Evidence map›Paper›PMID 40338516›Full record

SynthesisSpine deformity2025

Can postoperative changes in pelvic incidence occur after adult spine deformity surgery? When do they occur, and what factors influence them? A systematic review with pooled analysis.

Marco Manzetti, Alberto Ruffilli, Giovanni Viroli, Matteo Traversari, Marco Ialuna, Chiara Ricci Petitoni, Cesare Faldini

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Spine deformity, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Preoperative sacroiliac joint degeneration can predict changes in pelvic incidence and functional outcomes following lumbar fusion.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Marco Manzetti1st Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy. marco.manzetti@ior.it.ORCID http://orcid.org/0000-0003-3992-9637
Alberto Ruffilli1st Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Giovanni Viroli1st Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Matteo Traversari1st Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Marco Ialuna1st Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Chiara Ricci Petitoni1st Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Cesare Faldini1st Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivePelvic incidence (PI) is traditionally considered a constant anatomic parameter in adult spinal deformity (ASD) surgery. However, emerging evidence suggests that PI may change postoperatively, potentially influencing sagittal balance and mechanical complications. This study aims to systematically review the literature on postoperative PI variations in ASD patients, identifying potential radiologic and surgical predictors.

methodsPapers describing postoperative PI changes in ASD patients were included in the analysis. The rate of PI changes, in different subgroups of patients was considered for outcome measure. Meta-analyses were performed to determine the prevalence and factors influencing PI changes.

resultsThirteen studies (1055 patients) met the inclusion criteria. All included studies assessed spinopelvic parameters using standing full-spine X-rays, except for one that used full-body standing X-rays, demonstrating moderate\high reproducibility in PI measurement (ICC: 0.71-0.96). While the mean absolute PI value remained stable postoperatively, 46.3% of patients experienced significant changes (> 5°). Factors associated with PI variations included fusion area, pelvic fixation type, preoperative sagittal imbalance, and extreme PI values. Sacropelvic fixation reduced PI instability, whereas prolonged anterior imbalance and compensatory pelvic retroversion increased the likelihood of PI shifts. Long-term follow-ups indicated that PI changes could not recover or increase in patients without sacropelvic fixation and in patients with higher preoperative PI values if they experience a decrease in PI postoperatively.

conclusionThe current literature challenges the traditional belief that PI is a static parameter in ASD surgery, particularly in severely imbalanced patients or those with extreme PI values. Acknowledging that PI may change under certain preoperative conditions could help optimize postoperative sagittal realignment in selected groups of ASD patients.

Indexed as

Pelvic BonesPelvisPostoperative ComplicationsSpinal CurvaturesSpinal FusionSpineAdultHumansIncidencePostoperative PeriodAdult spine deformityPelvic incidencePostoperative PI changesSacropelvic fixationSagittal balanceSpinopelvic alignment

Identifiers

PMID40338516

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.