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Optimization of spinopelvic sagittal parameters in spinal deformity surgery have been shown to correlate with surgical outcomes. Commonly used parameters include pelvic incidence (PI), lumbar lordosis (LL) and PI–LL mismatch. Presence of lumbosacral transitional vertebra (LSTV) introduces variability regarding which endplate is considered the sacral endplate. This study aimed to determine the mathematical relationships between measurements using the upper transitional vertebra (UTV) versus the lower transitional vertebra (LTV). The property that internal angles of a triangle sum to 180° was used to create a system of equations to resolve the relationship between the PI–LL mismatch of the UTV and of the LTV. The ultimate relationship was employed on a lateral radiograph of a patient with LSTV for validation. It is possible to compute the PI–LL mismatch using either UTV or LTV and convert to the corresponding PI–LL when using the other vertebra simply by measuring one additional angle (PI–LL)L = (PI–LL)U + X. This angle X is defined by segments connecting the center of the femoral head to the midpoints of the superior endplates of the UTV and LTV. Using the LTV yields a larger PI–LL mismatch value. In patients with LSTV, it is controversial whether the UTV or LTV should be used as the sacral endplate for sagittal measurements. With this mathematical relationship, rather than completing two sets of measurements, the surgeon would only need to measure one set and the additional angle X to determine the resultant PI–LL mismatch for the other transitional vertebra.

Optimization of spinopelvic sagittal parameters in spinal deformity surgery have been shown to correlate with surgical outcomes. Commonly used parameters include pelvic incidence (PI), lumbar lordosis (LL) and PI-LL mismatch. Presence of lumbosacral transitional vertebra (LSTV) introduces variability regarding which endplate is considered the sacral endplate. This study aimed to determine the mathematical relationships between measurements using the upper transitional vertebra (UTV) versus the lower transitional vertebra (LTV).The property that internal angles of a triangle sum to 180° was used to create a system of equations to resolve the relationship between the PI-LL mismatch of the UTV and of the LTV. The ultimate relationship was employed on a lateral radiograph of a patient with LSTV for validation.It is possible to compute the PI-LL mismatch using either UTV or LTV and convert to the corresponding PI-LL when using the other vertebra simply by measuring one additional angle (PI-LL)In patients with LSTV, it is controversial whether the UTV or LTV should be used as the sacral endplate for sagittal measurements. With this mathematical relationship, rather than completing two sets of measurements, the surgeon would only need to measure one set and the additional angle X to determine the resultant PI-LL mismatch for the other transitional vertebra.

The COVID-19 crisis has challenged the U.S. health-care system in a variety of ways, including how we teach and train orthopaedic surgery residents and fellows. During the spring of 2020, the cessation of all elective surgical procedures and the diminished number of outpatient visits challenged graduate medical education. While residency programs in less affected areas may not have had to make many dramatic adjustments, some of those located in pandemic hotspots had to redirect trainees from orthopaedic rotations to COVID-19 units. No matter the region, the time that trainees have spent in rotations has been altered, and absences have occurred due to quarantines. This symposium summarizes the impact of restrictions related to the COVID-19 pandemic on residency and fellowship programs from the perspectives of the Accreditation Council for Graduate Medical Education (ACGME), a program director, and a graduating resident. Although new opportunities for virtual curricula, virtual surgical simulation, and virtual interviews have been innovated, residency programs and residents report primarily a negative effect from the pandemic due to decreased surgical volumes and the limitation of patient-care experiences. Ultimately, program directors have an obligation to the program, the trainee, and the general public to graduate only those residents and fellows who are truly prepared to practice independently; they have the responsibility of making the final decision regarding graduation. The COVID-19 pandemic has continued to underscore the need for competency-based medical education. Assessing competency includes evaluation of the knowledge, the operative skills, the nonoperative patient-care skills, and the professional behavior of each and every individual graduating from orthopaedic residency and fellowship training programs. A hybrid model for time and competency-based training, with established national standards not only for accreditation for our training programs but also for board certification of our graduating residents, was enhanced by the COVID-19 pandemic and is highlighted in this symposium.