• Hip & pelvis
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• 제35권1호
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• pp.6-14
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• 2023

Purpose: The aim of this study was to determine correlation between the spinopelvic parameters in sitting and standing positions (sacral slope [SS], lumbar lordosis [LL], spinopelvic tilt [SPT], pelvic incidence [PI], and pelvic femoral angle [PFA]), with hip function assessed using the modified Harris hip scores (mHHs) in patients with symptomatic femoroacetabular impingement (FAI) at diagnosis. Materials and Methods: A retrospective study of 52 patients diagnosed with symptomatic FAI was conducted. Evaluation of the spinopelvic complex in terms of SS, LL, SPT, PI and PFA was performed using lateral radiographs of the pelvis and lumbosacral spine in standing and sitting positions. Assessment of hip function at diagnosis was performed using the mHHs. Calculation of spinopelvic mobility was based on the difference (Δ) between measurements performed in standing and sitting position. Results: The median time of pain evolution was 11 months (interquartile range [IQR], 5-24 months) with a median mHHs of 66.0 points (IQR, 46.0-73.0) at diagnosis. The mean change of LL, SS, SPT, and PFA was 20.9±11.2°, 14.2±8.6°, 15.5±9.0°, and 70.7±9.5°, respectively. No statistically significant correlation was observed between spinopelvic parameters and the mHHs (P>0.05). Conclusion: Radiological parameters of the spinopelvic complex did not show correlation with hip function at the time of diagnosis in patients with symptomatic FAI. Conduct of further studies will be required in the effort to understand the effect of the spinopelvic complex and its compensatory mechanics, primarily between the hip and spine, in patients with FAI before and after hip arthroscopy.

• Hip & pelvis
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• 제36권2호
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• pp.87-100
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• 2024

Total hip arthroplasty (THA) is an effective treatment for osteoarthritis, and the popularity of the direct anterior approach has increased due to more rapid recovery and increased stability. Instability, commonly caused by component malposition, remains a significant concern. The dynamic relationship between the pelvis and lumbar spine, deemed spinopelvic motion, is considered an important factor in stability. Various parameters are used in evaluating spinopelvic motion. Understanding spinopelvic motion is critical, and executing a precise plan for positioning the implant can be difficult with manual instrumentation. Robotic and/or navigation systems have been developed in the effort to enhance THA outcomes and for implementing spinopelvic parameters. These systems can be classified into three categories: X-ray/fluoroscopy-based, imageless, and computed tomography (CT)-based. Each system has advantages and limitations. When using CT-based systems, preoperative CT scans are used to assist with preoperative planning and intraoperative execution, providing feedback on implant position and restoration of hip biomechanics within a functional safe zone developed according to each patient's specific spinopelvic parameters. Several studies have demonstrated the accuracy and reproducibility of robotic systems with regard to implant positioning and leg length discrepancy. Some studies have reported better radiographic and clinical outcomes with use of robotic-assisted THA. However, clinical outcomes comparable to those for manual THA have also been reported. Robotic systems offer advantages in terms of accuracy, precision, and potentially reduced rates of dislocation. Additional research, including conduct of randomized controlled trials, will be required in order to evaluate the long-term outcomes and cost-effectiveness of robotic-assisted THA.

• Journal of Korean Neurosurgical Society
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• 제58권4호
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• pp.357-362
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• 2015

Objective : To investigate risk factors for S1 screw loosening after lumbosacral fusion, including spinopelvic parameters and paraspinal muscles. Methods : We studied with 156 patients with degenerative lumbar disease who underwent lumbosacral interbody fusion and pedicle screw fixation including the level of L5-S1 between 2005 and 2012. The patients were divided into loosening and non-loosening groups. Screw loosening was defined as a halo sign larger than 1 mm around a screw. We checked cross sectional area of paraspinal muscles, mean signal intensity of the muscles on T2 weight MRI as a degree of fatty degeneration, spinopelvic parameters, bone mineral density, number of fusion level, and the characteristic of S1 screw. Results : Twenty seven patients showed S1 screw loosening, which is 24.4% of total. The mean duration for S1 screw loosening was $7.3{\pm}4.1$ months after surgery. Statistically significant risk factors were increased age, poor BMD, 3 or more fusion levels (p<0.05). Among spinopelvic parameters, a high pelvic incidence (p<0.01), a greater difference between pelvic incidence and lumbar lordotic angle preoperatively (p<0.01) and postoperatively (p<0.05). Smaller cross-sectional area and high T2 signal intensity in both multifidus and erector spinae muscles were also significant muscular risk factors (p<0.05). Small converging angle (p<0.001) and short intraosseous length (p<0.05) of S1 screw were significant screw related risk factors (p<0.05). Conclusion : In addition to well known risk factors, spinopelvic parameters and the degeneration of paraspinal muscles also showed significant effects on the S1 screw loosening.

