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      Sagittal Parameters of Spine and Pelvis in Young Adults Using the EOS Imaging System: Prospective Study of 92 Asymptomatic Subjects

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          Abstract

          Study Design

          This study adopted a prospective study design to evaluate the sagittal parameters of the spine and pelvis in young adults using the EOS imaging system.

          Purpose

          This study was designed to analyze spinopelvic sagittal alignment measurement values obtained using the EOS imaging system in asymptomatic young adults.

          Overview of Literature

          Sagittal alignment of the spine and pelvis is important in diagnosing and treating spinal diseases. We usually take sagittal images using whole-spine standing lateral radiography. Recently, the EOS imaging system, which uses a low-dose radiation in a weight-bearing state, was developed. So, we studied the sagittal parameters of the spine and pelvis in young adults by using the EOS imaging system.

          Methods

          We recruited young adults aged 20–30 years and explained the EOS imaging system. They voluntarily participated in the study. We took full-body standing orthogonal anteroposterior and lateral images using the EOS imaging system (EOS imaging, Paris, France). Then, we measured the pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), sagittal vertical axis (SVA), T1/T12 kyphosis, and L1/S1 lordosis. We analyzed each parameter using Student t-test, paired t-test, and Pearson’s correlation coefficient.

          Results

          Ninety-two patients were enrolled in the study. The average PI and SS were 47.18° and 36.03°, respectively. Moreover, PT and SVA were 11.17° and −10.15 mm, respectively. T1/T12 kyphosis was 37.37°, while L1/S1 lordosis was 46.64°. All parameters were enough for normal distribution. Pearson correlation coefficient analysis showed a meaningful correlation between PI and SS and PI and PT ( R>0.6, p<0.05).

          Conclusions

          Measuring spinal and pelvic sagittal values is important. Sagittal parameters could help decide how to operate patients with spinal diseases. We attempted to obtain sagittal values using the EOS imaging system. These parameters could help preoperatively estimate the lumbar lordosis restoration and could also be used as guidelines for spinopelvic sagittal balance.

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          Most cited references28

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          Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery.

          Current concepts review. Outline the basic principles in the evaluation and treatment of adult spinal deformity patients with a focus on goals to achieve during surgical realignment surgery. Proper global alignment of the spine is critical in maintaining standing posture and balance in an efficient and pain-free manner. Outcomes data demonstrate the clinical effect of spinopelvic malalignment and form a basis for realignment strategies. Correlation between certain radiographic parameters and patient self-reported pain and disability has been established. Using normative values for several important spinopelvic parameters (including sagittal vertical axis, pelvic tilt, and lumbar lordosis), spinopelvic radiographic realignment objectives were identified as a tool for clinical application. Because of the complex relationship between the spine and the pelvis in maintaining posture and the wide range of "normal" values for the associated parameters, a focus on global alignment, with proportionality of individual parameters to each other, was pursued to provide clinical relevance to planning realignment for deformity across a range of clinical cases. Good clinical outcome requires achieving proper spinopelvic alignment in the treatment of adult spinal deformity. Although variations in pelvic morphology exist, a framework has been established to determine ideal values for regional and global parameter in an individualized patient approach. When planning realignment surgery for adult spinal deformity, restoring low sagittal vertical axis and pelvic tilt values are critical goals, and should be combined with proportional lumbar lordosis to pelvic incidence.
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            Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves.

            This paper proposes an anatomical parameter, the pelvic incidence, as the key factor for managing the spinal balance. Pelvic and spinal sagittal parameters were investigated for normal and scoliotic adult subjects. The relation between pelvic orientation, and spinal sagittal balance was examined by statistical analysis. A close relationship was observed, for both normal and scoliotic subjects, between the anatomical parameter of pelvic incidence and the sacral slope, which strongly determines lumbar lordosis. Taking into account the Cobb angle and the apical vertebral rotation confers a three-dimensional aspect to this chain of relations between pelvis and spine. A predictive equation of lordosis is postulated. The pelvic incidence appears to be the main axis of the sagittal balance of the spine. It controls spinal curves in accordance with the adaptability of the other parameters.
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              Pelvic parameters: origin and significance.

              The adoption by humans of an upright position resulted in broadening and verticalisation of the pelvis together with the appearance of characteristic spinal curves, has profoundly modified the structure of the muscles supporting the spine. In order to characterise the sagittal balance of the pelvis, it is necessary to define parameters based on notable biomechanical forces involved in the transmission of constraints. The angle of incidence was constructed to enable reproducible analysis of the anatomical characteristics of the pelvis in the sagittal plane. The angle of incidence is the algebraic sum of two complementary angles: pelvic tilt (PT) and sacral slope (SS). Since the value of incidence is fixed for any given patient, the sum of pelvic tilt and sacral slope is a constant value: when one increases, the other necessarily decreases. The position of the lumbar spine, attached to the sacral plateau, is thus affected by the pelvic tilt and by the sacral slope. Consequently, the pelvic parameters affect the entire underlying sagittal spinal profile. Global spinal balance involves harmonisation of lumbar lordosis and thoracic kyphosis taking into account the pelvic parameters.
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                Author and article information

                Journal
                Asian Spine J
                Asian Spine J
                Asian Spine Journal
                Korean Society of Spine Surgery
                1976-1902
                1976-7846
                October 2022
                22 February 2022
                : 16
                : 5
                : 732-739
                Affiliations
                [1 ]Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea
                [2 ]Konyang University Myunggok Research Institute for Medical Scienece, Konyang University College of Medicine, Daejeon, Korea
                Author notes
                Corresponding author: Tae Kyun Kim, Department of Orthopaedic Surgery, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea, Tel: +82-42-600-9120, Fax: +82-42-545-2373, E-mail: ktk1113@ 123456kyuh.ac.kr
                Author information
                https://orcid.org/0000-0002-8739-2224
                https://orcid.org/0000-0003-1073-4211
                https://orcid.org/0000-0002-2001-0471
                https://orcid.org/0000-0002-3782-8827
                Article
                asj-2021-0111
                10.31616/asj.2021.0111
                9633236
                35184522
                782f831a-00b9-4622-8c64-d8374af27ea8
                Copyright © 2022 by Korean Society of Spine Surgery

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 April 2021
                : 03 October 2021
                : 05 October 2021
                Categories
                Clinical Study

                Orthopedics
                spine,pelvis,whole body imaging,postural balance
                Orthopedics
                spine, pelvis, whole body imaging, postural balance

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