Analysis of an unexplored group of sagittal deformity patients: low pelvic tilt despite positive sagittal malalignment

Emmanuelle Ferrero, Shaleen Vira, Christopher P. Ames, Khaled Kebaish, Ibrahim Obeid, Michael F. O’Brien, Munish C. Gupta, Oheneba Boachie-Adjei, Justin S. Smith, Gregory M. Mundis, Vincent Challier, Themistocles S. Protopsaltis, Frank J. Schwab, Virginie Lafage, Spine Study Group International Spine Study Group

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Purpose: In adult spinal deformity (ASD), patients increase pelvic tilt (PT) to maintain standing alignment. Previously, ASD patients with low PT and high disability were described. This study investigates this unusual population in terms of demographic, radiographic, and clinical features after three-column osteotomy (3CO). Methods: In this multicenter retrospective study, ASD patients underwent single lumbar 3CO. Since PT is proportional to pelvic incidence (PI), the low PT group (LowPT) was defined as having a baseline (BL) PT/PI <25th percentile. HRQOL and full spine x-rays were analyzed at BL and 1 year. LowPT patients were compared to those with high PT/PI (HighPT) in a matched range of T1 pelvic angle. Results: LowPT group had PT/PI <0.4 (n = 31). High disability was reported at baseline for both groups with significant improvement postoperatively, but without difference between groups. LowPT had significantly smaller lack lumbar lordosis but larger SVA, T1 spinopelvic inclination. Postoperatively, there were improvements in all sagittal modifiers except PT in LowPT. 33 % of LowPT had an increase in PT (>5°) postoperatively. This subset had more deformity at baseline, achieving good T1SPi postoperative correction but without achieving the SRS-Schwab target SVA at 1 year. Conclusion: LowPT group had high levels of disability. After 3CO surgery, low PT patients experience only partial improvements in sagittal vertical axis (SVA) and 33 % of the group increased their PT. Further work is necessary to determine optimal realignment approaches for this unusual set of patients. It is unclear if neuromuscular pathology plays a role in the setting of high SVA without pelvic retroversion.

Original languageEnglish (US)
JournalEuropean Spine Journal
DOIs
StateAccepted/In press - May 31 2015

Fingerprint

Incidence
Osteotomy
Multicenter Studies
Retrospective Studies
Demography
Pathology
Population

Keywords

  • 3 column osteotomy
  • Clinical outcomes
  • Compensatory mechanism
  • Pelvic tilt
  • Sagittal alignment

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Ferrero, E., Vira, S., Ames, C. P., Kebaish, K., Obeid, I., O’Brien, M. F., ... International Spine Study Group, S. S. G. (Accepted/In press). Analysis of an unexplored group of sagittal deformity patients: low pelvic tilt despite positive sagittal malalignment. European Spine Journal. https://doi.org/10.1007/s00586-015-4048-1

Analysis of an unexplored group of sagittal deformity patients : low pelvic tilt despite positive sagittal malalignment. / Ferrero, Emmanuelle; Vira, Shaleen; Ames, Christopher P.; Kebaish, Khaled; Obeid, Ibrahim; O’Brien, Michael F.; Gupta, Munish C.; Boachie-Adjei, Oheneba; Smith, Justin S.; Mundis, Gregory M.; Challier, Vincent; Protopsaltis, Themistocles S.; Schwab, Frank J.; Lafage, Virginie; International Spine Study Group, Spine Study Group.

In: European Spine Journal, 31.05.2015.

Research output: Contribution to journalArticle

Ferrero, E, Vira, S, Ames, CP, Kebaish, K, Obeid, I, O’Brien, MF, Gupta, MC, Boachie-Adjei, O, Smith, JS, Mundis, GM, Challier, V, Protopsaltis, TS, Schwab, FJ, Lafage, V & International Spine Study Group, SSG 2015, 'Analysis of an unexplored group of sagittal deformity patients: low pelvic tilt despite positive sagittal malalignment', European Spine Journal. https://doi.org/10.1007/s00586-015-4048-1
Ferrero, Emmanuelle ; Vira, Shaleen ; Ames, Christopher P. ; Kebaish, Khaled ; Obeid, Ibrahim ; O’Brien, Michael F. ; Gupta, Munish C. ; Boachie-Adjei, Oheneba ; Smith, Justin S. ; Mundis, Gregory M. ; Challier, Vincent ; Protopsaltis, Themistocles S. ; Schwab, Frank J. ; Lafage, Virginie ; International Spine Study Group, Spine Study Group. / Analysis of an unexplored group of sagittal deformity patients : low pelvic tilt despite positive sagittal malalignment. In: European Spine Journal. 2015.
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abstract = "Purpose: In adult spinal deformity (ASD), patients increase pelvic tilt (PT) to maintain standing alignment. Previously, ASD patients with low PT and high disability were described. This study investigates this unusual population in terms of demographic, radiographic, and clinical features after three-column osteotomy (3CO). Methods: In this multicenter retrospective study, ASD patients underwent single lumbar 3CO. Since PT is proportional to pelvic incidence (PI), the low PT group (LowPT) was defined as having a baseline (BL) PT/PI <25th percentile. HRQOL and full spine x-rays were analyzed at BL and 1 year. LowPT patients were compared to those with high PT/PI (HighPT) in a matched range of T1 pelvic angle. Results: LowPT group had PT/PI <0.4 (n = 31). High disability was reported at baseline for both groups with significant improvement postoperatively, but without difference between groups. LowPT had significantly smaller lack lumbar lordosis but larger SVA, T1 spinopelvic inclination. Postoperatively, there were improvements in all sagittal modifiers except PT in LowPT. 33 {\%} of LowPT had an increase in PT (>5°) postoperatively. This subset had more deformity at baseline, achieving good T1SPi postoperative correction but without achieving the SRS-Schwab target SVA at 1 year. Conclusion: LowPT group had high levels of disability. After 3CO surgery, low PT patients experience only partial improvements in sagittal vertical axis (SVA) and 33 {\%} of the group increased their PT. Further work is necessary to determine optimal realignment approaches for this unusual set of patients. It is unclear if neuromuscular pathology plays a role in the setting of high SVA without pelvic retroversion.",
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author = "Emmanuelle Ferrero and Shaleen Vira and Ames, {Christopher P.} and Khaled Kebaish and Ibrahim Obeid and O’Brien, {Michael F.} and Gupta, {Munish C.} and Oheneba Boachie-Adjei and Smith, {Justin S.} and Mundis, {Gregory M.} and Vincent Challier and Protopsaltis, {Themistocles S.} and Schwab, {Frank J.} and Virginie Lafage and {International Spine Study Group}, {Spine Study Group}",
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T2 - low pelvic tilt despite positive sagittal malalignment

