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

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.

Keywords

cerebral palsy / sagittal profile / kyphosis / lordosis / hip dislocation / hip subluxation

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Funding

Государственное бюджетное финансирование