Do spinopelvic parameters affect the severity of thoracolumbar trauma differently between in-vehicle traffic accidents and falling from a height?

Abstract

Purpose: Although there is a comprehensive characterization of the impact of spinopelvic parameters on outcomes after degenerative spine surgery, the impact of spinopelvic parameters on thoracolumbar trauma has not yet been defined. In the present study, it was aimed to reveal the correlation between the severity of vertebral fractures developing after trauma according to the mechanism of occurrence and sagittal spinopelvic parameters. Materials and methods: Patients with thoracolumbar vertebra fractures were evaluated retrospectively. The patients were divided into two groups: in-vehicle traffic accident (sitting group) and fall from height (standing group). The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and vertebral Hounsfield unit (HU) values were measured on computed tomography (CT) scans. Results: The results of the multivariate logistic regression analysis performed in the study revealed that a one-unit increase in PI reduced the risk of more comminuted fractures (A2 and above) by 0.90 times in sitting position trauma (Odds ratio (OR): 0.90; 95% CI: 0.84-0.96; p=0.002) and by 0.96 times in standing position trauma (OR: 0.96; 95% CI: 0.93-0.99; p=0.040). Conclusions: It was observed that in vertebral fractures developed after trauma, the fact that the vertebral column of patients with low PI is more rigid increased the severity of the fracture.

Keywords

• Vertebral fracture
• Hounsfield unit
• pelvic parameters
• AO Spine thoracolumbar classification

Spinopelvik parametreler torakolomber travmanın şiddetini araç içi trafik kazası ve yüksekten düşme arasında farklı şekilde etkiler mi?

Abstract

Amaç: Spinopelvik parametrelerin dejeneratif omurga cerrahisi sonrası sonuçlar üzerindeki kapsamlı bir etkisinin karakterizasyonu olmasına rağmen, spinopelvik parametrelerin torakolomber travma üzerindeki etkisi henüz tanımlanmamıştır. Bu çalışmada travma sonrası gelişen vertebra kırıklarının oluşma mekanizması ve tipine göre sagittal spinopelvik parametreler ile arasındaki ilişkinin ortaya konulması amaçlandı. Gereç ve yöntem: Torakolomber vertebra kırığı olan hastalar retrospektif olarak değerlendirildi. Hastalar araç içi trafik kazası (oturarak travmaya maruz kalan grup) ve yüksekten düşme (ayakta travmaya maruz kalan grup) olmak üzere iki gruba ayrıldı. Bilgisayarlı tomografi görüntülerinde pelvik insidans, pelvik tilt, sakral slop ve vertebral Hounsfield ünitesi değerleri ölçüldü. Bulgular: Çalışmada yapılan çok değişkenli lojistik regresyon analizi sonuçları, PI'deki bir birimlik artışın, oturan grup travmalarında daha fazla parçalı kırık (A2 ve üzeri) riskini 0,90 kat azalttığını ortaya koydu (Risk oranı: 0,90; 95). %GA: 0,84-0,96; p=0,002) ve ayakta durma pozisyonu travmasında 0,96 kat (Risk oranı: 0,96; %95 GA: 0,93-0,99; p=0,040). Sonuç: Travma sonrası gelişen vertebra kırıklarında düşük PI'li hastaların vertebral kolonunun daha rijit olmasının kırığın şiddetini arttırdığı görüldü.

Keywords

• Vertebral kırık
• Hounsfield ünitesi
• pelvik parametreler
• AO Spine torakolomber sınıflandırması

References

1. Whitney E, Alastra AJ. Vertebral fracture. StatPearls 2019.
2. Ferreira ML, March L. Vertebral fragility fractures - How to treat them?. Best Pract Res Clin Rheumatol. 2019;33(2):227-235. doi:10.1016/j.berh.2019.03.017
3. Liebsch C, Wilke HJ. Which traumatic spinal injury creates which degree of instability? A systematic quantitative review. Spine J. 2022;22(1):136-156. doi:10.1016/j.spinee.2021.06.004
4. Divi SN, Schroeder GD, Oner FC, et al. AOSpine-Spine Trauma Classification System: The Value of Modifiers: A Narrative Review With Commentary on Evolving Descriptive Principles. Global Spine J. 2019;9(1 Suppl):77S-88S. doi:10.1177/2192568219827260
5. Pizones J, Alvarez-González P, Sánchez-Mariscal F, Zúñiga L, Izquierdo E. Re: Vaccaro AR, Oner C, Kepler CK, et al. AOSpine thoracolumbar spine injury classification system. Fracture description, neurological status, and key modifiers. Spine 2013;38:2028-2037. Spine (Phila Pa 1976). 2014;39(9):783. doi:10.1097/BRS.0000000000000279
6. Christiansen BA, Bouxsein ML. Biomechanics of vertebral fractures and the vertebral fracture cascade. Curr Osteoporos Rep. 2010;8(4):198-204. doi:10.1007/s11914-010-0031-2
7. Niu J, Feng T, Huang C, et al. Characteristics of osteoporotic low lumbar vertebral fracture and related lumbosacral sagittal imbalance. Orthopedics. 2021;44(1):e7-e12. doi:10.3928/01477447-20201028-05
8. Fechtenbaum J, Etcheto A, Kolta S, Feydy A, Roux C, Briot K. Sagittal balance of the spine in patients with osteoporotic vertebral fractures. Osteoporos Int. 2016;27(2):559-567. doi:10.1007/s00198-015-3283-y

