Main Article Content
To assess the changing of pelvic incidence in patients who received lumbar and lumbosacral fusion with pedicle screw fixation.
MATERIAL AND METHODS:
This is a single-institute, retrospective study. From 2011-2016, 113 cases of lumbar and lumbosacral fusion with pedicle screw fixation were reviewed. Preoperative and postoperative (at 6-week, 1-year and latest follow-up) pelvic parameters including Pelvic incidence (PI), Pelvic tilt (PT), Sacral slope (SS) and Lumbar lordosis (LL) were measured in standing lateral view X-ray by 2 independent fellow-trained spine surgeon who were blind to the operation. Difference in preoperative and postoperative PI was defined as Pelvic incidence disparity (ΔPI). Other characteristic data of patients were also collected, including age, sex, body mass index, diagnosis, fusion technique, number of fusion levels and level of fusion.
Pelvic incidence disparity (ΔPI) was 3.2º ± 4.0 at 6-week postoperative, 3.3º ± 4.0 at 1-year postoperative and 3.2º ± 3.4 at last follow-up. This showed a significant change when compared to preoperative but did not change significantly over time after surgery. There was no correlation between ΔPI and fusion technique, L5-S1 fusion, diagnosis and number of fusion segments.
Lumbar and lumbosacral fusion with pedicle screw fixation can alter pelvic incidence parameters. This could be a consequence from increased stress and motion in SI joint after the surgery.
This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
2. Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 2005;30(6):682-8.
3. Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine 2005;30(18):2024-9.
4. Schwab FJ, Blondel B, Bess S, et al. Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine 2013;38(13):E803-12.
5. Smith JS, Klineberg E, Schwab F, et al. Change in classification grade by the SRS-Schwab Adult Spinal Deformity Classification predicts impact on health-related quality of life measures: prospective analysis of operative and nonoperative treatment. Spine 2013;38(19):1663-71.
6. Schwab F, Patel A, Ungar B, et al. Adult spinal deformitypostoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 2010;35(25):2224-31.
7. Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine 2012;37(12):1077-82.
8. Rothenfluh DA, Mueller DA, Rothenfluh E, et al. Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion. Eur Spine J 2015;24(6):1251-8.
9. Zhang HC, Zhang ZF, Wang ZH, et al. Optimal pelvic incidence minus lumbar lordosis mismatch after long posterior instrumentation and fusion for adult degenerative scoliosis. Orthop Surg 2017;9(3):304-10.
10. Senteler M, Weisse B, Snedeker JG, et al. Pelvic incidencelumbar lordosis mismatch results in increased segmental joint loads in the unfused and fused lumbar spine. Eur Spine J 2014;23(7):1384-93.
11. Lafage V, Schwab F, Patel A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 2009;34(17):E599-606.
12. Ozkunt O, Karademir G, Sariyilmaz K, et al. Analysing the change of sagittal balance in patients with Lenke 5 idiopathic scoliosis. Acta Orthop Traumatol Turc 2017;51(5):377-80.
13. Asai Y, Tsutsui S, Oka H, et al. Sagittal spino-pelvic alignment in adults: The Wakayama Spine Study. PloS one 2017;12(6):e0178697.
14. Kissling RO, Jacob HA. The mobility of the sacroiliac joint in healthy subjects. Bull Hosp Jt Dis 1996;54(3):158-64.
15. Mendoza-Lattes S, Ries Z, Gao Y, et al. Natural history of spinopelvic alignment differs from symptomatic deformity of the spine. Spine 2010;35(16):E792-8.
16. Cho KJ, Suk SI, Park SR, et al. Risk factors of sagittal decompensation after long posterior instrumentation and fusion for degenerative lumbar scoliosis. Spine 2010;35(17): 1595-601.
17. Jean L. Influence of age and sagittal balance of the spine on the value of the pelvic incidence. Eur Spine J 2014;23(7): 1394-9.
18. Skalli W, Zeller RD, Miladi L, et al. Importance of pelvic compensation in posture and motion after posterior spinal fusion using CD instrumentation for idiopathic scoliosis. Spine 2006;31(12):E359-66.
19. Baek SW, Park YS, Ha KY, et al. The analysis of spinopelvic parameters and stability following long fusions with S1, S2 or iliac fixation. Int Orthop 2013;37(10):1973-80.
20. Ivanov AA, Kiapour A, Ebraheim NA, et al. Lumbar fusion leads to increases in angular motion and stress across sacroiliac joint: a finite element study. Spine 2009;34(5): E162-9.
21. Frymoyer JW, Howe J, Kuhlmann D. The long-term effects of spinal fusion on the sacroiliac joints and ilium. Clin Orthop Relat Res1978(134):196-201.
22. Ha KY, Lee JS, Kim KW. Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion: a prospective cohort study over five-year follow-up. Spine 2008;33(11): 1192-8.
23. Kim YJ, Bridwell KH, Lenke LG, et al. An analysis of sagittal spinal alignment following long adult lumbar instrumentation and fusion to L5 or S1: can we predict ideal lumbar lordosis? Spine 2006;31(20):2343-52.
24. Lee JH, Na KH, Kim JH, et al. Is pelvic incidence a constant, as everyone knows? Changes of pelvic incidence in surgically corrected adult sagittal deformity. Eur Spine J 2016;25(11):3707-14.