J Korean Neurosurg Soc.  2017 Sep;60(5):560-566. 10.3340/jkns.2016.1212.002.

Evaluation of Global Sagittal Balance in Koreans Adults

• Cho Y

• KMID: 2457963
• DOI: http://doi.org/10.3340/jkns.2016.1212.002

Abstract

OBJECTVIE: The global sagittal postural patterns as characterized by Roussouly classification have been previously described in various ethnicities, there were no studies investigated in Koreans. To analyze the distribution of the global sagittal postural patterns in Korean adults using Roussouly classification, the author prospectively studied.
METHODS
252 asymptomatic Korean adults was recruited. Data was obtained by reviewing the films for each subject. Spinopelvic parameters were measured and sagittal postural patterns were then determined according to Roussouly classification. We compared the data across different ethnicities from our study and a previous study to further characterize Korean sagittal postures.
RESULTS
The subject included 151 males and 101 females, with mean age of 33.2±8.2 years. The average descriptive results were as below: thoracic kyphosis 28.6±7.7°, lumbar lordosis 48.3±10.2°, sacral slope 37.8±5.8°, pelvic incidence 45.1±7.5°, pelvic tilt 9.4±6.7°, spinosacral angle 130.1±5.4°, and sagittal vertical axis 16.25±22.5 mm. 125 subjects among 252 (49.6%) belonged to Roussouly type 3 (namely neutral). There were also 58 (23%), 33 (13.1%), and 36 (14.3) subjects in type 1, 2, and 4 (namely non-neutral), respectively.
CONCLUSION
Enrolling 252 asymptomatic Korean adults, this prospective study found that 49.6% of asymptomatic Korean adults possessed a sagittal posture of Roussouly type 3. All radiologic parameters follows general concept of spinal sagittal balance pattern. Overall, this study might be a basis for further investigation of spinal sagittal balance.

Keyword

Spinal curvatures; Spine; Postural balance

MeSH Terms

Adult*
Animals
Classification
Female
Humans
Incidence
Kyphosis
Lordosis
Male
Postural Balance
Posture
Prospective Studies
Spinal Curvatures
Spine

Figure

• 

  Fig. 1 Drawings of Roussouly types. Type 1: SS<35°, apex of lumbar lordosis (LL) at middle L5, the spine is hypolordotic and relatively normokyphotic; type 2: SS<35°, apex of LL at base L4, the spine is hypolordotic and hypokyphotic; type 3: 35°45°, apex of LL at base L3, the spine is hyperlordotic and hyperkyphotic. *Apex of lumbar lordosis (inflection point). SS: sacral slope.

• 

  Fig. 2 Measurement of spinopelvic parameters. C7PL: C7 plumb-line, TK: thoracic kyphosis, LL: lumbar lordosis, SSA: spinosacral angle, SVA: sagittal vertical axis, SS: sacral slope, PT: pelvic tilt, PI: pelvic incidence.

Reference

References

1. Diebo BG, Henry J, Lafage V, Berjano P. Sagittal deformities of the spine: factors influencing the outcomes and complications. Eur Spine J. 24(Suppl 1):S3–S15. 2015.

2. Evcik D, Yucel A. Lumbar lordosis in acute and chronic low back pain patients. Rheumatol Int. 23:163–165. 2003.

3. Garbossa D, Pejrona M, Damilano M, Sansone V, Ducati A, Berjano P. Pelvic parameters and global spine balance for spine degenerative disease: the importance of containing for the well being of content. Eur Spine J. 23(Suppl 6):616–627. 2014.

4. Hasegawa K, Okamoto M, Hatsushikano S, Shimoda H, Ono M, Watanabe K. Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects. Eur Spine J. 25:3675–3686. 2016.

5. Hu P, Yu M, Sun Z, Li W, Jiang L, Wei F, et al. Analysis of global sagittal postural patterns in asymptomatic Chinese adults. Asian Spine J. 10:282–288. 2016.

6. Kostuik JP, Maurais GR, Richardson WJ, Okajima Y. Combined single stage anterior and posterior osteotomy for correction of iatrogenic lumbar kyphosis. Spine (Phila Pa 1976). 13:257–266. 1988.

7. Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittal balance of spondylolisthesis: a review and classification. Eur Spine J. 20(Suppl 5):641–646. 2011.

8. Lee JH, Kim KT, Suk KS, Lee SH, Jeong BO, Kim JS, et al. Analysis of spinopelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine (Phila Pa 1976). 35:E1386–E1391. 2010.

9. Mac-Thiong JM, Roussouly P, Berthonnaud E, Guigui P. Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine (Phila Pa 1976). 35:E1193–E1198. 2010.

10. Noun Z, Lapresle P, Missenard G. Posterior lumbar osteotomy for flat back in adults. J Spinal Disord. 14:311–316. 2001.

11. Rousseau MA, Lazennec JY, Tassin JL, Fort D. Groupe d’Etude la Scoliose [French Scoliosis Study Group]. Sagittal rebalancing of the pelvis and the thoracic spine after pedicle subtraction osteotomy at the lumbar level. J Spinal Disord Tech. 27:166–173. 2014.

12. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976). 30:346–353. 2005.

13. Stagnara P, De Mauroy JC, Dran G, Gonon GP, Costanzo G, Dimnet J, et al. Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine (Phila Pa 1976). 7:335–342. 1982.

14. Vaz G, Roussouly P, Berthonnaud E, Dimnet J. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J. 11:80–87. 2002.

15. Vrtovec T, Janssen MM, Likar B, Castelein RM, Viergever MA, Pernuš F. A review of methods for evaluating the quantitative parameters of sagittal pelvic alignment. Spine J. 12:433–446. 2012.

16. Yagi M, Takeda K, Machida M, Asazuma T. Discordance of gravity line and C7PL in patient with adult spinal deformity--factors affecting the occiput-trunk sagittal discordance. Spine J. 15:213–221. 2015.

17. Yu M, Silvestre C, Mouton T, Rachkidi R, Zeng L, Roussouly P. Analysis of the cervical spine sagittal alignment in young idiopathic scoliosis: a morphological classification of 120 cases. Eur Spine J. 22:2372–2381. 2013.

18. Zhu Z, Xu L, Zhu F, Jiang L, Wang Z, Liu Z, et al. Sagittal alignment of spine and pelvis in asymptomatic adults: norms in Chinese populations. Spine (Phila Pa 1976). 39:E1–E6. 2014.