Abstract
This paper describes and presents a stable and reliable set of stereo-photogrammetric normative data for global and spino-pelvic sagittal alignment, as a proven reference system for evaluating/measuring a fully unconstrained natural upright neutral standing attitude in a young healthy adult population. The methodological features described in this article will enable future studies to replicate and/or directly compare a wide range of different postural tests and/or sagittal alignment assessment procedures including the study of sagittal spine shape variations occurring during gait performance. To date, the quantitative evaluation of adult spinal deformity (ASD) has been mainly confined to the X-ray imaging approach and, more recently, to 3D X-ray reconstruction. Within the existing evaluation framework an opportunity exists for an additional approach: a quantitative evaluation procedure which is easy, accurate, relatively speedy and non-ionising, in order to monitor and track the progress of patients in the areas of both surgical and non-surgical treatment. The resources and methodology described in this paper have been proven to meet all these criteria. They have enabled full 3D posture (including 3D spine shape and sagittal alignment of the skeleton) to be consistently and successfully measured in adult volunteers. All the measurement/evaluation procedures and outcomes carried out were based entirely on the new non-ionising 3D opto-electronic stereo-photogrammetric approach described in this article. The protocol for this methodology was based on a standard set of 27 pre-selected anatomical “landmarks” on the human body, providing standard reference points for observation and measurement. A total of 124 healthy subjects were successfully assessed and, for each subject, 27 individual markers were applied to the corresponding locations on his/her body. Statistical tests to investigate gender differences were also carried out. Descriptive statistics are provided for all 15 of the spino-pelvic parameters under consideration. Results indicated significant differences between genders in five sets of parameters: Kyphosis tilt, Head tilt, Pelvic tilt, Spino-pelvic angle and T1-pelvic angle. The data also demonstrate a high degree of congruity with results obtained using the X-ray method, as evidenced by the existing literature in the field. In summary, the current study presents a new stereo-photogrammetric opto-electronic technology which can be used successfully for ASD evaluation and introduces a comprehensive set of normative data analogous to those proposed in X-ray analysis for sagittal spino-pelvic and total body alignment.
Highlights
Given its high prevalence in the adult population [1, 2] and the increasing social burden it creates [3,4,5] adult spinal deformity (ASD) is receiving ever-growing attention in both clinical and research fields for its potential economic impact in health care [2]
The problems associated with ASD are not confined to the field of Orthopaedics and there are indications a “vicious cycle” could develop more broadly: Bess et al [12] demonstrated that the mental and physical disability caused by spinal deformity was comparable to that caused by cancer or diabetes
Some of the stereo-photogrammetric parameters presented in this paper demonstrate measurement-values very similar to those reported in the literature for X-ray imaging analysis, for healthy populations of the same age range as those considered in the present study. (See D’Amico et al [21] for a thorough review of the X-ray based literature relative to spine shape parameters.) This should not be surprising, given that definitions for both systems are intrinsically geometrically equivalent, apart from the evident difference that for the stereo-photogrammetric system, measurements are taken from markers positioned on the skin above the spinous processes
Summary
Given its high prevalence in the adult population [1, 2] and the increasing social burden it creates [3,4,5] adult spinal deformity (ASD) is receiving ever-growing attention in both clinical and research fields for its potential economic impact in health care [2]. With regard to hyperkyphosis its prevalence in older individuals is not precisely known but has been reported to be between 20% and 40% [9, 10]. This high level of prevalence might be considered within the context of an ageing population in Western countries generally. The problems associated with ASD are not confined to the field of Orthopaedics and there are indications a “vicious cycle” could develop more broadly: Bess et al [12] demonstrated that the mental and physical disability caused by spinal deformity was comparable to that caused by cancer or diabetes
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