Normative data for parameters of sagittal spinal alignment in healthy subjects: an analysis of gender specific differences and changes with aging in 626 asymptomatic individuals

Yukawa, Yasutsugu; Kato, Fumihiko; Suda, Kota; Yamagata, Masatsune; Ueta, Takayoshi; Yoshida, Munehito

doi:10.1007/s00586-016-4807-7

Cited by 110 publications

(84 citation statements)

References 22 publications

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“…In this study, we did not directly control for pelvic tilt by placing a pillow underneath the legs in supine. Despite this, our measured Cobb angles in standing are consistent with a prior report that also included young, asymptomatic individuals (48). Further, it has been shown that externally applied loads during standing can alter the lumbar spine to be in less lordosis in pMRI (6, 36, 37).…”

Section: Discussionsupporting

confidence: 91%

Effects of Standing on Spinal Alignment and Lumbar Intervertebral Discs in Young, Healthy Individuals Determined by Positional Magnetic Resonance Imaging

Hwang

Lrv

et al. 2019

Preprint

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23Traditional diagnostic imaging of the spine is performed in supine, a relatively unloaded position. 24However, the spine is subjected to complex loading environments in daily activities such as standing. 25Therefore, we seek to quantify the changes from supine to standing in the spines of young, healthy 26 individuals in standing using a positional MRI system. This is an observational study that examined the 27 changes in the spine and individual intervertebral discs (IVDs) during supine and standing of forty healthy 28 participants (19 males / 21 females) without a history of low back pain. The regional lumbar spinal 29 alignment was measured by the sagittal Cobb angle. Segmental IVD measurements included the segmental 30 Cobb angle, anterior to posterior height (A/P) ratio, and IVD width measured at each L1/L2 -L5/S1 levels. 31The intra-observer intra-class correlation (ICC) consistency model showed values for measurements ranged 32 from 0.76-0.98. The inter-observer ICC values ranged from 0.68-0.99. The Cobb angle decreased in 33 standing. The L5/S1 segmental Cobb angle decreased in standing. The L2/L3 and L3/L4 A/P ratios 34 increased and the L5/S1 A/P ratio decreased in standing. No differences in IVD width were observed from 35 supine to standing. This study examined the regional lumbar spinal alignment and segmental IVD changes 36 from supine to standing in young, healthy individuals without LBP using pMRI. In developing and 37 validating these measurements, we have also established the normative data for healthy, asymptomatic 38 population that could be useful for other investigations examining how individuals with spinal or IVD 39 pathologies may adapt between supine and standing. 42Despite the association between IVD degeneration and LBP, the correspondence between the clinical 43 presentation of LBP and IVD imaging findings is quite poor (35). One possibility for this lack of specificity 44 may be that most diagnostic imaging of the spine is performed in supine, a minimally loaded position (5, 45 45). An individual in standing generates lumbar intradiscal pressures approximately five times greater 46 than in supine (31) and complex multiaxial forces (32) that result in different tensile and shear deformations the spine and for the visualization of hydrated tissue structures such as the IVDs. Positional MRI (pMRI) 52with an open magnet configuration enables the imaging of the human participants in different positions (4, 53 18, 19); thus, the pMRI provides the opportunity to observe the spinal structures in loaded positions other 54 than supine (6, 18, 36, 37). Examining the lumbar spine in an upright position using a pMRI has improved 55 the specificity in discriminating acute and chronic LBP populations (42) and increased the reliability of 56 observing stenosis and IVD degeneration (12). Prior studies have utilized pMRI to examine spinal 57 adaptations between sitting to standing (20), supine to standing in athletes (29) and patients with lumbar 58 spinal stenosis (27), and changes of the dural sac...

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Section: Discussionsupporting

confidence: 91%

Effects of Standing on Spinal Alignment and Lumbar Intervertebral Discs in Young, Healthy Individuals Determined by Positional Magnetic Resonance Imaging

Hwang

Lrv

et al. 2019

Preprint

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“…Defined as the angle subtended from a line running from the bicoxofemoral axis to the midpoint of the sacral endplate and a line perpendicular to the sacral endplate, the PI has been studied extensively for its association with spinal pathology and used for surgical planning (Faundez and Le Huec, ; Rothenfluh et al, ; Pesenti et al, ). Many have described normative values for PI and subsequently related the normal spinal curvature, including lumbar lordosis and thoracic kyphosis, back to the PI allowing surgical planning to restore spinopelvic harmony (Hasegawa et al, ; Le Huec and Hasegawa, ; Yukawa et al, ). The importance of maintenance or restoration of spinopelvic balance cannot be understated with numerous works demonstrating the correlation of quality of life measures with spinal parameters (Schwab et al, ; Takemoto et al, ; Kyrola et al, ; Protopsaltis et al, ).…”

