# The role of pelvic coronal parameters in determining sagittal balance: a prospective radiographic analysis of pelvic spinopelvic alignment in Chinese asymptomatic Han adolescents

## TL;DR

This study explores how pelvic coronal parameters relate to spinal balance in healthy Chinese adolescents, finding correlations that could help assess pelvic rotation.

## Contribution

The study introduces new coronal parameters that correlate with traditional spinopelvic parameters for assessing pelvic sagittal balance.

## Key findings

- Pelvic incidence correlates positively with pelvic tilt and sacral slope.
- New coronal parameters like sacral-femoral-pubic angle correlate with traditional spinopelvic parameters.
- Gender differences were observed in skeletal maturity and pelvic tilt.

## Abstract

Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional spinal deformity where sagittal alignment significantly influences clinical outcomes. This study aims to analyze spinopelvic balance parameters in asymptomatic adolescents without scoliosis, examining the correlation between pelvic coronal parameters and sagittal balance parameters to validate their use as preliminary indicators in assessing pelvic rotation.

A prospective study was conducted involving 354 adolescents (199 females, 155 males) aged 6–18 years who underwent full-length anteroposterior (AP) and lateral spine radiographs at The Third Hospital of Hebei Medical University between October 2022 and December 2023. Ethical approval and informed consent were obtained. Radiographic assessments included measuring pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), pelvic sacral angle (PSA), and other related parameters. Statistical analysis was performed using SPSS software.

Significant gender differences were observed in Risser sign distribution and pelvic tilt, with females exhibiting more advanced skeletal maturity. Positive correlations were found between pelvic incidence and pelvic tilt (r = 0.41), and pelvic incidence and sacral slope (r = 0.57), while negative correlations were noted between pelvic incidence and pelvic sacral angle (r = −0.43). Strong correlations between sagittal parameters and newly introduced coronal parameters, such as sacral-femoral-pubic angle and Pubo-Hilgenreiner Distance, were also identified.

The study demonstrates that parameters like Iliac tilt, Pelvic sacral angle, Sacral-femoral-pubic angle, and Pubo-Hilgenreiner Distance correlate well with traditional spinopelvic parameters and can be used to assess pelvic sagittal balance in clinical settings. Future research should focus on longitudinal studies to further validate these findings.