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Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects.
J Bone Joint Surg Am 2005; 87(2):260-7JB

Abstract

BACKGROUND

There is an increasing recognition of the clinical importance of the sagittal plane alignment of the spine. A prospective study of several radiographic parameters of the sagittal profile of the spine was conducted to determine the physiological values of these parameters, to calculate the variations of these parameters according to epidemiological and morphological data, and to study the relationships among all of these parameters.

METHODS

Sagittal radiographs of the head, spine, and pelvis of 300 asymptomatic volunteers, made with the subject standing, were evaluated. The following parameters were measured: lumbar lordosis, thoracic kyphosis, T9 sagittal offset, sacral slope, pelvic incidence, pelvic tilt, intervertebral angulation, and vertebral wedging angle from T9 to S1. The radiographs were digitized, and all measurements were performed with use of a software program. Two different analyses, a descriptive analysis characterizing these parameters and a multivariate analysis, were performed in order to study the relationships among all of them.

RESULTS

The mean values (and standard deviations) were 60 degrees 10 degrees for maximum lumbar lordosis, 41 degrees +/- 8.4 degrees for sacral slope, 13 degrees +/- 6 degrees for pelvic tilt, 55 degrees +/-10.6 degrees for pelvic incidence, and 10.3 degrees +/- 3.1 degrees for T9 sagittal offset. A strong correlation was found between the sacral slope and the pelvic incidence (r = 0.8); between maximum lumbar lordosis and sacral slope (r = 0.86); between pelvic incidence and pelvic tilt (r = 0.66); between maximum lumbar lordosis and pelvic incidence, pelvic tilt, and maximum thoracic kyphosis (r = 0.9); and, finally, between pelvic incidence and T9 sagittal offset, sacral slope, pelvic tilt, maximum lumbar lordosis, and thoracic kyphosis (r = 0.98). The T9 sagittal offset, reflecting the sagittal balance of the spine, was dependent on three separate factors: a linear combination of the pelvic incidence, maximum lumbar lordosis, and sacral slope; the pelvic tilt; and the thoracic kyphosis.

CONCLUSIONS AND CLINICAL RELEVANCE

This description of the physiological spinal sagittal balance should serve as a baseline in the evaluation of pathological conditions associated with abnormal angular parameter values. Before a patient with spinal sagittal imbalance is treated, the reciprocal balance between various spinal angular parameters needs to be taken into account. The correlations between angular parameters may also be useful in calculating the corrections to be obtained during treatment.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Hôpital Beaujon, 100 Boulevard de Général Leclerc, F-92110 Clichy, France. ravialle@noos.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15687145

Citation

Vialle, Raphaël, et al. "Radiographic Analysis of the Sagittal Alignment and Balance of the Spine in Asymptomatic Subjects." The Journal of Bone and Joint Surgery. American Volume, vol. 87, no. 2, 2005, pp. 260-7.
Vialle R, Levassor N, Rillardon L, et al. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am. 2005;87(2):260-7.
Vialle, R., Levassor, N., Rillardon, L., Templier, A., Skalli, W., & Guigui, P. (2005). Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. The Journal of Bone and Joint Surgery. American Volume, 87(2), pp. 260-7.
Vialle R, et al. Radiographic Analysis of the Sagittal Alignment and Balance of the Spine in Asymptomatic Subjects. J Bone Joint Surg Am. 2005;87(2):260-7. PubMed PMID: 15687145.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. AU - Vialle,Raphaël, AU - Levassor,Nicolas, AU - Rillardon,Ludovic, AU - Templier,Alexandre, AU - Skalli,Wafa, AU - Guigui,Pierre, PY - 2005/2/3/pubmed PY - 2005/3/24/medline PY - 2005/2/3/entrez SP - 260 EP - 7 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 87 IS - 2 N2 - BACKGROUND: There is an increasing recognition of the clinical importance of the sagittal plane alignment of the spine. A prospective study of several radiographic parameters of the sagittal profile of the spine was conducted to determine the physiological values of these parameters, to calculate the variations of these parameters according to epidemiological and morphological data, and to study the relationships among all of these parameters. METHODS: Sagittal radiographs of the head, spine, and pelvis of 300 asymptomatic volunteers, made with the subject standing, were evaluated. The following parameters were measured: lumbar lordosis, thoracic kyphosis, T9 sagittal offset, sacral slope, pelvic incidence, pelvic tilt, intervertebral angulation, and vertebral wedging angle from T9 to S1. The radiographs were digitized, and all measurements were performed with use of a software program. Two different analyses, a descriptive analysis characterizing these parameters and a multivariate analysis, were performed in order to study the relationships among all of them. RESULTS: The mean values (and standard deviations) were 60 degrees 10 degrees for maximum lumbar lordosis, 41 degrees +/- 8.4 degrees for sacral slope, 13 degrees +/- 6 degrees for pelvic tilt, 55 degrees +/-10.6 degrees for pelvic incidence, and 10.3 degrees +/- 3.1 degrees for T9 sagittal offset. A strong correlation was found between the sacral slope and the pelvic incidence (r = 0.8); between maximum lumbar lordosis and sacral slope (r = 0.86); between pelvic incidence and pelvic tilt (r = 0.66); between maximum lumbar lordosis and pelvic incidence, pelvic tilt, and maximum thoracic kyphosis (r = 0.9); and, finally, between pelvic incidence and T9 sagittal offset, sacral slope, pelvic tilt, maximum lumbar lordosis, and thoracic kyphosis (r = 0.98). The T9 sagittal offset, reflecting the sagittal balance of the spine, was dependent on three separate factors: a linear combination of the pelvic incidence, maximum lumbar lordosis, and sacral slope; the pelvic tilt; and the thoracic kyphosis. CONCLUSIONS AND CLINICAL RELEVANCE: This description of the physiological spinal sagittal balance should serve as a baseline in the evaluation of pathological conditions associated with abnormal angular parameter values. Before a patient with spinal sagittal imbalance is treated, the reciprocal balance between various spinal angular parameters needs to be taken into account. The correlations between angular parameters may also be useful in calculating the corrections to be obtained during treatment. SN - 0021-9355 UR - https://www.unboundmedicine.com/medline/citation/15687145/Radiographic_analysis_of_the_sagittal_alignment_and_balance_of_the_spine_in_asymptomatic_subjects_ L2 - http://dx.doi.org/10.2106/JBJS.D.02043 DB - PRIME DP - Unbound Medicine ER -