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Published in: European Spine Journal 6/2013

01-11-2013 | Original Article

Compensatory mechanisms contributing to keep the sagittal balance of the spine

Authors: Cédric Barrey, Pierre Roussouly, Jean-Charles Le Huec, Gennaro D’Acunzi, Gilles Perrin

Published in: European Spine Journal | Special Issue 6/2013

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Abstract

Introduction

Aging spine is characterized by facet joints arthritis, degenerative disc disease, bone remodeling and atrophy of extensor muscles resulting in a progressive kyphosis of the lumbar spine.

Objective

The aim of this paper is to describe the different compensatory mechanisms for patients with severe degenerative lumbar spine.

Material and methods

According to the severity of the imbalance, three stages are observed: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permit to limit the consequences of loss of lumbar lordosis on global sagittal alignment and therefore contribute to keep the sagittal balance of the spine.

Results

The basic concept is to extend adjacent segments of the kyphotic spine allowing for compensation of the sagittal unbalance but potentially inducing adverse effects.

Conclusion

Finally, we propose a three-step algorithm to analyze the global balance status and take into consideration the presence of the compensatory mechanisms in the spinal, pelvic and lower limb areas.
Literature
1.
go back to reference Barrey C (2004) Equilibre sagittal pelvi-rachidien et pathologies lombaires dégénératives. Etude comparative à propos de 100 cas (in French). Thèse de Médecine. Université Claude Bernard, Lyon Barrey C (2004) Equilibre sagittal pelvi-rachidien et pathologies lombaires dégénératives. Etude comparative à propos de 100 cas (in French). Thèse de Médecine. Université Claude Bernard, Lyon
2.
go back to reference Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases: a comparative study about 85 cases. Eur Spine J 16:1459–1467PubMedCrossRef Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases: a comparative study about 85 cases. Eur Spine J 16:1459–1467PubMedCrossRef
3.
go back to reference Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18:40–47PubMedCrossRef Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18:40–47PubMedCrossRef
4.
go back to reference During J, Goudfrooij H, Keessen W, Beeker TW, Crowe A (1985) Towards standards for posture. Postural characteristics of the lower back system in normal and pathologic conditions. Spine 10:83–87PubMedCrossRef During J, Goudfrooij H, Keessen W, Beeker TW, Crowe A (1985) Towards standards for posture. Postural characteristics of the lower back system in normal and pathologic conditions. Spine 10:83–87PubMedCrossRef
5.
go back to reference Duval-Beaupère G, Legaye J (2004) Composante sagittale de la statique rachidienne (in French). Rev Rhum 71:105–119CrossRef Duval-Beaupère G, Legaye J (2004) Composante sagittale de la statique rachidienne (in French). Rev Rhum 71:105–119CrossRef
6.
go back to reference Gelb DE, Lenke LG, Bridwell KH, Blanke K, MacEnery KW (1995) An analysis of sagittal spinal aligment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358PubMed Gelb DE, Lenke LG, Bridwell KH, Blanke K, MacEnery KW (1995) An analysis of sagittal spinal aligment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358PubMed
7.
go back to reference Izumi Y, Kumano K (2001) Analysis of sagittal lumbar alignment before and after posterior instrumentation: risk factor for adjacent unfused segment. Eur J Orthop Surg Traum 1:9–13CrossRef Izumi Y, Kumano K (2001) Analysis of sagittal lumbar alignment before and after posterior instrumentation: risk factor for adjacent unfused segment. Eur J Orthop Surg Traum 1:9–13CrossRef
8.
go back to reference Jackson RP, MacManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex and size. Spine 19:1611–1618PubMedCrossRef Jackson RP, MacManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex and size. Spine 19:1611–1618PubMedCrossRef
9.
go back to reference Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine 25:575–586PubMedCrossRef Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine 25:575–586PubMedCrossRef
10.
go back to reference Kobayashi T, Atsuta Y, Matsuno T, Takeda N (2004) A longitudinal study of congruent sagittal spinal alignment in an adult cohort. Spine 29:671–676PubMedCrossRef Kobayashi T, Atsuta Y, Matsuno T, Takeda N (2004) A longitudinal study of congruent sagittal spinal alignment in an adult cohort. Spine 29:671–676PubMedCrossRef
11.
go back to reference Korovessis PG, Stamatakis MV, Baikousis AG (1998) Reciprocal angulation of vertebral bodies in the sagittal plane in a asymptomatic greek population. Spine 23:700–704PubMedCrossRef Korovessis PG, Stamatakis MV, Baikousis AG (1998) Reciprocal angulation of vertebral bodies in the sagittal plane in a asymptomatic greek population. Spine 23:700–704PubMedCrossRef
12.
