Variations in Sagittal Spinopelvic Parameters According to the Lumbar Spinal Morphology in Healthy Korean Young Men

Young-Jun Ahn; Young-Bae Kim; Kyu-Bok Kang; Seung-Won Lee; Yongjung J Kim

doi:10.4184/JKSS.2010.17.2.66

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Ahn, Kim, Kang, Lee, and Kim: Variations in Sagittal Spinopelvic Parameters According to the Lumbar Spinal Morphology in Healthy Korean Young Men

Original Research

J Korean Soc Spine Surg 2010;17(2):66-73.

Published online: 18 June 2010

DOI: https://doi.org/10.4184/JKSS.2010.17.2.66

Variations in Sagittal Spinopelvic Parameters According to the Lumbar Spinal Morphology in Healthy Korean Young Men

Young-Jun Ahn, M.D., Young-Bae Kim, M.D.^∗,, Kyu-Bok Kang, M.D.^∗, Seung-Won Lee, M.D., Yongjung J Kim, M.D.^†

Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea

^∗Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, Korea

^{^†}Department of Orthopaedic Surgery, Columbia University Medical Center, NY, USA

Corresponding author: Young-Bae Kim, M.D. Department of Orthopaedic Surgery, Seoul Veterans Hospital,6-2 Dunchon-dong, Gangdong-gu, Seoul, Korea TEL: 82-2-2225-1351, FAX : 82-2-2225-1910 E-mail: drortho@korea.com

Received 16 July 20096 April 2010 Accepted 24 May 2010

“This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.”

Abstract

Study Design

This is a prospective radiographic study.

Objectives

We wanted to describe and quantify the common variations in the sagittal lumbar spine.

Summary of the Literature Review

No previous study of the spinopelvic parameters with a large cohort of asymptomatic young men was performed on subjects with the same ethnic background.

Materials and Methods

166 young males without disease, trauma or a history of operation on the spine or lower extremities were included. The sagittal standing radiographs of the whole spine on 36 inch film were taken. The distances from the plumb line of C7, T12, the lumbar apex and the bicoxofemoral head to the posterosuperior corner of the sacrum were measured. Thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, the segmental vertebral slopes, the sacral slope and the pelvic incidence were measured. Groups 1 and 2 were classified by having a sacral slope less than 35° (group 1: apex below L4, group 2: above L4). Group 3 had a sacral slope between 35° and 45°, and group 4 had a sacral slope greater than 45°.

Results

The average age was 21.8 years (range: 19~26 years). Group 1 contained 37 cases, group 2 had 44, group 3 had 62 and group 4 had 23. Thoracolumbar kyphosis was significantly increased in group 1 and lumbar lordosis and pelvic incidence were increased in groups 3 and 4. Thoracic kyphosis and the vertebral slope of T12 did not demonstrate any difference between the groups.

Conclusions

The sagittal spinopelvic parameters showed significant changes according to the morphology of the lower lumbar spine. Understanding the patterns of variation in the spinopelvic parameters may help surgeons to plan treatment for various spinal lesions.

Keywords: Lumbar, Sagittal balance, Lordosis, Sacral slope, Classification

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Fig.1.

A four-part classification of the normal variation in the sagittal spinopelvic alignment in the standing position. Group 1. Sacral slope is less than 35° and the apex of lumbar lordosis is below L4 center. Group 2. Sacral slope is less than 35° and the apex of lumbar lordosis is above L4 base. Group 3 includes subjects with sacral slope from 35° to 45°, and Group 4 with sacral slope above 45°.

Fig.2.

The method of measuring the sagittal parameters. (A) The distances from the plumbs of C7 (a), T12 (b), Lumbar apex (c) and bicoxofemoral (d) to the posterosuperior corner of sacrum are measured. A positive value means forward transition and a negative value means backward transition. (B) The vertebral slopes are measured in T5 upper end plate (UEP), T10 UEP, T12 lower end plate (LEP), L2 LEP, L4 UEP. A positive value means vertebral slope is below the horizontal line. (C) The angular parameters are given by vertebral slopes. Thoracic kyphosis (TK, T5 UEP - T12 LEP), thoracolumbar kyphosis (TLK, T10 UEP - L2 LEP), total lumbar lordosis (LL, T12 LEP – S1 UEP) are measured. (D) Sacral slope (SS) and pelvic incidence (PI) are measured for the pelvic parameters.

Table 1.

