The Effect of the Fixed Sagittal Plane caused by Spinal Instrumentation at an Early Age on the Natural Evolution of Pelvic Incidence During Growth Bekmez.

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The Effect of the Fixed Sagittal Plane caused by Spinal Instrumentation at an Early Age on the Natural Evolution of Pelvic Incidence During Growth Bekmez S, Demirkiran G, Dede O, Kruyt MC, Atici Y, Balioglu B, Yazici M

Introduction Sagittal pelvic alignment has profound impact on outcomes after spinal surgery In normal children, there is a natural evolution of Pelvic incidence during growth Increase of approx. 0.6 deg/year

Purpose “Determine the effect of stabilizing the sagittal spinal alignment on the natural progression of pelvic orientation in children.”

Patients and Methods Four separate Institutions Between 2004-2013 36 patients with idiopathic or idiopathic-like EOS Lower instrumented vertebra L3 or upper >2 years f/u

Radiographic Analyzes Sagittal balance (SB) Pelvic Incidence (PI) Sacral slope (SS) Pelvic tilt (PT) Thoracic kyphosis (TK: T2-T12) Lumbar lordosis (LL: L1-L5)

Results Average age at the index surgery 7.7 years (range 4 to 10) Average f/u time 72 months (range 27 to 132) Average L1-S1 50.1° (preop.) 41.6° (index sur.)  46.8 (last f/u)

Results The difference is statistically significant Average PI of the study group 44.8° (preop.) 44° (index sur.) 45.9° (last f/u) If sagittal alignment have not been stabilized in these children, the average PI would progress to 48.7° The difference is statistically significant

Results No significant difference in TK and L1-S1 angle during follow-up No correlation between L1-S1 angles and PI

Conclusion The natural evolution of pelvic incidence was not observed after stabilizing the lumbar sagittal alignment The consequences of this arrest in adult period are not known These patients should therefore be monitored carefully during follow-up