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Impact of pelvic obliquity on coronal alignment in patients with adolescent idiopathic scoliosis

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Abstract

Study design

Retrospective study.

Objective

To investigate pelvic obliquity prevalence and its coronal alignment effects in patients with adolescent idiopathic scoliosis (AIS).

Summary of background data

Pelvic obliquity observed on standing radiographs could affect coronal alignment; however, its incidence or relationship with coronal alignment remains unclear.

Methods

Data of 141 patients with AIS (11 men, 130 women; mean age, 14.2 years) were retrospectively analyzed. Pelvic obliquity (pelvic coronal obliquity angle (PCOA) value ≥ 3°) was evaluated on standing radiographs; PCOAs were classified into two groups: right-upward and left-upward. Cobb angle and flexibility of proximal thoracic, main thoracic, thoracolumbar/lumbar curve, radiographic shoulder height (RSH), L4 tilt, and coronal balance were measured. Iliac crest and femoral head height differences were measured to evaluate correlations between pelvic obliquity and leg length discrepancy. We compared patients with and without pelvic obliquity according to Lenke classifications.

Results

Among 141 patients, 33 (23%) showed pelvic obliquity: 12 were type 1, 3 were type 2, 1 was type 3, 13 were type 5, and 4 were type 6. Right-upward obliquity was observed in 25 patients (76%), all B or C curves; left-upward obliquity was observed in 8 (24%) and most were lumbar modifier A curves. PCOA and iliac crest height difference correlated with femoral head height difference. Among patients with Lenke type 1 with and without pelvic obliquity, those with right-upward pelvic obliquity showed significantly greater absolute RSH values, while those with left-upward pelvic obliquity showed significant smaller absolute RSH values. Among patients with Lenke types 5 and 6, those with pelvic obliquity showed significantly greater L4 tilt absolute values.

Conclusions

Pelvic obliquity was frequently observed in patients with AIS, especially lumbar scoliosis. Right–upward pelvic obliquity influenced by lumbar curves promoted shoulder imbalance and left-upward obliquity compensated for shoulder imbalance in Lenke type 1.

Level of Evidence

Level 3.

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References

  1. Hresko MT (2013) Clinical practice. Idiopathic scoliosis in adolescents. N Engl J Med 368:834–841. https://doi.org/10.1056/NEJMcp1209063

    Article  CAS  PubMed  Google Scholar 

  2. Qiu XS, Zhang JJ, Yang SW, Lv F, Wang ZW, Chiew J, Ma WW, Qiu Y (2012) Anatomical study of the pelvis in patients with adolescent idiopathic scoliosis. J Anat 220:173–178. https://doi.org/10.1111/j.1469-7580.2011.01458.x

    Article  PubMed  Google Scholar 

  3. Ploumis A, Trivedi V, Shin JH, Wood KB, Grottkau BE (2018) Progression of idiopathic thoracic or thoracolumbar scoliosis and pelvic obliquity in adolescent patients with and without limb length discrepancy. Scoliosis Spinal Disord 13:18. https://doi.org/10.1186/s13013-018-0166-y

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lee CS, Ha JK, Kim DG, Kim H, Hwang CJ, Lee DH, Cho JH (2015) The clinical importance of sacral slanting in patients with adolescent idiopathic scoliosis undergoing surgery. Spine J 15:834–840. https://doi.org/10.1016/j.spinee.2015.01.023

    Article  PubMed  Google Scholar 

  5. Jung JY, Cha EJ, Kim KA, Won Y, Bok SK, Kim BO, Kim JJ (2015) Influence of pelvic asymmetry and idiopathic scoliosis in adolescents on postural balance during sitting. Biomed Mater Eng 26(Suppl 1):S601–610. https://doi.org/10.3233/bme-151351

    Article  PubMed  Google Scholar 

  6. Boulay C, Tardieu C, Benaim C, Hecquet J, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupere G, Pelissier J (2006) Three-dimensional study of pelvic asymmetry on anatomical specimens and its clinical perspectives. J Anat 208:21–33. https://doi.org/10.1111/j.1469-7580.2006.00513.x

    Article  PubMed  PubMed Central  Google Scholar 

  7. Walker AP, Dickson RA (1984) School screening and pelvic tilt scoliosis. Lancet 2:152–153

    Article  CAS  Google Scholar 

  8. Schwender JD, Denis F (2000) Coronal plane imbalance in adolescent idiopathic scoliosis with left lumbar curves exceeding 40 degrees: the role of the lumbosacral hemicurve. Spine 25:2358–2363

