Toward understanding the underlying mechanisms of pelvic tilt reserve in adult spinal deformity: the role of the 3D hip orientation
TypeArticles dans des revues avec comité de lecture
Purpose: To explore 3D hip orientation in standing position in subjects with adult spinal deformity (ASD) presenting with different levels of compensatory mechanisms. Methods: Subjects with ASD (n = 159) and controls (n = 68) underwent full-body biplanar X-rays with the calculation of 3D spinopelvic, postural and hip parameters. ASD subjects were grouped as ASD with knee flexion (ASD-KF) if they compensated by flexing their knees (knee flexion ≥ 5°), and ASD with knee extension (ASD-KE) otherwise (knee flexion < 5°). Spinopelvic, postural and hip parameters were compared between the three groups. Univariate and multivariate analyses were then computed between spinopelvic and hip parameters. Results: ASD-KF had higher SVA (67 ± 66 mm vs. 2 ± 33 mm and 11 ± 21 mm), PT (27 ± 14° vs. 18 ± 9° and 11 ± 7°) and PI-LL mismatch (20 ± 26° vs − 1 ± 18° and − 13 ± 10°) when compared to ASD-KE and controls (all p < 0.05). ASD-KF also had a more tilted (34 ± 11° vs. 28 ± 9° and 26 ± 7°), anteverted (24 ± 6° vs. 20 ± 5° and 18 ± 4°) and abducted (59 ± 6° vs. 57 ± 4° and 56 ± 4°) acetabulum, with a higher posterior coverage (100 ± 6° vs. 97 ± 7° for ASD-KE) when compared to ASD-KE and controls (all p < 0.05). The main determinants of acetabular tilt, acetabular abduction and anterior acetabular coverage were PT, SVA and LL (adjusted R² [0.12; 0.5]). Conclusions: ASD subjects compensating with knee flexion have altered hip orientation, characterized by increased posterior coverage (acetabular anteversion, tilt and posterior coverage) and decreased anterior coverage which can together lead to posterior femoro-acetabular impingement, thus limiting pelvic retroversion. This underlying mechanism could be potentially involved in the hip-spine syndrome.
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Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants KAWKABANI, Georges; SALIBY, Renée Maria; MEKHAEL, Mario; RACHKIDI, Rami; MASSAAD, Abir; GHANEM, Ismat; KHARRAT, Khalil; KREICHATI, Gaby; SAAD, Eddy; LAFAGE, Virginie; LAFAGE, Renaud; SKALLI, Wafa; ASSI, Ayman (Elsevier BV, 2021)Background: Adults with spinal deformity (ASD) are known to have postural malalignment affecting their quality of life. Classical evaluation and follow-up are usually based on full-body static radiographs and health related ...
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ASSI, Ayman; BAKOUNY, Ziad; BIZDIKIAN, Aren Joe; OTAYEK, Joeffroy; YARED, Fares; LAFAGE, Virginie; KHALIL, Nour; MASSAAD, Abir; GHANEM, Ismat; SKALLI, Wafa (ELSEVIER, 2018)Patients with adult spinal deformities (ASD) are known to have altered postural alignment aﬀecting their quality of life and activities of daily living, especially gait. The Sagittal Vertical Axis (SVA), a postural parameter ...