Preoperative imaging of spinopelvic pathologies
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. Almansour1 · M. Innmann2 · M. Akbar3 · F. Springer1,4 · C. Rehnitz5 1
Department of Diagnostic and Interventional Radiology, Tübingen University Hospital, Eberhard-KarlsUniversity Tübingen, Tübingen, Germany 2 Center for Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany 3 Clinic for Spine Diseases and Therapies, Meoclinic, Berlin, Germany 4 Department of Radiology, BG Trauma Hospital, Tübingen, Germany 5 Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
Preoperative imaging of spinopelvic pathologies State of the art Introduction Pathologies afflicting the locomotor system encompass over 150 diagnoses [1]. Globally, one in every three patients suffers from a chronic musculoskeletal pathologic entity [1]. According to the World Health Organization (WHO), these pathologies have a far-reaching individual, epidemiological, and economic burden [2]. Furthermore, these pathologies are the main culprits for chronic and unrelenting pain across all ages and all geographies [1, 3]. Interestingly, one of the most substantial global burdens for noncommunicable disease was musculoskeletal pathologies, such as osteoarthritis and low back pain as shown by the 2010 and 2016 Global Burden of Disease data [1, 4, 5]. Diffuse back pain on clinical examination constitutes a real challenge for treating physicians. The lumbar spine and hips are anatomically, physiologically and pathologically interdependent. The diagnosis of spinopelvic pathologies is challenging due to the confusing overlap of symptoms, especially due to overlapping innervation [6]. However, the field of musculoskeletal diagnostics has undergone a revolutionary transformation due to a deeper understanding of skeletal biomechanics and due to technological advancements. Analogous to this transformation, our understanding of spinopelvic conditions has undergone a paradigm shift in terms
of both static and dynamic changes in spinopelvic pathologies and enabled a more accurate delineation of the drivers of disability [7]. As a result, radiologists, orthopedic surgeons and researchers are better equipped to induce a substantial positive impact on patients’ healthrelated quality of life. In the recent literature there has been an increased emphasis on hip osteoarthritis and sagittal malalignment of the spine and on the interplay between them especially in the context of surgical intervention on the hip, the spine or on both [8, 9].
Muskuloskeletal pathologies »are the main culprits for chronic and unrelenting pain across all ages and all geographies Therefore, the purpose of this review is two-fold. Firstly, to describe the standard and state of the art of preoperative diagnostic and planning methods for common spinopelvic pathologies with an emphasis on degenerative entities. Spinopelvic pathologies have a vast spectrum, hence, in this review, preoperative imaging of a few selected pathologies is discussed. Secondly, the purpose is to discuss both the added clinical value and limitations
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