AU - Ferrero, Emmanuelle

AU - Vira, Shaleen

AU - Ames, Christopher P.

AU - Kebaish, Khaled

AU - Obeid, Ibrahim

AU - O’Brien, Michael F.

AU - Gupta, Munish C.

AU - Boachie-Adjei, Oheneba

AU - Smith, Justin S.

AU - Mundis, Gregory M.

AU - Challier, Vincent

AU - Protopsaltis, Themistocles S.

AU - Schwab, Frank J.

AU - Lafage, Virginie

AU - International Spine Study Group, Spine Study Group

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Y1 - 2015/5/31

N2 - Purpose: In adult spinal deformity (ASD), patients increase pelvic tilt (PT) to maintain standing alignment. Previously, ASD patients with low PT and high disability were described. This study investigates this unusual population in terms of demographic, radiographic, and clinical features after three-column osteotomy (3CO). Methods: In this multicenter retrospective study, ASD patients underwent single lumbar 3CO. Since PT is proportional to pelvic incidence (PI), the low PT group (LowPT) was defined as having a baseline (BL) PT/PI <25th percentile. HRQOL and full spine x-rays were analyzed at BL and 1 year. LowPT patients were compared to those with high PT/PI (HighPT) in a matched range of T1 pelvic angle. Results: LowPT group had PT/PI <0.4 (n = 31). High disability was reported at baseline for both groups with significant improvement postoperatively, but without difference between groups. LowPT had significantly smaller lack lumbar lordosis but larger SVA, T1 spinopelvic inclination. Postoperatively, there were improvements in all sagittal modifiers except PT in LowPT. 33 % of LowPT had an increase in PT (>5°) postoperatively. This subset had more deformity at baseline, achieving good T1SPi postoperative correction but without achieving the SRS-Schwab target SVA at 1 year. Conclusion: LowPT group had high levels of disability. After 3CO surgery, low PT patients experience only partial improvements in sagittal vertical axis (SVA) and 33 % of the group increased their PT. Further work is necessary to determine optimal realignment approaches for this unusual set of patients. It is unclear if neuromuscular pathology plays a role in the setting of high SVA without pelvic retroversion.

AB - Purpose: In adult spinal deformity (ASD), patients increase pelvic tilt (PT) to maintain standing alignment. Previously, ASD patients with low PT and high disability were described. This study investigates this unusual population in terms of demographic, radiographic, and clinical features after three-column osteotomy (3CO). Methods: In this multicenter retrospective study, ASD patients underwent single lumbar 3CO. Since PT is proportional to pelvic incidence (PI), the low PT group (LowPT) was defined as having a baseline (BL) PT/PI <25th percentile. HRQOL and full spine x-rays were analyzed at BL and 1 year. LowPT patients were compared to those with high PT/PI (HighPT) in a matched range of T1 pelvic angle. Results: LowPT group had PT/PI <0.4 (n = 31). High disability was reported at baseline for both groups with significant improvement postoperatively, but without difference between groups. LowPT had significantly smaller lack lumbar lordosis but larger SVA, T1 spinopelvic inclination. Postoperatively, there were improvements in all sagittal modifiers except PT in LowPT. 33 % of LowPT had an increase in PT (>5°) postoperatively. This subset had more deformity at baseline, achieving good T1SPi postoperative correction but without achieving the SRS-Schwab target SVA at 1 year. Conclusion: LowPT group had high levels of disability. After 3CO surgery, low PT patients experience only partial improvements in sagittal vertical axis (SVA) and 33 % of the group increased their PT. Further work is necessary to determine optimal realignment approaches for this unusual set of patients. It is unclear if neuromuscular pathology plays a role in the setting of high SVA without pelvic retroversion.

KW - 3 column osteotomy

KW - Clinical outcomes

KW - Compensatory mechanism

KW - Pelvic tilt

KW - Sagittal alignment

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