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Characterization of the influence of spinopelvic parameters on thoracolumbar trauma

Presented at the 2023 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Joseph S. Withrow, Michael D. Monterey, Analisa Narro, Lauren Haley, Marco Martinez Cruz, Bradley Budde, Duncan Trimble, Dallas Sheinberg, Jennifer Zaragoza, Wen Li, Zhouxuan Li, John Caridi, and John C. Quinn

T he Roussouly classification advanced our current understanding of the heterogeneity of “normal” spine shapes, sagittal balance, spinopelvic parameters, and surgical planning for degenerative spine surgery. 1 , 2 The importance of restoring spinopelvic parameters during deformity corrections and fusion procedures to optimize outcomes is well reported. 3 , 4 Furthermore, biomechanical principles predict different spine morphologies to have a predilection to incur different pathologies. 5 , 6 While there has been extensive characterization of the

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Novel artificial intelligence algorithm: an accurate and independent measure of spinopelvic parameters

Lindsay D. Orosz, Fenil R. Bhatt, Ehsan Jazini, Marcel Dreischarf, Priyanka Grover, Julia Grigorian, Rita Roy, Thomas C. Schuler, Christopher R. Good, and Colin M. Haines

precision. 12 – 15 Although validated software does exist to assist in the measurement of spinopelvic parameters, these continue to require user input to identify several landmarks, and therefore user experience and time are factors preventing widespread adoption. 12 , 16 – 19 There is a need for an automated tool to measure sagittal parameters accurately and independently. Artificial intelligence (AI) has shown promise in carrying out repetitive tasks performed by humans and often achieves a more accurate and reliable result. 16 , 17 , 20 – 22 This study aimed to

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Is achieving optimal spinopelvic parameters necessary to obtain substantial clinical benefit? An analysis of patients who underwent circumferential minimally invasive surgery or hybrid surgery with open posterior instrumentation

Paul Park, Kai-Ming Fu, Robert K. Eastlack, Stacie Tran, Gregory M. Mundis Jr., Juan S. Uribe, Michael Y. Wang, Khoi D. Than, David O. Okonkwo, Adam S. Kanter, Pierce D. Nunley, Neel Anand, Richard G. Fessler, Dean Chou, Mark E. Oppenlander, Praveen V. Mummaneni, and the International Spine Study Group

retrospectively queried. Inclusion criteria for the database included a diagnosis of ASD in addition to age ≥ 18 years and one of the following: coronal Cobb angle > 20°, SVA > 5 cm, PT > 20°, or PI-LL mismatch > 10°. Patients with a minimum of 2 years’ follow-up were included. Surgical treatment consisted of either a circumferential minimally invasive surgery (cMIS) or hybrid surgery consisting of a minimally invasive anterior or lateral surgery combined with open posterior surgery. A total of 223 patients were identified. Based on postoperative optimal spinopelvic parameters

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The influence of spinopelvic parameters on adjacent-segment degeneration after short spinal fusion for degenerative spondylolisthesis

Ming-Kai Hsieh, Fu-Cheng Kao, Wen-Jer Chen, I-Jung Chen, and Sheng-Fen Wang

associated with sagittal balance. 21 The horizontal distance from the posterosuperior corner of the sacrum to the plumb line is recorded as the magnitude of the sagittal vertical axis (SVA), and the degree of the SVA indicates sagittal balance. 18 Measurement of the C7 plumb line for evaluation of the SVA is often difficult and several studies have shown that pelvic parameters, especially the pelvic incidence (PI) angle, are an indirect method of checking sagittal balance. 3 , 19 Spinopelvic parameters, such as the PI, sacral slope (SS) angle, and pelvic tilt (PT) angle

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Sagittal spinopelvic parameters in children with achondroplasia: identification of 2 distinct groups

Clinical article

Isaac O. Karikari, Ankit I. Mehta, Can Solakoglu, Carlos A. Bagley, Michael C. Ain, and Oren N. Gottfried

of the sacral plate to the center of the bicoxofemoral axis, provides the foundation for sagittal alignment and thus determines TK and LL. 4 The impact of pelvic parameters on TLK progression and the need for surgery remains unknown. Because the spinal manifestations of achondroplasia begin in infancy, accurate analysis of spinopelvic parameters and sagittal alignment is needed in this special patient population. A thorough understanding of the natural history of achondroplasia along with identification of the radiographic factors that predict the development of

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Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?

