Pelvic Alignment Research Articles

Association of Lumbopelvic Pain with Pelvic Alignment and Gait Pattern during Pregnancy

Study background: Management of lumbopelvic pain (LPP) during pregnancy is important and the anatomical and movement aspects may be related to LPP. This study aimed to investigate the association of LPP with pelvic alignment and gait pattern during pregnancy.Methods: Fifty-seven pregnant women were categorized into either the LPP or non-LPP (NLPP) group. Anterior pelvic tilt and bilateral difference in pelvic tilt as pelvic asymmetry were measured. An inertial measurement unit was attached at the participants’ L3 spinous process to measure 3-axes acceleration during gait. The degrees of movement symmetry, gait variability, and trunk movement were expressed as the autocorrelation peak (AC), coefficient of variance, and root mean square (RMS), respectively. An independent t-test was used to investigate differences in pelvic alignment and gait parameters between the groups. Multivariate stepwise logistic regression analysis was used to identify parameters that affected LPP. Additionally, multivariate linear regression analyses were performed to determine the parameters affected by LPP. Each significant parameter (from the previous analysis) was included as a dependent variable. Meanwhile, the presence or absence of LPP, BMI, and pregnancy months were included as explanatory variables.Results: In the LPP group, pelvic asymmetry was significantly higher, and the AC and RMS were significantly lower than that in the NLPP group. In the multivariate analysis, pelvic asymmetry and AC significantly affected LPP, while LPP significantly affected pelvic asymmetry and RMS. Conclusion: Pelvic asymmetry and movement asymmetry during gait affect LPP, while LPP affect pelvic asymmetry and trunk movement during gait. Therefore, evaluating both of the pelvic alignment and gait pattern especially focusing on asymmetry is important for management LPP during pregnancy.

Effects of Stretching and Sling Exercise on Pelvic Correction and Dysmenorrhea in University Students

Background/Objectives: The purpose of this study was to investigate the effects of stretching and sling exercises on pelvic correction and dysmenorrhea in university students. Methods/Statistical Analysis: The subjects were divided into three groups: sling exercise group, stretching group, and control group. All groups performed each exercise for 40 minutes three times a week for 4 weeks. The control group received thermotherapy. All groups were measured for pelvic alignment, Visual Analog Scale(VAS) and Menstrual Distress Questionnaire(MDQ). Repeated measures ANOVA were used to verify differences between groups and assessment times with respect to pelvic alignment, VAS and MDQ. Findings: Comparisons of all three groups before and after the intervention revealed significant differences in the VAS and MDQ scores. The post-intervention decreases in the VAS scores of the stretching group were more significant than those of the control group. Comparisons of pelvic alignment before and after the intervention in each group indicated that sling exercise significantly decreased sagittal imbalance, coronal imbalance, pelvic inclination, and pelvic torsion. In addition, stretching significantly decreased sagittal imbalance, coronal imbalance, pelvic inclination, pelvic torsion, and pelvic obliquity. The control group, however, did not demonstrate decreases in any of the variables, with the exception of coronal imbalance. In the stretching group, in particular, post-intervention pelvic inclination was more significantly decreased than that of the control group. Improvements/Applications: Sling and stretching exercises improve pelvic alignment, painful menstruation and dysmenorrhea. These exercises can be used as the data for various directions of interventions to alleviate or prevent dysmenorrhea.

The effects of calcaneal posture on thoracolumbar alignment in a standing position.

[Purpose] Severe calcaneus misalignment is correlated with low back pain, and affects pelvic alignment. However, little has been published with regard to the influence of pronation and supination on trunk alignment. Therefore, the present study aimed to investigate the influence of calcaneal inversion on pelvic and trunk alignment. [Subjects and Methods] A 3-dimensional motion analysis system was used to assess pelvic and trunk alignment in 10 healthy male subjects with unilateral and bilateral calcaneus inversion. [Results] Medial and anterior tilting of the pelvis, and posterior tilting and lateral rotation of the trunk were observed. [Conclusion] Calcaneal inversion induces changes in the alignment of the pelvis and trunk. These changes may induce lumbar lordosis and body misalignment, leading to back pain.

Relationship between Pelvic Alignment and Weight-bearing Asymmetry in Community-dwelling Chronic Stroke Survivors.

