Correlation between frontal X-ray parameters of the hip joint and sagittal vertebral-pelvic profile in patients with cerebral palsy

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Abstract

BACKGROUND: Posture disorders and spinal deformity in the sagittal plane (kyphotic deformity of the thoracic region and lumbar hyperlordosis in combination with pelvic inclination) are quite common in patients with cerebral palsy. However, their relationship with the frontal indicators of the hip joint is not reported in the scientific literature.

AIM: To reveal the relationship between the radiographic frontal indicators of the hip joint and the indicators of the spinal-pelvic sagittal balance in patients with cerebral palsy.

MATERIALS AND METHODS: A transverse study of the X-ray parameters of the hip joints in the frontal plane and sagittal vertebral-pelvic profile was performed in 46 patients with cerebral palsy aged 5–15 (mean age, 8.2 ± 3.6) years.

RESULTS: A significant difference from the norm was found in the following parameters: cervical-diaphyseal angle, pelvic tilt angle, pelvic tilt angle, sacral tilt angle, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis deviation (p < 0.05). The Sharp angle, migration index, Wiberg angle, and thoracic kyphosis were normal. Measurements of the frontal radiographic parameters of the right and left hip joints do not differ significantly from each other. The pelvic tilt showed a positive and strong correlation with pelvic tilt (p = 0.71). A positive and moderate correlation was found determined between a sequential chain of related elements of the axial skeleton, namely, sacral inclination-lumbar lordosis (p = 0.66) and lumbar lordosis-thoracic kyphosis (p = 0.41). The deviation of the sagittal vertical axis negatively correlated with lumbar lordosis (p = −0.69) and thoracic kyphosis (p = −0.38). The results demonstrate a negative and weak correlation between SDA and sacral tilt (p = −0.40).

CONCLUSIONS: The results of this study indicate a correlation between the inclination of the sacrum and the lumbar spine in patients with cerebral palsy, which confirms the main theories of the formation of excessive lumbar lordosis of the spine in these patients and allows us to develop pathogenetic preventive measures against spinal deformities. In this study, we failed to identify a significant relationship between the frontal radiographic parameters of the hip joint and sagittal pelvic-vertebral profile. However, hip joint instability in a child with cerebral palsy can play a significant role in the occurrence and development of sagittal spinal deformities.

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About the authors

Vladimir A. Novikov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: novikov.turner@gmail.com
ORCID iD: 0000-0002-3754-4090
SPIN-code: 2773-1027
Scopus Author ID: 57193252858

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Valery V. Umnov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: umnovvv@gmail.com
ORCID iD: 0000-0002-5721-8575
SPIN-code: 6824-5853

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Dmitry V. Umnov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dmitry.umnov@gmail.com
ORCID iD: 0000-0003-4293-1607
SPIN-code: 1376-7998

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Alexey V. Zvozil

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: zvosil@mail.ru
ORCID iD: 0000-0002-5452-266X

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Dmitry S. Zharkov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: striker5621@gmail.com
ORCID iD: 0000-0002-8027-1593

MD, orthopedic and trauma surgeon

Russian Federation, Saint Petersburg

Alina R. Mustafaeva

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: alina.mys23@yandex.ru
ORCID iD: 0009-0003-4108-7317

MD, resident

Russian Federation, Saint Petersburg

Sergei V. Vissarionov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN-code: 7125-4930
Scopus Author ID: 6504128319
ResearcherId: P-8596-2015

MD, PhD, Dr. Sci. (Med.), Professor, Corresponding Member of RAS

Russian Federation, Saint Petersburg

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2. Fig. 1. Indicators of the sagittal pelvic profile, measured on the radiograph in the lateral projection. Pelvic incidence (PI) is the angle between the perpendicular line from the center of the upper plate and the line connecting the center of the upper plate with the hip joint axis. Pelvic tilt (PT) is the angle between the vertical line and the line connecting the center of the upper plate with the hip joint axis. The sacral slope (SS) is the angle between the center of the upper plate and the horizontal line. Pelvic incidence is geometrically equal to the sum of the SS and the PT

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3. Fig. 2. Indicators of the sagittal pelvic profile, measured in lateral radiographs. TK, magnitude of thoracic kyphosis; LL, value of the lumbar lordosis

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4. Fig. 3. Correlogram with the results of the analysis of the relationship between the angular parameters of the frontal plane of the hip joints and the sagittal spinal–pelvic profile. CDA, cervical–diaphyseal angle; MI, migration index

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5. Fig. 4. Results of the correlation analysis of the present study (a) and the Mac-Thiong study (b). Arrows with a solid line show a strong correlation (r > 0.5), those with a dotted line show a moderate correlation (0.3 < r < 0.5), and the absence of arrows indicates a weak correlation

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