Top

European Spine Journal

Published in:

01-03-2020 | Original Article

Age-based normal sagittal alignment in Chinese asymptomatic adults: establishment of the relationships between pelvic incidence and other parameters

Authors: Siyu Zhou, Fei Xu, Wei Wang, Da Zou, Zhuoran Sun, Weishi Li

Published in: European Spine Journal | Issue 3/2020

Abstract

Purpose

To investigate the age-based normal values of sagittal parameters and establish the relationships between them in Chinese population.

Method

Two hundred eighteen asymptomatic adult volunteers were included in this cross-sectional study. The whole spine standing radiograph was taken from them, and the parameters including sagittal vertical axis (SVA), T1 pelvic angle (TPA), global tilt (GT), spino-sacral angle, lumbar lordosis (LL), thoracic kyphosis (TK), T1 slope (T1S), cervical lordosis (CL), C2–C7SVA, pelvic tilt (PT), sacral slop (SS) and pelvic incidence (PI) were measured. The gender differences in sagittal alignment were compared. Pearson correlation was calculated, and a linear regression analysis was used to establish the relation between PI and other parameters.

Results

The average values of PI, LL, TPA and GT were 46.2°, 48.2°, 7.8° and 10.6°, respectively, in this cohort. SVA, GT, TPA, TK, T1S, CL and PT significantly increased with age (p < 0.05). The females presented smaller T1S, C2–C7SVA and larger PI, PT than the males. The relationships between PI and TPA, GT, SS, LL could be presented as TPA = 0.411 * PI − 11.2 (R² = 0.328, p < 0.001), GT = 0.483 * PI − 11.7 (R² = 0.297, p < 0.001), SS = 0.354 * PI + 16.1 (R² = 0.203, p < 0.001), LL = 0.588 * PI + 21.0 (R² = 0.267, p < 0.001), respectively.

Conclusion

The normal values of sagittal parameters were presented and changed with age in Chinese asymptomatic population. The gender differences existed in sagittal parameters. The relationships between PI and other parameters were established which could be used for further research.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

Available only for authorised users

Dubousset J (1994) Three-dimensional analysis of the scoliotic deformity. In: Weinstein SL (ed) The Pediatric Spine: Principles and Practices. Raven Press, New York, pp 479–496

Terran J, Schwab F, Shaffrey CI, Smith JS, Devos P, Ames CP, Fu KM, Burton D, Hostin R, Klineberg E, Gupta M, Deviren V, Mundis G, Hart R, Bess S, Lafage V, International Spine Study G (2013) The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 73:559–568. https://doi.org/10.1227/NEU.0000000000000012 CrossRefPubMed

Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination two key radiographic parameters in the setting of adults with spinal deformity. Spine 38:E803–E812

Yilgor C, Sogunmez N, Boissiere L, Yavuz Y, Obeid I, Kleinstuck F, Perez-Grueso FJS, Acaroglu E, Haddad S, Mannion AF, Pellise F, Alanay A, European Spine Study G (2017) Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am 99:1661–1672. https://doi.org/10.2106/JBJS.16.01594 CrossRefPubMed

Diebo BG, Henry J, Lafage V, Berjano P (2015) Sagittal deformities of the spine: factors influencing the outcomes and complications. Eur Spine J 24(Suppl 1):S3–15. https://doi.org/10.1007/s00586-014-3653-8 CrossRefPubMed

Schwab F, Patel A, Ungar B, Farcy J-P, Lafage V (2010) Adult spinal deformity—postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 35:2224–2231. https://doi.org/10.1097/BRS.0b013e3181ee6bd4 CrossRefPubMed

Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, DeWald C, Mehdian H, Shaffrey C, Tribus C, Lafage V (2012) Scoliosis research society—Schwab adult spinal deformity classification: a validation study. Spine 37:1077–1082. https://doi.org/10.1097/BRS.0b013e31823e15e2 CrossRefPubMed

Protopsaltis T, Schwab F, Bronsard N, Smith JS, Klineberg E, Mundis G, Ryan DJ, Hostin R, Hart R, Burton D, Ames C, Shaffrey C, Bess S, Errico T, Lafage V, International Spine Study G (2014) The T1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life. J Bone Joint Surg Am 96:1631–1640. https://doi.org/10.2106/JBJS.M.01459 CrossRef

Banno T, Hasegawa T, Yamato Y, Kobayashi S, Togawa D, Oe S, Mihara Y, Matsuyama Y (2016) T1 pelvic angle is a useful parameter for postoperative evaluation in adult spinal deformity patients. Spine (Phila Pa 1976) 41:1641–1648. https://doi.org/10.1097/BRS.0000000000001608 CrossRef

10.