Background and Purpose:Altered pelvic alignment and asymmetrical weight bearing on lower extremities are the most common findings observed in standing and walking after stroke. The purpose of this study was to find the relationship between pelvic alignment and weight-bearing asymmetry (WBA) in community-dwelling chronic stroke survivors.Materials and Methods:This cross-sectional study was conducted in tertiary care rehabilitation centers. In standing, the lateral and anterior pelvic tilt angle of chronic stroke survivors was assessed using palpation (PALM™) meter device. The percentage of WBA was measured with two standard weighing scales. Pearson correlation coefficient (r) was used to study the correlation between pelvic tilt and WBA.Results:Of 112 study participants, the mean (standard deviation) age was 54.7 (11.7) years and the poststroke duration was 14 (11) months. The lateral pelvic tilt on the most affected side and bilateral anterior pelvic tilt were 2.47 (1.8) and 4.4 (1.8) degree, respectively. The percentage of WBA was 23.2 (18.94). There was a high correlation of lateral pelvic tilt with WBA (r = 0.631; P < 0.001) than anterior pelvic tilt (r = 0.44; P < 0.001).Conclusion:Excessive lateral pelvic tilt toward the most affected side in standing may influence the weight-bearing ability of the ipsilateral lower extremity in community-dwelling chronic stroke survivors.

The Association Between Visual Assessment of Quality of Movement and Three-Dimensional Analysis of Pelvis, Hip, and Knee Kinematics During a Lateral Step Down Test.

Rabin, A, Portnoy, S, and Kozol, Z. The association between visual assessment of quality of movement and three-dimensional analysis of pelvis, hip, and knee kinematics during a lateral step down test. J Strength Cond Res 30(11): 3204-3211, 2016-Altered movement patterns including contralateral pelvic drop, increased hip adduction, knee abduction, and external rotation have been previously implicated in several lower extremity pathologies. Although various methods exist for assessing movement patterns, real-time visual observation is the most readily available method. The purpose of this study was to determine whether differing visual ratings of trunk, pelvis, and knee alignment, as well as overall quality of movement, are associated with differences in 3-dimensional trunk, pelvis, hip, or knee kinematics during a lateral step down test. Trunk, pelvis, and knee alignment of 30 healthy participants performing the lateral step down were visually rated as "good" or "faulty" based on previously established criteria. An additional categorization of overall quality of movement as either good or moderate was performed based on the aggregate score of each individual rating criterion. Three-dimensional motion analysis of trunk, pelvis, hip, and knee kinematics was simultaneously performed. A faulty pelvis alignment displayed a greater peak contralateral pelvic drop (effect size [ES], 1.65; p < 0.01) and a greater peak hip adduction (ES: 1.04, p = 0.01) compared with participants with a good pelvis alignment. Participants with a faulty knee alignment displayed greater peak knee external rotation compared with participants with a good knee alignment (ES, 0.78; p = 0.02). Participants with an overall moderate quality of movement displayed increased peak contralateral pelvic drop (ES, 1.07; p = 0.01) and peak knee external rotation (ES, 0.72; p = 0.04) compared with those with an overall good quality of movement. Visual rating of quality of movement during a lateral step down test, as performed by an experienced physical therapist, is associated with differences in several kinematics previously implicated in various pathologies.

Paper #24 Natural History of Sagittal Spinal Alignment in Children with Achondroplasia

A cross sectional and longitudinal study of 315 children with achondroplasia showed that thoracolumbar kyphosis improves significantly during the first three years of age and hyperlordosis at the lumbosacral level is the compensatory mechanism. Pelvic alignment and hip positioning are directly affected by this mechanism. After three years of age, thoracolumbar kyphosis gradually improves until age ten. While pelvic incidence is stable before age ten, it increases gradually afterwards.

Pelvic Rotation in Femoroacetabular Impingement Is Decreased Compared to Other Symptomatic Hip Conditions.

