Center of Gravity and Radiographic Posture Analysis: A Preliminary Review of Adult Volunteers and Adult Patients Affected by Scoliosis

Fegoun, Abdelkrim Benchikh El; Schwab, Frank J.; Gamez, Lorenzo; Champain, Nicolas; Skalli, Wafa; Farcy, Jean-Pierre

doi:10.1097/01.brs.0000167534.49069.e9

Cited by 102 publications

(51 citation statements)

References 14 publications

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“…Several clinical studies using a force plate have been performed to investigate the balance mechanism [42][43][44][45][46][47]. El Fegoun et al [43] reported a highly significant negative correlation between the gravity line and plumbline in the sagittal plane based on simultaneous assessment of fulllength freestanding spine radiographs and the floor projection of the center of pressure (gravity line), suggesting that the value of the plumbline as a marker of true postural balance must be questioned. We investigated balance using a force plate measurement during X-ray scanning and found that a representative balance parameter, ENV, had a tendency of positive correlation with PI-LL, suggesting that spino-pelvic mismatch affects not only the static sagittal alignment but also dynamic alignment, balance.…”

Section: Discussionmentioning

confidence: 99%

Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects

Hara¹,

Okamoto²,

et al. 2016

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Purpose To elucidate the normative values of whole body sagittal alignment and balance of a healthy population in the standing position; and to clarify the relationship among the alignment, balance, health-related quality of life (HRQOL), and age. Methods Healthy Japanese adult volunteers [n = 126, mean age 39.4 years (20-69), M/F = 30/96] with no history of spinal disease were enrolled in a cross-sectional cohort study. The Oswestry Disability Index (ODI) questionnaire was administered and subjects were scanned from the center of the acoustic meati (CAM) to the feet while standing on a force plate to determine the gravity line (GL), and the distance between CAM and GL (CAM-GL) was measured in the sagittal plane. Standard X-ray parameters were measured from the head to the lower extremities. ODI was compared among age groups stratified by decade. Correlations were investigated by simple linear regression analysis. Ideal lumbar lordosis was investigated using the least squares method. Results The present study yielded normative values for whole standing sagittal alignment including head and lower extremities in a cohort of 126 healthy adult volunteers, comparable to previous reports and thus a formula for ideal lumbar lordosis was deduced: LL = 32.9 ? 0.60 9 PI -0.23 9 age. There was a tendency of positive correlation between McGregor slope, thoracic kyphosis, PT, and age. SVA, T1 pelvic angle, sacrofemoral angle, knee flexion angle, and ankle flexion angle, but not CAM-GL, increased with age, suggesting that the spinopelvic alignment changes with age, but standing whole body alignment is compensated for to preserve a horizontal gaze. ODI tended to increase from the 40s in the domain of pain intensity, personal care, traveling, and total score. ODI weakly, but significantly positively correlated with age and PI-LL. Conclusion Whole body standing alignment even in healthy subjects gradually deteriorates with age, but is compensated to preserve a horizontal gaze. HRQOL is also affected by aging and spinopelvic malalignment.

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Section: Discussionmentioning

confidence: 99%

Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects

Hara¹,

Okamoto²,

et al. 2016

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“…However, no correlations were found between gravity line (GL) and C7 position by patients [6,7]. Gangnet et al [8] showed that the center of acoustic meati (CAM) remains near GL and proposed evaluating the distance from CAM to HA to quantify sagittal balance.…”

Section: Introductionmentioning

confidence: 99%

“…Antero-posterior (AP) and lateral (LAT) radiographs are commonly done but most studies evaluate posture only in the sagittal plane [10,11] although some authors report frontal values [6,12]. Simultaneous use of coronal and sagittal information was not found but in few studies [8,13].…”

Section: Introductionmentioning

confidence: 99%

3D postural balance with regard to gravity line: an evaluation in the transversal plane on 93 patients and 23 asymptomatic volunteers