Section: Introductionmentioning

confidence: 99%

Pelvic Incidence: Computed Tomography Study Evaluating Correlation with Sagittal Sacropelvic Parameters

2019

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Normal values for spinal alignment are often based on the pelvic incidence (PI), defined as the angle subtended by a line from the bicoxofemoral axis to the midpoint of the sacral endplate and a line perpendicular to the midpoint. Despite widespread use, determinants of its values remain obscure. The aim of this study was to determine correlation of sacropelvic parameters with the PI on computed tomography (CT). CT scans performed for trauma were identified over a 1-year period. Patients aged over 16 were included. PI, sacral anatomic orientation, sacral table angle (STA), sacral kyphosis (SK), pelvic thickness (PTH), femorosacral pelvic angle, pelvisacral angle, and sacropelvic angle were measured. Additional novel measures including crest-to-pubis distance, crest-to-sacrum distance (CSD), inlet distance, outlet distance, and inlet-outlet angle were taken. One hundred and seventy-seven scans were analyzed. Mean age 44.3 years; 62% male. The mean PI was 50.1 (SD 10.8; range 29-87). SK (r = 0.769), inlet-outlet angle (r = −0.533), PTH (r = −0.370), CSD (r = 0.290), and STA (r = −0.276) significantly correlated with PI. Multivariate analysis developed a predictive equation of: PI = 101.45 − (0.52 × STA) + (0.67 × SK) − (0.34 × inlet-outlet angle), with an adjusted R 2 0.734 (P < 0.001).Measures that represent the sacral morphology, particularly SK, and the position of the sacrum in space correlated strongly with the PI and contributed strongly to a predictive equation. These findings may direct further efforts to explore how the PI is determined and therefore how it may be modified. Clin. Anat. 33:237-244, 2020Rothenfluh et al., 2015;Pesenti et al., 2018). Many have described normative values for PI and subsequently related the normal spinal curvature, including lumbar lordosis and thoracic kyphosis, back to the

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“…SVA can be used to determine the relationship between the spine and pelvis, and has a normal range. Yukawa et al [26] reported the average value of 3.1 ± 12.6 mm for the SVA of 626 asymptomatic volunteers, and SVA may steadily increase from ages of 30 to 70 years.…”

Section: Discussionmentioning

confidence: 99%

Artificial Intelligence for Automatic Measurement of Sagittal Vertical Axis Using ResUNet Framework

Weng¹,

Wang

Huang

et al. 2019

JCM

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We present an automated method for measuring the sagittal vertical axis (SVA) from lateral radiography of whole spine using a convolutional neural network for keypoint detection (ResUNet) with our improved localization method. The algorithm is robust to various clinical conditions, such as degenerative changes or deformities. The ResUNet was trained and evaluated on 990 standing lateral radiographs taken at Chang Gung Memorial Hospital, Linkou and performs SVA measurement with median absolute error of 1.183 ± 0.166 mm. The 5-mm detection rate of the C7 body and the sacrum are 91% and 87%, respectively. The SVA calculation takes approximately 0.2 s per image. The intra-class correlation coefficient of the SVA estimates between the algorithm and physicians of different years of experience ranges from 0.946 to 0.993, indicating an excellent consistency. The superior performance of the proposed method and its high consistency with physicians proved its usefulness for automatic measurement of SVA in clinical settings.

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Normative data for parameters of sagittal spinal alignment in healthy subjects: an analysis of gender specific differences and changes with aging in 626 asymptomatic individuals

Abstract: Standard values of spino-pelvic sagittal alignment were established in each gender and each decade from 20' to 70'. A remarkable change of spino-pelvic sagittal alignment was seen from 7th decade to 8th decade in asymptomatic subjects.

Cited by 110 publications

References 22 publications

Effects of Standing on Spinal Alignment and Lumbar Intervertebral Discs in Young, Healthy Individuals Determined by Positional Magnetic Resonance Imaging

Effects of Standing on Spinal Alignment and Lumbar Intervertebral Discs in Young, Healthy Individuals Determined by Positional Magnetic Resonance Imaging

Pelvic Incidence: Computed Tomography Study Evaluating Correlation with Sagittal Sacropelvic Parameters

Artificial Intelligence for Automatic Measurement of Sagittal Vertical Axis Using ResUNet Framework

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