• Spine · Jan 2024

    Can Pelvic Incidence Change After Lumbo-Pelvic Fixation for Adult Spine Deformity and Would the Change Be Affected By the Type of Pelvic Fixation?

    • Maroun Rizkallah, Jesse Shen, Philippe Phan, Fidaa Al-Shakfa, Yousef Kamel, Jia Liu, Daniel Shedid, Sung Joo Yuh, Ghassan Boubez, and Zhi Wang.
    • Department of Orthopedic Surgery, University of Montreal Health Center, Montreal, Quebec, Canada.
    • Spine. 2024 Jan 1; 49 (1): E1E7E1-E7.

    Study DesignRetrospective review.ObjectiveTo assess the change in pelvic incidence (PI) after lumbo-pelvic fixation and the differential impact of the type of pelvic fixation: S2-alar-iliac screws (S2AI) versus Iliac screws (IS) on postoperative PI.Summary Of Background DataRecent studies suggest that changes occur to the previously assumed fixed PI after spino-pelvic fixation.MethodsAdult spine deformity (ASD) patients who underwent spino-pelvic fixation with≥4 levels of fusion were included. Preoperative and postoperative PI, lumbar lordosis (LL), thoracic kyphosis, pelvic tilt, sacral slope, PI-LL mismatch, and the Sagittal Vertical Axis (SVA) were analyzed on EOS imaging. A significant PI change was established at≥6°. Patients were categorized based on the type of pelvic fixation (S2AI vs. IS).ResultsOne-hundred-forty-nine patients were included. Of these, 77(52%) had a>6° change in their PI postoperatively. In patients with high preoperative PI (>60°), 62% had a significant PI change compared with 33% of patients with normal PI (40°-60°) and 53% in patients with low PI (<40°; P =0.01). PI was likely to decrease in patients with high baseline PI (>60°) and to increase in patients with low baseline PI (<40°). Patients with a significant PI change had a higher PI-LL. Patients in the S2AI group (n=99) and those in the IS group (n=50) were comparable at baseline. In the S2AI group, 50 (51%) patients had>6° change in their PI compared with 27(54%) patients in the IS group( P =0.65). In both groups, patients with high preoperative PI were more prone to significant postoperative changes ( P =0.02 in IS, P =0.01 in S2AI).ConclusionPI changed significantly in 50% of patients postoperatively, especially in those with high/low preoperative PI and those with severe baseline sagittal imbalance. This occurs similarly in patients with S2AI and those with IS screws. Surgeons should keep in mind these anticipated changes while planning ideal LL, as this impacts postoperative PI-LL mismatch.Level Of Evidence4.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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