Pelvic Evaluation in Thoracolumbar Corrective Spine Surgery

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 14, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.00
Procedures: 1.00
Head, Spine, and Musculoskeletal: 1.00

Magnetic Resonance Imaging: 1.00
Procedures: 1.00
Neurological: 0.50
Musculoskeletal: 0.50

Radiography: 1.00
Procedures: 1.00
Head, Spine and Pelvis Procedures: 1.00

Registered Radiologist Assistant: 1.75
Procedures: 1.75
Musculoskeletal and Endocrine Sections: 0.75
Neurological, Vascular, and Lymphatic Sections: 1.00

Outline

1. Introduction
2. Cone of Economy
3. Imaging and Measurement Technique
4. The Concept of Coronal Balance and Important Radiologic Parameters
   1. Coronal Plane Decompensation
   2. Cobb Angles
5. The Concept of Sagittal Balance and Important Radiologic Parameters
   1. Spinal Vertical Alignment
   2. Thoracic Kyphosis
   3. Lumbar Lordosis
6. The Role of the Pelvis in Maintenance of Sagittal and Coronal Balance and Important Radiologic Parameters
   1. Pelvic Obliquity
   2. Pelvic Incidence
   3. Pelvic Tilt
   4. Sacral Slope
   5. T1 Pelvic Angle
7. Bringing it all Together
8. Summary

Objectives

Upon completion of this course, students will:

1. be able to explain how the pelvis plays an important role in the maintenance of proper posture in patients with spinal deformities
2. understand the role that the pelvis plays in coronal and sagittal balance
3. understand how surgeons originally treated spinal deformities and the current change in mind set
4. explain the changes in body mechanics in order to compensate for posture that is outside the normal comfort range
5. be able to explain who introduced the “cone of economy” concept and what it is
6. be able to explain the position that the patient should be in for radiographs for spinal deformities
7. understand the benefits and limitation of using radiography in the evaluation of patients with spinal deformities
8. understand the benefits and limitation of using computed tomography in the evaluation of patients with spinal deformities
9. know what low-dose digital stereoradiography is and how it is used for imaging spinal deformities
10. understand the benefits and limitation of using low-dose digital stereoradiography in the evaluation of patients with spinal deformities
11. understand the benefits and limitation of using magnetic resonance (MR) imaging in the evaluation of patients with spinal deformities
12. be able to describe the concepts of coronal balance in patients with spinal deformities and how it pertains to radiologic parameters
13. be able to explain the physiologic factors that affect humans in standing upright while in the neutral midline posture
14. know which two measurements are the most important ones in the interpretation of coronal balance from the standpoint of the spine and exclusive of the pelvis
15. be able to describe how coronal plane decompensation is calculated
16. know what is the most common spinal deformity that causes coronal plane decompensation
17. be able to describe what the Cobb angle is, what the measurement determines, and how the angle affects treatment planning
18. understand the principles of sagittal balance and how they pertain to patients with spinal deformities
19. be able to describe the relevant radiologic parameters in the understanding of sagittal balance in patients with spinal deformities
20. understand the basics of the SRS-Schwab Classification as a guideline for the interpretation and treatment of adult spinal deformities
21. understand how thoracic kyphosis is calculated and the normal range of variances in men and women
22. know how lumbar lordosis is calculated and what a Flatback deformity is
23. be able to define what pelvic obliquity is and the role it plays in the coronal correction strategy of spinal deformities
24. know how the pelvic incidence angle is created and its relationship to lumbar lordosis
25. be able to define how pelvic tilt is calculated as well as how the SRS-Schwab Classification relates to pelvic retroversion
26. be able to define how sacral slope is calculated and its relationship to pelvic tilt and incidence
27. be able to define the T1 pelvic angle and how it relates to spinal vertical alignment and pelvic tilt measurements
28. know what Ryan, et al, define as the ideal T1 pelvic angle for surgery
29. understand the key information a radiologist should document on both AP and lateral radiographs of the spine for diagnosing spinal deformities
30. be able to summarize the key measurement parameters that should be included in a radiologist report pertaining to spinal and pelvic radiography for diagnosing spinal deformities