Primary Pelvic Anteversion

Spine, vol. 49, pp. 1107–1115

Abstract

STUDY DESIGN: Retrospective analysis of prospectively collected data. OBJECTIVE: To identify the best definition of primary anteverted pelvis in the setting of adult spine deformity (ASD), and to investigate whether this is a pathologic setting that requires surgical correction. SUMMARY OF BACKGROUND DATA: While pelvic retroversion has been thoroughly investigated, pelvic anteversion (AP) is a far lesser discussed topic. Four different AP definitions have been proposed, and AP has been described as a normal or pathologic entity by different authors. MATERIALS AND METHODS: All patients consulting for ASD at the five participating sites were included. First, the four definitions of AP were compared with descriptive statistics (anatomic method-Pelvic Tilt <0°; Relative Pelvic Version method-RPV >5°; Roussouly method-Pelvic Incidence (PI)<50° and Sacral Slope (SS)>35°); low PT method-PT/PI <25th percentile). Second a subgroup analysis among operated AP patients with a two-year follow-up was performed. Complication rate, radiographic parameters, and clinical scores (ODI, SF-36) were compared in a multivariate analysis between patients who did and did not maintain an AP at the 2-year follow-up. RESULTS: A total of 1163 patients were available for the first analysis. The RPV method seemed to be the most appropriate to define AP in ASD patient. For the second analysis, data on 410 subjects were available, and most of them were young adults with idiopathic scoliosis that did not require pelvic fixation. AP patients who maintained an AP after ASD surgery presented comparable radiographic and clinical outcomes to the patients who presented a normoverted/retroverted pelvis after surgery. CONCLUSIONS: According to the results of the presented study, the RPV method is the most appropriate to define primary AP, which is not a pathologic condition and is most often observed in young adults with idiopathic scoliosis. Anteverted pelvis does not require direct surgical correction in this patient group.

Authors 12

1. Alice Baroncini corresponding Aachen Department of Orthopaedics and Trauma Surgery reprint requests to Alice Baroncini

   SpineVision (France) · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedics and Trauma Surgery, RWTH Uniklinik Aachen, Germany

   AA: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie

   Availability of data: data can be made available in anonymized form and upon reasonable request

   CY: Consultant, Medtronic. All conflict of interest are not relevant to the present study

   Conflict of interest: AlBa, CY, DL, CR, AnBu: none

   Consent to participate and publication: consent to data collection, study participation and publication was obtained for each patient in written form

   DECLARATIONS: Sources of funding: The ESSG is funded by DePuy Synthes

   Ethics Approval: the study was approved by the IRBs of the respective sites

   FK: Depuy Spine Speakers Bureau and Research Grant

   FP: Research support: DePuySpine Synthes / Medtronic / Nuvasive / Orthofix / SpineArt Consultant: Medtronic / Nuvasive

   IO: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy

   IRB APPROVAL: The present study has been approved by the local IRB committees of the participating sites

   JP Consultant: Medtronic, Grants: medtronic Depuy

   LB Consultant: Spineart, Spinevision

   YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic

   reprint requests to Alice Baroncini, MD, PhD, Department of Orthopaedics and Trauma Surgery, RWTH Uniklinik Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany

2. Louis Boissière

   SpineVision (France) · Hôpital Pellegrin

   Affiliation as printed

   ELSAN, Polyclinique Jean Villar, Bruges Cedex, France

   Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France

   AA: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie

   Availability of data: data can be made available in anonymized form and upon reasonable request

   CY: Consultant, Medtronic. All conflict of interest are not relevant to the present study

   Conflict of interest: AlBa, CY, DL, CR, AnBu: none

   Consent to participate and publication: consent to data collection, study participation and publication was obtained for each patient in written form

   DECLARATIONS: Sources of funding: The ESSG is funded by DePuy Synthes

   Ethics Approval: the study was approved by the IRBs of the respective sites

   FP: Research support: DePuySpine Synthes / Medtronic / Nuvasive / Orthofix / SpineArt Consultant: Medtronic / Nuvasive

   IO: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy

   IRB APPROVAL: The present study has been approved by the local IRB committees of the participating sites

   JP Consultant: Medtronic, Grants: medtronic Depuy

   LB Consultant: Spineart, Spinevision

   YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic

3. Çağlar Yılgör

   Acıbadem University · SpineVision (France)

   Affiliation as printed

   Spine Center, Acibadem University School of Medicine, Istanbul, Turkey

   AA: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie

   Availability of data: data can be made available in anonymized form and upon reasonable request

   CY: Consultant, Medtronic. All conflict of interest are not relevant to the present study

   Conflict of interest: AlBa, CY, DL, CR, AnBu: none

   Consent to participate and publication: consent to data collection, study participation and publication was obtained for each patient in written form

