Abstract
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 ≤ 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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References
Hresko MT, Labelle H, Roussouly P et al (2007) Classification of high-grade spondylolisthesis based on pelvic version and spine balance: possible rationale for reduction. Spine 32:2208–2213
Jackson RP, Phipps T, Hales C et al (2003) Pelvic lordosis and alignment in spondylolisthesis. Spine 28:151–160
Labelle H, Roussouly P, Berthonnaud É et al (2004) Spondylolisthesis, pelvic incidence, and spinopelvic balance. A correlation study. Spine 29:2049–2954
Labelle H, Roussouly P, Chopin D et al (2008) Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J 17:1170–1176
Mac-Thiong J-M, Wang Z, de Guise JA et al (2008) Postural model of sagittal spino-pelvic balance and its relevance for lumbosacral developmental spondylolisthesis. Spine 33:2316–2325
Mac-Thiong J-M, Labelle H, Parent S et al (2008) Reliability and development of a new classification of lumbosacral spondylolisthesis. Scoliosis 3:19
Marty C, Boisaubert B, Descamps H et al (2002) The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients. Eur Spine J 11:119–125
Rajnics P, Templier A, Skalli W et al (2002) The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord 15:24–30
Roussouly P, Gollogly S, Berthonnaud É et al (2006) Sagittal alignment of the spine and pelvis in the presence of L5–S1 isthmic lysis and low-grade spondylolisthesis. Spine 31:2484–2490
Vialle R, Ilharreborde B, Dauzac C et al (2007) Is there a sagittal imbalance of the spine in isthmic spondylolisthesis? A correlation study. Eur Spine J 16:1641–1649
Wang Z, Parent S, Mac-Thiong J-M et al (2008) Influence of sacropelvic morphology in developmental spondylolisthesis. Spine 33:2185–2191
Whitesides TE Jr, Horton WC, Hutton WC et al (2005) Spondylotic spondylolisthesis. A study of pelvic and lumbosacral parameters of possible etiologic effect in two genetically and geographically distinct groups with high occurrence. Spine 30(6S):S12–S21
Barrey C, Jund J, Perrin G et al (2007) Spinopelvic alignment of patients with degenerative spondylolisthesis. Neurosurgery 61:981–986
Morel E, Ilharreborde B, Lenoir T et al (2005) Sagittal balance of the spine and degenerative spondylolisthesis [French]. Rev Chir Orthop Reparatrice Appar Mot 91:615–626
Mac-Thiong J-M, Labelle H, Charlebois M et al (2003) Sagittal plane analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type. Spine 28:1404–1409
Tanguay F, Mac-Thiong J-M, de Guise JA et al (2007) Relation between the sagittal pelvic and lumbar spine geometries following surgical correction of adolescent idiopathic scoliosis. Eur Spine J 16:531–536
Upasani V, Tis J, Bastrom T et al (2007) Analysis of sagittal alignment in thoracic and thoracolumbar curves in adolescent idiopathic scoliosis. How do these two curve types differ? Spine 32:1355–1359
Gottfried ON, Daubs MD, Patel AA et al (2009) Spinopelvic parameters in postfusion flatback deformity patients. Spine J 9:639–647
Kim YJ, Bridwell KH, Lenke LG et al (2006) An analysis of sagittal spinal alignment following long adult lumbar instrumentation and fusion to L5 or S1: can we predict ideal lumbar lordosis? Spine 31:2343–2352
Rose PS, Bridwell KH, Lenke LG et al (2009) Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle substraction osteotomy. Spine 34:785–791
De Thomasson E, Guingand O, Terracher R et al (2004) Role of sagittal spinal curvature in early dislocation after revision total hip arthroplasty: prospective analysis of 49 revision procedures [French]. Rev Chir Orthop Reparatrice Appar Mot 90:226–231
Lazennec JY, Riwan A, Gravez F et al (2007) Hip spine relationships: application to total hip arthroplasty. Hip Int 17:91–104
Tardieu C, Hecquet J, Boulay C et al (2008) Two key describers of the sacro-acetabular relationships: the angles of sacral and acetabular incidence (French). Rev Chir Orthop Reparatrice Appar Mot 94:327–335
Yoshimoto H, Sato S, Masuda T et al (2005) Spinopelvic alignement in patients with osteoarthrosis of the hip. A radiographic comparison to patients with low back pain. Spine 30:1650–1657
Mac-Thiong J-M, Labelle H, Berthonnaud É et al (2007) Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J 16:227–234
Boulay C, Tardieu C, Hecquet J et al (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422
Berthonnaud É, Dimnet J, Roussouly P et al (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18:40–47
Janssen MMA, Drevelle X, Humbert L et al (2009) Differences in male and female spino-pelvic alignment in asymptomatic young adults. Spine 34:E826–E832
Kuntz C, Levin LS, Ondra SL et al (2007) Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine 6:104–112
Vialle R, Levassor N, Rillardon L et al (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 87:260–267
Hammerberg EM, Wood KB (2003) Sagittal profile of the elderly. J Spinal Disord 16:44–50
Berthonaud E, Labelle H, Roussouly P et al (2005) A variability study of computerized sagittal spinopelvic radiologic measurements of trunk balance. J Spinal Disord Tech 18:66–71
Vaz G, Roussouly P, Berthonnaud E et al (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–88
Cohen J ((1988)) Statistical power analysis for the behavioural sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale, New Jersey, pp 100–110
Albanese J (2003) A metric method for sex determination using the hipbone and the femur. J Forensic Sci 48:263–273
Bruzek J (2002) A method for visual determination of sex, using the human hip bone. Am J Phys Anthropol 117:157–168
Igbigbi P, Nanono-Igbigbi AM (2003) Determination of sex and race from the subpubic angle in Ugandan subjects. Am J Forensic Med Pathol 24:168–172
McBride DG, Dietz MJ, Vennemeyer MT et al (2001) Bootstrap methods for sex determination from the os coxae using the ID3 algorithm. J Forensic Sci 46:427–431
Patriquin ML, Steyn M, Loth SR (2005) Metric analysis of sex differences in South African black and white pelves. Forensic Sci Int 147:119–127
Gelb D, Lenke LG, Bridwell KH, Blanke K, McEnery KW (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358
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Mac-Thiong, JM., Roussouly, P., Berthonnaud, É. et al. Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults. Eur Spine J 20 (Suppl 5), 572 (2011). https://doi.org/10.1007/s00586-011-1923-2
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DOI: https://doi.org/10.1007/s00586-011-1923-2