• Journal of Korean Neurosurgical Society
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• 제54권3호
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• pp.207-210
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• 2013

Objective : To compare spinopelvic parameters in young adult patients with spondylolysis to those in age-matched patients without spondylolysis and investigate the clinical impact of sagittal spinopelvic parameters in patients with L5 spondylolysis. Methods : From 2009 to 2012, a total of 198 young adult male patients with spondylolysis were identified. Eighty age-matched patients without spondylolysis were also selected. Standing lateral films that included both hip joints were obtained for each subject. Pelvic incidence (PI), sacral slope (SS), pelvic tilt, lumbar lordosis angle, sacral inclination, lumbosacral angle, and sacral table angle were measured in both groups. A comparative study of the spinopelvic parameters of these two groups was performed using SPSS 15.0 (SPSS Inc., Chicago, IL, USA). Results : Among the aforementioned spinopelvic parameters, PI, SS and STA were significantly different between patients with spondylolysis and those without spondylolysis. PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. Conclusion : PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. Patients with spondylolysis have low STA at birth, which remains constant during growth; a low STA translates into high SS. As a result, PI is also increased in accordance with SS. Therefore, we suggest that STA is an important etiologic factor in young adult patients with L5 spondylolysis.

• Journal of Korean Neurosurgical Society
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• 제53권2호
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• pp.96-101
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• 2013

Objective : The purpose of this study was to analyze the differences of spinopelvic parameters between degenerative spondylolisthesis (DSPL) and isthmic spondylolisthesis (ISPL) patients. Methods : Thirty-four patients with DSPL and 19 patients with ISPL were included in this study. Spinopelvic parameters were evaluated on whole spine X-rays in a standing position. The following spinopelvic parameters were measured : pelvic incidence (PI), sacral slope, pelvic tilt (PT), lumbar lordosis (LL), and sagittal vertical axis from C7 plumb line (SVA). The population of patients was compared with a control population of 30 normal and asymptomatic adults. Results : There were statistically significant differences in LL (p=0.004) and SVA (p=0.005) between the DSPL and ISPL group. The LL of DSPL ($42{\pm}13^{\circ}$) was significantly lower than that of the control group ($48{\pm}11^{\circ}$; p=0.029), but that of ISPL ($55{\pm}6^{\circ}$) was significantly greater than a control group (p=0.004). The SVA of DSPL ($55{\pm}49$ mm) was greater than that of a control group (<40 mm), but that of ISPL ($21{\pm}22$ mm) was within 40 mm as that of a control group. The PT of DSPL ($24{\pm}7^{\circ}$) and ISPL ($21{\pm}7^{\circ}$) was significantly greater than that of a control group ($11{\pm}6^{\circ}$; p=0.000). Conclusion : Both symptomatic DSPL and ISPL patients had a greater PI than that of the asymptomatic control group. In conclusion, DSPL populations are likely to have global sagittal imbalance (high SVA) compared with ISPL populations because of the difference of lumbar lordosis between two groups.

• Journal of Korean Neurosurgical Society
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• 제55권6호
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• pp.331-336
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• 2014

Objective : The purpose of this study was to evaluate the differences in sagittal spinopelvic alignment between lumbar degenerative spondylolisthesis (DSPL) and degenerative spinal stenosis (DSS). Methods : Seventy patients with DSPL and 72 patients with DSS who were treated with lumbar interbody fusion surgery were included in this study. The following spinopelvic parameters were measured on whole spine lateral radiographs in a standing position : pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LL), L4-S1 segmental lumbar angle (SLL), thoracic kyphosis (TK), and sagittal vertical axis from the C7 plumb line (SVA). Two groups were subdivided by SVA value, respectively. Normal SVA subgroup and positive SVA subgroup were divided as SVA value (<50 mm and ${\geq}50mm$). Spinopelvic parameters/PI ratios were assessed and compared between the groups. Results : The PI of DSPL was significantly greater than that of DSS (p=0.000). The SVA of DSPL was significantly greater than that of DSS (p=0.001). In sub-group analysis between the positive (34.3%) and normal SVA (65.7%), there were significant differences in LL/PI and SLL/PI (p<0.05) in the DSPL group. In sub-group analysis between the positive (12.5%) and normal SVA (87.5%), there were significant differences in PT/PI, SS/PI, LL/PI and SLL/PI ratios (p<0.05) in the DSS group. Conclusion : Patients with lumbar degenerative spondylolisthesis have the propensity for sagittal imbalance and higher pelvic incidence compared with those with degenerative spinal stenosis. Sagittal imbalance in patients with DSPL is significantly correlated with the loss of lumbar lordosis, especially loss of segmental lumbar lordosis.

