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Sagittal Plane Considerations and the Pelvis in the Adult Patient

Schwab, Frank, MD; Lafage, Virginie, PhD; Patel, Ashish, MD; Farcy, Jean-Pierre, MD

doi: 10.1097/BRS.0b013e3181a13c08

Study Design. Research update, focused review.

Objective. Identify the role of the pelvis in the setting of adults with spinal deformity.

Summary of Background Data. Sagittal plane alignment is increasingly recognized as a critical parameter in the setting of adult spinal deformity. Additionally, pelvic parameters reveal to be a key component in the regulation of sagittal alignment.

Methods. Analysis of the pelvis in the sagittal plane is commonly assessed by 3 angular measurements: the pelvic incidence (morphologic parameter directly linked to sagittal morphotypes), the pelvic tilt (or pelvis retroversion used to maintain an upright posture in the setting of spinal deformity), and the sacral slope. Recent work using force plate technology has revealed that in the setting of anterior trunk inclination (“spinal imbalance”), the pelvis shifted posteriorly (toward the heels) in order to maintain a balanced mass distribution. The complex relationship between pelvic and spinal parameter were investigated in order to construct predictive formulas of postoperative spinopelvic alignment. It has emerged that pelvic tilt is highly correlated with patient self reported function (ODI, SF-12, and SRS).

Conclusion. It has become evident that good clinical outcome in the treatment of spinal deformity requires proper alignment. Pelvis parameters play an essential role not only in terms of spine morphotypes but also in regulating standing balance and postoperative alignment. Thus, optimal treatment of a patient with spinal deformity requires integration of the pelvis in the preoperative evaluation and treatment plan.

This review article investigated the role of the pelvis in the setting of adults with spinal deformity. Pelvic parameters appeared to be of primary importance to regulate the standing posture and to predict the postoperative sagittal alignment. Furthermore, recent data revealed significant correlation between pelvic position and self-reported outcomes.

From the NYU Hospital for Joint Diseases, New York, NY.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Corporate/Industry funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Virginie Lafage, PhD, NYU Hospital for Joint Diseases, 380 2nd Ave., Suite 1001, New York, NY 10010; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.