Analysis of hip dysplasia and spinopelvic alignment in cerebral palsy

Abstract

Background context: Knowledge of sagittal spinopelvic parameters and hip dysplasia is important in cerebral palsy (CP) patients because these parameters differ from those found in the general population and can be related to symptoms.

Purpose: The purpose of this study was to analyze sagittal spinopelvic alignment and determine its relation to hip dysplasia in CP patients.

Study design: Radiological analysis was conducted on patients with CP.

Patient sample: Fifty-four patients with CP and 24 normal controls were included in this study.

Outcome measures: Participants underwent radiographs of the whole spine.

Methods: The patient and control groups comprised 54 CP patients and 24 volunteers, respectively. All underwent lateral radiography of the whole spine and hip joint anteroposterior radiography. The radiographic parameters examined were sacral slope, pelvic tilt, pelvic incidence, S1 overhang, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, sagittal balance, center edge angle, acetabular angle, and migration index. Statistical analysis was performed to identify significant differences and correlations between the two groups.

Results: Sacral slope, thoracolumbar kyphosis, lumbar lordosis, sagittal balance, acetabular angle, and migration index were significantly higher in CP patients, whereas pelvic tilt, S1 overhang, and center edge angle were significantly lower (p<.05). Correlation analysis revealed that pelvic incidence, sacral slope, pelvic tilt, and S1 overhang were related to each other and that thoracolumbar kyphosis was related to the thoracic kyphosis and lumbar lordosis (p<.05). For spinal and pelvic parameters, lumbar lordosis was related to sacral slope, pelvic incidence, pelvic tilt, and S1 overhang; for hip dysplasia parameters, center edge angle and acetabular angle were found to be interrelated (p<.05). Regarding symptoms, pelvic tilt, S1 overhang, and thoracolumbar kyphosis were found to be correlated with symptom severity in patients. However, no hip dysplasia parameters were found to be related to hip or spinal symptoms.

Conclusions: This study found significant differences between CP patients and normal controls in terms of spinopelvic alignment and hip dysplasia. Furthermore, relationships were found between the sagittal spinopelvic parameters and hip dysplasia, and correlations were found between sagittal spinopelvic parameters and pain.

Keywords: Cerebral palsy; Hip dysplasia; Lumbar lordosis; Pelvic incidence; Pelvic orientation; Sagittal spinal alignment.