Why is it important to visualize the femoral heads on the lateral standing spine radiograph

There is an interrelationship between the orientation of the distal lumbar spine, sacrum, and the pelvic unit, which influences sagittal alignment of the spine. Three pelvic parameters are measured: pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). Pelvic incidence (PI) is a fixed anatomic parameter unique to the individual. Sacral slope (SS) and pelvic tilt (PT) are variable parameters. The relationship among the parameters determines the overall alignment of the sacropelvic unit according to the formula PI = PT + SS. Increased pelvic tilt is a compensatory mechanism for a positive shift in SVA and should be considered when planning reconstructive spinal surgery for sagittal imbalance. (See Chapter 10, Question 28.)

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