Study Design Cross-sectional, case-control design. Background Pelvic movement has been considered a possible discriminating parameter associated with femoroacetabular impingement (FAI) symptom onset. Decreased pelvic rotation has been found during squatting in people with FAI when compared to people with healthy hips. However, it is possible that changes in pelvic movement may occur in other hip conditions because of pain and may not be specific to FAI. Objectives To compare sagittal pelvic rotation during hip flexion and in sitting between people with FAI and people with other symptomatic hip conditions. Methods Thirty people with symptomatic FAI, 30 people with other symptomatic hip conditions, and 20 people with healthy hips participated in the study. Sagittal pelvic rotation was calculated based on measures of pelvic alignment in standing, hip flexion to 45° and 90°, and sitting. Results There were significant differences in sagittal pelvic rotation among the 3 groups in all conditions (P<.05). Post hoc analyses revealed that participants in the symptomatic FAI group had less pelvic rotation during hip flexion to 45° and 90° compared to participants in the other symptomatic hip conditions group and the hip-healthy group (mean difference, 1.2°-1.9°). In sitting, participants in the other symptomatic hip conditions group had less posterior pelvic rotation compared to those in the hip-healthy group (mean difference, 3.9°). Conclusion People with symptomatic FAI have less posterior pelvic rotation during hip flexion when compared to people with other symptomatic hip conditions and those with healthy hips. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(11):957-964. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6713.

Pelvic alignment in standing, and its relationship with trunk control and motor recovery of lower limb after stroke

AbstractBackgroundThe pelvis is not stable after stroke, and poor trunk recovery might be the foremost contributor to altered pelvic alignment in sitting, standing and during walking.AimTo analyze the relationship between pelvic alignment in standing and trunk control after stroke, and also test how these correlations are related to Brunnstrom's lower limb motor recovery.MethodsIn the present cross‐sectional study, 116 ambulant patients after stroke were assessed for their pelvic tilt angles in standing and trunk control using a palpation meter (PALM device) and the Trunk Impairment Scale (TIS), respectively. The pelvic tilt values were correlated to TIS scores by the Pearson's correlation coefficient.ResultsThe mean age, post‐stroke duration, and Brunnstrom's lower limb motor recovery of study participants were 55 (13) years, 14.2 (11.3) months and 3.75 (0.79), respectively. The present study reported more lateral pelvic tilt of 2.47° (1.78°) towards the most affected side and an anterior pelvic tilt of 4.4° (1.8°) bilaterally. The mean score of TIS was 10.4 (3). Pelvic tilt angles had a moderately inverse correlation with the total TIS score and coordination subscale of TIS (r‐value from –0.44 to –0.54), but a low inverse relationship to the dynamic sitting balance subscale of TIS (–0.36 to –0.45). Also, the pelvic tilt had a high negative correlation with trunk control (r‐value from –0.68 to –0.84) in lower limb motor recovery stage 5.ConclusionPelvic alignment when standing is not normal after stroke, and this is influenced by poor trunk control and impairment of the lower extremities. Assessment of the pelvis provides further insight into planning the appropriate rehabilitation strategies in stroke.

The effects of increased unilateral and bilateral calcaneal eversion on pelvic and trunk alignment in standing position

Objective: Generally, it is known that there is a correlation between excessive calcaneus eversion and a patient with low back pain and it also affects pelvic alignment. However, there are not enough studies that show calcaneal eversion having an effect on the alignment of the trunk. Design: Cross-sectional study. Methods: A 3-dimensional motion analysis system was used to assess the lower limbs, pelvic alignment, and trunk alignment with increased unilateral and bilateral calcaneal eversion in twenty-one subjects. All subjects were asked to maintain a static posture for seven seconds on a wedge three times per posture for measurement and analysis purposes. The wedge used in the process was a lateral wedge with a 10-degree tilt to the lateral direction. To unify all of the subjects` foot position, the front and inner side of the wedge were marked. The height of the tilted wedge`s inner side and flat wedge were balanced equally in order to be able to maintain the lateral part of the foot to the same height when producing an increased calcaneal eversion. Results: Comparing the changes in trunk and pelvic alignment in accordance to calcaneal eversion for each posture, there was a significant different in the X and Y-axis for each posture, but not in the Z-axis (p<0.05). Thus, it can be confirmed that calcaneal eversion in the sagittal plane and frontal plane may have and effect on the pelvis and the trunk. Conclusions: Postures with increased bilateral and unilateral calcaneal eversion has an effect on pelvic alignment, but does not cause any changes in trunk alignment.

A Kirschner wire as a transverse-axis guide to improve acetabular cup positioning.

