[Scoliosis] Correlation of Pelvic Orientation With Adult Scoliosis

[Justin]

Journal of Spinal Disorders & Techniques
Issue: Volume 23(7), October 2010, pp 461-466

Correlation of Pelvic Orientation With Adult Scoliosis

Hong, Jae-Young MD*; Suh, Seung-Woo MD, PhD*; Modi, Hitesh N. MS*; Hur, Chang-Yong MD, PhD†; Yang, Jae-Hyuk MD*; Song, Hae-Ryong MD, PhD‡. Author Information: *Department of Orthopedics, Scoliosis Research Institute, †Department of Spine Surgery, ‡Rare Disease Institute, Korea University Guro Hospital, Seoul, South Korea. © 2010 Lippincott Williams & Wilkins, Inc.

Study Design: Prospective analysis of elderly volunteers with adult scoliosis.

Objectives: To analyze the correlation between the sagittal pelvic parameters and adult scoliosis.

Summary of Background Data: There are little data on the relationship between the sagittal pelvic parameters and adult scoliosis.

Methods: The study group comprised 108 elderly volunteers (21 men and 87 women). All underwent anteroposterior and lateral radiographs of whole spine including hip joints. The participants were classified into 3 groups: normal (Cobb angle <10 degrees), low grade (Cobb angle 10 to 19 degrees), and high grade (Cobb angle >=20 degrees). The radiographic parameters were magnitude, location and direction of curves, sacral slope, pelvic tilting, pelvic incidence, S1 overhang, thoracic kyphosis, lumbar lordosis, and C7 plumbline. Statistical analysis was performed to identify the significant differences between the groups. Analysis of variance and Pearson correlation coefficient were used to determine the significance.

Results: The mean age and Cobb angle of the participants was 73 years (range: 61 to 87 y), and 11.2 degrees (range: 0.3 to 36.3 degrees), respectively. There were no significant differences in the sacral slope, thoracic kyphosis, and lumbar lordosis between the 3 groups (P>0.05, analysis of variance). The mean pelvic tilting of the high-grade or low-grade groups was significantly higher than that of the normal group (P<0.0001, P=0.003, Tukey HSD post hoc test). The high-grade group had significantly higher pelvic incidence than either the low-grade or normal groups (P=0.016, P<0.0001), and the low-grade group had higher pelvic incidence than the normal group (P<0.0001). The high-grade or low-grade groups had a significantly higher S1 overhang than the normal groups (P<0.0001, P=0.002). Comparing the C7 plumbline, high-grade or low-grade groups had a significantly higher value than normal groups (P<0.0001, P=0.012). The pelvic incidence, pelvic tilting, and S1 overhang were significantly correlated with the magnitude of curvature (r=0.592, P=0.0001; r=0.434, P=0.0001; and r=0.461, P=0.0001, respectively).

Conclusions: There was a significant correlation between the sagittal pelvic parameters and adult scoliosis in elderly volunteers. There was a significant difference in the pelvic incidence between the normal, low-grade, high-grade adult scoliosis groups. The pelvic tilting and S1 overhang of the high-grade or low-grade groups were significantly higher than the normal group. These 3 parameters were also associated with the magnitude of curvature.

[Susan.303]

I'm so glad to see you mention this study as I read about it online but didn't understand the conclusions. Do you know in what direction the pelvic tilt different in us scoliosis patients? Is it tilted forward more, and maybe I should mentally being trying to tuck it under, tilt back....or is it the other way around? My hope is to mindfully adjust my posture while walking so that might help slow down my scoliosis.

[Justin]

Hi Susan,

There are many classifications of scoliosis. Compensatory scoliosis is usually associated with a leg-length discrepancy, which causes an inherent pelvic tilt that is seen in addition to the scoliotic curve(s). This publication has a good discussion on pelvic tilt and scoliosis:

Hoikka V, Ylikoski M, Tallroth K. Leg-Length Inequality has Poor Correlation with Lumbar Scoliosis, A Radiological Study of 100 Patients with Chronic Low-Back Pain. Arch Orthop Trauma Surg, 1989; 108(3):173-175.

Here's the Abstract...the full-text has a fee associated with it.

Abstract

Leg-length inequality and its hypothetical consequences, pelvic tilt and lumbar scoliosis, were measured in 100 young or middle-aged adults suffering from chronic low-back pain. Leg-length inequality had a good correlation with the pelvic tilt assessed from the iliac crests, a moderate correlation with the sacral tilt, but a poor correlation with the lumbar scoliosis. The sacral tilt correlated well with the lumbar scoliosis when the tilt was more than 3° but poorly when it was smaller. Thus, there is a gradually decreasing correlation between the posture parameters when moving from the hips up to the lumbar spine. We conclude that before a radiologically observed leg-length inequality be considered as the cause of low-back pain, an erect-posture radiograph of the whole pelvis and lumbar spine is essential, in order to assess an existing pelvic tilt and scoliosis.


Archives of Orthopaedic and Trauma Surgery, Volume 108, Number 3 - SpringerLink

I'm so glad to see you mention this study as I read about it online but didn't understand the conclusions. Do you know in what direction the pelvic tilt different in us scoliosis patients? Is it tilted forward more, and maybe I should mentally being trying to tuck it under, tilt back....or is it the other way around? My hope is to mindfully adjust my posture while walking so that might help slow down my scoliosis.

[Susan.303]

"The pelvic tilting and S1 overhang of the high-grade or low-grade groups were significantly higher than the normal group".

Justin, I get totally lost in the lingo. Maybe you can help clarify it for me, as I think you just tried to do. Is the above mentioned "Pelvic Tilting" in a particular direction like down and forward, or under and up? Or is this study just saying the "Pelvic Tilting" in ANY direction, is greater in scoliosis patients and those with one leg shorter than the other. <--Kind of a "No Duh" conclusion in my book. lol

Thanks for your help,
Susan