    Article  CAS  Google Scholar 

  9. Lenke LG, Edwards CCI, Bridwell KH (2003) The lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine 28(Suppl 20):S199–S207. https://doi.org/10.1097/01.brs.0000092216.16155.33

    Article  PubMed  Google Scholar 

  10. Stokes IAF, Bigalow LC, Moreland MS (1986) Measurement of axial rotation of vertebrae in scoliosis. Spine 11:213–218

    Article  CAS  Google Scholar 

  11. Faber MJ, Bosscher RJ, van Wieringen PC (2006) Clinimetric properties of the performance-oriented mobility assessment. Phys Ther 86:944–954

    Article  Google Scholar 

  12. Cho JH, Lee CS, Joo YS, Park J, Hwang CJ, Lee DH (2017) Association between sacral slanting and adjacent structures in patients with adolescent idiopathic scoliosis. Clin Orthopedic Surg 9:57–62. https://doi.org/10.4055/cios.2017.9.1.57

    Article  Google Scholar 

  13. Raczkowski JW, Daniszewska B, Zolynski K (2010) Functional scoliosis caused by leg length discrepancy. Arch Med Sci 6:393–398. https://doi.org/10.5114/aoms.2010.14262

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sekiya T, Aota Y, Yamada K, Kaneko K, Ide M, Saito T (2018) Evaluation of functional and structural leg length discrepancy in patients with adolescent idiopathic scoliosis using the EOS imaging system: a prospective comparative study. Scoliosis Spinal Disord 13:7. https://doi.org/10.1186/s13013-018-0152-4

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gum JL, Asher MA, Burton DC, Lai SM, Lambart LM (2007) Transverse plane pelvic rotation in adolescent idiopathic scoliosis: primary or compensatory? Eur Spine J 16:1579–1586. https://doi.org/10.1007/s00586-007-0400-4

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zabjek KF, Leroux MA, Coillard C, Martinez X, Griffet J, Simard G, Rivard CH (2001) Acute postural adaptations induced by a shoe lift in idiopathic scoliosis patients. Eur Spine J 10:107–113

    Article  CAS  Google Scholar 

  17. Gurney B (2002) Leg length discrepancy. Gait Posture 15:195–206

    Article  Google Scholar 

  18. Pasha S, Aubin CE, Sangole AP, Labelle H, Parent S, Mac-Thiong JM (2014) Three-dimensional spinopelvic relative alignment in adolescent idiopathic scoliosis. Spine 39:564–570. https://doi.org/10.1097/brs.0000000000000193

    Article  PubMed  Google Scholar 

  19. Wang ZW, Wang WJ, Sun MH, Liu Z, Zhu ZZ, Zhu F, Qiu XS, Qian BP, Wang SF, Qiu Y (2014) Characteristics of the pelvic axial rotation in adolescent idiopathic scoliosis: a comparison between major thoracic curve and major thoracolumbar/lumbar curve. Spine J 14:1873–1878. https://doi.org/10.1016/j.spinee.2013.10.036

    Article  PubMed  Google Scholar 

  20. Menon KV, Tahasildar N, Pillay HM, Anbuselvam M, Jayachandran RK (2014) Patterns of shoulder imbalance in adolescent idiopathic scoliosis: a retrospective observational study. J Spinal Disord Tech 27:401–408. https://doi.org/10.1097/bsd.0000000000000166

    Article  PubMed  Google Scholar 

  21. Qiu XS, Ma WW, Li WG, Wang B, Yu Y, Zhu ZZ, Qian BP, Zhu F, Sun X, Ng BK, Cheng JC, Qiu Y (2009) Discrepancy between radiographic shoulder balance and cosmetic shoulder balance in adolescent idiopathic scoliosis patients with double thoracic curve. Eur Spine J 18(1):45–51. https://doi.org/10.1007/s00586-008-0833-4

    Article  PubMed  Google Scholar 

  22. Bago J, Carrera L, March B, Villanueva C (1996) Four radiological measures to estimate shoulder balance in scoliosis. J Pediatr Orthop B 5:31–34. https://doi.org/10.1097/01202412-199605010-00006

