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. 2023 Jul 2;12(13):4445.
doi: 10.3390/jcm12134445.

Analysis of the Spinopelvic Parameters in Patients with Fragility Fractures of the Pelvis

Moritz F Lodde  1 , Thies M Fischer  2 , Oliver Riesenbeck  1 , Steffen Roßlenbroich  1 , J Christoph Katthagen  1 , Daria Rometsch  3 , Dennis Günes  2 , Marc Schneider  2 , Michael J Raschke  1 , Ulf Liljenqvist  2
Affiliations

Analysis of the Spinopelvic Parameters in Patients with Fragility Fractures of the Pelvis

Moritz F Lodde et al. J Clin Med. .

Abstract

Background: We investigated the spinopelvic parameters of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) in patients with fragility fractures of the pelvis (FFPs). We hypothesized that these parameters differ from asymptomatic patients.

Methods: All patients treated for FFPs in a center of maximal care of the German Spine Society (DWG) between 2017 and 2021 were included. The inclusion criteria were age ≥ 60 years and the availability of a standing lateral radiograph of the spine and pelvis in which the spine from T12 to S1 and both femoral heads were visible. The baseline characteristics and study parameters were calculated and compared with databases of asymptomatic patients. The two-sample t-Test was performed with p < 0.05.

Results: The study population (n = 57) consisted of 49 female patients. The mean age was 81.0 years. The mean LL was 47.9°, the mean PT was 29.4°, the mean SS was 34.2° and the mean PI was 64.4°. The mean value of LLI was 0.7. LL, LLI and SS were significantly reduced, and PI and PT were significantly increased compared to asymptomatic patients.

Conclusions: The spinopelvic parameters in patients with FFPs differ significantly from asymptomatic patients. In patients with FFPs, LL, LLI and SS are significantly reduced, and PI and PT are significantly increased. The sagittal spinopelvic balance is abnormal in patients with FFPs.

Keywords: FFPs (fragility fractures of the pelvis); lumbar lordosis index; osteoporosis; pelvic incidence; pelvic tilt; sacral slope; sagittal balance; spinopelvic parameters.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
An 82-year-old patient presenting with a fragility fractures of the pelvis (FFP) type IV or OF4 (OF-Pelvis classification) with displaced bilateral posterior lesions. The bilateral fractures are seen in the computer tomography (CT) (left side) and magnetic resonance imaging (MRI) (right side). The patient suffered from a low-energy trauma, falling on her back.
Figure 2
Figure 2
Modified after [23,24]: The spinopelvic parameters are lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS).
Figure 3
Figure 3
Spinopelvic parameters of LL, PT, SS and PI were analyzed for all patients. Measurement was conducted in a standing lateral radiograph of the spine and pelvis in which the spine from T12 to S1 and both femoral heads were visible.
Figure 4
Figure 4
Type II FFP (fragility fracture of the pelvis) was observed in 44 patients (77.2%) according to the FFP classification system [9] and OF-Pelvis classification system [10].
Figure 5
Figure 5
The mean lumbar lordosis and pelvic incidence of the study’s population were significantly (p < 0.01) different.
Figure 6
Figure 6
The spinopelvic parameters in the present study compared to the spinopelvic parameters in previous studies. LL (47.9°) and SS (34.2°) in the present study were significantly reduced (p < 0.01). PI (64.4°) and PT (29.4°) were significantly increased (p < 0.01).
Figure 7
Figure 7
Modified after [23,24]: The spinopelvic parameters of asymptomatic patients are drawn on the left side. The spinopelvic parameters of patients suffering from FFPs are drawn on the right side. In patients with FFPs, LL and SS are reduced, whereas PI and PT are increased. A higher PT and lower SS result from the backward rotation of the pelvis as a compensatory mechanism.
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