European Spine Journal

, Volume 15, Issue 4, pp 415–422 | Cite as

Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis

  • C. Boulay
  • C. Tardieu
  • J. Hecquet
  • C. Benaim
  • B. Mouilleseaux
  • C. Marty
  • D. Prat-Pradal
  • J. Legaye
  • G. Duval-Beaupère
  • J. Pélissier
Original Article


Pelvis and spinal curves were studied with an angular parameter typical of pelvis morphology: pelvic incidence. A significant chain of correlations between positional pelvic and spinal parameters and incidence is known. This study investigated standards of incidence and a predictive equation of lordosis from selective pelvic and spinal individual parameters. One hundred and forty nine (78 men and 71 women) healthy adults, aged 19–50 years, with no spinal disorders, were included and had a full-spine lateral X-ray in a standardised upright position. Computerised technology was used for the measurement of angular parameters. Mean-deviation section of each parameter and Pearson correlation test were calculated. A multivariate selection algorithm was running with the lordosis (predicted variable) and the other spinal and pelvic parameters (predictor variables), to determine the best sets of predictors to include in the model. A low incidence (<44°) decreased sacral-slope and the lordosis is flattened. A high incidence (>62°) increased sacral-slope and the lordosis is more pronounced. Lordosis predictive equation is based on incidence, kyphosis, sacral-slope and ±T9 tilt. The confidence limits and the residuals (the difference between measured and predicted lordosis) assessed the predicted lordosis accuracy of the model: respectively, ±1.65 and 2.41° with the 4-item model; ±1.73 and 3.62° with the 3-item model. The ability of the functional spine-pelvis unit to search for a sagittal balance depended both on the incidence and on the variation section of the other positional parameters. Incidence gave an adaptation potential at two levels of positional compensation: overlying state (kyphosis, T9 tilt), underlying state (sacral slope, pelvic tilt). The biomechanical and clinical conditions of the standing posture (as in scoliosis, low back pain, spondylisthesis, spine surgery, obesity and postural impairments) can be studied by comparing the measured lordosis with the predicted lordosis.


Pelvis Spine Spinal balance Lordosis 



We would like to thank some colleagues for their scientific contribution (C. Charbonnier, P. Fender, F. Montagnon, J. Sengler, MD) and their valuable advice (J. Dubousset, Ph D and MD). We would like to thank the Montpellier E.R.R.F. Association for their grant and contribution in the project.


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • C. Boulay
    • 1
    • 4
  • C. Tardieu
    • 2
  • J. Hecquet
    • 2
  • C. Benaim
    • 1
  • B. Mouilleseaux
    • 7
  • C. Marty
    • 3
  • D. Prat-Pradal
    • 4
  • J. Legaye
    • 5
  • G. Duval-Beaupère
    • 6
  • J. Pélissier
    • 1
  1. 1.Département de Médecine Physique et de Réadaptation, CHU CaremeauNîmes cedex 4France
  2. 2.Unité Mixte de Recherche UMR 8570, Laboratoire d’Anatomie comparée, Museum National d’Histoire NaturelleC.N.R.S.Paris cedexFrance
  3. 3.Service de Médecine Physique et de Réadaptation, CHU Raymond PoincaréGarches cedexFrance
  4. 4.Laboratoire d’Anatomie, UFR de Médecine Montpellier-NîmesNîmes cedexFrance
  5. 5.Service d’OrthopédieClinique Universitaire U.C.L. de Mont-GodinneYvoirBelgique
  6. 6.Directeur de RechercheDirectrice Honoraire de l’Unité U 215 INSERM, CHU Raymond PoincaréGarches cedexFrance
  7. 7.Service de Médecine Physique et de RéadaptationCentre Hospitalier GénéralMulhouse cedexFrance

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