    Article  CAS  PubMed  Google Scholar 

  23. Akel I, Pekmezci M, Hayran M, Genc Y, Kocak O, Derman O, Erdoğan I, Yazici M (2008) Evaluation of shoulder balance in the normal adolescent population and its correlation with radiological parameters. Eur Spine J 17:348–354. https://doi.org/10.1007/s00586-007-0546-0

    Article  PubMed  Google Scholar 

  24. Chung WH, Chiu CK, Ng SJ, Goh SH, Chan CYW, Kwan MK (2019) How common is medial and lateral shoulder discordance in lenke 1 and 2 curves?: A preoperative analysis of medial and lateral shoulder balance among 151 lenke 1 and 2 adolescent idiopathic scoliosis patients. Spine 44:E480–E486. https://doi.org/10.1097/brs.0000000000002890

    Article  PubMed  Google Scholar 

  25. Maurice B, Jean-Marie G, Jean-Michel T (2011) Taking the shoulders and pelvis into account in the preoperative classification of idiopathic scoliosis in adolescents and young adults (a constructive critique of King's and Lenke's systems of classification). Eur Spine J 20:1780–1787. https://doi.org/10.1007/s00586-011-1899-y

    Article  PubMed  PubMed Central  Google Scholar 

  26. He C, Wong MS (2018) Spinal flexibility assessment on the patients with adolescent idiopathic scoliosis: a literature review. Spine 43:e250–e258. https://doi.org/10.1097/brs.0000000000002276

    Article  PubMed  Google Scholar 

  27. Qin X, He Z, Yin R, Qiu Y, Zhu Z (2019) Where to stop distally in Lenke modifier C AIS with lumbar curve more than 60 degrees : L3 or L4? Clin Neurol Neurosurg 178:77–81. https://doi.org/10.1016/j.clineuro.2019.02.005

    Article  PubMed  Google Scholar 

  28. Brady RJ, Dean JB, Skinner TM, Gross MT (2003) Limb length inequality: clinical implications for assessment and intervention. J Orthop Sports Phys Ther 33:221–234. https://doi.org/10.2519/jospt.2003.33.5.221

    Article  PubMed  Google Scholar 

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Acknowledgements

No other person aside from the authors made substantial contributions to conception, design, acquisition of data, or analysis and interpretation of data, or was involved in drafting the manuscript or revising it critically for important intellectual content.

Funding

No funding was received for the design, in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. No language editor or scientific (medical) writer was involved in the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan

    Tomohiro Banno, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Tatsuya Yasuda, Hideyuki Arima, Shin Oe, Hiroki Ushirozako, Tomohiro Yamada, Koichiro Ide, Yuh Watanabe & Yukihiro Matsuyama

  2. Department of Orthopaedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan

    Sho Kobayashi

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  1. Tomohiro Banno
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Contributions

TB: conceptualization, design, interpretation, drafting, data analysis. YY: conceptualization, data curation, interpretation, revising. TH: conceptualization, interpretation, revising. GY: conceptualization, interpretation, revising. SK: conceptualization, interpretation, revising. TY: conceptualization, interpretation, revising. HA: conceptualization, interpretation, revising. SO: conceptualization, data curation, interpretation, revising. HU; conceptualization, data curation, revising. TY: conceptualization, data curation, revising. KI: conceptualization, data curation, revising. YW: conceptualization, data curation, revising. YM: conceptualization, interpretation, revising, supervision. All authors approved the manuscript to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or intergrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Tomohiro Banno.

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Conflict of interest

TB, TH, GY, SK, TY, HA, HU, TY, KI, YW, and YM have nothing to disclose. YY and SO belong to the division as follows; Donated Fund Laboratory (Division of Geriatric Musculoskeletal Health, Hamamatsu University, School of Medicine, Shizuoka, Japan). Meitoku medical institute Jyuzen memorial hospital, Shizuoka, Japan. Japan Medical Dynamic Marketing Inc, Tokyo, Japan. Medtronic Sofamor Danek Inc., Memphis, United States.

IRB approval

All study participants provided informed consent, and the study design was approved by the appropriate ethics review boards in Hamamatsu University School of Medicine.

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Banno, T., Yamato, Y., Hasegawa, T. et al. Impact of pelvic obliquity on coronal alignment in patients with adolescent idiopathic scoliosis. Spine Deform 8, 1269–1278 (2020). https://doi.org/10.1007/s43390-020-00145-x

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  • DOI: https://doi.org/10.1007/s43390-020-00145-x

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