pelvic incidence, and spinopelvic balance

The classification defines 6 types of spondylolisthesis based on features that can be assessed on sagittal radiographs of the spine and pelvis: (1) grade of slip, (2) pelvic incidence, and (3) spino-pelvic alignment. A reliability study has demonstrated substantial intra- and inter-observer reliability similar to other currently used classifications for spinal deformity. Furthermore, health-related quality of life measures were found to be significantly different between the 6 types, thus supporting the value of a classification based on spino-pelvic alignment.

Spondylolisthesis, pelvic incidence, and spinopelvic balance.

07/09/2015 · Treatment strategies for high-grade spondylolisthesis ..

Surgical Treatment Strategies for High-Grade Spondylolisthesis: ..

The relationship of the pelvis to the spine has previously been overlooked, and its importance in sagittal balance has been underestimated. There is a crucial interplay between structural pelvic features, spinopelvic parameters, and sagittal alignment in both normal volunteers and patients with spondylolisthesis. Although satisfactory outcomes have been reported for multiple surgical techniques in the management of spondylolisthesis, restoration of disc height, lumbar lordosis, and global sagittal balance may improve clinical recovery rates and prevent future junctional problems [9,10].

pelvic incidence, and spinopelvic balance.

The authors describe the use of sacral pedicle subtraction osteotomy (PSO) with multiple sacral alar osteotomies for the correction of sacral kyphosis and pelvic incidence and for achieving sagittal balance correction in cases of fixed sagittal deformity after a sacral fracture. In this paper, the authors report on a novel technique using a series of sacral osteotomies and a sacral PSO to correct a fixed sagittal deformity in a patient with a sacral fracture that had healed in a kyphotic position. The patient sustained this fracture after a previous surgery for multilevel instrumented fusion. Preoperative and postoperative radiographic studies are reviewed and the clinical course and outcome are presented. Experts agree that the pelvic incidence is a fixed parameter that dictates the morphological characteristics of the pelvis and affects spinopelvic orientation and sagittal spinal alignment. An increased pelvic incidence is associated with a higher degree of spondylolisthesis in the lumbosacral junction, and increased shear forces across this junction. The authors demonstrate that the pelvic incidence can be altered and corrected with a series of sacral osteotomies to improve sacral kyphosis, compensatory lumbar hyperlordosis, and sagittal balance.

The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: ..
et al, Spondylolisthesis, pelvic incidence, and spinopelvic balance: a ..

in deformity and degenerative spondylolisthesis.

AB - Purpose: To present in a single source the relevant information needed to assess spinopelvic balance and alignment, and to estimate the amount of correction needed in a patient during surgical treatment. Methods: Narrative literature review Results: Sagittal balance can be evaluated by global balance estimates (sagittal vertical axis and T1 tilt). Other important parameters are the relationship between pelvic incidence and lumbar lordosis (spinopelvic harmony), between pelvic incidence and difference of thoracic kyphosis and lumbar lordosis (spinopelvic balance), excess of pelvic tilt, knee flexion and thoracic compensatory hypokyphosis. Different methods to calculate the amount of surgical correction needed in patients with sagittal imbalance have been based on combinations of these parameters. Conclusions: Relevant parameters of sagittal imbalance have been identified and correlated with clinical outcomes. Methods for calculation of surgical correction of imbalance have been proposed, but not validated in patients with midterm follow-up.

We compare the pelvic incidence and other parameters of sagittal spinopelvic balance in ..

adult isthmic spondylolisthesis at ..

Currently, most treatment protocols proposed in the literature for developmental spondylolisthesis have focused mainly on the abnormalities noted at the L5-S1 junction, mostly the slip grade. Surgery is usually recommended for patients with low-grade deformities, which are unresponsive to conservative management, and for all high-grade slips. While slip grade is an important component of the deformity, the evidence presented above demonstrates that sacro-pelvic morphology and balance are strong determinants of sagittal spino-pelvic alignment and that they should be considered in any treatment algorithm. The presence of different patterns of sagittal spino-pelvic balance suggests that the biomechanics involved in spondylolisthesis may differ from one patient to the other. Accordingly, the specific pattern of sagittal spino-pelvic balance for each patient should influence the risk of progression and the treatment outcome. In support of this concept [], a cohort of 397 adolescents with L5-S1 spondylolisthesis has been compared to an aged-matched control population: health-related quality of life measures were found to be clearly abnormal in spondylolisthesis, with significant differences according to various types of spino-pelvic alignment, thus supporting the value of a classification based on spino-pelvic alignment.

References. Labelle H, Roussouly P, Berthonnaud E , et al. Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine (Phila Pa 1976) 2004;

Classification of high-grade spondylolistheses ..

In summary, the proposed classification emphasizes that subjects with L5-S1 spondylolisthesis are a heterogeneous group with various adaptations of their posture and that clinicians need to keep this fact in mind for evaluation and treatment. Although outcome studies are obviously needed before a definitive treatment algorithm can be established for each subtype, it is suggested that for subjects with a type 4 spino-pelvic alignment, forceful attempts at reduction of the deformity may not be required and that simple instrumentation and fusion after postural reduction may be sufficient to maintain adequate sagittal alignment. For subjects with type 5 posture, reduction and realignment procedures should preferably be attempted, but in difficult cases, instrumentation and fusion after postural reduction may also be sufficient to achieve adequate sagittal alignment, since spinal alignment is maintained. Reduction and realignment procedures would appear mandatory in type 6 deformities where sagittal alignment is severely disturbed.