To compare cup-positioning accuracy in total hip arthroplasty (THA) with or without use of a Kirschner wire as a transverse-axis guide for pelvic alignment. Records of 18 men and 73 women (mean age, 60 years) who underwent primary THA with (n=49) or without (n=42) use of a Kirschner wire as a transverse-axis guide for pelvic alignment were reviewed. A 2.4-mm Kirschner wire as a transversea-xis guide was inserted to the anterior superior iliac spine and was parallel to a line linking the left and right anterior superior iliac spine. The safe zone for cup positioning was defined as 30º to 50° abduction and 10º to 30º anteversion. Of the 5 operative surgeons, 2 were classified as experienced (total surgical volume >300) and 3 as inexperienced (total surgical volume of <50). The proportion of patients with the cup in the safe zone was compared in patients with or without use of the transverse-axis guide and in experienced and inexperienced surgeons. For inexperienced surgeons, the use of the transverse-axis guide significantly improved the proportion of patients with the cup in the safe zone from 90% to 100% for abduction, from 50% to 82.4% for anteversion, and from 40% to 82.4% for both. Patients with the cup inside or outside the safe zone were comparable in terms of body height, weight, BMI, subcutaneous fat thickness, incision length, and acetabular cup size. The use of the transverse-axis guide improved the accuracy of cup positioning by inexperienced surgeons.

FUNCTIONAL DISABILITY, SAGITTAL ALIGNMENT AND PELVIC BALANCE IN LUMBAR SPONDYLOLISTHESIS

ABSTRACT Objectives: To demonstrate the recovery of lumbar sagittal pelvic alignment and sagittal pelvic balance after surgical reduction of lumbar spondylolisthesis and establish the benefits of the surgery for reduction and fixation of the lumbar spondylolisthesis with 360o circumferential arthrodesis for 2 surgical approaches by clinical and functional evaluation. Method: Eight patients with lumbar spondylolisthesis treated with surgical reduction and fixation of listhesis and segmental circumferential fusion with two surgical approaches were reviewed. They were evaluated before and after treatment with Oswestry, Visual Analogue for pain and Odom scales, performing radiographic measurement of lumbar sagittal alignment and pelvic sagittal balance with the technique of pelvic radius. Results: Oswestry scales and EVA reported improvement of symptoms after treatment in 8 cases; the Odom scale had six outstanding cases reported. The lumbar sagittal alignment presented a lumbosacral lordosis angle and a lumbopelvic lordosis angle reduced in 4 cases and increased in 4 other cases; pelvic sagittal balance increased the pelvic angle in 4 cases and decreased in 3 cases and the sacral translation of the hip axis to the promontory increased in 6 cases. Conclusion: The surgical procedure evaluated proved to be useful by modifying the lumbar sagittal alignment and the pelvic balance, besides reducing the symptoms, enabling the patient to have mobility and movement and the consequent satisfaction with the surgery.

Sports influence on transverse plane pelvic alignment

Sports influence on transverse plane pelvic alignment

The effect of total hip arthroplasty on sagittal spinal-pelvic-leg alignment and low back pain in patients with severe hip osteoarthritis.

Sagittal spinopelvic malalignment has been reported in spinal disorders such as low back pain (LBP), and restoration of normal alignment is targeted when treating these disorders. Abnormal sagittal spinal-pelvic-leg alignment has been reported in patients with severe hip osteoarthritis (OA), who have a high prevalence of associated LBP. This prospective longitudinal study aimed to investigate changes in sagittal spinal-pelvic-leg alignment after total hip arthroplasty (THA) in patients with severe hip OA, and whether these changes contribute to LBP relief. Patients undergoing primary THA due to severe unilateral hip OA were recruited. Physical examination and X-ray films were taken to rule out any spinal disorder. Sagittal alignment of pelvis, hip, and spine was analyzed on lateral radiographs taken before (baseline) and 1year after (follow-up) THA. Functional instruments were completed by patients including: visual analog scale (VAS) for LBP, Roland-Morris Disability Questionnaire (RMDQ), and Harris Hip Score (HHS). Comparisons were carried out at baseline and follow-up, and between patients with and without LBP. The recruited 69 patients showed significantly reduced hip flexion and improved global spinal balance at follow-up compared with baseline. LBP was reported by 39 patients (56.5%) before surgery; at follow-up, 17 reported complete resolution, while 22 reported significant relief. Significant decreases in VAS and RMDQ scores in lumbar spine and increase in hip HHS were observed. THA in patients with severe hip OA could help correct abnormal sagittal spinal-pelvic-leg alignment and relieve comorbid LBP. Improvements in hip flexion and global spinal balance might be involved in the mechanism of LBP relief.

