Impact of sagittal Impact of sagittal plane spinal deformity plane spinal deformity on the spino-pelvic on the spino-pelvic relationship and relationship and gravity line position gravity line position in adults in adults Virginie Lafage, Frank Schwab, Francisco Rubio, Jean- Virginie Lafage, Frank Schwab, Francisco Rubio, Jean- Pierre Farcy Pierre Farcy Maimonides Medical Center - NYU HJD, New York
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Impact of sagittal plane spinal deformity on the spino-pelvic relationship and gravity line position in adults Virginie Lafage, Frank Schwab, Francisco.
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Impact of sagittal plane Impact of sagittal plane spinal deformity on the spinal deformity on the
spino-pelvic relationship and spino-pelvic relationship and gravity line position in adultsgravity line position in adults
Virginie Lafage, Frank Schwab, Francisco Rubio, Jean-Pierre Virginie Lafage, Frank Schwab, Francisco Rubio, Jean-Pierre FarcyFarcy
balance if the balance if the trunk inclines trunk inclines
or shifts or shifts forward ?forward ?
Gravity Line vs. Heel = Gravity Line vs. Heel = ConstantConstant
Required to keep standing position
Age and pathologies do not affect this constraint
By definition, the whole body mass is equally distributed around the gravity line
What do we know ?What do we know ? Pelvis moves
backward Pelvic tilt increases Feet do not move
Only possible if lower Only possible if lower extremities are involvedextremities are involved
Hip flexion ? Knee flexion ?
Ankle regulation ?
SRS - 2006
Wide variation of SVA / pelvic tilt can be toleratedWide variation of SVA / pelvic tilt can be tolerated– compensatory mechanisms to maintain standing compensatory mechanisms to maintain standing
balancebalance– Evaluation requires foot positionEvaluation requires foot position
Balance formula ?Balance formula ?– regional spinal and pelvic parametersregional spinal and pelvic parameters– global parametersglobal parameters– foot positionfoot position
all adding up to a rather fixed GL-heel offset (GHO)all adding up to a rather fixed GL-heel offset (GHO)