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Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine.

Jentzsch T, Geiger J, Bouaicha S, Slankamenac K, Nguyen-Kim TD, Werner CM - BMC Med Imaging (2013)

Bottom Line: PI was significantly and linearly correlated with (4) LL (p = < 0.0001).An increased PI was also significantly associated with more sagitally oriented FJs at L5/S1 (p = 0.01).Once symptomatic or in the event of spinal trauma, patients with increased PI and LL could benefit from corrective surgery and spondylodesis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Trauma Surgery, Department of Surgery, University Hospital Zuerich, Zuerich, Switzerland. thorsten.jentzsch@usz.ch.

ABSTRACT

Background: Correct sagittal alignment with a balanced pelvis and spine is crucial in the management of spinal disorders. The pelvic incidence (PI) describes the sagittal pelvic alignment and is position-independent. It has barely been investigated on CT scans. Furthermore, no studies have focused on the association between PI and facet joint (FJ) arthritis and orientation. Therefore, our goal was to clarify the remaining issues about PI in regard to (1) physiologic values, (2) age, (3) gender, (4) lumbar lordosis (LL) and (5) FJ arthritis and orientation using CT scans.

Methods: We retrospectively analyzed CT scans of 620 individuals, with a mean age of 43 years, who presented to our traumatology department and underwent a whole body CT scan, between 2008 and 2010. The PI was determined on sagittal CT planes of the pelvis by measuring the angle between the hip axis to an orthogonal line originating at the center of the superior end plate axis of the first sacral vertebra. We also evaluated LL, FJ arthritis and orientation of the lumbar spine.

Results: 596 individuals yielded results for (1) PI with a mean of 50.8°. There was no significant difference for PI and (2) age, nor (3) gender. PI was significantly and linearly correlated with (4) LL (p = < 0.0001). Interestingly, PI and (5) FJ arthritis displayed a significant and linear correlation (p = 0.0062) with a cut-off point at 50°. An increased PI was also significantly associated with more sagitally oriented FJs at L5/S1 (p = 0.01).

Conclusion: PI is not correlated with age nor gender. However, this is the first report showing that PI is significantly and linearly associated with LL, FJ arthritis and more sagittal FJ orientation at the lower lumbar spine. This may be caused by a higher contact force on the lower lumbar FJs by an increased PI. Once symptomatic or in the event of spinal trauma, patients with increased PI and LL could benefit from corrective surgery and spondylodesis.

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Pelvic Incidence (PI) and Facet Joint (FJ) Arthritis: PI and FJ arthritis displayed a significant linear correlation.
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Figure 9: Pelvic Incidence (PI) and Facet Joint (FJ) Arthritis: PI and FJ arthritis displayed a significant linear correlation.

Mentions: PI and FJ arthritis displayed a significant association (p = 0.0062, odds ratio 1.020 [95%-CI 1.005, 1.034]) (Figure 8 and Figure 7), whereby an increased PI was associated with increased FJ arthritis. Interestingly, the cut-off point ranged around a PI of 50°. The median PI of 49.6° (ICR 43°-56.8°) was lower in 293 individuals without FJ arthritis (grade 0) compared to the median PI of 50.4° (IQR 43.5°-59.3°) in 301 individuals with signs of FJ arthritis (grade 1–3). The unadjusted difference was 1.76° (95% CI: -0.02-3.5, p = 0.052). The median PI of 51.7° (IQR 43.2-57.0) was highest in 97 individuals with the most severe FJ arthritis (grade 3) compared to the median PI of 49.8° in individuals with a lower grade of FJ arthritis (grade 0–2). The unadjusted difference was 2.2 (95% CI: -0.18-4.59, p = 0.070). There was a significant difference in the logarithm of the mean PI and FJ orientation at the lower lumbar spine. Specifically, an increased PI was significantly associated with sagitally oriented FJs at L5/S1 (p = 0.01) (Figure 9 and Figure 7). However, comparison of the logarithm of the mean PI with FJ orientation at the upper lumbar spine did not reveal any significant differences (p = 0.71, 0.23 and 0.35 at L2/3, L3/4 and L4/5).


Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine.

