Sagittal Plane Analysis of the Spine and Pelvis in Adolescent Idiopathic Scoliosis According to the Coronal Curve Type

Study Design: A retrospective study investigated the sagittal alignment in adolescent idiopathic scoliosis (AIS).

Objective: To evaluate the sagittal alignment of the spine and pelvis in adolescent idiopathic scoliosis on the basis of curve type.

Summary Of Background Data: The relation between the spine and pelvis highly influences the sagittal balance in adults. However, the sagittal alignment of the spine and pelvis in adolescent idiopathic scoliosis is poorly defined in the literature.

Methods: Five sagittal parameters were evaluated on lateral radiographs of 160 patients with adolescent idiopathic scoliosis: thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence. The patients were classified according to their coronal curve type. Analysis of variance was used to compare the parameters between the curve types, and Pearson coefficients were used to investigate the relation between all parameters (alpha = 0.05).

Results: The thoracic kyphosis was significantly lower for King I, II, and III curves than for lumbar curves. The lumbar lordosis was higher for lumbar curves, although not significantly. No significant change between the groups was observed for the sacral slope, pelvic tilt, or pelvic incidence. The pelvic incidence was significantly correlated with the lumbar lordosis, sacral slope, and pelvic tilt for all the groups. The lumbar lordosis was strongly related to the sacral slope in all cases, but not with the thoracic kyphosis, except in the case of thoracolumbar curves.

Conclusions: Thoracic kyphosis depended mostly on the spinal deformity, whereas lumbar lordosis was influenced mainly by the pelvic configuration. The scoliotic curve type was not associated with a specific pattern of sagittal pelvic morphology and balance. The pelvic incidence found in this study was significantly higher than that reported in the literature for normal adolescents. The role of the pelvic incidence in the pathogenesis of adolescent idiopathic scoliosis needs to be explored in a longitudinal study involving patients with adolescent idiopathic scoliosis and normal adolescents.