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确定最佳的测量骨盆脊椎incidence and spinopelvic parameters in adult spinal deformity patients with transitional anatomy

Fares Ani Department of Orthopedic Surgery, NYU Langone Health, New York, New York;

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Themistocles S. Protopsaltis Department of Orthopedic Surgery, NYU Langone Health, New York, New York;

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Yesha Parekh Department of Orthopedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland;

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Khalid Odeh Department of Orthopedic Surgery, NYU Langone Health, New York, New York;

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Renaud Lafage Department of Orthopedic Surgery, Lenox Hill, Northwell Health, New York, New York;

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贾斯汀·史密斯 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;

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Robert K. Eastlack Department of Orthopedic Surgery, Scripps Memorial Hospital, La Jolla, California;

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Lawrence Lenke Department of Orthopedic Surgery, Columbia University, New York, New York;

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Frank Schwab Department of Orthopedic Surgery, Lenox Hill, Northwell Health, New York, New York;

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Gregory M. Mundis Jr. Department of Orthopedic Surgery, Scripps Memorial Hospital, La Jolla, California;

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Munish C. Gupta Department of Orthopedic Surgery, Washington University in St. Louis, Missouri;

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Eric O. Klineberg Department of Orthopedic Surgery, University of California, Davis, California;

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Virginie Lafage Department of Orthopedic Surgery, Lenox Hill, Northwell Health, New York, New York;

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Robert Hart Department of Orthopedic Surgery, Swedish Medical Center, Seattle, Washington;

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Douglas Burton Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas;

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Christopher P. Ames Department of Neurological Surgery, University of California, San Francisco, California;

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Christopher I. Shaffrey Department of Neurological Surgery, Duke Health, Durham, North Carolina; and

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Shay Bess Department of Spine Surgery, Denver International Spine Center, Denver, Colorado

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Publication Date:
20 Oct 2023
Page Range:
1–7
Volume/Issue:
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DOI link:
https://doi.org/10.3171/2023.8.SPINE23432
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OBJECTIVE

The aim of this study was to determine if spinal deformity patients with L5 sacralization should have pelvic incidence (PI) and other spinopelvic parameters measured from the L5 or S1 endplate.

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This study was a multicenter retrospective comparative cohort study comprising a large database of adult spinal deformity (ASD) patients and a database of asymptomatic individuals. Linear regression modeling was used to determine normative T1 pelvic angle (TPA) and PI − lumbar lordosis (LL) mismatch (PI-LL) based on PI and age in a database of asymptomatic subjects. In an ASD database, patients with radiographic evidence of L5 sacralization had the PI, LL, and TPA measured from the superior endplate of S1 and then also from L5. The differences in TPA and PI-LL from normative were calculated in the sacralization cohort relative to L5 and S1 and correlated to the Oswestry Disability Index (ODI). Patients were grouped based on the Scoliosis Research Society (SRS)–Schwab PI-LL modifier (0, +, or ++) using the L5 PI-LL and S1 PI-LL. Baseline ODI and SF-36 Physical Component Summary (PCS) scores were compared across and within groups.

RESULTS

1179名自闭症患者中,276例(23.4%)有transitional anatomy, 176 with sacralized L5 (14.9%) and 100 (8.48%) with lumbarization of S1. The 176 patients with sacralized L5 were analyzed. When measured using the L5 superior endplate, pelvic parameters were significantly smaller than those measured relative to S1 (PI: 24.5° ± 11.0° vs 55.7° ± 12.0°, p = 0.001;TPA: 11.2° ± 12.0° vs 20.3° ± 12.5°, p = 0.001; and PI-LL: 0.67° ± 21.1° vs 11.4° ± 20.8°, p = 0.001). When measured from S1, 76 (43%), 45 (25.6%), and 55 (31.3%) patients had SRS-Schwab PI-LL modifiers of 0, +, and ++, respectively, compared with 124 (70.5%), 22 (12.5%), and 30 (17.0%), respectively, when measured from L5. There were significant differences in ODI and PCS scores as the SRS-Schwab grade increased regardless of L5 or S1 measurement. The L5 group had lower PCS functional scores for SRS-Schwab modifiers 0 and ++ relative to same grades in the S1 group. Offset from normative TPA (0.5° ± 11.1° vs 9.6° ± 10.8°, p = 0.001) and PI-LL (4.5° ± 20.4° vs 15.2° ± 19.3°, p = 0.001) were smaller when measuring from L5. Moreover, S1 measurements were more correlated with health status by ODI (TPA offset from normative: S1, R = 0.326 vs L5, R = 0.285; PI-LL offset from normative: S1, R = 0.318 vs L5, R = 0.274).

CONCLUSIONS

Measuring the PI and spinopelvic parameters at L5 in sacralized anatomy results in underestimating spinal deformity and is less correlated with health-related quality of life. Surgeons may consider measuring PI and spinopelvic parameters relative to S1 rather than at L5 in patients with a sacralized L5.

