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Standing versus supine pelvic incidence in adult spinal deformity patients

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Abstract

Purpose

Pelvic incidence (PI) is commonly used to determine sagittal alignment. Historically, PI was believed to be a fixed anatomic parameter. However, recent studies have suggested that there is positionally-dependent motion that occurs through the sacroiliac joint (SIJ) resulting in changes in PI.

Methods

We reviewed 100 consecutive adult spinal deformity (ASD) patients seen at our academic tertiary referral center. Two reviewers measured pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) on standing radiographs and scout computed tomography scans (CT). Unilateral, bilateral, or absent SIJ vacuum sign (VS) was determined using CTs.

Results

Eighty-six patients (42 M:44 F) were included with an average age of 64.1 years and BMI of 28.8 kg/m2. Standing PI was low (< 50°) in 35 patients (40.7%), average (50°-60°) in 22 (25.6%), and high (> 60°) in 29 (33.7%). Average and high PI patients had significant PI changes of 3.0° (p = 0.037) and 4.6° (p = 0.005), respectively. Bilateral SIJ VS was seen in 68 patients, unilateral VS in 9, and VS was absent in 9. The average change in PI between standing and supine was 2.1° in bilateral SIJ VS patients (p = 0.045), 2.2° in unilateral SIJ VS (p = 0.23), and − 0.1° in patients without SIJ VS (p = 0.93). The average absolute difference in PI between supine and standing was 5.5° ±5.5° (p < 0.001).

Conclusion

There is a change in PI from supine to standing. In patients with high PI and bilateral VS on CT, the change from supine to standing is significant, perhaps representing instability of the SIJ.

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Authors and Affiliations

  1. The Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA

    Matthew W. Godlewski, Jason J. Haselhuhn & David W. Polly Jr.

  2. The Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

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Contributions

MG, JH, and DP made substantial contributions to the conception of the work; acquisition, analysis, and interpretation of data; drafted the work and revised it critically for important intellectual content; and all authors approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to David W. Polly Jr..

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The authors did not receive support from any organization for the submitted work. MG and JH have nothing to disclose. DP declares consulting fees from Alexion, Globus Medical, and SI Bone; institutional research support from Medtronic and Mizuho OSI; honoraria from SI Bone; and royalties from SI Bone and Springer.

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This observational study was reviewed and deemed exempt by the Institutional Review Board prior to the start of data collection. Due to the retrospective design, it provided no more than minimal risks to subjects, and thus a waiver of patient consent was granted.

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Godlewski, M.W., Haselhuhn, J.J. & Polly, D.W. Standing versus supine pelvic incidence in adult spinal deformity patients. Eur Spine J 33, 3851–3856 (2024). https://doi.org/10.1007/s00586-024-08386-4

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