• The Journal of Korean Physical Therapy
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• 제31권2호
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• pp.122-128
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• 2019

Purpose: This study examined the effects of sagittal spinopelvic alignment on the clinical parameters, motor symptoms, and respiratory function in patients with mild to moderate Parkinson's disease (PD). Methods: This study was a prospective assessment of treated patients (n=28, Hoehn and Yahr (H&Y) stage 2-3) in a PD center. Twenty-eight subjects ($68.5{\pm}5.7yrs$) participated in this study. The clinical and demographic parameters, including age, sex, symptoms duration, treatment duration, and H&Y stage, were collected. Kinematic analysis was conducted in the upright standing posture with a motion capture system. A pulmonary function test (PFT) was performed in the sitting position using a spirometer. The motor symptoms were assessed on part III of the movement disorder society sponsored version of the unified Parkinson's disease rating scale (MDS-UPDRS). SPSS 18.0 was used to analyze the collected data. Results: The exceeding 12 degrees group of the lower trunk showed significantly higher on the clinical parameters than the below 12 degrees group. In addition, the exceeding 12 degrees group of the lower trunk showed a significantly lower forced expiratory volume at one second (FEV1) / forced vital capacity (FVC) (%) and 25-75% forced mid-expiratory flow (FEF) (L/s) than in the below group. On the other hand, there was no difference in the upper trunk and the cervical pelvis between the groups. Conclusion: These findings suggest that the sagittal balance in the lower trunk is related to the clinical parameters and respiratory function, but not the motor symptoms in patients with mild to moderate PD.

• 한국산학기술학회논문지
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• 제15권2호
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• pp.962-969
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• 2014

본 연구는 한국의 건강한 청소년을 대상으로 Rasterstereography를 이용하여 성별에 따른 척추-골반 정렬 패턴을 분석하여 특성을 확인하고, 각 변수의 상관관계를 확인하기 위하여 수행하였다. 2013년 5월부터 10월까지 정상 청소년 61명(남 31명, 여 30명)을 대상으로 실시하였고, 평균 나이는 $16.40{\pm}2.20$세였다. 그 결과 PSIS비율이 남자 $21.15{\pm}2.40$%, 여자 $23.41{\pm}3.28$%로 유의한 차이가 있었으며(p<.01), 요추전만각에서 남자 $33.44{\pm}8.46^{\circ}$, 여자 $38.96{\pm}8.11^{\circ}$로 유의한 차이가 있었으나(p<0.01), 그 외의 변수에서 성별에 따른 유의한 차이는 없었다(p>.05). 요추전만각은 골반기울기(r=.348), 흉추후만각(r=.609)과 유의한 상관관계가 있었다. 척추회전각은 흉추후만각(r=-.278), 요추전만각(r=-.256), 척추옆치우침(r=.493)과 유의한 상관관계를 보였다. 본 연구 결과는 한국 청소년의 성별에 따른 Rasterstereography를 이용한 척추-골반 정렬 분석의 기초자료가 될 것이고, 척추 및 골반에 구조적 질환을 가진 청소년과 비교할 수 있는 자료로 활용할 수 있을 것이다.

• Journal of Korean Neurosurgical Society
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• 제56권4호
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• pp.315-322
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• 2014

Objective : Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods : A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. Results : A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance ($R^2=0.286$, p=0.0005). Conclusion : Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back.

• 대한방사선기술학회지:방사선기술과학
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• 제45권5호
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• pp.391-396
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• 2022

The purpose of this study was to investigate the effect of cross arms and palms facing forward on spinopelvic parameters during the whole spine lateral radiography. In addition, we would like to present the usefulness of a posture with the palm facing forward during whole spine lateral radiography of the spine using EOS. The subjects of this study were images of a total of 50 patients (18 males, 32 females) who whole spine lateral radiography using the conventional method and the EOS method from October 2020 to March 2021. The posture used in this study was set as 'CAP' for cross arms and 'PUSH' for posture with palms facing forward. In this study, among the spinal stability factors, thoracic kyphosis (thoracic vertebrae 4 to 12), lumbar lordosis (lumbar vertebrae 1 to sacrum 1), sagittal vertical axis, sacral slope, and shoulder flexion angle were compared on average. The mean thoracic kyphosis was 34.52±12.46° for CAP and 28.46±10.81° for PUSH (p<0.01). The lumbar lordosis of CAP was 42.45±17.45°and that of PUSH was 40.56±16.14°(p>0.57). The sagittal vertical axis was 26.59±34.34 mm in CAP and 21.21±35.41 mm in PUSH (p>0.44). In CAP, the sacral slope was 30.96±10.29°, and in PUSH, it was 31.01±10.19° (p>0.98). shoulder flexion angle was 38.31±8.24° for CAP and 26,08±6.71° for PUSH(p<0.01). As a result of this study, the PUSH posture is considered to be a posture that can minimize the shoulder flexion angle and can perform a stable examination while minimizing changes in spino-pelvic parameter.