go back to reference Korovessis PG, Dimas A, Iliopoulos P, Lambiris E (2002) Correlative analysis of lateral vertebral radiographic variables and medical outcomes study short-form health survey: a comparative study in asymptomatic volunteers versus patients with low back pain. J Spinal Disord Tech 15:384–390PubMedCrossRef Korovessis PG, Dimas A, Iliopoulos P, Lambiris E (2002) Correlative analysis of lateral vertebral radiographic variables and medical outcomes study short-form health survey: a comparative study in asymptomatic volunteers versus patients with low back pain. J Spinal Disord Tech 15:384–390PubMedCrossRef
13.
go back to reference Kumar MN, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319PubMedCrossRef Kumar MN, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319PubMedCrossRef
14.
go back to reference Lafage V, Schwab F, Skalli W, Hawkinson N, Gagey PM, Ondra S, Farcy JP (2008) Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine 33:1572–1578PubMedCrossRef Lafage V, Schwab F, Skalli W, Hawkinson N, Gagey PM, Ondra S, Farcy JP (2008) Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine 33:1572–1578PubMedCrossRef
15.
go back to reference Lamartina C, Berjano P, Petruzzi M, Sinigaglia A, Casero G, Cecchinato R, Damilano M, Bassani R (2012) Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J 21(Suppl):27–31CrossRef Lamartina C, Berjano P, Petruzzi M, Sinigaglia A, Casero G, Cecchinato R, Damilano M, Bassani R (2012) Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J 21(Suppl):27–31CrossRef
16.
go back to reference Lazennec JY, Ramare S, Arafati N, Laudet CG, Gorin M, Roger B, Hansen S, Saillant G, Maurs L, Trabelsi R (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9:47–55PubMedCrossRef Lazennec JY, Ramare S, Arafati N, Laudet CG, Gorin M, Roger B, Hansen S, Saillant G, Maurs L, Trabelsi R (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9:47–55PubMedCrossRef
17.
go back to reference Legaye J, Duval-Beaupère G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103PubMedCrossRef Legaye J, Duval-Beaupère G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103PubMedCrossRef
18.
go back to reference Obeid I, Hauger O, Aunoble S, Bourghli A, Pellet N, Vital JM (2011) Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee. Eur Spine J 20(Suppl 5):681–685PubMedCrossRef Obeid I, Hauger O, Aunoble S, Bourghli A, Pellet N, Vital JM (2011) Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee. Eur Spine J 20(Suppl 5):681–685PubMedCrossRef
19.
go back to reference Rajnics P, Templier A, Skalli W, Lavaste F, Illes T (2002) The importance of spinopelvic parameters in patients with lumbar disc lesions. Int Orthop 26:104–108PubMedCrossRef Rajnics P, Templier A, Skalli W, Lavaste F, Illes T (2002) The importance of spinopelvic parameters in patients with lumbar disc lesions. Int Orthop 26:104–108PubMedCrossRef
20.
go back to reference Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353PubMedCrossRef Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353PubMedCrossRef
21.
go back to reference Roussouly P, Gollogly S, Noseda O, Berthonnaud E, Dimnet J (2006) The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumbline: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine 31:E320–E325PubMedCrossRef Roussouly P, Gollogly S, Noseda O, Berthonnaud E, Dimnet J (2006) The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumbline: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine 31:E320–E325PubMedCrossRef
22.
go back to reference Schuller S, Charles YP, Steib JP (2011) Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis. Eur Spine J 20:713–719PubMedCrossRef Schuller S, Charles YP, Steib JP (2011) Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis. Eur Spine J 20:713–719PubMedCrossRef
23.
go back to reference Stagnara P, De Mauroy JC, Dran G, Gonon G, Costanzo G, Dimnet J, Pasquet A (1982) Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine 7:335–342PubMedCrossRef Stagnara P, De Mauroy JC, Dran G, Gonon G, Costanzo G, Dimnet J, Pasquet A (1982) Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine 7:335–342PubMedCrossRef
24.
go back to reference Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y (1988) Lumbar degenerative kyphosis: clinical, radiological and epidemiological studies. Spine 13:1317–1326PubMedCrossRef Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y (1988) Lumbar degenerative kyphosis: clinical, radiological and epidemiological studies. Spine 13:1317–1326PubMedCrossRef
25.
go back to reference Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–87PubMedCrossRef Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–87PubMedCrossRef
Metadata
Title
Compensatory mechanisms contributing to keep the sagittal balance of the spine
Authors
Cédric Barrey
Pierre Roussouly
Jean-Charles Le Huec
Gennaro D’Acunzi
Gilles Perrin
Publication date
01-11-2013
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue Special Issue 6/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-013-3030-z

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