Sagittal spinal-pelvic alignment in patients with Crowe type IV developmental dysplasia of the hip
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RESEARCH ARTICLE
Open Access
Sagittal spinal-pelvic alignment in patients with Crowe type IV developmental dysplasia of the hip Peng Ren1,2†, Xiangpeng Kong2†, Wei Chai2* and Yan Wang2*
Abstract Background: The impact of high dislocated dysplastic hips on spinal-pelvic alignment has not been well described. This study aims to evaluate compensatory spinal radiographic changes and presence of back pain in patients with Crowe type IV developmental dysplasia of the hip (DDH). Methods: An observational study was conducted from July 2016 to December 2017, and 49 consecutive patients with Crowe IV DDH were enrolled. Forty-nine sex- and age-matched asymptomatic healthy adults were recruited as the controls. The sacral slope (SS), lumbar lordosis (LL), spino-sacral angle (SSA), C7 tilt (C7T), and sagittal vertical axis (SVA [C7]) were measured on lateral whole spine radiographs. The presence of low back pain and visual analogue scale (VAS) scores were recorded. Results: The patients with Crowe IV DDH showed significantly greater SS (47.5 ± 7.5° vs. 40.4 ± 6.7°, p < 0.05), LL (− 63.7 ± 9.2° vs. − 53.3 ± 11.5°, P < 0.05), SSA (141.8° ± 7.2° vs. 130.6 ± 7.9°, p < 0.05), C7T (93.9 ± 3.6° vs. 91.1 ± 3.7°, P < 0.05), and lower SVA(C7) (− 16 mm[− 95–45] vs. 6.4 mm[− 52–47], p < 0.05) compared to the controls. The patients with bilateral Crowe IV DDH also exhibited larger SS, LL, SSA, and C7T and a smaller SVA (C7) than those with unilateral Crowe IV DDH. Sixty-three percent of the patients with Crowe IV DDH reported low back pain. Conclusion: The patients with Crowe IV DDH exhibited abnormal spinal-pelvic alignment characterized by anterior pelvic tilt, lumbar hyperlordosis, and a backward-leaning trunk. Bilateral Crowe IV DDH had a greater impact on spinal-pelvic alignment than unilateral Crowe IV DDH. Keywords: Spinal-pelvic alignment, Sacral slope, Lumbar lordosis, Developmental dysplasia of the hip, Hip-spine syndrome
Background The compensatory mechanisms of the spine, pelvis, and lower limbs are essential in daily activities to maintain a stable, upright posture in the sagittal plane [1]. Sagittal spinal-pelvic alignment, first described in 1998, has been well studied in patients with spinal disorders, including low back pain, spondylolisthesis, and spinal deformities * Correspondence: [email protected]; [email protected] † Peng Ren and Xiangpeng Kong are co-first author 2 Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China Full list of author information is available at the end of the article
[2–5]. Patients with severe hip osteoarthritis (OA) have also been reported to have abnormal sagittal spinalpelvic alignment [6, 7]. The incidence of hip dysplastic dislocation was reported to be between 0.1–0.15% in newborns and often involved unilateral side [8]. Girls are more likely to be involved than boys [9, 10]. In adults, high dislocated dysplastic hips are classified as Crowe IV developmental dysplasia of the hip (DDH), and may lead to hip pai
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