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Spinopelvic balance App

The  assessment of the parameters involved in spinopelvic jucture are of paramount importance for spine and joint replacement surgeon. The dynamic interplay between flexibility and balance around the axis of gravity determine the type and the amount of influence in spine and hips. Radiographic parameters to evaluate objectively the spinopelvic saggital balance are Pelvic incidence (PI), Sacral slope (SS), Pelvic Tilt (PT), Lumbar lordosis (LL).  Drawings in patients X-rays and precise measurements are important in order to quantify the magnitude of spinal deformities, to monitor the success or failure of treatment and thus optimise the management of patients according to the severity of the imbalance or even to identify patient at risk of degenerative spondylolisthesis or disk herniation.

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The Spinopelvic Balance App is medical software aimed for orthopaedic surgeons, providing tools that allow doctors to:
-Securely import medical images directly from the camera or stored photos.
-By marking few points at the image of X-ray, the App calculates and offers a very convenient way to determine the most accurate possibly way at once, Pelvic incidence (PI), Sacral slope (SS), Pelvic Tilt (PT), Lumbar lordosis (LL), thoracic kyphosis, PI–LL Pelvic incidence Angle (PI) minus Lumbar lordosis Angle (LL) PI–LL, theoretical normal pelvic tilt (tPT),theoretical normal L1-S1 lumbar lordosis (tL1S1), Pelvic Radius Angle  (PRA). According to measured parameters the app categorises the severity of the imbalance of spine, in different stages: optimal  or non optimal.
-Save the planned images, for later review or consultation.The measured values are compared by normal reference databases and also data are exported as txt file, ready to print or to input as cells to excel for research.
-The app  allows choosing between simple and extended method according to everyday preference and also by choosing points in vertebra body in an in independent manner from order.
-The app can be used to measure  L5 Incidence  (L5I) Angle or L4 respectively.
-The app offers theoretical value estimation this is particularly  useful because a sensible difference between theoretical value and measured value reveals  a compensation phenomenon if the pelvis tilt (PT) is higher than its theoretical value, then it is due to pelvis retroversion, which is a compensation phenomenon. Knowing the theoretical value of Pelvis Tilt (PT) provided it is easy to understand that a sensible difference between theoretical value and measured value is a compensation phenomenon
All information received from the software output must be clinically reviewed regarding its plausibility before patient treatment! Spinopelvic Balance App indicated for assisting healthcare professionals. Clinical judgment and experience are required to properly use the software.The software is not for primary image interpretation.
 In a busy everyday practice, the examiner have to draw lines in X-rays or in clinical settings, this it is time consuming and cumbersome. Accessory instruments like protractors, hinged goniometers, well sharped pencils, rulers or even transparent papers must be available. The app offers a very convenient and accurate way to perform most common radiographic measurements for spine, at the spinopelvic juncture in a blink of an eye in front of your screen. The build in feature of the app, allows results to be categorized may help decide what could be considered normal or pathologic.
The app is not a simple goniometer, is an enhanced product which helps to monitor objectively the course of the treatment and evaluate optimally the spine. This App is particular useful in clinical settings where you need a quick results without losing time. Please see tutorial videos at the developer’s web site www.orthopractis.com


Reference databases

1. Nunes VR, et al .Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery.Rev Bras Ortop. 2016 Sep 22;51(6):662-666.
2. Jackson R, et al. Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with  constant low back pain. Spine. 2000;25:575-586.

How to measure Spinopelvic balance with the App.

 

The app offers a very convenient way to determine the most accurate lines in order to measure the angle. Once you load or capture the patient’s image  by default the simple method is highlighted .

Simple method

With the transparent circular template you aim to locate  the posterior corner on the top margin of S1 of the sacrum and by clicking the button ‘point’ the P1 point is marked and 

By  clicking the ‘point’, button at the anterior corner of the superior end plate  of S1 vetebra , the point P2 is marked. Next you aim at center of the femoral heads and by clicking the ‘point’ button you  mark the center of femoral head(C3)automatically Pelvic incidence Angle (PI)

Sacral slope Angle (SS)  are Pelvic tilt Angle (PT),  are calculated 

Extended method 

Once you press the ‘ext’  button which is highlighted and the extended method is activated and instead of marking the S1 vertebra you aim to mark the L1 vertebra. By clicking the button ‘point’ the point P1 over the left edge of the superior end plate of the L1 is marked and by the same manner locating the right edge of the superior end plate the point P2 is also marked- the order of marking does not affect the measurement. A green line P1,P2 over the anterior and posterior, superior endplate of  vertebra  body of L1 appears. With the transparent circular template you aim to locate  the posterior corner on the top margin of S1 of the sacrum and by clicking the button ‘point’ the P3 point is marked and by  clicking also  the ‘point’, button at the anterior corner of the superior end plate  of S1 vertebra , the point P4 is marked. Next you aim at center of the femoral head and by clicking the ‘point’ button you mark the center of femoral head (C5) .Automatically the Pelvic incidence Angle (PI) ,Sacral slope Angle (SS)  are Pelvic tilt Angle (PT), Lumbar lordosis Angle (LL), Pelvic Radius Angle (PRA) ,PI–LL Pelvic incidence Angle (PI) minus Lumbar lordosis Angle (LL), tPT ,tL1S1  are being  calculated and normal values appears respectively

The software is a class II medical device in the FDA. All information received from the software output must be clinically reviewed regarding its plausibility before patient treatment! Spinopelvic Balance App indicated for assisting healthcare professionals. Clinical judgment and experience are required to properly use the software.

 

 

 

 

 

What is calculated  in the Spinopelvic Balance App  with both methods

 

1. Lumbar lordosis Angle (LL) -Cobb angles L1-S1

2. Pelvic incidence Angle (PI) -the  angle subtended  by the perpendicular to the sacral plate at its midpoint and the line connecting this point to the femoral heads axis (point C)

3. Sacral slope Angle (SS) the angle subtended  by the superior plate of S1 and a horizontal reference line (HRL). 

4. Pelvic tilt Angle (PT), the angle  subtended by the vertical bi-coxo-femoral axis (BCFA) and the line connecting the midpoint of the sacral plate .

 

5. Pelvic Radius Angle (PRA) is an angle  subtended by the pelvic radius line, which  is drawn from the center of the femoral head to  the posterior superior corner of S1 and a line  drawn along the sacral end plate.

6. PI–LL- Pelvic incidence Angle (PI) minus Lumbar lordosis Angle (LL) ,normal valus < 10degrees

7.tPT - theoretical normal pelvic tilt, difference between theoretical value and measured value is a compensation phenomenon
8. tL1S1 - theoretical normal L1-S1 lumbar lordosis