Lumbopelvic parameters can be used to predict thoracic kyphosis in adolescents
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ORIGINAL ARTICLE
Lumbopelvic parameters can be used to predict thoracic kyphosis in adolescents Jean‑Luc Clément1 · Federico Solla1 · Veronica Amorese1 · Ioana Oborocianu1 · Olivier Rosello1 · Virginie Rampal1 Received: 20 February 2020 / Revised: 2 March 2020 / Accepted: 10 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Distal thoracic kyphosis (DTK) equivalent to proximal lumbar lordosis (PLL) is the sum of pelvic tilt (PT) and the difference (Δ) between lumbar lordosis (LL) and pelvic incidence (PI): PLL = DTK = PT + Δ. With the assumption that proximal thoracic kyphosis (PTK) is similar to DTK, we propose the equation TK = 2(PT + LL − PI) to express the relationship between thoracic kyphosis (TK) and pelvic parameters. The objective of this work is to verify this relationship in a normal population. Methods Full spine radiographs of 100 adolescents and young adults (13 to 20 years old), free from vertebral pathology, were analyzed. Measurements included pelvic parameters, LL, PLL, DLL, TK, PTK, DTK and C7 global tilt. The measured global TK was compared with the theoretical TK calculated according to the formula TK = 2(PT + LL − PI). Results The difference between measured TK and calculated TK was + 2.3° and correlated with the C7 global tilt (r = 0.86). There was a significant linear regression between TK and PT + ∆ (p 60°, vertebral growth dystrophy, sequelae of fracture, spondylolysis, etc.) were excluded. The spinopelvic parameters were measured using the graphical software “Keops Analyzer” [13]. The inflection
European Spine Journal
Fig. 2 Geometric demonstration of DTK = PT + LL − PI. a We draw a line perpendicular to the inflection line and passing through the middle of SS. b It creates an angle ∆ which added to PI is equal to
LL (angles with perpendicular sides). Δ = LL − PI. c If we associate ∆ and PT, we obtain an angle equal to PLL (perpendicular sides). PLL = PT + ∆ or PLL = DTK = PT + LL − PI
points and limit vertebrae were automatically determined by the software. The sagittal tilt of C7, the angle between the vertical and the line from the center of C7 vertebral body to the middle of the sacral plate, was chosen as the balance parameter. It was positive if the angle was opened forward and negative backward. The calculated TK according to the formula TK = 2(PT + LL − PI) was compared with the measured TK. Correlations were looked for between all parameters.
Table 1 Average, minimum, maximum and standard deviation of pelvic and spinal parameters on 100 EOS sagittal radiographs of healthy adolescents
Ethic This study has been approved by the authors’ Institutional Review Board: CCP (committee for the protection of persons) with Number FC/2019-91.
Statistical analysis It was performed using the XLSTAT Addinsoft software. The means were compared by Student’s t test. Univariate correlations were explored by Pearson’s formula. Multivariate analysis was performed through linear regressions [14].
Results The values of the parameters from the 100
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