• Hyun Jun Jang, Jeong Yoon Park, Sung Uk Kuh, Yoon Ha, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho, and Kyung Hyun Kim.
• Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
• Yonsei Med. J. 2022 Nov 1; 63 (11): 1027-1034.

PurposeThe biplanar whole body imaging system (EOS) is a new tool for measuring the whole body sagittal alignment in a limited space. This tool may affect the sagittal balance of patients compared to conventional whole spine X-ray (WSX). This study aimed to investigate the difference in sagittal alignment between WSX and EOS.Materials And MethodsWe compared the spinal and pelvic sagittal parameters in 80 patients who underwent EOS and WSX within one month between July 2018 and September 2019. The patients were divided based on sagittally balanced and imbalanced groups according to pelvic tilt (PT) >20°, pelvic incidence-lumbar lordosis >10°, C7-sagittal vertical axis (SVA) >50 mm in WSX.ResultsIn the sagittally imbalanced group, compared to WSX, the pelvic parameters demonstrated compensation in EOS with smaller PT (27.4±11.6° vs. 24.9±10.9°, p=0.003) and greater sacral slope (SS), and the patients tended to stand more upright with smaller C7-SVA (58.4±17.0 mm vs. 48.9±57.3 mm, p=0.018), T1-pelvic angle (TPA), T5-T12, and T2-T12. However, in the sagittally balanced group, these differences were less pronounced only with smaller PT (10.8±6.9° vs. 9.4±4.7°, p=0.040), TPA and T2-T12 angle, but with similar SS and C7-SVA (p>0.05).ConclusionEOS showed a negative SVA shift and lesser PT compared to WSX, especially in patients with sagittal imbalance. When preparing a surgical plan, surgeons should consider these differences between EOS and WSX.© Copyright: Yonsei University College of Medicine 2022.

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