   DECLARATIONS: Sources of funding: The ESSG is funded by DePuy Synthes

   Ethics Approval: the study was approved by the IRBs of the respective sites

   FP: Research support: DePuySpine Synthes / Medtronic / Nuvasive / Orthofix / SpineArt Consultant: Medtronic / Nuvasive

   IO: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy

   IRB APPROVAL: The present study has been approved by the local IRB committees of the participating sites

   JP Consultant: Medtronic, Grants: medtronic Depuy

   LB Consultant: Spineart, Spinevision

   YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic

4. Daniel Larrieu

   SpineVision (France) · Hôpital Pellegrin

   Affiliation as printed

   Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France

   AA: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie

   Availability of data: data can be made available in anonymized form and upon reasonable request

   CY: Consultant, Medtronic. All conflict of interest are not relevant to the present study

   Conflict of interest: AlBa, CY, DL, CR, AnBu: none

   Consent to participate and publication: consent to data collection, study participation and publication was obtained for each patient in written form

   DECLARATIONS: Sources of funding: The ESSG is funded by DePuy Synthes

   Ethics Approval: the study was approved by the IRBs of the respective sites

   FP: Research support: DePuySpine Synthes / Medtronic / Nuvasive / Orthofix / SpineArt Consultant: Medtronic / Nuvasive

   IO: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy

   IRB APPROVAL: The present study has been approved by the local IRB committees of the participating sites

   JP Consultant: Medtronic, Grants: medtronic Depuy

   LB Consultant: Spineart, Spinevision

   YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic

5. Ahmet Alanay

   Acıbadem University · SpineVision (France)

   Affiliation as printed

   Spine Center, Acibadem University School of Medicine, Istanbul, Turkey

   AA: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie

   Availability of data: data can be made available in anonymized form and upon reasonable request

   CY: Consultant, Medtronic. All conflict of interest are not relevant to the present study

   Conflict of interest: AlBa, CY, DL, CR, AnBu: none

   Consent to participate and publication: consent to data collection, study participation and publication was obtained for each patient in written form

   DECLARATIONS: Sources of funding: The ESSG is funded by DePuy Synthes

   Ethics Approval: the study was approved by the IRBs of the respective sites

   FP: Research support: DePuySpine Synthes / Medtronic / Nuvasive / Orthofix / SpineArt Consultant: Medtronic / Nuvasive

   IO: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy

   IRB APPROVAL: The present study has been approved by the local IRB committees of the participating sites

   JP Consultant: Medtronic, Grants: medtronic Depuy

   LB Consultant: Spineart, Spinevision

   YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic

6. Ferrán Pellisé

   SpineVision (France) · Vall d'Hebron Hospital Universitari

   Affiliation as printed

   Spine Surgery Unit, Vall D’Hebron Hospital, Barcelona, Spain

   AA: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie

   Availability of data: data can be made available in anonymized form and upon reasonable request

   CY: Consultant, Medtronic. All conflict of interest are not relevant to the present study

   Conflict of interest: AlBa, CY, DL, CR, AnBu: none

   Consent to participate and publication: consent to data collection, study participation and publication was obtained for each patient in written form

   DECLARATIONS: Sources of funding: The ESSG is funded by DePuy Synthes

   Ethics Approval: the study was approved by the IRBs of the respective sites

   FP: Research support: DePuySpine Synthes / Medtronic / Nuvasive / Orthofix / SpineArt Consultant: Medtronic / Nuvasive

   IO: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy

   IRB APPROVAL: The present study has been approved by the local IRB committees of the participating sites

   JP Consultant: Medtronic, Grants: medtronic Depuy

   LB Consultant: Spineart, Spinevision

   YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic

7. Frank S. Kleinstück

   SpineVision (France) · Schulthess-Klinik

   Affiliation as printed

   Schulthess Klinik, Zürich, Switzerland

   AA: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie

   Availability of data: data can be made available in anonymized form and upon reasonable request

   CY: Consultant, Medtronic. All conflict of interest are not relevant to the present study

   Conflict of interest: AlBa, CY, DL, CR, AnBu: none

   Consent to participate and publication: consent to data collection, study participation and publication was obtained for each patient in written form

   DECLARATIONS: Sources of funding: The ESSG is funded by DePuy Synthes

   Ethics Approval: the study was approved by the IRBs of the respective sites

   FK: Depuy Spine Speakers Bureau and Research Grant

   FP: Research support: DePuySpine Synthes / Medtronic / Nuvasive / Orthofix / SpineArt Consultant: Medtronic / Nuvasive

   IO: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy

   IRB APPROVAL: The present study has been approved by the local IRB committees of the participating sites

   JP Consultant: Medtronic, Grants: medtronic Depuy

   LB Consultant: Spineart, Spinevision

   YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic

8. Javier Pizones

   Hospital Universitario La Paz · SpineVision (France)

   Affiliation as printed

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

   AA: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie

   Availability of data: data can be made available in anonymized form and upon reasonable request

   CY: Consultant, Medtronic. All conflict of interest are not relevant to the present study

