Sagittal spinopelvic balance in normal children and adolescents
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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.
KeywordsKyphosis 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.
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