European Spine Journal

, Volume 16, Issue 2, pp 227–234 | Cite as

Sagittal spinopelvic balance in normal children and adolescents

  • Jean-Marc Mac-Thiong
  • Hubert Labelle
  • Eric Berthonnaud
  • Randal R. Betz
  • Pierre Roussouly
Original Article


The sagittal spinopelvic balance is poorly documented in normal pediatric subjects. The purpose of this study is to characterize the sagittal spinopelvic balance in the pediatric population and to evaluate the correlations between spinopelvic parameters. Seven parameters were evaluated from the lateral standing radiographs of 341 normal subjects aged 3–18 years old: thoracic kyphosis (TK), thoracic tilt (TT), lumbar lordosis (LL), lumbar tilt (LT), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI). The mean values for the pelvic parameters were 49.1±11.0, 7.7±8.0 and 41.4±8.2° for PI, PT and SS, respectively. The mean values for the spinal parameters were 48.0±11.7, 44.0±10.9, −7.3±5.2 and −3.1±5.2° for LL, TK, LT and TT, respectively. The spinopelvic parameters were different from those reported in normal adults, but the correlations between the parameters were similar. PI was significantly related to SS and PT. Significant correlations were found between the parameters of adjacent anatomical regions. Pelvic morphology (PI) regulates sagittal sacro-pelvic orientation (SS and PT). Sacral orientation (SS) is correlated with the shape (LL) and orientation (LT) of the lumbar spine. Adjacent anatomical regions of the spine and pelvis are interdependent, and their relationships result in a stable and compensated posture, presumably to minimize energy expenditure. Results from this study could be used as an aid for the planning of surgery in pediatric patients with spinal deformity in order to restore a relatively normal sagittal spinopelvic balance.


Kyphosis Lordosis Pelvic morphology Pediatric orthopedics Pelvis Posture Sagittal balance Spine 



The authors sincerely thank the following members of the Spinal Deformity Study Group for contributing cases to this study: John R. Dimar II (Kenton D. Leatherman Spine Center, Louisville, KY, USA), Peter O. Newton (Children’s Hospital and Health Center, San Diego, CA, USA), Charles E. Johnston II (Texas Scottish Rite Hospital for Children, Dallas, TX, USA), Keith H. Bridwell (Barnes-Jewish Hospital, St. Louis, MO, USA), Ensor E. Transfeldt (Twin Cities Spine Center, Minneapolis, MN, USA), and Michael F. O’Brien (Woodbridge Orthopaedic and Spine Center, Denver, CO, USA). This research was assisted by support from the Spinal Deformity Group. This research was funded by an educational/research grant from Medtronic Sofamor Danek, by the Canadian Institute of Health Research and by the Fonds de Recherche en Santé du Québec.