   Conflict of interest: AlBa, CY, DL, CR, AnBu: none

   Consent to participate and publication: consent to data collection, study participation and publication was obtained for each patient in written form

   DECLARATIONS: Sources of funding: The ESSG is funded by DePuy Synthes

   Ethics Approval: the study was approved by the IRBs of the respective sites

   FP: Research support: DePuySpine Synthes / Medtronic / Nuvasive / Orthofix / SpineArt Consultant: Medtronic / Nuvasive

   IO: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy

   IRB APPROVAL: The present study has been approved by the local IRB committees of the participating sites

   JP Consultant: Medtronic, Grants: medtronic Depuy

   LB Consultant: Spineart, Spinevision

   YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic

9. Yann Philippe Charles

   SpineVision (France) · Hôpitaux Universitaires de Strasbourg

   Affiliation as printed

   Spine Surgery Unit, Strasbourg University Hospital, Strasbourg, France

   AA: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie

   Availability of data: data can be made available in anonymized form and upon reasonable request

   CY: Consultant, Medtronic. All conflict of interest are not relevant to the present study

   Conflict of interest: AlBa, CY, DL, CR, AnBu: none

   Consent to participate and publication: consent to data collection, study participation and publication was obtained for each patient in written form

   DECLARATIONS: Sources of funding: The ESSG is funded by DePuy Synthes

   Ethics Approval: the study was approved by the IRBs of the respective sites

   FP: Research support: DePuySpine Synthes / Medtronic / Nuvasive / Orthofix / SpineArt Consultant: Medtronic / Nuvasive

   IO: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy

   IRB APPROVAL: The present study has been approved by the local IRB committees of the participating sites

   JP Consultant: Medtronic, Grants: medtronic Depuy

   LB Consultant: Spineart, Spinevision

   YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic

10. Cécile Roscop

    SpineVision (France) · Hôpital Pellegrin

    Affiliation as printed

    Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France

    AA: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie

    Availability of data: data can be made available in anonymized form and upon reasonable request

    CY: Consultant, Medtronic. All conflict of interest are not relevant to the present study

    Conflict of interest: AlBa, CY, DL, CR, AnBu: none

    Consent to participate and publication: consent to data collection, study participation and publication was obtained for each patient in written form

    DECLARATIONS: Sources of funding: The ESSG is funded by DePuy Synthes

    Ethics Approval: the study was approved by the IRBs of the respective sites

    FP: Research support: DePuySpine Synthes / Medtronic / Nuvasive / Orthofix / SpineArt Consultant: Medtronic / Nuvasive

    IO: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy

    IRB APPROVAL: The present study has been approved by the local IRB committees of the participating sites

    JP Consultant: Medtronic, Grants: medtronic Depuy

    LB Consultant: Spineart, Spinevision

    YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic

11. Anouar Bourghli

    King Faisal Specialist Hospital & Research Centre · SpineVision (France)

    Affiliation as printed

    Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    AA: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie

    Availability of data: data can be made available in anonymized form and upon reasonable request

    CY: Consultant, Medtronic. All conflict of interest are not relevant to the present study

    Conflict of interest: AlBa, CY, DL, CR, AnBu: none

    Consent to participate and publication: consent to data collection, study participation and publication was obtained for each patient in written form

    DECLARATIONS: Sources of funding: The ESSG is funded by DePuy Synthes

    Ethics Approval: the study was approved by the IRBs of the respective sites

    FP: Research support: DePuySpine Synthes / Medtronic / Nuvasive / Orthofix / SpineArt Consultant: Medtronic / Nuvasive

    IO: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy

    IRB APPROVAL: The present study has been approved by the local IRB committees of the participating sites

    JP Consultant: Medtronic, Grants: medtronic Depuy

    LB Consultant: Spineart, Spinevision

    Spine surgery department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic

12. Ibrahim Obeid

    SpineVision (France) · Hôpital Pellegrin

    Affiliation as printed

    ELSAN, Polyclinique Jean Villar, Bruges Cedex, France

    Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France

    AA: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie

    Availability of data: data can be made available in anonymized form and upon reasonable request

    CY: Consultant, Medtronic. All conflict of interest are not relevant to the present study

    Conflict of interest: AlBa, CY, DL, CR, AnBu: none

    Consent to participate and publication: consent to data collection, study participation and publication was obtained for each patient in written form

    DECLARATIONS: Sources of funding: The ESSG is funded by DePuy Synthes

    Ethics Approval: the study was approved by the IRBs of the respective sites

    FP: Research support: DePuySpine Synthes / Medtronic / Nuvasive / Orthofix / SpineArt Consultant: Medtronic / Nuvasive

    IO: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy

    IRB APPROVAL: The present study has been approved by the local IRB committees of the participating sites

    JP Consultant: Medtronic, Grants: medtronic Depuy

    LB Consultant: Spineart, Spinevision

    YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic