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Three-dimensional pelvic incidence is much higher in (thoraco)lumbar scoliosis than in controls
Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands..
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands..
Division of Neuroradiology, Diagnostic Centre for Imaging and Functional Medicine, Faculty of Medicine, Lund University, Skåne University Hospital, Malmö, Sweden..
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2018 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose

The pelvic incidence (PI) is used to describe the sagittal spino-pelvic alignment. In previous studies, radiographs were used, leading to less accuracy in establishing the three-dimensional (3D) spino-pelvic parameters. The purpose of this study is to analyze the differences in the 3D sagittal spino-pelvic alignment in adolescent idiopathic scoliosis (AIS) subjects and non-scoliotic controls.

Methods

Thirty-seven female AIS patients that underwent preoperative supine low-dose computed tomography imaging of the spine, hips and pelvis as part of their general workup were included and compared to 44 non-scoliotic age-matched female controls. A previously validated computerized method was used to measure the PI in 3D, as the angle between the line orthogonal to the inclination of the sacral endplate and the line connecting the center of the sacral endplate with the hip axis.

Results

The PI was on average 46.8° ± 12.4° in AIS patients and 41.3° ± 11.4° in controls (p = 0.025), with a higher PI in Lenke type 5 curves (50.6° ± 16.2°) as compared to controls (p = 0.042), whereas the Lenke type 1 curves (45.9° ± 12.2°) did not differ from controls (p = 0.141).

Conclusion

Lenke type 5 curves show a significantly higher PI than controls, whereas the Lenke type 1 curves did not differ from controls. This suggests a role of pelvic morphology and spino-pelvic alignment in the pathogenesis of idiopathic scoliosis. Further longitudinal studies should explore the exact role of the PI in the initiation and progression of different AIS types.

Place, publisher, year, edition, pages
Heidelberg: Springer, 2018.
Keywords [en]
Idiopathic scoliosis, Sagittal alignment, Pelvic incidence, Three-dimensional analysis, Computed tomography
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:liu:diva-152573DOI: 10.1007/s00586-018-5718-6PubMedID: 30128762Scopus ID: 2-s2.0-85051834138OAI: oai:DiVA.org:liu-152573DiVA, id: diva2:1261490
Available from: 2018-11-07 Created: 2018-11-07 Last updated: 2018-11-23Bibliographically approved
In thesis
1. Adolescent Idiopathic Scoliosis: A Deformity in Three Dimensions
Open this publication in new window or tab >>Adolescent Idiopathic Scoliosis: A Deformity in Three Dimensions
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Scoliosis is a complex three-dimensional deformity of the spine. Even though it has been known for centuries, treatment of the deformity has focused on correcting only in the frontal plane. In the last decades, the need for three-dimensional assessment regarding scoliosis has been highlighted to better understand the cause and the principles of treating scoliosis. The overall aim of this dissertation is to provide knowledge to assess scoliosis as a three-dimensional problem.

The severity of scoliosis is measured with the Cobb angle from standing radiographs. Computed tomography (CT) examinations are used throughout this thesis. The first paper investigates the difference in Cobb angle measured from standing radiographs and supine CT examinations. The standing radiographs had larger Cobb angles with a mean difference of 11° and a linear correlation between the two examinations from 128 consecutive patients with adolescent idiopathic scoliosis (AIS) planned for surgery.

The second paper compares the axial shape of vertebrae in 20 patients with AIS with a reference group. Clear asymmetry was observed in all vertebrae – superior and inferior end vertebrae as well as the apical vertebra – compared with corresponding vertebrae among the reference group. The asymmetry was most pronounced in the apical vertebra. A novel parameter, frontal vertebral body rotation (FVBR), was introduced to describe the internal rotation of the vertebrae in the axial plane.

Pelvic incidence (PI) is a measurement of the position of the sacrum in relation to the femoral heads. This is relevant in scoliosis because PI determines the pelvic configuration acting as a foundation to the spine. PI has traditionally been measured from standing radiographs. The third study investigates PI three-dimensionally, based on low-dose CT examinations, in 37 patients with Lenke type 1 or 5 curves compared with a reference group. A significantly higher PI was observed in patients with Lenke type 5 curves compared with the reference group and patients with Lenke type 1 curves.

Severe AIS is treated with corrective surgery. Two approaches are available: the predominant posterior approach and the anterior approach. In the fourth paper, these two approaches are evaluated with regard to three-dimensional correction, how well the correction is maintained over a 2-year follow-up and patient-reported outcome measures. Twenty-seven patients treated with the posterior approach and 26 patients treated with the anterior approach, all with Lenke type 1 curves, were included. Fewer vertebrae were fused in the anterior group, but the posterior group had a better correction of the deformity in the frontal plane. No difference was observed regarding three-dimensional correction and patient-reported outcome measures.

AIS is truly a complex three-dimensional deformity. More research is needed to fully comprehend the complexity of the scoliotic spine.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 76
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1635
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-152572 (URN)10.3384/diss.diva-152572 (DOI)9789176852361 (ISBN)
Public defence
2018-12-14, Berzeliussalen, Campus US, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2018-11-07 Created: 2018-11-07 Last updated: 2018-11-23Bibliographically approved

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Vavruch, LudvigTropp, Hans

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Department of Clinical and Experimental MedicineFaculty of Medicine and Health SciencesCenter for Medical Image Science and Visualization (CMIV)Division of Surgery, Orthopedics and OncologyDepartment of Orthopaedics in Linköping
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