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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

Journal of Orthopaedic Surgery and Research 1/2015

A new sagittal parameter to estimate pelvic tilt using the iliac cortical density line and iliac tilt: a retrospective X-ray measurement study

Journal of Orthopaedic Surgery and Research > Ausgabe 1/2015
Toshio Doi, Osamu Tono, Kiyoshi Tarukado, Katsumi Harimaya, Yoshihiro Matsumoto, Mitsumasa Hayashida, Seiji Okada, Yukihide Iwamoto
Wichtige Hinweise

Competing interests

The authors declare no competing interests associated with this study.

Authors’ contributions

TD contributed to the conception and design of the study, acquisition of the data, analysis and interpretation of the data, and drafting the manuscript. OT and KT aided in the acquisition of the data. KH, YM, SO, and MH performed the literature review. YI participated in the design and coordination and helped in drafting the manuscript. All authors read and approved the final manuscript.



When spinal kyphosis increases, the compensatory mechanism activates and the pelvic position changes. Increasing the pelvic tilt, which is the orientation of the pelvis with respect to the femoral head, is known to associate with the clinical symptoms in kyphosis in the aging population. It is often difficult to detect the femoral head on radiographs, limiting the ability to determine the pelvic tilt. Therefore, there is a need to establish another parameter independent of the femoral head which closely correlates with the pelvic tilt.


Eighty-two adult patients with full-length lateral standing spine radiographs were recruited (mean age: 73.0 years). A new parameter, the iliac cortical density line (a component of the arcuate line of the ilium) and the iliac tilt (defined as the angle between the iliac cortical density line and the vertical), was analyzed to determine the correlation with the pelvic tilt.


Both the pelvic tilt (PT) and iliac tilt (IT) could be identified in 67 patients, and a significant correlation was observed between the PT and IT (r = 0.86, P < 0.0001). The PT could be estimated using the following formula: PT = IT − 12.9 (in females), PT = IT − 16.7 (in males).


The iliac tilt, which can be easily and directly measured using the iliac cortical density line, is a new parameter that can reliably estimate the pelvic tilt even when the femoral head is not detectable on the radiograph.
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