9. Ozer AF, Kaner T, Bozdogan C. Sagittal balance in the spine. Turk Neurosurg 2014;24:13-19.
10. Balta O, Yılmaz MA, Aytekin K, et al. Reliability of fossae lumbales laterales and pelvic ıncidence for estimating transsacral corridors assessed using reconstruction computed tomography. Clin Orthop Surg. 2022;14(3):417-425. doi:10.4055/cios22090
11. Baker JF, Don AS, Robertson PA. Pelvic incidence: computed tomography study evaluating correlation with sagittal sacropelvic parameters. Clin Anat. 2020;33(2):237-244. doi:10.1002/ca.23478
12. Ike H, Bodner RJ, Lundergan W, Saigusa Y, Dorr LD. The effects of pelvic incidence in the functional anatomy of the hip joint. J Bone Joint Surg Am. 2020;102(11):991-999. doi:10.2106/JBJS.19.00300
13. Labelle H, Roussouly P, Berthonnaud E, et al. Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine (Phila Pa 1976). 2004;29(18):2049-2054. doi:10.1097/01.brs.0000138279.53439.cc
14. Yoshimoto H, Sato S, Masuda T, et al. Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain. Spine (Phila Pa 1976). 2005;30(14):1650-1657. doi:10.1097/01.brs.0000169446.69758.fa
15. Mehta VA, Amin A, Omeis I, Gokaslan ZL, Gottfried ON. Implications of spinopelvic alignment for the spine surgeon [published correction appears in Neurosurgery. 2012May;70(5):1324. Neurosurgery. 2012;70(3):707-721. doi:10.1227/NEU.0b013e31823262ea
16. Barrey C, Jund J, Perrin G, Roussouly P. Spinopelvic alignment of patients with degenerative spondylolisthesis. Neurosurgery. 2007;61(5):981-986. doi:10.1227/01.neu.0000303194.02921.30
17. Innmann MM, Merle C, Gotterbarm T, Ewerbeck V, Beaulé PE, Grammatopoulos G. Can spinopelvic mobility be predicted in patients awaiting total hip arthroplasty? A prospective, diagnostic study of patients with end-stage hip osteoarthritis. Bone Joint J. 2019;101-B(8):902-909. doi:10.1302/0301-620X.101B8.BJJ-2019-0106.R1
18. Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med. 2013;158(8):588-595. doi:10.7326/0003-4819-158-8-201304160-00003
19. Zou D, Ye K, Tian Y, et al. Characteristics of vertebral CT Hounsfield units in elderly patients with acute vertebral fragility fractures. Eur Spine J. 2020;29(5):1092-1097. doi:10.1007/s00586-020-06363-1
20. Graffy PM, Lee SJ, Ziemlewicz TJ, Pickhardt PJ. Prevalence of Vertebral Compression Fractures on Routine CT Scans According to L1 Trabecular Attenuation: Determining Relevant Thresholds for Opportunistic Osteoporosis Screening. AJR Am J Roentgenol. 2017;209(3):491-496. doi:10.2214/AJR.17.17853
21. Lee SJ, Binkley N, Lubner MG, Bruce RJ, Ziemlewicz TJ, Pickhardt PJ. Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density. Osteoporos Int. 2016;27(3):1131-1136. doi:10.1007/s00198-015-3318-4
22. Zou D, Li W, Deng C, Du G, Xu N. The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases. Eur Spine J. 2019;28(8):1758-1766. doi:10.1007/s00586-018-5776-9
23. Makhni MC, Shillingford JN, Laratta JL, Hyun SJ, Kim YJ. Restoration of Sagittal Balance in Spinal Deformity Surgery. J Korean Neurosurg Soc. 2018;61(2):167-179. doi:10.3340/jkns.2017.0404.013
24. Briggs AM, Greig AM, Wark JD, Fazzalari NL, Bennell KL. A review of anatomical and mechanical factors affecting vertebral body integrity. Int J Med Sci. 2004;1(3):170-180. doi:10.7150/ijms.1.170
25. Briggs AM, Greig AM, Wark JD. The vertebral fracture cascade in osteoporosis: a review of aetiopathogenesis. Osteoporos Int. 2007;18(5):575-584. doi:10.1007/s00198-006-0304-x
26. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285(3):320-323. doi:10.1001/jama.285.3.320
27. Johnell O, Kanis JA, Odén A, et al. Fracture risk following an osteoporotic fracture. Osteoporos Int. 2004;15(3):175-179. doi:10.1007/s00198-003-1514-0
28. Schwab FJ, Blondel B, Bess S, et al. Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976). 2013;38(13):E803-E812. doi:10.1097/BRS.0b013e318292b7b9