  1. 1.
    Berthonnaud É, Roussouly P, Dimnet J (1998) The parameters describing the shape and the equilibrium of the set back pelvis and femurs in sagittal view. Innov Techn Biol Med 19:411–426Google Scholar
  2. 2.
    Berthonnaud É, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord 18:40–47CrossRefGoogle Scholar
  3. 3.
    Berthonnaud É, Labelle H, Roussouly P, Grimard G, Vaz G, Dimnet J (2005) A variability study of computerized sagittal spinopelvic radiological measurements of trunk balance. J Spinal Disord 18:66–71CrossRefGoogle Scholar
  4. 4.
    Curylo LJ, Edwards C, DeWald RW (2002) Radiographic markers in spondyloptosis. Implications for spondylolisthesis progression. Spine 27:2021–2025CrossRefPubMedGoogle Scholar
  5. 5.
    Descamps H, Commare-Nordmann MC, Marty C, Hecquet J, Duval-Beaupère G (1999) Modification of pelvic angle during the human growth (in French). Biom Hum Anthropol 17:59–63Google Scholar
  6. 6.
    During J, Goudfrooij H, Keessen W, Beekr TW, Crowe A (1985) Toward standards for posture. Postural characteristics of the lower back system in normal and pathologic conditions. Spine 10:83–87PubMedCrossRefGoogle Scholar
  7. 7.
    Duval-Beaupère G, Schimdt C, Cosson P (1992) A barycentremetric Study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng 20:451–462PubMedCrossRefGoogle Scholar
  8. 8.
    Faro FD, Marks MC, Pawelek J, Newton PO (2004) Evaluation of a functional position for lateral radiograph acquisition in adolescent idiopathic scoliosis. Spine 29:2284–2289PubMedCrossRefGoogle Scholar
  9. 9.
    Gelb DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW (1995) An analysis of sagittal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358PubMedCrossRefGoogle Scholar
  10. 10.
    Guigui P, Levassor N, Rillardon L, Wodecki P, Cardinne L (2003) Physiological value of pelvic and spinal parameters of sagittal balance: analysis of 250 healthy volunteers (in French). Rev Chir Orthop Reparatrice Appar Mot 89:496–506PubMedGoogle Scholar
  11. 11.
    Hanson DS, Bridwell KH, Rhee JM, Lenke LG (2002) Correlation of pelvic incidence with low- and high-grade isthmic spondylolisthesis. Spine 27:2026–2029PubMedCrossRefGoogle Scholar
  12. 12.
    Horton WC, Brown CW, Bridwell KH, Glassman SD, Suk S-I, Cha CW (2005) Is there an optimal patient stance for obtaining a lateral 36′′ radiograph? A critical comparison of three techniques. Spine 30:427–433PubMedCrossRefGoogle Scholar
  13. 13.
    Inoue H, Ohmori K, Miyasaka K (2002) Radiographic classification of L5 isthmic spondylolisthesis as adolescent or adult vertebral slip. Spine 27:831–838CrossRefPubMedGoogle Scholar
  14. 14.
    Jackson RP, Hales C (2000) Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine 25:2808–2815PubMedCrossRefGoogle Scholar
  15. 15.
    Jackson RP, Phipps T, Hales C, Surber J (2003) Pelvic lordosis and alignment in spondylolisthesis. Spine 28:151–160PubMedCrossRefGoogle Scholar
  16. 16.
    Kobayashi T, Atsuta Y, Matsuno T, Takeda N (2004) A longitudinal study of congruent sagittal spinal alignement in an adult cohort. Spine 29:671–676CrossRefPubMedGoogle Scholar
  17. 17.
    Korovessis PG, Stamatakis MV, Baikousis AG (1998) Reciprocal angulation of vertebral bodies in the sagittal plane in an asymptomatic Greek population. Spine 23:700–704PubMedCrossRefGoogle Scholar
  18. 18.
    Labelle H, Roussouly P, Berthonnaud É, Transfeldt E, O’Brien M, Chopin D, Hresko T, Dimnet J (2004). Spondylolisthesis, pelvic incidence, and spinopelvic balance. A correlation study. Spine 29:2049–2054PubMedCrossRefGoogle Scholar
  19. 19.
    Legaye J, Duval-Beaupère G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103CrossRefPubMedGoogle Scholar
  20. 20.
    Mac-Thiong J-M, Labelle H, Charlebois M, Huot M-P, de Guise JA (2003) Sagittal plane analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type. Spine 28:1404–1409PubMedCrossRefGoogle Scholar
  21. 21.
    Mac-Thiong J-M, Berthonnaud É, Dimar JR II, Betz RR, Labelle H (2004) Sagittal alignment of the spine and pelvis during growth. Spine 29:1642–1647PubMedCrossRefGoogle Scholar
  22. 22.
    Mangione P, Sénégas J (1997) Normal and pathologic sagittal balance of the spine and pelvis (in French). Rev Chir Orthop Reparatrice Appar Mot 83:22–32PubMedGoogle Scholar
  23. 23.
    Mangione P, Gomez D, Senegas J (1997) Study of the course of the incidence angle during growth. Eur Spine J 6:163–167PubMedCrossRefGoogle Scholar
  24. 24.
    Marty C, Boisaubert B, Descamps H, Montigny JP, Hecquet J, Legaye J, Duval-Beaupère G (2002) The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients. Eur Spine J 11:119–125CrossRefPubMedGoogle Scholar
  25. 25.
    Öhlen G, Aaro S, Bylund P (1988) The sagittal configuration and mobility of the spine in idiopathic scoliosis. Spine 13:413–416PubMedCrossRefGoogle Scholar
  26. 26.
    Poussa M, Härkönen H, Mellin G (1989) Spinal mobility in adolescent girls with idiopathic scoliosis and in structurally normal controls. Spine 14:217–219PubMedCrossRefGoogle Scholar
  27. 27.
    Propst-Proctor SL, Bleck EE (1983) Radiographic determination of lordosis and kyphosis in normal and scoliotic children. J Pediatr Orthop 3:344–346PubMedGoogle Scholar
  28. 28.
    Rajnics P, Templier A, Skalli W, Lavaste F, Illés T (2002) The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord 15:24–30Google Scholar
  29. 29.
    Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–87CrossRefPubMedGoogle Scholar
  30. 30.
    Vedantam R, Lenke LG, Keeney JA, Bridwell KH (1998) Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults. Spine 23:211–215CrossRefPubMedGoogle Scholar
  31. 31.
    Voutsinas SA, MacEwen GD (1986) Sagittal profiles of the spine. Clin Orthop 210:235–242PubMedGoogle Scholar
  32. 32.
    Wright JG, Bell D (1991) Lumbosacral joint angles in children. J Pediatr Orthop 11:748–751PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Jean-Marc Mac-Thiong
    • 1
    • 2
  • Hubert Labelle
    • 1
    • 2
  • Eric Berthonnaud
    • 3
  • Randal R. Betz
    • 4
  • Pierre Roussouly
    • 5
  1. 1.Division of OrthopaedicsHopital Sainte-JustineMontrealCanada
  2. 2.Research CenterHopital Sainte-JustineMontrealCanada
  3. 3.Groupe de BiomecaniqueLyonFrance
  4. 4.Department of OrthopaedicsShriners Hospital of PhiladelphiaPhiladelphiaUSA
  5. 5.Department of OrthopaedicsCentre Medico-Chirurgical des MassuesLyonFrance

Personalised recommendations