1. DR. Jamlick Micheni Muthuuri
Assessment of Spino-pelvic morphometry, a predictor of lumbosacral instability
DR. Jamlick Micheni Muthuuri

2. organization Objectives Rationale Methodology Data Analysis Results
Introduction & Background
Objectives
Rationale
Methodology
Data Analysis
Results
Discussion
Conclusion
References

3. Introduction & Background
What is spinal Balance?
Both
Central axis - center of mass of the human body
Plumb line – drawn from body of CV7 (anteriorly) to SV1 (posteriorly)

4. What measurements are taken to determine the spino-pelvic morphology as a measure of spinal balance?
Lumbar lordosis
Sacral slope
Pelvic tilt
Pelvic incidence
Pelvic overhang

5. Definitions
LL = Lordosis is an increased inward curving of the lumbar spine
SS = Orientation of the sacral plate in the horizontal plane
PI = Anatomic constant which measures the thickness of the pelvis (distance between the centre of sacrum and the centre of hips in the sagittal plain.
PT = Orientation of the pelvis in the sagittal plane, described either as anterior or posterior planes
SO = Distance between the centre of the sacrum and the bicoxo-femoral axis in the horizontal plane

6. Objectives
To determine which posture (represented by a morphometric measurement) would predict instability.

7. MEASUREMENTS
Pelvic incidence measured using the Duval-Beaupere method:
SS=Sacral Slope,
PI=Pelvic Incidence,
PT=Pelvic Tilt).

8. KEY Results Group 1 (study) Instability (L4L5 OR L5S1)
Group 2 (Control)
NORMAL MRI

9. Gender distribution Male Female Total % Group 1 24 32 56 45 Group 2 36
Male
Female
Total %
Group 1 24 32 56 45
Group 2 36 68 55
124
100

10. Summary of distribution according to their age groups

11. BMI BMI Mean CI SD Group 1 29.2 0.1 4.9 Group 2 28.4 7.3 P VALUE
Mean CI SD
P VALUE
Group 1
29.2
0.1
4.9
Group 2
28.4
7.3
0.7241

12. Distribution of the angle of lumbar lordosis
Mean CI SD
P VALUE
Group 1
36.9
0.2
20.5
Group 2
41.9
0.3
22.4
0.3896

13. Distribution of the angle of sacral slope
Mean CI SD
TTEST
Group 1
33.8
0.1
13.2
Group 2
41.3
12.3
0.0232

14. Distribution of the angle of pelvic tilt
Mean CI SD
P VALUE
Group 1
24.3
0.2
12.7
Group 2
21.6
15.3

15. Distribution of the angle of pelvic incidence morphological constant
Mean CI SD
P VALUE
Group 1
66.4
0.1
11.3
Group 2
55.2
11.9

16. Distribution of the sacral overhang (displacement)
SARAL OVERHANG
Mean CI SD
P VALUE
Group 1
45.3 mm
0.3
21.4
Group 2
39.8 mm
26.4
0.3670

17. Conclusion
Sagittal spino-pelvic alignment is measurements are significantly different in chronic LBP
There is a pattern of imbalance among those with instability
Pelvic incidence is significantly higher in those with instability
Positional parameters (LL, SS, and SO) are significantly reduced in those with instability,
PT is increased to compensate for reduce SS.

18. Clinical Application The assessment of sagittal balance:
essential in the predication of instability
a consideration during planning for spine surgery.
A simple discectomy in an instable segment
Loss of lordosis in fusion

19. References Roussouly P, Gollogly S, Berthonnaud E, et al.
Classification of the normal variation in the sagittal alignment of the human lumbar spine and
pelvis in the standing position. Spine 2005;30:346–53.
Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 2005;18:40–7.
Legaye J, Duval-Beaupere G. Sagittal plane alignment of the spine and gravity: a radiological and clinical evaluation. Acta Orthop Belg 2005;71:213–20.
Rillardon L, Levassor N, Guigui P, et al. Validation of a tool to measure pelvic and spinal parameters of sagittal balance. Rev Chir Orthop Reparatrice Appar Motil 2003;89:218–27.
Jackson RP, Hales C. Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine 2000;25:2808–15.

20. THANK YOU
IT’S ALL ABOUT BALANCE