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Failure of Pelvic Compensation in Patients With Severe Positive Sagittal Imbalance

Comparison Between Static Radiographs and Gait Analysis of Spinopelvic Parameters in Adult Spinal Deformity and Lumbar Stenosis

Kim, Ho-Joong MD; Shen, Feng MD; Kang, Kyoung-Tak PhD; Chun, Heoung-Jae PhD; Kim, Sung Taeck MD; Chang, Bong-Soon MD; Lee, Choon-Ki MD; Yeom, Jin S. MD

doi: 10.1097/BRS.0000000000002985
DEFORMITY
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Study Design. Case–control study for motion analysis.

Objective. To compare spinopelvic parameters using static radiographs with the values obtained using motion analysis during gait between adult spinal deformity (ASD) or lumbar spinal stenosis (LSS).

Summary of Background Data. It is still unclear whether measurement of radiological parameters using static radiographs can reflect natural sagittal balance during gait in the patients with severe positive sagittal imbalance.

Methods. In this age- and sex-matched case control study, a total of 40 patients, each 20 subjects with either ASD or LSS who were scheduled to undergo surgery were included. Both clinical outcomes and sagittal spinopelvic parameters, including sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI) were measured. In motion analysis during walking, the angle of anterior pelvic tilt and the angles of the pelvis, hip, and knee were estimated. The correlation between variables was analyzed.

Results. On standing lateral x-rays, SVA, PT, and PI – LL were significantly higher in the ASD group while SS and LL were significantly lower in the ASD group. However, on motion analysis, the average mean anterior pelvic tilt ± SD values in the ASD group were 8.3 ± 10.7 and 8.5 ± 10.7 on the right and left, respectively, and were not different from matched values in the LSS group. A Bland–Altman plot demonstrated a good agreement between the SS in the x-ray and anterior pelvic tilt in the motion analysis. In the ASD group, SS and SVA showed a significant positive correlation with mean anterior pelvic tilt in motion analysis during gait.

Conclusion. The present study showed that the failure of pelvic compensation would likely occur in patients with severe positive sagittal imbalance during walking.

Level of Evidence: 3

The present study showed that the failure of pelvic compensation would likely occur in patients with severe positive sagittal imbalance during walking.

Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Republic of Korea

Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea

Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea.

Address correspondence and reprint requests to Jin S. Yeom, MD, Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea; E-mail: highcervical@gmail.com

Received 25 October, 2018

Revised 12 December, 2018

Accepted 28 December, 2018

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

Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2016R1A2B3012850) and the SNUBH Research Fund (grant no 14-2018-005) funds were received in support of this work.

No relevant financial activities outside the submitted work.

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