Abstract
Purpose
There is controversy regarding age-related deterioration of spinal sagittal alignment in cross-sectional study. Although we reported that deterioration in spinal alignment originated at the cervical spine in males and the pelvis in females, others studies have indicated that the lumbar spine is initially implicated in both sexes. The purpose of this study was to clarify these differences in a longitudinal cohort study.
Methods
Our analysis was based on 237 individuals aged 60–89 years who participated in our health screening study in 2014 and 2018. They were classified into six groups by birth year and sex: 60–69 years (26 males, 49 females); 70–79 years (35 males, 88 females); and 80–89 years (19 males, 20 females). The following parameters were measured from standing radiographs: pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis, T1 slope, cervical lordosis, C7 sagittal vertical axis (C7 SVA), and C2-7 SVA.
Results
In males, the first significant change was an increase in the PT angle (19°, in 2014, to 21°, in 2018) in the 80–89 years age group (P < 0.05), with no significant deterioration in cervical parameters. In females, spinal deterioration included a change in the SS (32°–30°), PT (18°–20°), and SVA (− 8 to 6 mm) in the 60–69 years age group (P < 0.05), with no change in the LL.
Conclusions
Contrary to prior studies, our longitudinal data indicated that deterioration in spinal alignment originates in the pelvis for both sex but develops earlier in females than males.
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03 June 2020
Unfortunately, figure 3 was incorrectly published in the original publication. The complete correct figure 3 is given below.
References
Glassman SD, Bridwell K, Dimar JR et al (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029
Schwab F, Dubey A, Pagala M et al (2003) Adult scoliosis: a health assessment analysis by SF-36. Spine 28:602–606
Oe S, Togawa D, Nakai K et al (2015) The influence of age and sex on cervical spinal alignment among volunteers aged over 50. Spine 40:1487–1494
Uehara M, Takahashi J, Ikegami S et al (2019) Sagittal spinal alignment deviation in the general elderly population: a Japanese cohort survey randomly sampled from a basic resident registry. Spine J 19:349–356
Asai Y, Tsutsui S, Oka H et al (2017) Sagittal spino-pelvic alignment in adults: the Wakayama Spine Study. PLoS ONE 12:e0178697
Zhu Z, Xu L, Zhu F et al (2014) Sagittal alignment of spine and pelvis in asymptomatic adults: norms in Chinese populations. Spine 39:E1–E6
Mac-Thiong JM, Roussouly P, Berthonnaud E et al (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine 35:E1193–E1198
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 Jt Surg Am 87:260–267
Legaye J, Duval-Beaupère G, Hecquet J et al (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103
Mendoza-Lattes S, Ries Z, Gao Y et al (2010) Natural history of spinopelvic alignment differs from symptomatic deformity of the spine. Spine 35:E792–E798
Takemitsu Y, Harada Y, Iwahara T et al (1988) Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine 13:1317–1326
Kim YB, Kim YJ, Ahn YJ et al (2014) A comparative analysis of sagittal spinopelvic alignment between young and old men without localized disc degeneration. Eur Spine J 23:1400–1406
Milne JS, Lauder IJ (1974) Age effects in kyphosis and lordosis in adults. Ann Hum Biol 1:327–337
Fon GT, Pitt MJ, Thies AC Jr (1980) Thoracic kyphosis: range in normal subjects. Am J Roentgenol 134:979–983
Oe S, Togawa D, Yoshida G et al (2018) Effects of mirror placement on sagittal alignment of the spine during acquisition of full-spine standing X-Rays. Eur Spine J 27:442–447
Genant HK, Wu CY, van Kuijk C et al (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148
Kobayashi T, Atsuta Y, Matsuno T et al (2004) A longitudinal study of congruent sagittal spinal alignment in an adult cohort. Spine 29:671–676
Statistics Bureau, Ministry of Internal Affairs and Communications in Japan: Specific age and gender height (Table 24-3) and Specific age and gender weight (Table 24-4). https://www.stat.go.jp/data/chouki/24.html. Accessed 3 Oct 2019
Bailey JF, Sparrey CJ, Williams FMK et al (2020) The effect of parity on age-related degenerative changes in sagittal balance. Spine (Phila Pa 1976) 45:E210-6
Acknowledgements
The study protocol was approved by the institutional review board of Hamamatsu University School of Medicine, Shizuoka, Japan (IRB No. 201201).
Funding
Shin Oe and Yu Yamato are members of the Division of Geriatric Musculoskeletal Health which is funded by a donor. Medtronic Sofamor Danek Inc. Japan Medical Dynamic Marketing Inc. Meitoku Medical Institution Jyuzen Memorial Hospital. We have not received funding from the NIH or HHMI.
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Tomohiko Hasegawa, Go Yoshida, MD, Sho Kobayashi, Tatsuya Yasuda,Tomohiro Banno, Hideyuki Arima, Yuki Mihara, Hiroki Ushirozako, Tomohiro Yamada, Koichiro Ide, Yuh Watanabe, Daisuke Togawa, Haruo Niwa, and Yukihiro Matsuyama has no conflict of interest.
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Oe, S., Yamato, Y., Hasegawa, T. et al. Deterioration of sagittal spinal alignment with age originates from the pelvis not the lumbar spine: a 4-year longitudinal cohort study. Eur Spine J 29, 2329–2339 (2020). https://doi.org/10.1007/s00586-020-06431-6
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DOI: https://doi.org/10.1007/s00586-020-06431-6