Obeid I, Boissiere L, Yilgor C, Larrieu D, Pellise F, Alanay A, Acaroglu E, Perez-Grueso FJ, Kleinstuck F, Vital JM, Bourghli A, European Spine Study Group E (2016) Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J 25:3644–3649. https://doi.org/10.1007/s00586-016-4649-3 CrossRefPubMed

11.

Iyer S, Lenke LG, Nemani VM, Albert TJ, Sides BA, Metz LN, Cunningham ME, Kim HJ (2016) Variations in sagittal alignment parameters based on age: a prospective study of asymptomatic volunteers using full-body radiographs. Spine (Phila Pa 1976) 41:1826–1836. https://doi.org/10.1097/BRS.0000000000001642 CrossRef

12.

Hasegawa K, Okamoto M, Hatsushikano S, Shimoda H, Ono M, Watanabe K (2016) 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. https://doi.org/10.1007/s00586-016-4702-2 CrossRefPubMed

13.

Lee CS, Chung SS, Kang KC, Park SJ, Shin SK (2011) Normal patterns of sagittal alignment of the spine in young adults radiological analysis in a Korean population. Spine (Phila Pa 1976) 36:E1648–1654. https://doi.org/10.1097/BRS.0b013e318216b0fd CrossRef

14.

Endo K, Suzuki H, Nishimura H, Tanaka H, Shishido T, Yamamoto K (2014) Characteristics of sagittal spino-pelvic alignment in Japanese young adults. Asian Spine J 8:599–604. https://doi.org/10.4184/asj.2014.8.5.599 CrossRefPubMedPubMedCentral

15.

Mac-Thiong JM, Roussouly P, Berthonnaud E, Guigui P (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine 35:E1193CrossRefPubMed

16.

Zhu Z, Xu L, Zhu F, Jiang L, Wang Z, Liu Z, Qian BP, Qiu Y (2014) Sagittal alignment of spine and pelvis in asymptomatic adults: norms in Chinese populations. Spine (Phila Pa 1976) 39:E1–6. https://doi.org/10.1097/BRS.0000000000000022 CrossRef

17.

Banno T, Togawa D, Arima H, Hasegawa T, Yamato Y, Kobayashi S, Yasuda T, Oe S, Hoshino H, Matsuyama Y (2016) The cohort study for the determination of reference values for spinopelvic parameters (T1 pelvic angle and global tilt) in elderly volunteers. Eur Spine J 25:3687–3693. https://doi.org/10.1007/s00586-016-4411-x CrossRefPubMed

18.

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 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine 31:E320CrossRefPubMed

19.

Ryan DJ, Protopsaltis TS, Ames CP, Hostin R, Klineberg E, Mundis GM, Obeid I, Kebaish K, Smith JS, Boachie-Adjei O, Burton DC, Hart RA, Gupta M, Schwab FJ, Lafage V, International Spine Study G (2014) T1 pelvic angle (TPA) effectively evaluates sagittal deformity and assesses radiographical surgical outcomes longitudinally. Spine (Phila Pa 1976) 39:1203–1210. https://doi.org/10.1097/BRS.0000000000000382 CrossRef

20.

Qiao J, Zhu F, Xu L, Liu Z, Zhu Z, Qian B, Sun X, Qiu Y (2014) T1 pelvic angle: a new predictor for postoperative sagittal balance and clinical outcomes in adult scoliosis. Spine (Phila Pa 1976) 39:2103–2107. https://doi.org/10.1097/BRS.0000000000000635 CrossRef

21.

Tang JA, Scheer JK, Smith JS, Deviren V, Bess S, Hart RA, Lafage V, Shaffrey CI, Schwab F, Ames CP, Issg (2012) The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 71:662–669. https://doi.org/10.1227/NEU.0b013e31826100c9(discussion 669) CrossRefPubMed

22.

