Pelvic Evaluation in Thoracolumbar Corrective Spine Surgery

A presentation of how pelvic compensation is used to maintain balance and posture by the scoliotic patient, and thus must be measured and accounted for in treatment options.

Course ID: Q00507 Category:
Modality:

2.0

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$24.00

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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Radiography: 2.00
Procedures: 2.00
Head, Spine and Pelvis Procedures: 2.00

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Musculoskeletal and Endocrine Sections: 2.00

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