ABBREVIATIONS

ASD = adult spinal deformity ; HRQOL = health-related quality of life ; LL = lumbar lordosis ; LSTV = lumbosacral transitional vertebra ; ODI = Oswestry Disability Index ; PCS = Physical Component Summary ; PI = pelvic incidence ; PI-LL = PI − LL mismatch ; PT = pelvic tilt ; SRS = Scoliosis Research Society ; SVA = sagittal vertical axis ; TPA = T1 pelvic angle .
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Contributor Notes

CorrespondenceThemistocles S. Protopsaltis: NYU Langone Health, New York, NY.themistocles.protopsaltis@nyumc.org.

INCLUDE WHEN CITINGPublished online October 20, 2023; DOI: 10.3171/2023.8.SPINE23432.

Disclosures从Globu Protopsaltis博士报道个人费用s Medical, Medtronic, NuVasive, and Stryker outside the submitted work. Dr. R. Lafage reported personal fees from Carlsmed outside the submitted work. Dr. Smith reported grants from DePuy Synthes/ISSGF during the conduct of the study; and grants from DePuy Synthes/ISSGF; personal fees from DePuy Synthes, Cerapedics, Carlsmed, ZimVie, NuVasive, Thieme, and SeaSpine; grants from NuVasive and AO Spine; and stockownership in NuVasive and Alphatec outside the submitted work. Dr. Eastlack reported personal fees from NuVasive, Aesculap, Spinal Elements, DePuy, Medtronic, Bidermann Motech, Neo, Silony, SI Bone, and SeaSpine; grants from NuVasive, SI Bone, and SeaSpine; and shareholder in Alphatec outside the submitted work. Dr. Lenke reported grants from AO Spine; and consultant for Medtronic, Abryx, and Acuity Surgical outside the submitted work. Dr. Schwab reported consultant for Zimmer Biomet, Mainstay Medical, and MSD; royalties from Zimmer Biomet and MSD; executive committee of ISSG; and shareholder in VFT and SeaSpine outside the submitted work. Dr. Mundis Jr. reported royalties from NuVasive, SeaSpine, and Stryker; consultant for NuVasive, SeaSpine, Carlsmed, SI Bone, and Viseon; stock options in NuVasive, Alphatec Spine, and Orthofix outside the submitted work; and scientific advisory board for NuVasive, SeaSpine, Carlsmed; CEO of Global Spine Outreach, President of San Diego Spine Foundation, board member of San Diego Orthopaedic Society. Dr. Gupta reported grants from ISSGF during the conduct of the study; and royalties from DePuy, Innomed, and Globus; consultant for DePuy, Globus, and Medtronic; travel fees from DePuy, Globus, Medtronic, Zimmer, Scoliosis Research Society, and AO Spine; stock in J&J; board of directors of Scoliosis Research Society; and honoraria from LSU Grand Rounds, Wright State Grand Rounds, and AO Spine outside the submitted work. Dr. Klineberg reported consultant for DePuy Synthes, Stryker, Medtronic, SI Bone, and Agnovos; stock ownership in MMI and Relatable; educational grants from AO Spine; and chair elect of IMAST and AO Spine outside the submitted work. Dr. V. Lafage reported grants (paid to institution) from ISSG during the conduct of the study; consultant for Alphatec, Globus Medical; royalties from NuVasive; lectures for Johnson & Johnson and Stryker; EC member of ISSG; and committee member of SRS outside the submitted work. Dr. Hart reported royalties from Globus and SeaSpine; stock ownership in Mirus, Amplify; and consultant for Medtronic outside the submitted work. Dr. Burton reported personal fees from DePuy Spine, Globus, and Blue Ocean Spine; stock options in Progenerative Medical; and board of directors for Scoliosis Research Society and other from International Spine Study Group outside the submitted work. Dr. Ames reported royalties from Stryker, Biomet Zimmer Spine, DePuy Synthes, NuVasive, Next Orthosurgical, K2M, and Medicrea; consultant for DePuy Synthes, Medtronic, Medicrea, K2M, Agada Medical, and Carlsmed; research support from Titan Spine, DePuy Synthes, and ISSG; editorial board member of Operative Neurosurgery, Neurospine; grants from SRS; executive committee of ISSG; director of Global Spinal Analytics; and chair of SRS Safety and Value Committee outside the submitted work. Dr. Shaffrey reported grants from ISSG Foundation to Duke University during the conduct of the study; and personal fees from NuVasive, Medtronic, SI Bone, and Proprio outside the submitted work. Dr. Bess reported grants from DePuy Synthes, NuVasive, K2M Stryker, and ISSGF during the conduct of the study; and grants from Medtronic, Globus, Stryker, Carlsmed, SeaSpine, and ISSGF outside the submitted work.
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