Demographic data

	Total	Group1	Group2	Group3	Group4	P-value
No. of cases	166	37	44	62	23
Height (cm)	175.2 ± 5.7	172.9 ± 5.1 ^a∗	176.5 ± 5.2 ^b	175.8 ± 6.1 ^a,b	175.2 ± 5.6 ^a,b	0.027
Weight (kg)	68.7 ± 8.0	69.3 ± 8.6	68.1 ± 7.3	69.1 ± 8.4	67.9 ± 6.8	0.825
BMI	22.4 ± 2.1	23.1 ± 2.6 ^a	21.8 ± 1.9 ^b	22.3 ± 2.0 ^a,b	22.1± 1.8 ^a,b	0.043

BMI; Body Mass Index

∗ Different letters (a, b, and c) indicate significant differences between each others by Tukey test.

Table 2.

Sagittal distance parameters (cm)

	Total	Group1	Group2	Group3	Group4	P-value
C7 Plumb	-0.6 ± 2.5	-1.4 ± 1.6 ^a	0.0 ± 2.3 ^b	-0.7 ± 2.8 ^a	-0.1 ± 2.5 ^a	0.045
T12 plumb	-0.8 ± 1.7	-2.5 ± 1.1 ^a	-0.4 ± 1.3 ^b	-0.4 ± 1.7 ^b	0.2 ± 1.9 ^b	0.000
Lumbar Apex plumb	3.0 ± 0.7	2.4 ± 2.6 ^a	3.0 ± 0.7 ^b	3.1 ± 0.7 ^b	3.5 ± 0.8 ^c	0.000
Bicox plumb	3.5 ± 1.2	3.9 ± 1.2 ^a	4.0 ± 1.1 ^a	3.2 ± 1.2 ^b	3.0 ± 1.4 ^b	0.001

Table 3.

Sagittal angular parameters – vertebral slopes(°)

	Total	Group1	Group2	Group3	Group4	P-value
T12 LEP∗	-15.8 ± 5.0	-16.4 ± 4.3	-14.5 ± 5.1	-16.4 ± 5.0	-15.9 ± 5.7	0.207
L2 LEP	-13.3 ± 5.7	-17.8 ± 4.0 ^a	-11.9 ± 5.0 ^b	-12.5 ± 5.5 ^b	-11.0 ± 6.5 ^b	0.000
L4 UEP^†	3.8 ± 6.2	-3.4 ± 3.2 ^a	4.8 ± 3.9 ^b	5.3 ± 5.2 ^b	9.6 ± 5.9 ^c	0.000

LEP∗ Lower End Plate

UEP† Upper End Plate

Table 4.

Sagittal angular parameters (°)

	Total	Group1	Group2	Group3	Group4	P-value
Thoracic Kyphosis	21.3 ± 7.6	23.2 ± 6.4	19.9 ± 7.7	21.9 ± 8.0	19.6 ± 7.5	0.241
Thoracolumbar Kyphosis	s 2.8 ± 7.3	8.6 ± 5.8 ^a	2.0 ± 7.4 ^b	1.0 ± 6.3 ^b	0.1 ± 7.4 ^b	0.000
Lumbar Lordosis	-52.1 ± 9.1	-45.8 ± 7.2 ^a	-45.6 ± 6.1 ^a	-56.1 ± 5.3 ^b	-63.7 ± 7.4 ^c	0.000

Table 5.

Pelvic parameters (°)

	Total	Group1	Group2	Group3	Group4	P-value
Sacral Slope	36.3 ± 7.2	29.4 ± 5.0 ^a	31.2 ± 3.2 ^a	43.7 ± 2.4 ^b	47.8 ± 3.3 ^c	0.000
Pelvic Incidence	46.4 ± 7.7	41.3 ± 5.7 ^a	43.0 ± 6.1 ^a	48.4 ± 6.2 ^b	55.5 ± 7.1 ^c	0.000

Table 6.

Matrix of correlations among the main spinal and pelvic parameters (R values after the pearson test)

	C7 Plumb	Thoracic Kyphosis	Thoracolumbar Kyphosis	Lumbar Lordosis	Sacral Slope	Pelvic Incidence
C7 Plumb	1
Thoracic Kyphosis	0.19	1
Thoracolumbar Kyphosis	.001	.356^†	1
Lumbar Lordosis	.231^†	-.343^†	.194^∗	1
Sacral Slope	.047	-.075	-.338^†	-.837^†	1
Pelvic Incidence	.126	-.073	-.315^†	-.522^†	.623^†	1

^∗ . Correlation is significant at the 0.05 level (2-tailed).

^† . Correlation is significant at the 0.01 level (2-tailed).

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