Jentzsch T, Geiger J, Bouaicha S, Slankamenac K, Nguyen-Kim TD, Werner CM - BMC Med Imaging (2013)

Pelvic Incidence (PI) and Facet Joint (FJ) Arthritis: PI and FJ arthritis displayed a significant linear correlation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228336&req=5

Figure 9: Pelvic Incidence (PI) and Facet Joint (FJ) Arthritis: PI and FJ arthritis displayed a significant linear correlation.
Mentions: PI and FJ arthritis displayed a significant association (p = 0.0062, odds ratio 1.020 [95%-CI 1.005, 1.034]) (Figure 8 and Figure 7), whereby an increased PI was associated with increased FJ arthritis. Interestingly, the cut-off point ranged around a PI of 50°. The median PI of 49.6° (ICR 43°-56.8°) was lower in 293 individuals without FJ arthritis (grade 0) compared to the median PI of 50.4° (IQR 43.5°-59.3°) in 301 individuals with signs of FJ arthritis (grade 1–3). The unadjusted difference was 1.76° (95% CI: -0.02-3.5, p = 0.052). The median PI of 51.7° (IQR 43.2-57.0) was highest in 97 individuals with the most severe FJ arthritis (grade 3) compared to the median PI of 49.8° in individuals with a lower grade of FJ arthritis (grade 0–2). The unadjusted difference was 2.2 (95% CI: -0.18-4.59, p = 0.070). There was a significant difference in the logarithm of the mean PI and FJ orientation at the lower lumbar spine. Specifically, an increased PI was significantly associated with sagitally oriented FJs at L5/S1 (p = 0.01) (Figure 9 and Figure 7). However, comparison of the logarithm of the mean PI with FJ orientation at the upper lumbar spine did not reveal any significant differences (p = 0.71, 0.23 and 0.35 at L2/3, L3/4 and L4/5).

Bottom Line: PI was significantly and linearly correlated with (4) LL (p = < 0.0001).An increased PI was also significantly associated with more sagitally oriented FJs at L5/S1 (p = 0.01).Once symptomatic or in the event of spinal trauma, patients with increased PI and LL could benefit from corrective surgery and spondylodesis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Trauma Surgery, Department of Surgery, University Hospital Zuerich, Zuerich, Switzerland. thorsten.jentzsch@usz.ch.

ABSTRACT

Background: Correct sagittal alignment with a balanced pelvis and spine is crucial in the management of spinal disorders. The pelvic incidence (PI) describes the sagittal pelvic alignment and is position-independent. It has barely been investigated on CT scans. Furthermore, no studies have focused on the association between PI and facet joint (FJ) arthritis and orientation. Therefore, our goal was to clarify the remaining issues about PI in regard to (1) physiologic values, (2) age, (3) gender, (4) lumbar lordosis (LL) and (5) FJ arthritis and orientation using CT scans.

Methods: We retrospectively analyzed CT scans of 620 individuals, with a mean age of 43 years, who presented to our traumatology department and underwent a whole body CT scan, between 2008 and 2010. The PI was determined on sagittal CT planes of the pelvis by measuring the angle between the hip axis to an orthogonal line originating at the center of the superior end plate axis of the first sacral vertebra. We also evaluated LL, FJ arthritis and orientation of the lumbar spine.

Results: 596 individuals yielded results for (1) PI with a mean of 50.8°. There was no significant difference for PI and (2) age, nor (3) gender. PI was significantly and linearly correlated with (4) LL (p = < 0.0001). Interestingly, PI and (5) FJ arthritis displayed a significant and linear correlation (p = 0.0062) with a cut-off point at 50°. An increased PI was also significantly associated with more sagitally oriented FJs at L5/S1 (p = 0.01).

Conclusion: PI is not correlated with age nor gender. However, this is the first report showing that PI is significantly and linearly associated with LL, FJ arthritis and more sagittal FJ orientation at the lower lumbar spine. This may be caused by a higher contact force on the lower lumbar FJs by an increased PI. Once symptomatic or in the event of spinal trauma, patients with increased PI and LL could benefit from corrective surgery and spondylodesis.

Show MeSH
Related in: MedlinePlus