Hyun SJ, Kim KJ, Jahng TA, Kim HJ (2016) Relationship between T1 slope and cervical alignment following multilevel posterior cervical fusion surgery: impact of T1 slope minus cervical lordosis. Spine (Phila Pa 1976) 41:E396–402. https://doi.org/10.1097/BRS.0000000000001264 CrossRef

23.

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. JBJS 87:260–267. https://doi.org/10.2106/jbjs.d.02043 CrossRef

24.

Han F, Weishi L, Zhuoran S, Qingwei M, Zhongqiang C (2017) Sagittal plane analysis of the spine and pelvis in degenerative lumbar scoliosis. J Orthop Surg (Hong Kong) 25:2309499016684746. https://doi.org/10.1177/2309499016684746 CrossRef

25.

Iyer (2016)

26.

Iyer S, Lenke LG, Nemani VM, Fu M, Shifflett GD, Albert TJ, Sides BA, Metz LN, Cunningham ME, Kim HJ (2016) Variations in occipitocervical and cervicothoracic alignment parameters based on age: a prospective study of asymptomatic volunteers using full-body radiographs. Spine (Phila Pa 1976) 41:1837–1844. https://doi.org/10.1097/BRS.0000000000001644 CrossRef

27.

Yang M, Yang C, Ni H, Zhao Y, Li M (2016) The relationship between T1 sagittal angle and sagittal balance: a retrospective study of 119 healthy volunteers. PLoS ONE 11:e0160957. https://doi.org/10.1371/journal.pone.0160957 CrossRefPubMedPubMedCentral

28.

Mannion AF, Käser L, Weber E, Rhyner A, Dvorak J, Müntener M (2000) Influence of age and duration of symptoms on fibre type distribution and size of the back muscles in chronic low back pain patients. Eur Spine J 9:273–281CrossRefPubMedPubMedCentral

29.

Korovessis PG, Stamatakis MV, Baikousis AG (1998) Reciprocal angulation of vertebral bodies in the sagittal plane in an asymptomatic Greek population. Spine 23:700CrossRefPubMed

30.

Lafage R, Schwab F, Challier V, Henry JK, Gum J, Smith J, Hostin R, Shaffrey C, Kim HJ, Ames C, Scheer J, Klineberg E, Bess S, Burton D, Lafage V, International Spine Study G (2016) Defining spino-pelvic alignment thresholds: should operative goals in adult spinal deformity surgery account for age? Spine (Phila Pa 1976) 41:62–68. https://doi.org/10.1097/BRS.0000000000001171 CrossRef

31.

Xu L, Qin X, Zhang W, Qiao J, Liu Z, Zhu Z, Qiu Y, Qian BP (2015) Estimation of the ideal lumbar lordosis to be restored from spinal fusion surgery: a predictive formula for chinese population. Spine (Phila Pa 1976) 40:1001–1005. https://doi.org/10.1097/BRS.0000000000000871 CrossRef

Title: Age-based normal sagittal alignment in Chinese asymptomatic adults: establishment of the relationships between pelvic incidence and other parameters
Authors: Siyu Zhou
Fei Xu
Wei Wang
Da Zou
Zhuoran Sun
Weishi Li
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 3/2020
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-06178-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Age-based normal sagittal alignment in Chinese asymptomatic adults: establishment of the relationships between pelvic incidence and other parameters

Abstract

Purpose

Method

Results

Conclusion

Graphic abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Method

Results

Conclusion

Graphic abstract

Please log in to get access to this content

Other articles of this Issue 3/2020

Chronic physical illnesses, mental health disorders, and psychological features as potential risk factors for back pain from childhood to young adulthood: a systematic review with meta-analysis

A novel tool to provide predictable alignment data irrespective of source and image quality acquired on mobile phones: what engineers can offer clinicians

Correlation between the apex of lumbar lordosis and pelvic incidence in asymptomatic adult

Correction to: Disc inflammation and Modic changes show an interaction effect on recovery after surgery for lumbar disc herniation

Safe range of shortening the middle thoracic spine, an experimental study in canine

Relationship between cervical and global sagittal balance in patients with dropped head syndrome