P Guigui1, N Levassor, L Rillardon, P Wodecki, L Cardinne. 1. Service de Chirurgie Orthopédique, Hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy. pierre.guigui@bjn.ap-hop-paris.fr
Abstract
PURPOSE OF THE STUDY: Sagital balance of the spine is a fundamental element necessary for understanding spinal disease and instituting proper treatment. The aim of this prospective work was to establish the physiological values of pelvic and spinal parameters of sagital balance of the spine and to investigate their interactions. MATERIAL AND METHOD: Pelvic and spinal parameters were measured on the standing radiographs of 250 healthy volunteers. The following parameters were measured on lateral views including the head, the spine and the pelvis: lumbar lordosis, thoracic kyphosis, sagital tilt at T9, sacral inclination, pelvic incidence, pelvic version, intervertebral angulation, and the vertebral cuneiformization from T9 to S1. These measurements were taken after digitalization of the radiographs. Two types of analysis were performed: a descriptive univariate analysis to characterize the angular parameters and multivariate analysis (correlation, principal component analysis) to detail the relative variations of these parameters. RESULTS AND DISCUSSION: Mean values were: maximal lumbar lordosis 61 +/- 12.7 degrees, maximal thoracic kyphosis 41.4 +/- 9.2 degrees, sacral inclination 44.2 +/- 8.5 degrees, pelvic version 13 +/- 6 degrees, pelvic incidence 55 +/- 11.2 degrees, sagital tilt at T9 10.5 +/- 3.1 degrees. There was a strong correlation between sacral inclination and pelvic incidence (r=0.86), pelvic version and pelvic incidence (r=0.66), lumbar lordosis pelvic incidence pelvic version and thoracic kyphosis (r=0.9) and finally between pelvic incidence and the following parameters: sagital tilt at T9, sacral inclination, pelvic version, lumbar lordosis, and thoracic kyphosis (r=0.98). The relations between the different parameters studied demonstrated that saggital tilt at T9, which reflects spinal balance, is determined by three independent factors. The first is a linear combination of pelvic incidence, lumbar lordosis, and sacral inclination. The second is pelvic version. The third is thoracic kyposis. CONCLUSION: This work provided a useful tool for analyzing and understanding anteroposterior imbalance in patients with spinal disease and also a means of calculating corrections to be made with treatment, established from the linear regression equations which were elaborated.
PURPOSE OF THE STUDY: Sagital balance of the spine is a fundamental element necessary for understanding spinal disease and instituting proper treatment. The aim of this prospective work was to establish the physiological values of pelvic and spinal parameters of sagital balance of the spine and to investigate their interactions. MATERIAL AND METHOD: Pelvic and spinal parameters were measured on the standing radiographs of 250 healthy volunteers. The following parameters were measured on lateral views including the head, the spine and the pelvis: lumbar lordosis, thoracic kyphosis, sagital tilt at T9, sacral inclination, pelvic incidence, pelvic version, intervertebral angulation, and the vertebral cuneiformization from T9 to S1. These measurements were taken after digitalization of the radiographs. Two types of analysis were performed: a descriptive univariate analysis to characterize the angular parameters and multivariate analysis (correlation, principal component analysis) to detail the relative variations of these parameters. RESULTS AND DISCUSSION: Mean values were: maximal lumbar lordosis 61 +/- 12.7 degrees, maximal thoracic kyphosis 41.4 +/- 9.2 degrees, sacral inclination 44.2 +/- 8.5 degrees, pelvic version 13 +/- 6 degrees, pelvic incidence 55 +/- 11.2 degrees, sagital tilt at T9 10.5 +/- 3.1 degrees. There was a strong correlation between sacral inclination and pelvic incidence (r=0.86), pelvic version and pelvic incidence (r=0.66), lumbar lordosis pelvic incidence pelvic version and thoracic kyphosis (r=0.9) and finally between pelvic incidence and the following parameters: sagital tilt at T9, sacral inclination, pelvic version, lumbar lordosis, and thoracic kyphosis (r=0.98). The relations between the different parameters studied demonstrated that saggital tilt at T9, which reflects spinal balance, is determined by three independent factors. The first is a linear combination of pelvic incidence, lumbar lordosis, and sacral inclination. The second is pelvic version. The third is thoracic kyposis. CONCLUSION: This work provided a useful tool for analyzing and understanding anteroposterior imbalance in patients with spinal disease and also a means of calculating corrections to be made with treatment, established from the linear regression equations which were elaborated.