An Analysis of Sagittal Spinal Alignment in 100 Asymptomatic Middle and Older Aged Volunteers

Gelb, Daniel E.; Lenke, Lawrence G.; Bridwell, Keith H.; Blanke, Kathy; McEnery, Kevin W.

doi:10.1097/00007632-199520120-00005

Cited by 651 publications

(400 citation statements)

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“…This suggests that, not only does the growth of the pelvis in the sagittal plane between the femoral heads and the upper sacral endplate ceases during adulthood, but also that normal degenerative changes to the hips, sacrum and sacro-iliac joints do not significantly influence the PI. On the opposite, PT and SS, respectively, increased and decreased slightly with aging, indicating an increased retroversion of the pelvis presumably to compensate for degenerative processes (bone and soft tissues) occurring in the spine that tend to decrease the lumbar lordosis and induce a positive spinal balance (forward displacement of the spine) with increasing age, as observed in previous studies [31,40]. However, changes in PT and SS with age are minor in normal individuals, and therefore an important increase in PT and/or decrease in SS should alert the clinician about the possible presence of underlying spine pathology.…”

Section: Discussionsupporting

confidence: 68%

Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults

et al. 2011

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Introduction Many studies suggest the importance of the sagittal sacropelvic balance and morphology in spinal and hip disorders. This study describes the normal age-and sex-related changes in sacropelvic morphology and balance in a prospective cohort of asymptomatic adults without spinal disorder. Materials and methods A prospective cohort of 709 asymptomatic adults without spinal pathology was recruited. There were 354 males and 355 females aged 37.9 ± 14.7 and 35.7 ± 13.9 years, respectively. For each subjects, pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured from standing lateral radiographs. Ratios of SS to PI (SS/PI), PT to PI (PT/PI), and PT to SS (PT/SS) were also calculated. Results There was no significant difference in PI (pelvic incidence), SS (sacral slope), PT (pelvic tilt), PT/PI, SS/PI, or PT/SS between males and females. The mean ± 2 standard deviations (SD) range was 32°-74°, 0°-27°, and 24°-55°for PI, PT and SS, respectively. The mean ± 2 SD range was greater than 0.5 for SS/PI and less than 0.5 for PT/PI. PI was not related to age in either sex group. PT, SS, PT/PI, SS/PI, and PT/SS presented only weak correlation coefficients (r B 0.21) with respect to age. Conclusion The current study presents the largest cohort of asymptomatic adults in the literature dedicated to the evaluation of sagittal sacropelvic morphology and balance. The range of values corresponding to the mean ± 2 SD can provide invaluable information to clinicians about the normal range of values expected in 95% of the normal population.

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Section: Discussionsupporting

confidence: 68%

Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults

et al. 2011

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“…In case of incongruent relations between pelvis inclination and lumbar lordosis angle, increases of thoracic angles could be observed in the time course of aging, meaning a rounder kyphosis [14]. Comparable findings could be established for age-related decreases of the lumbar angle, meaning a flatter lordosis [7,24]. On the other hand, there might be an assessment-related influence, especially affecting our results of lumbar lordosis angles.…”

Section: Discussionmentioning

confidence: 71%

“…The target of the present investigation was to determine the role of age for this topic, although age should not be considered to be the sole factor for spinal degeneration [6]. So far frontal plane parameters have not been assumed to be depending on age [7,9,14,19,24]. In factor analyses, we found rotated component models that were comparable within the patients' subsamples, but different from the controls.…”

Section: Discussionmentioning

confidence: 79%

“…Parameters of the sagittal plane were extracted as being associated with low back pain, too. But with respect to the literature and inconsistency of different multivariate analysis approaches, those parameters also might to some extent be affected by aging and degeneration [7,9,14,19,24]. Despite assessment-specific limitations for the lumbosacral transition and despite a missing subsample of older controls, due to the inclusion criterion set prior to the investigation, we conclude that frontal plane trunk imbalance remains a low back pain indicator irrespective of age, while it was not possible to tell if it is the cause or a symptom of unspecific low back pain complaints.…”

