J Korean Soc Spine Surg.  2003 Dec;10(4):327-334.

A Comparative Analysis of Sagittal Spinal Balance in 100 Asymptomatic Young and Older Aged Volunteers

• Kim WJ
• Kang JW
• Yeom JS
• Kim KH
• Jung YH
• Lee SH
• Choy WS

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 degrees, ranging from 3 to 42 degrees, in group A, and 33 degrees, ranging from 9 to 53 degrees, in group B (p<0.001). The average lumbar lordosis was -47 degrees, ranging from -65 to -23 degrees, and -51 degrees, ranging from -69 to -33 degrees, 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 degrees, ranging from 30 to 61 degrees, and 54 degrees, ranging from 28 to 76 degrees, in groups A and B, respectively (p<0.05). The average pelvic tilt was 14 degrees, ranging from 4 to 33 degrees, and 19 degrees, ranging from 3 to 37 degrees, in groups A and B, respectively (p<0.05). The average sacral slope was 32 degrees, ranging from 17 to 47 degrees, and 35 degrees, ranging from 25 to 50 degrees, 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.

Keyword

Sagittal spinal alignment; Lumbosacrum; Pelvis; Hip axis

MeSH Terms

Aging
Animals
Axis, Cervical Vertebra
Hip
Incidence
Kyphosis
Lordosis
Pelvis
Reference Values
Volunteers*

Figure

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  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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