranial sacral end plate to the center of the bicoxofemoral axis. Adapted from Raphael. The Journal of Bone & Joint Surgery. 2005;87-A:260-67.
Fig. 2.
Method of measurement of spinal parameters on radiography. Pelvic parameters on a lateral radiograph. The lumbar lordosis is the angle between the cranial end plate of L1 and the caudal end plate of L5. The thoracic kyphosis is the angle between the cranial end plate of T4 and the caudal end plate of T12. The T9 sagittal offset is the angle between the vertical plumb line and the line between the center of the vertebral body of T9 and the center of the bicoxofemoral axis. Adapted from Raphael. The Jounal of Bone & Joint Surgery. 2005;87-A:260-67.
Fig. 3.
The spinopelvic accordion. A normal pelvic incidence typically involves lumbar lordosis and thoracic kyphosis with normal values. A flat pelvis (small pelvic incidence) with small spinal curvatures is like a compressed accordion. A thick pelvis (great pelvic incidence) with large spinal curvatures is similar to a stretched accordion. Adapted from Morvan; European Spine Journal. 2011;20(5):602-8.
Fig. 4.
Types of sagittal disturbances and their evolution. Lack of lordosis with a sacral slope value too low for the value of the pelvic incidence (A). Excessive sacral slope value reflecting a forward pelvic rotation (B). Lordosis insufficient to compensate for excessive kyphosis, with backwards pelvic rotation and a low sacral slope value (C). Adapted from Legaye; Biomechanics in applications. ISBN. 2011:978-53.
Table 1.
Values of the parameters: differences according to gender (∗ p<0.05 ∗∗ p<0.01 ∗∗∗ p<0.001)
| Duval - Beaupere (1998) | Guigui (2003) | |||||
|---|---|---|---|---|---|---|
| Women | Men | Sign. | Women | Men | Sign. | |
| Pelvic incidence | 49 | 58 | ∗∗ | 57 | 54 | ∗ |
| Sacral slope | 39 | 45 | ∗∗ | 44 | 41 | ∗∗ |
| Lordosis | 57 | 65 | ∗∗ | 63 | 59 | ∗∗∗ |
| Kyphosis | 45 | 46 | ns | 39 | 42 | ns |
Table 2.
Reported angular values expressed of the parameters and spearman's coefficients “r” for the significant relation between parameters
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