Comparison of Pelvic Alignment among Never-Pregnant Women,Pregnant Women, and Postpartum Women (Pelvic Alignment and Pregnancy)

Objective: To compare the pelvic alignment among never-pregnant women, pregnant women, and postpartum women. Methods: A total of 177 nulliparous women (mean age, 18.9 ± 1.0 years), 45 pregnant women between the third and tenth month of pregnancy (mean age, 29.4 ± 3.8 years), and 124 primiparous women between the first and sixth months after delivery (mean age, 30.1 ± 4.4 years) were enrolled in this study. Pelvic alignment was measured by using the anterior superior iliac spine (ASIS) and posterior superior iliac spines (PSIS) as landmarks. The bilateral difference of pelvic tilt was defined as pelvic asymmetry (PA), the distance between bilateral ASIS was defined as the anterior width of the pelvis (AWP), and the distance between the bilateral PSIS was defined as the posterior width of the pelvis (PWP). Results: PA of the pregnant group and postpartum group were significantly greater than the never-pregnant group (2.8 ± 2.4°, 4.2 ± 3.0°, and 3.7 ± 3.2°, respectively, p < 0.001). AWP of the pregnant and postpartum group was wider than the never-pregnant group (24.9 ± 0.3 cm, 24.1 ± 0.1 cm, and 23.6 ± 0.2 cm, respectively, p < 0.001). PWP of the pregnant and postpartum group was narrower than the never-pregnant group (8.2 ± 0.3 cm, 8.6 ± 0.1 cm, and 9.2 ± 0.1 cm, respectively, p = 0.008). In the multivariate regression analysis using never-pregnant women as the reference, pregnant and postpartum women were significantly more likely to have greater PA (β = 0.156, 0.156), wider AWP (β = 0.116, 0.202), and narrower PWP (β = -0.132, -0.147) than never-pregnant women. Conclusions: We found that the alignment of the pelvis was different among never-pregnant, pregnant, and postpartum women.

The relationship between pelvic alignment and dysmenorrhea.

[Purpose] The purpose of this study was to investigate the relationship between pelvic alignment and dysmenorrhea in general women. [Subjects and Methods] One hundred two females participated in this study. They were divided into a dysmenorrhea group and a normal group based on the results of a Visual Analogue Scale (VAS) assessment of pain and the Menstrual Distress Questionnaire (MDQ). The survey data was collecting from 5th July to 20th September, 2014. Formetric 4D was used to measure the pelvic alignment, including the values of Trunk Imbalance, Pelvic Tilt, Surface Rotation, Lateral Deviation, Kyphosis Angle, Lordosis Angle. [Results] There was a difference in the spine alignments of each group. The value of pelvic torsion was 2.4 ± 1.8 degree in those with dysmenorrhea, while it was 1.7 ± 1.1 degree in those without. [Conclusion] In conclusion, the results suggest that there is a relationship between menstrual pain and pelvic torsion.

Screw Loosening and Pelvic Canal Narrowing After Lateral Plating of Feline Ilial Fractures With Locking and Nonlocking Plates.

To compare the frequency of complications, including screw loosening and pelvic canal narrowing, associated with dynamic compression plating, locking plating, and double locking plating of ilial fractures in cats. Historical cohort study. The radiographs and medical records of cats with pelvic fractures that were presented between 2004 and 2013 were reviewed. The cases were categorized based on the plate type and number as dynamic compression plate (DCP), single locking plate (LPS) and double locking plates (dLPS). The frequency of screw loosening was compared across categories using a Fisher's exact test. The change in pelvic alignment, described by the change in sacral index (postoperative sacral index-followup sacral index), was compared across plate categories using ANOVA. The frequency of screw loosening for DCP (5/10) was significantly higher than LPS (1/13) and dLPS (0/11) (P = .05, P = .012, respectively). There was no significant difference in the SI change across plate categories. The mean change in sacral index for DCP was -0.11 (95%CI -0.25 to 0.03), for LPS was 0.0007 (95%CI -0.07 to 0.08), and for dLPS was -0.01 (95%CI -0.04 to 0.02). None of the cats showed constipation postoperatively. Screw loosening occurred less often but the change in pelvic canal alignment was not significantly different in ilial fractures repaired with LPS or dLPS compared to ilial fractures repaired with DCP. Locking plating of ilial fractures in cats may offer advantages compared to nonlocking plating.

