Abstract
ObjectivesTo establish the normal values of spino-pelvic alignment and to clarify the effect of age-related changes using large, community-based cohorts.MethodsIn this study, data from 1461 participants (466 men, 995 women) were analyzed. On lateral standing radiographs, the following parameters were measured: thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and C7 sagittal vertical axis (SVA). All values are expressed as the mean±standard deviation. The Spearman rank correlation coefficient was used to examine correlations between variables of spino-pelvic parameters. Finally, we analyzed the relationship between age and spino-pelvic parameters. Therefore, we entered values for the body mass index (BMI), SVA, TK, and PI-LL into a multiple regression model to adjust for potential confounding factors.ResultsThe SVA, TK, and PT increased with age, and LL decreased with age. Regarding sex differences, the TK was statistically significantly larger in men than in women, and LL, PT, and PI were statistically significantly smaller in men than in women. Correlation coefficients between the SVA and TK, between the SVA and PI-LL, and between TK and PI-LL were none, strong, and weak, respectively. Results of multiple regression analysis between age and spino-pelvic parameters showed that the standardized partial regression coefficients for the SVA, TK, and PI-LL were 0.17, 0.30, and 0.23, respectively, in men and 0.29, 0.32, and 0.23, respectively, in women.ConclusionsWe found that all parameters were significantly associated with age in men and women. The SVA, TK, and PT increased with age, and LL decreased with age. Results of multiple regression analysis also demonstrated that the SVA, TK, and PI-LL are related to age. Indeed, the PI-LL value increased with age. In this study, a more excessive PI-LL mismatch was shown, indicating an increased risk of spinal malalignment. Differences in the absolute values of spino-pelvic parameters in each sex were small yet statistically significant. Thus, further study should be performed to corroborate this finding.
Highlights
Sagittal spino-pelvic malalignment is one of the most prevalent disorders of the aging spine
The sagittal vertical axis (SVA), thoracic kyphosis (TK), and pelvic tilt (PT) increased with age, and lumbar lordosis (LL) decreased with age
Results of multiple regression analysis between age and spino-pelvic parameters showed that the standardized partial regression coefficients for the SVA, TK, and pelvic incidence (PI)-LL were 0.17, 0.30, and 0.23, respectively, in men and 0.29, 0.32, and 0.23, respectively, in women
Summary
Sagittal spino-pelvic malalignment is one of the most prevalent disorders of the aging spine. Glassman et al reported that positive sagittal balance was significantly related to clinical symptoms and health-related quality of life in patients with adult spinal deformity [6]. The C7 plumb line was used to measure sagittal global alignment [10,11,12,13,14]. The C7 plumb line has been used by previous authors to evaluate possible changes in sagittal spinal global alignment that occur with age. Increasing age was shown to correlate with increasingly anterior positions of the C7 plumb line [10, 11, 15]. PI is an important anatomic parameter that reflects the anatomic configuration of the pelvis and greatly affects sagittal spino-pelvic alignment (SSPA). Schwab et al recommend that PI-LL should be corrected to less than 10 ̊ to achieve successful, harmonious spino-pelvic realignment in corrective operation of spinal deformity [19]
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