Pelvic incidence change on the operating table

Abstract

Purpose: While a change in the pelvic incidence (PI) after long spine fusion surgery has been reported, no studies have examined the change in the PI on the operating table. The present study examined the PI-change on the operating table and elucidated the patients' background characteristics associated with this phenomenon.

Methods: This study included patients who underwent lumbar posterior spine surgery and had radiographs taken in a full-standing position preoperatively and a pelvic lateral radiograph in the prone position in the operative room. The patients with PI-change on the operating table (PICOT; PICOT group) and without PICOT (control group) were compared for their background characteristics and preoperative radiographic parameters.

Results: There were 128 eligible patients (62 males, 66 females) with a mean age (± standard deviation) of 69.9 ± 11.7 (range: 25-93) years old. Sixteen patients (12.5%) showed a decrease in the PI > 10°, which indicated placement in the PICOT group. The preoperative lumbar lordosis (LL) and PI-LL in the PICOT group were significantly worse than those in the control group (LL: 20.8 ± 16.6 vs. 30.6 ± 16.2, p = 0.0251, PI-LL: 33.9 ± 19.0 vs. 17.3 ± 14.8, p < 0.0001). The PICOT group had a higher proportion of patients who underwent fusion surgery than the control group, but the difference was not significant (62.5% vs. 44.6%, p = 0.1799).

Conclusion: A decreased PI was observed in some patients who underwent lumbar posterior surgery on the operating table before surgery. Patients with a PI decrease on the operating table had a significantly worse preoperative global alignment than those without such a decrease.

Level of evidence i: Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Keywords: Lumbar spine surgery; Pelvic incidence; Sacroiliac joint; Sagittal alignment; Spinopelvic alignment.