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Relative pelvic version displays persistent compensatory measures with normalised sagittal vertical axis after deformity correction

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Abstract

Purpose

A normal sagittal vertical axis (SVA) after spinal deformity correction can yield mechanical complications of up to 30%. Post-operative compensatory pelvic orientation can produce a normal SVA. We assess relative pelvic version (RPV), an individualised measure, for persistent post-operative compensatory measures.

Methods

Adult spinal deformity (ASD) patients who were treated operatively, with a normal SVA (< ± 50 mm) at 6-week follow-up were included, who were then followed-up after 2 years. These only included patients with fusion of > 4 vertebrae extending to L5 or below. Six-week subgroups were made regarding pelvis orientation, relative pelvic version (RPV: anteversion, aligned, moderate or severe retroversion) with analysis of patient-related outcome measures (PROMs), complications and spino-pelvic sagittal parameters.

Results

At 6 weeks, 140 patients met the inclusion criteria, 5 (3.6%) patients had anteversion, 59 (42.1%) were aligned, 60 (42.9%) had moderate retroversion and 16 (11.4%) patients had severe retroversion. Follow-up after 2 years demonstrated increased RPV in all groups except the severe RPV group who were more likely to develop SVA > 50 mm. Complications occurred in all groups. Significant 2-year differences were observed between moderate and severe RPV for back pain and PROMs but not between other RPV groups.

Conclusion

Adult spinal deformity patients with a normal SVA after spino-pelvic instrumentation carry a significant risk of retroversion progression post-operatively, followed by increased positive sagittal balance. Relative pelvic version (RPV) measurements when categorised into anteversion, aligned, moderate retroversion and severe retroversion at 6 weeks were predictive of PROMs at 2 years.

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Funding

Depuy-Synthes funds were received by European Spine Study Group in support of this work. Relevant financial activities outside the submitted work: consultancy, royalties, grants. Funding was provided by Spineart, K2M, Medtronic, Zimmer Biomet, Alphatec Spine, Clariance.

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Authors and Affiliations

  1. Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France

    Derek T. Cawley, Louis Boissiere, Daniel Larrieu, Takashi Fujishiro, David Kieser & Ibrahim Obeid

  2. Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey

    Caglar Yilgor & Ahmet Alanay

  3. Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain

    Francisco Sánchez Pérez-Grueso

  4. Spine Surgery Unit, University Hospital Vall d’Hebron, Barcelona, Spain

    Ferran Pellisé

  5. Spine Center, Schulthess Klinik, Zurich, Switzerland

    Frank Kleinstück

  6. Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan

    Takashi Fujishiro

  7. Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand

    David Kieser

  8. Mater Private Hospital, Eccles St, Dublin 1, Republic of Ireland

    Derek T. Cawley

Authors
  1. Derek T. Cawley
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  2. Louis Boissiere
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  3. Caglar Yilgor
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  4. Daniel Larrieu
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  5. Takashi Fujishiro
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  7. Ahmet Alanay
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  8. Frank Kleinstück
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  9. Francisco Sánchez Pérez-Grueso
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  10. Ferran Pellisé
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  11. Ibrahim Obeid
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Consortia

The European Spine Study Group (ESSG)

Contributions

DTC: material preparation, analysis, methodology, commented on previous versions of the manuscript, approved current version of manuscript. LB: material preparation, analysis, methodology, commented on previous versions of the manuscript, approved current version of manuscript. CY: material preparation, analysis, methodology, commented on previous versions of the manuscript, approved current version of manuscript. DL: material preparation, analysis, methodology, commented on previous versions of the manuscript, approved current version of manuscript. TF: material preparation, analysis, methodology, commented on previous versions of the manuscript, approved current version of manuscript. DK: material preparation, analysis, methodology, commented on previous versions of the manuscript, approved current version of manuscript. AA: study conception and design, data collection, methodology, funding acquisition, commented on previous versions of the manuscript, approved current version of manuscript. FK: study conception and design, data collection, methodology, funding acquisition, commented on previous versions of the manuscript, approved current version of manuscript. FSP: study conception and design, data collection, methodology, funding acquisition, commented on previous versions of the manuscript, approved current version of manuscript. FP: study conception and design, data collection, methodology, funding acquisition, commented on previous versions of the manuscript, approved current version of manuscript. IO: study conception and design, data collection, methodology, funding acquisition, commented on previous versions of the manuscript, approved current version of manuscript, supervision.

Corresponding author

Correspondence to Derek T. Cawley.

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Cawley, D.T., Boissiere, L., Yilgor, C. et al. Relative pelvic version displays persistent compensatory measures with normalised sagittal vertical axis after deformity correction. Spine Deform 9, 1449–1456 (2021). https://doi.org/10.1007/s43390-021-00345-z

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  • DOI: https://doi.org/10.1007/s43390-021-00345-z

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