Steffen

Obeid²,

Aurouer³

et al. 2009

Eur Spine J

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Relevance of posture assessment has been reported in case of spine disorders. This study explores the interest in quantifying posture using 3D reconstruction from biplanar X-rays in free standing position and a force plate. 93 patients consulting for spine disorders were divided ('3D deformity', 'sagittal imbalance' and 'mild deformity') and compared with 23 asymptomatic volunteers. Registration of the gravity line (GL) in reconstruction yielded transversal position of the center of acoustic meati (CAM) T1, T4, T9, L3, S1 and hip axis (HA) with regard to GL. Transversal position of CAM and L3 appeared as relevant parameters to discriminate patients from volunteers. Sagittal inclination of the axis linking the CAM to HA was correlated with position of the CAM to GL (r = 0.92 for patients). In conclusion, observing posture in 3D with regard to GL provides clinical relevant information. CAM-HA inclination may improve postural evaluation without force plate.

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“…Indeed, differences in C7PL and GL positions have been demonstrated (GL -C7PL = 35.25 ± 19.4 mm): when the C7PL increased, no changes in GL position in relation to the heels were observed (the mean distance between GL and the heels was 111 mm). 7,22,31,40 Moreover, a poor correlation existed between C7PL and the true GL (r = 0.098; p < 0.3) 37 . In asymptomatic patients, GL is defined by a vertical line crossing the center of the mass of the entire body, which normally falls over the femoral heads and lies anterior to all vertebrae.…”

Section: 21mentioning

confidence: 99%

Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity

Ferrero

Liabaud

Challier

et al. 2016

SPI

112

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OBJECT Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pelvic parameters have demonstrated the compensatory mechanisms of pelvis translation in addition to rotation. However, the mechanisms recruited for this pelvic rotation were not assessed. This study aims to analyze the relationship between spinopelvic and lower-extremity parameters and clarify the role of pelvic translation. METHODS This is a retrospective study of patients with spinal deformity and full-body EOS images. Patients with only stenosis or low-back pain were excluded. Patients were grouped according to T-1 spinopelvic inclination (T1SPi): sagittal forward (forward, > 0.5°), neutral (−6.3° to 0.5°), or backward (< −6.3°). Pelvic translation was quantified by pelvic shift (sagittal offset between the posterosuperior corner of the sacrum and anterior cortex of the distal tibia), hip extension was measured using the sacrofemoral angle (SFA; the angle formed by the middle of the sacral endplate and the bicoxofemoral axis and the line between the bicoxofemoral axis and the femoral axis), and chin-brow vertical angle (CBVA). Univariate and multivariate analyses were used to compare the parameters and correlation with the Oswestry Disability Index (ODI). RESULTS In total, 336 patients (71% female; mean age 57 years; mean body mass index 27 kg/m2) had mean T1SPi values of −8.8°, −3.5°, and 5.9° in the backward, neutral, and forward groups, respectively. There were significant differences in the lower-extremity and spinopelvic parameters between T1SPi groups. The backward group had a normal lumbar lordosis (LL), negative SVA and pelvic shift, and the largest hip extension. Forward patients had a small LL and an increased SVA, with a large pelvic shift creating compensatory knee flexion. Significant correlations existed between lower-limb parameter and pelvic shift, pelvic tilt, T-1 pelvic angle, T1SPi, and sagittal vertical axis (0.3 < r < 0.8; p < 0.001). ODI was significantly correlated with knee flexion and pelvic shift. CONCLUSIONS This is the first study to describe full-body alignment in a large population of patients with spinal pathologies. Furthermore, patients categorized based on T1SPi were found to have significant differences in the pelvic shift and lower-limb compensatory mechanisms. Correlations between lower-limb angles, pelvic shift, and ODI were identified. These differences in compensatory mechanisms should be considered when evaluating and planning surgical intervention for adult patients with spinal deformity.

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Center of Gravity and Radiographic Posture Analysis: A Preliminary Review of Adult Volunteers and Adult Patients Affected by Scoliosis

Cited by 102 publications

References 14 publications

Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects

Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects

3D postural balance with regard to gravity line: an evaluation in the transversal plane on 93 patients and 23 asymptomatic volunteers

Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity

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