Long-term effects of the Chêneau brace on coronal and sagittal alignment in adolescent idiopathic scoliosis.

The aim of the present study was to retrospectively evaluate progressive correction of coronal and sagittal alignment and pelvic parameters in patients treated with a Chêneau brace. Thirty-two patients with adolescent idiopathic scoliosis (AIS) were assessed before initiation of bracing treatment and at the final follow-up. Each patient underwent radiological examinations, and coronal, sagittal, and pelvic parameters were measured. No statistically significant modification of the Cobb angle was noted. The pelvic incidence remained unchanged in 59% of the cases and increased in 28% of the cases. The sacral slope decreased in 34% of the cases but remained unchanged in 50%. Thoracic kyphosis and lumbar lordosis were significantly decreased, whereas the sagittal vertical axis was significantly increased from a mean of -44.0 to -30.2 mm (p = 0.02). The mean pelvic tilt increased significantly from 4.5° to 8.3° (p = 0.002). The Chêneau brace can be useful for preventing curvature progression in patients with AIS. However, the results of this study reveal high variability in the effect of brace treatment on sagittal and pelvic alignment. Treatment with the Chêneau brace may also influence sagittal global balance.

Influence of Bilateral and Unilateral Flatfoot on Pelvic Alignment

Influence of Bilateral and Unilateral Flatfoot on Pelvic Alignment

The Relationship Between Foot and Pelvic Alignment While Standing.

A normal motion and segmental interrelationship has been determined as a significant factor in normal function. Yet, the relationship between distal segments and pelvic alignment needs further investigation. The aim of this study was to investigate the interrelationship between distal and proximal lower extremity segments while standing and during induced feet hyperpronation. Changes in alignment of the pelvis and lower extremities were measured at a gait laboratory using the VICON 612 computerized motion analysis system. Thirty-five healthy volunteer subjects were recruited. Four randomized repeated-measure standing modes were used: standing directly on the floor and then on three wedges angled at 10°, 15° and 20° to induce bilateral hyperpronation for 20 seconds. A significant (p<0.05) bi-variate relationship was found between the anterior pelvic tilt and thigh internal rotation, in all four standing positions (.41≤r≤.46, in all p<0.014). A combined effect of rotational alignment between segments and the cumulative effect of foot hyperpronation on pelvic tilt revealed that only the shank significantly affected pelvic alignment, acting as a mediator between a foot and a thigh with the thigh having a crude significant effect on the pelvis. When internal rotation of the shank occurs, calcaneal eversion couples with thigh internal rotation and anterior pelvic tilt. It can be concluded that in response to induced hyperpronation, the shank is a pivotal segment in postural adjustment.

Characteristics and Mechanisms of Adjusting Spinopelvic Sagittal Balance in Patients with Thoracic and Thoracolumbar Kyphosis

Introduction This study determined the mechanisms of adjusting trunk sagittal balance and the impact of surgery on spinopelvic sagittal morphology and alignment in patients with thoracic and thoracolumbar kyphosis. Materials and Methods Whole spine and standing lateral radiographs of 49 Chinese patients with thoracic and thoracolumbar kyphosis were obtained before surgery, immediately after surgery, and in the final follow-up. A total of 171 asymptomatic Chinese adults were recruited as controls. The age at which the patients developed kyphotic deformity was recorded. The pelvic and spinal parameters were measured and the correlations of all parameters were analyzed. Results The mean age at which the patients developed kyphosis was 7.1 years. Preoperative mean pelvic incidence was 35.1 degrees, and mean pelvic tilt was −0.1 degrees, significantly less than those of normal subjects. Preoperative mean lumbar lordosis was 68.0 degrees, significantly higher than that of normal subjects. After surgery, kyphosis and lumbar hyperlordosis were significantly corrected, however, the preoperative and postoperative pelvic sagittal morphology and alignment made no difference, even in the final follow-up. There were no correlations between spinal and pelvic parameters before surgery. In the final follow-up, the correlations were recovered. Conclusion The mechanisms of adjusting the trunk sagittal balance in patients with thoracic and thoracolumbar kyphosis not only including pelvis anteverting, but also lumbar hyperlordosis. The latter serves as the main mechanism once skeletal maturation has been established. Although kyphosis and lumbar hyperlordosis were corrected by surgery, pelvic sagittal morphology remained unchanged. Surgery can reestablish the spinal sagittal balance and recover the correlations between spinal and pelvic parameters.