Journal List > J Korean Soc Spine Surg > v.10(4) > 1035597

J Korean Soc Spine Surg. 2003 Dec;10(4):327-334. Korean.
Published online December 31, 2003.  https://doi.org/10.4184/jkss.2003.10.4.327
Copyright © 2003 Korean Society of Spine Surgery
A Comparative Analysis of Sagittal Spinal Balance in 100 Asymptomatic Young and Older Aged Volunteers
Whoan Jeang Kim, M.D., Jong Won Kang, M.D., Jin Sup Yeom, M.D.,* Kyou Hyun Kim, M.D.,** Yu Hun Jung, M.D., Sung Hun Lee, M.D. and Won Sik Choy, M.D.
Department of Orthopaedic Surgery, Eulji University, Korea.
*Department of Orthopaedic Surgery, Seoul National University, Korea.
**Department of Orthopaedic Surgery, Soonchunhyang University, Korea.

Address reprint requests to Jong Won Kang, M.D. Department of Orthopaedic Surgery, Eulji Medical University, 24, Mok-dong, Jung-gu, Daejon, 301-726, Korea. Tel: 82-42-259-1284, Fax: 82-42-259-1289, Email: jwkang@emc.eulji.ac.kr
Abstract

Study Design

A radiological analysis of the sagittal balance in younger and older aged volunteers.

Objectives

To determine the normal range of the sagittal spinal alignment, and define significant spinopelvic compensations over the hip axis for the sagittal balance with aging.

Summary of Literature Review

Normative data of the sagittal spinal alignment has wide variation and limited clinical usefulness. In addition, the extent to which the "normal" sagittal spinal contour changes with aging remains unknown.

Materials and Methods

Inclusion criteria were an age between 20 and 29 years (n=50), group A, and between 55 and 65 years (n=50), group B, for the asymptomatic subjects. Measurements made on the standing lateral radiographs included the following: thoracic kyphosis, lumbar lordosis and sagittal vertical axis. In addition, measurements of the sacropelvic translation, spinopelvic balance, pelvic incidence, pelvic tilting and sacral slope were made.

Results

The average thoracic kyphosis was 24°, ranging from 3 to 42°, in group A, and 33°, ranging from 9 to 53°, in group B (p<0.001). The average lumbar lordosis was -47°, ranging from -65 to -23°, and -51°, ranging from -69 to -33°, in groups A and B, respectively (p>0.05). The C7 plumb line, on average, fell 15.4 mm more anteriorly to the posterosuperior corner of S1 in group B than in group A (p<0.05). The anterior positioning of the C7 was also positively correlated with decreasing lordosis (p<0.001). The average sacropelvic translation was -41mm, ranging from -76 to 20 mm, and -48 mm, ranging from -76 to -17 mm, in groups A and B, respectively (p<0.05). The average spinopelvic balance was -57 mm, ranging from -104 to -4 mm, and -49 mm, ranging from -101 to -3 mm, in groups A and B, respectively. The C7 plumb line fell posterior to the hip axis in all cases. The average pelvic incidence was 46°, ranging from 30 to 61°, and 54°, ranging from 28 to 76°, in groups A and B, respectively (p<0.05). The average pelvic tilt was 14°, ranging from 4 to 33°, and 19°, ranging from 3 to 37°, in groups A and B, respectively (p<0.05). The average sacral slope was 32°, ranging from 17 to 47°, and 35°, ranging from 25 to 50°, in groups A and B, respectively (p<0.05). There was significant correlation between pelvic incidence and lumbar lordosis (p<0.001).

Conclusions

The sagittal spinal balance is maintained by spinopelvic compensations over the hip axis with aging, and sacropelvic parameters over the hip axis are important for the evaluation of the sagittal spinal balance.

Keywords: Sagittal spinal alignment; Lumbosacrum; Pelvis; Hip axis

Figures


Fig. 1
(A) Photograph of arms raised horizontally forward at 60° flexion at the shoulder. (B) Photograph of ar arms raised horizontally forward at 90° flexion at the shoulder.
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Fig. 2
Method of measuring sagittal vertical axis, thoracic kyphosis, lumbar lordosis.
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Fig. 3
Method of performing measurements of spinopelvic balance.
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Fig. 4
Method of measuring pelvic tilt and pelvic incidence.
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Tables


Table 1
Average values of thoracic kyphosis, lumbar lordosis and sagittal vertical axis in each group.
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Table 2
Average values of spinopelvic parameters in each group.
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Table 3
Statistical analysis between the parameters.
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Table 4
Average values of each parameters according to arms raised horizontally forward at 60° and 90° flexion at the shoulder.
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