29. Cooperstein R, Lew M. The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature. J Chiropr Med. 2009;8(3):107-118. doi:10.1016/j.jcm.2009.06.001
30. Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J. 2011;20(Suppl 5):609-618. doi:10.1007/s00586-011-1928-x
31. Imagama S, Ando K, Kobayashi K, et al. Impact of pelvic incidence on lumbar osteophyte formation and disc degeneration in middle-aged and elderly people in a prospective cross-sectional cohort. Eur Spine J. 2020;29(9):2262-2271. doi:10.1007/s00586-019-06204-w
32. Strube P, Pumberger M, Sonnow L, et al. Association Between Lumbar Spinal Degeneration and Anatomic Pelvic Parameters. Clin Spine Surg. 2018;31(6):263-267. doi:10.1097/BSD.0000000000000660
33. Kobayashi T, Morimoto T, Yoshihara T, Sonohata M, Rivière C, Mawatari M. The relationship between pelvic incidence and anatomical acetabular anteversion in female Japanese patients with hip osteoarthritis: a retrospective iconographic study. Surg Radiol Anat. 2021;43(7):1141-1147. doi:10.1007/s00276-021-02710-z
34. Dai J, Yu X, Huang S, et al. Relationship between sagittal spinal alignment and the incidence of vertebral fracture in menopausal women with osteoporosis: a multicenter longitudinal follow-up study. Eur Spine J. 2015;24(4):737-743. doi:10.1007/s00586-014-3637-8
35. Le Huec JC, Aunoble S, Philippe L, Nicolas P. Pelvic parameters: origin and significance. Eur Spine J. 2011;20 Suppl 5(Suppl 5):564-571. doi:10.1007/s00586-011-1940-1
36. Dubousset J, Gaume M, Miladi L. Ilio-sacral screw pelvic fixation when correcting spinal deformities with or without pelvic obliquity: our experience over 40 years. Spine Deform. 2021;9(3):665-670. doi:10.1007/s43390-020-00263-6
37. Camp JF, Caudle R, Ashmun RD, Roach J. Immediate complications of Cotrel-Dubousset instrumentation to the sacro-pelvis. A clinical and biomechanical study. Spine (Phila Pa 1976). 1990;15(9):932-941. doi:10.1097/00007632-199009000-00018
38. Bao H, Liabaud B, Varghese J, et al. Lumbosacral stress and age may contribute to increased pelvic incidence: an analysis of 1625 adults. Eur Spine J. 2018;27(2):482-488. doi:10.1007/s00586-017-5324-z
39. Le Huec JC, Hasegawa K. Normative values for the spine shape parameters using 3D standing analysis from a database of 268 asymptomatic Caucasian and Japanese subjects. Eur Spine J. 2016;25(11):3630-3637. doi:10.1007/s00586-016-4485-5
40. Chau LTC, Hu Z, Yiu Ko KS, et al. Global sagittal alignment of the spine, pelvis, lower limb after vertebral compression fracture and its effect on quality of life. BMC Musculoskelet Disord. 2021 May 24;22(1):476. doi:10.1186/s12891-021-04311-8
41. Ru N, Li J, Li Y, Sun J, Wang G, Cui X. Sacral anatomical parameters varies in different Roussouly sagittal shapes as well as their relations to lumbopelvic parameters. JOR Spine. 2021;4(4):e1180. doi:10.1002/jsp2.1180
42. Barrey C, Roussouly P, Le Huec JC, D'Acunzi G, Perrin G. Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J. 2013;22(Suppl 6):S834-S841. doi:10.1007/s00586-013-3030-z
43. Smorgick Y, Geftler A, Goldstein S, Mirovsky Y, Blecher R, Anekstein Y. Determination of any correlation between sagittal spinopelvic configuration and progressive collapse of acute osteoporotic compression spine fractures: a retrospective radiological analysis. Asian Spine J. 2020;14(6):872-877. doi:10.31616/asj.2019.0139
44. Muraki S, Yamamoto S, Ishibashi H, et al. Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women. Osteoporos Int. 2004;15(9):724-728. doi:10.1007/s00198-004-1600-y
45. Engelke K, Lang T, Khosla S, et al. Clinical use of quantitative computed tomography-based advanced techniques in the management of osteoporosis in adults: the 2015 ISCD Official Positions-Part III. J Clin Densitom. 2015;18(3):393-407. doi:10.1016/j.jocd.2015.06.010