Clinical article

Virginie Lafage, Frank Schwab, Shaleen Vira, Robert Hart, Douglas Burton, Justin S. Smith, Oheneba Boachie-Adjei, Alexis Shelokov, Richard Hostin, Christopher I. Shaffrey, Munish Gupta, Behrooz A. Akbarnia, Shay Bess, and Jean-Pierre Farcy

high complication rates, as high as 50%, associated with this technique. 1 , 4 , 5 , 7 , 10 , 17 , 27 However, to date, there is a paucity of data regarding PSO in terms of its impact on spinopelvic parameters. A large data set and multicenter analysis are lacking. Such a study is of marked significance because it can lead to greater understanding of the increasingly popular PSO surgery with regard to global alignment and pelvic parameters, which are critical for clinical success. Information gained will permit better operative planning for the surgeon and improved

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Determining the best vertebra for measuring pelvic incidence and spinopelvic parameters in adult spinal deformity patients with transitional anatomy

Fares Ani, Themistocles S. Protopsaltis, Yesha Parekh, Khalid Odeh, Renaud Lafage, Justin S. Smith, Robert K. Eastlack, Lawrence Lenke, Frank Schwab, Gregory M. Mundis Jr., Munish C. Gupta, Eric O. Klineberg, Virginie Lafage, Robert Hart, Douglas Burton, Christopher P. Ames, Christopher I. Shaffrey, and Shay Bess

increased articulation of the L5 vertebra to the sacrum may impact how pelvic incidence (PI) and spinopelvic parameters should be measured. Measuring spinopelvic parameters radiographically in patients with an LSTV in relation to the superior endplate of S1 differs when measured with respect to the superior endplate of L5. 11 Zhou et al. found that the PI was approximately 20° greater with a PI − lumbar lordosis (LL) mismatch (PI-LL) of 12° when measured at the superior endplate of S1 compared with when it was measured at the superior endplate of L5. 11 In addition

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Influence of postoperative sagittal balance and spinopelvic parameters on the outcome of patients surgically treated for degenerative lumbar spondylolisthesis

Ingrid Radovanovic, Jennifer C. Urquhart, Venkat Ganapathy, Fawaz Siddiqi, Kevin R. Gurr, Stewart I. Bailey, and Christopher S. Bailey

spinopelvic parameters between groups, adjusting for type of surgical procedure. A post hoc analysis using an unpaired t-test or chi-square test was performed to compare radiographic parameters among patients with single-level spondylolisthesis and among those having multiple levels of spondylolisthesis. Pearson's correlation coefficient was used to assess the association between radiographic parameters and patient-rated outcome measures. A statistically significant difference was defined as p < 0.05. Results Eighty-four (60.9%) of 138 patients satisfied all of the

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Natural history of the aging spine: a cross-sectional analysis of spinopelvic parameters in the asymptomatic population

Mark Attiah, Bilwaj Gaonkar, Yasmine Alkhalid, Diane Villaroman, Rogelio Medina, Christine Ahn, Tianyi Niu, Joel Beckett, Christopher Ames, and Luke Macyszyn

, spinal surgery, or radiographic abnormality were identified retrospectively and included in this study. After institutional review board approval, 210 consecutive patients who were asymptomatic and underwent imaging of the spinal axis (including pelvis) with 36-inch full-length standing spine radiographs at the University of California Los Angeles were included. Radiographs were extracted from the patient record along with the patient’s age at the time of the imaging study. Radiographs were digitized and sagittal spinopelvic parameters were assessed using Surgimap, a

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Patient outcomes after circumferential minimally invasive surgery compared with those of open correction for adult spinal deformity: initial analysis of prospectively collected data

Dean Chou, Virginie Lafage, Alvin Y. Chan, Peter Passias, Gregory M. Mundis Jr., Robert K. Eastlack, Kai-Ming Fu, Richard G. Fessler, Munish C. Gupta, Khoi D. Than, Neel Anand, Juan S. Uribe, Adam S. Kanter, David O. Okonkwo, Shay Bess, Christopher I. Shaffrey, Han Jo Kim, Justin S. Smith, Daniel M. Sciubba, Paul Park, Praveen V. Mummaneni, and

same surgical goals as open treatment of adult spinal deformity (ASD) but with less morbidity. 8 However, one of the main hurdles for cMIS has been limited ability to correct spinopelvic parameters as effectively as open surgery. 9 Recent studies have shown that minimally invasive techniques have become more effective for correcting sagittal plane deformities, reflecting cognizance to address the sagittal plane when considering cMIS for ASD. 10 cMIS for ASD has become more powerful and effective, but prospective data that directly compare cMIS with open ASD