Skip Navigation LinksHome > April/May 2011 - Volume 31 - Issue 3 > Transverse-plane Pelvic Asymmetry in Patients With Cerebral...
Journal of Pediatric Orthopaedics:
doi: 10.1097/BPO.0b013e31820fc65b
Neuromuscular

Transverse-plane Pelvic Asymmetry in Patients With Cerebral Palsy and Scoliosis

Ko, Phebe S. BS; Jameson, Paul G. II BS; Chang, Tai-Li MD; Sponseller, Paul D. MD

Collapse Box

Abstract

Background: Pelvic obliquity and loss of sitting balance develop from progressive scoliosis in cerebral palsy (CP) and are indications for surgery. Our goal was to quantify pelvic asymmetry to help understand skeletal deformity in CP and its surgical correction.

Methods: We assessed pelvic angles and transverse plane symmetry in 27 consecutive patients with scoliosis and severe CP who had undergone computed tomography for spinal surgery (subjects). The program used allowed measurement of angles in the true transverse plane, compensating for any obliquity present. Measurements included angles of the upper and lower ilium with respect to the sacrum, acetabular anteversion, and sacroiliac joint angles. We compared subject measurements with those of 20 age-matched controls and used Student t test to determine whether subjects had greater asymmetry and if the asymmetry direction was correlated with the adducted hip and/or the scoliosis in subjects with windswept hips.

Results: Subjects had significantly more iliac angle asymmetry (P=0.01) and asymmetry of at least 10 degrees in these categories: upper ilium, 15 (mean difference, 18); above sciatic notch, 14 (mean difference, 17); just below sciatic notch, 15 (mean difference, 19); sacroiliac joint, 5; and acetabular anteversion, 6. No control had asymmetry greater than 10 degrees. Comparing subjects with and without windswept hips, the former had more asymmetrical upper iliac angles. In 16 subjects with windswept hips, the scoliosis curve convexity was ipsilateral to the more internally rotated ilium. In 4 of the 5 subjects with severely windswept hips, the side of the adducted hip had more inward iliac rotation than did the contralateral (abducted) hip.

Conclusions: Transverse pelvic asymmetry, a little-recognized deformity in patients with severe CP, is most pronounced above the acetabulum and is more common in patients with windswept hips. Spine surgeons should be aware of such asymmetry because it may make iliac fixation challenging and account for some persistent postoperative deformity.

Level of Evidence: Case-control study, Level III.

© 2011 Lippincott Williams & Wilkins, Inc.

The Pediatric Orthopaedic Society of North America (POSNA)
is a group of healthcare professionals, primarily pediatric orthopaedic surgeons, dedicated to advancing musculoskeletal care of children and adolescents. JPO is our official member journal. 
Like us on facebook and become a member today!

Login

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.