Can pelvic incidence change after spinal deformity correction to the pelvis with S2-alar-iliac screws?
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ORIGINAL ARTICLE
Can pelvic incidence change after spinal deformity correction to the pelvis with S2‑alar‑iliac screws? Chao Wei1 · Scott L. Zuckerman2 · Meghan Cerpa2 · Hong Ma3 · Ming Yang4 · Suomao Yuan4 · Lawrence G. Lenke2 Received: 10 June 2020 / Revised: 14 October 2020 / Accepted: 3 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Pelvic incidence (PI) is assumed to be fixed, yet studies have reported PI changes after long fusions to the pelvis. In a cohort of ASD patients undergoing surgery with S2-alar-iliac (S2AI) screws, we sought to: (1) report the magnitude of PI changes, and (2) evaluate subsequent pelvic parameter changes. Methods A retrospective case series of ASD patients undergoing surgical correction with S2AI screw placement and sagittal cantilever correction maneuvers was conducted. Patients were categorized based on preoperative PI: High-PI (H-PI) (PI ≥ 60°); Normal-PI (N-PI) (60° > PI > 40°); Low-PI (L-PI) (PI ≤ 40°). PI was measured preoperatively and immediately postoperatively. A significant PI change was established a priori at ≥ 6.0. PI, pelvic tilt (PT), lumbar lordosis (LL), and PI-LL mismatch were analyzed. Results In 68 patients (82.3% female, ages 22–75 years), the average change in PI was 4.6° ± 3.1, and 25 (36.8%) had a PI change ≥ 6.0° with breakdown as follows: H-PI 12 (66.7%) patients, 9 (25.87%) patients, and 4 (33.3%) patients. Of 25 patients with PI changes, 10 (14.7%) had a PI increase and 15 (22.1%) had a PI decrease. Significant improvements were seen in PT, LL, PI-LL mismatch in all patients with a PI change ≥ 6.0°, in addition to both subgroups with an increase or decrease in PI. Conclusions PI changes of ≥ 6.0° occurred in 36.8% of patients, and H-PI patients most commonly experienced PI changes. Despite PI alterations, pelvic parameters significantly improved postoperatively. These results may be explained by sacroiliac joint laxity, S2AI screw placement, or aggressive sagittal cantilever techniques. Keywords Pelvic incidence · Adult spinal deformity · S2-alar-iliac screws · Pelvic parameters
Introduction
This work has been previously presented at the 2018 SRS Annual Meeting in Bologna, Italy. * Scott L. Zuckerman [email protected] 1
Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
2
Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, New York, NY, USA
3
Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
4
Department of Spine Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
Symptomatic adult spinal deformity (ASD) has become an increasingly common condition with a prevalence of 32–35% in the general population, and as high as 68 % in patients older than 60 years [1]. Global spinal malalignment often leads to compression of neural structures, resulting in disability, pain, and reduced q
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