Section: Discussionmentioning

confidence: 99%

“…Using video rasterstereography and multivariate analysis procedures, frontal plane (e.g., trunk imbalance and pelvis torsion) and sagittal plane (e.g., trunk inclination, lordosis angle) spine shape parameters could be identified to be associated with chronic low back pain in an adult population, ranging in age from 19 to 79 years [20][21][22]. In view of the corresponding literature, especially the sagittal plane parameters could have been affected by interfering influences of age [7,9,14,19,24]. The present investigation was aiming at separating age influences from low back pain-related spinal alignment deviations.…”

Section: Introductionmentioning

confidence: 99%

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Spinal alignment in low back pain patients and age-related side effects: a multivariate cross-sectional analysis of video rasterstereography back shape reconstruction data

2013

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Purpose Spinal form in the sagittal plane and asymmetries of spinal alignment in the frontal plane were identified earlier to be associated with low back pain. This study was aiming at investigating whether age was influencing the significance of these findings. Methods Spinal alignment of 155 older and 58 younger low back pain patients was investigated using non-invasive video rasterstereography and compared to 192 pain free controls. Trunk inclination and imbalance, pelvis tilt and torsion, and the thoracic kyphosis and lumbar lordosis angle served as dependent variables, which were analyzed using multivariate procedures. Results Frontal plane parameters-trunk imbalance (k [ 0.60) in combination with pelvis tilt (k [ 0.64)-constituted an independent component in a factor analysis model of spine shape parameters in younger and older patients, but not in pain free controls. Trunk imbalance (frontal), trunk inclination (sagittal) and partially thoracic kyphosis angle (sagittal) were extracted to separate patients from controls (discriminant coefficients [0.50). Age could not be excluded as interfering variable for the lumbar lordosis angle. Significant univariate analyses revealed higher effect sizes for trunk imbalance and inclination (g 2 [ 0.07) than for lordosis, kyphosis or pelvic parameters (g 2 \ 0.06). Conclusions In line with corresponding findings trunk imbalance remained a low back pain-associated parameter not depending on age. Over all, sagittal trunk inclination and the thoracic kyphosis angle could not be established as being completely free from age influences, while the lumbar lordosis angle played a minor role and seemed to be influenced more by age than by low back pain in this rasterstereography study.

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3D geometric morphometric analysis of variation in the human lumbar spine

Zlolniski

Torres-Tamayo

García‐Martínez

et al. 2019

American J Phys Anthropol

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Objectives: The shape of the human lumbar spine is considered to be a consequence of erect posture. In addition, several other factors such as sexual dimorphism and variation in genetic backgrounds also influence lumbar vertebral morphology. Here we use 3D geometric morphometrics (GM) to analyze the 3D morphology of the lumbar spine in different human populations, exploring those potential causes of variation.Material and methods: We collected 390 (semi) landmarks from 3D models of the CT scans of lumbar spines of seven males and nine females from a Mediterranean population (Spain, Israel) and seven males and either females from a South African population for geometric morphometric (GM) analysis. We carried out Generalized Procrustes Analysis, Principal Components, and Regression analyses to evaluate shape variation; and complemented these analyses with the Cobb Method.Results: The Mediterranean sample was considerably more lordotic than the South African sample. In both populations, female lumbar spines showed proportionally narrower and more craniocaudally elongated lumbar segments than in males. In addition, the point of maximum curvature in females tended to be located more inferiorly than in males. Discussion:Our results show that sexual dimorphism is an important factor of lumbar spine variation that mainly affects features of lumbar spine robustness (height proportions) and the structure-but not the degree-of its curvature. Differences in lordosis, however, are clearer at the inter-population level. This reflects previous conflicting studies casting doubts on pregnancy as an adaptive factor influencing lordosis. Other factors, for example, shape of the individual lumbar vertebrae and intervertebral discs and their relative proportions within the lumbar spine should be considered when exploring variation in vertebral column morphology. K E Y W O R D Slordosis, Mediterranean Caucasian, population variation, sexual dimorphism, South African

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An Analysis of Sagittal Spinal Alignment in 100 Asymptomatic Middle and Older Aged Volunteers

Cited by 651 publications

References 0 publications

Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults

Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults

Spinal alignment in low back pain patients and age-related side effects: a multivariate cross-sectional analysis of video rasterstereography back shape reconstruction data

3D geometric morphometric analysis of variation in the human lumbar spine

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