European Spine Journal

, Volume 16, Issue 9, pp 1459–1467 | Cite as

Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases

  • Cédric Barrey
  • Jérôme Jund
  • Olivier Noseda
  • Pierre Roussouly
Original Article


Retrospective analysis of the spino-pelvic alignment in a population of 85 patients with a lumbar degenerative disease. Several previous publications reported the analysis of spino-pelvic alignment in the normal and low back pain population. Data suggested that patients with lumbar diseases have variations of sagittal alignment such as less distal lordosis, more proximal lumbar lordosis and a more vertical sacrum. Nevertheless most of these variations have been reported without reference to the pelvis shape which is well-known to strongly influence spino-pelvic alignment. The objective of this study was to analyse spino-pelvic parameters, including pelvis shape, in a population of 85 patients with a lumbar degenerative disease and compare these patients with a control group of normal volunteers. We analysed three different lumbar degenerative diseases: disc herniation (DH), n = 25; degenerative disc disease (DDD), n = 32; degenerative spondylolisthesis (DSPL), n = 28. Spino-pelvic alignment was analysed pre-operatively on full spine radiographs. Spino-pelvic parameters were measured as following: pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, thoracic kyphosis, spino-sacral angle and positioning of C7 plumb line. For each group of patients the sagittal profile was compared with a control population of 154 asymptomatic adults that was the subject of a previous study. In order to understand variations of spino-pelvic parameters in the patients’ population a stratification (matching) according to the pelvic incidence was done between the control group and each group of patients. Concerning first the pelvis shape, patients with DH and those with DDD demonstrated to have a mean pelvic incidence equal to 49.8° and 51.6°, respectively, versus 52° for the control group (no significant difference). Only young patients, less than 45 years old, with a disc disease (DH or DDD) demonstrated to have a pelvic incidence significantly lower (48.3°) than the control group, P < 0.05. On the contrary, in the DSPL group the pelvic incidence was significantly greater (60°) than the control group (52°), P < 0.0005. Secondly the three groups of patients were characterized by significant variations in spino-pelvic alignment: anterior translation of the C7 plumb line (P < 0.005 for DH, P < 0.05 for DDD and P < 0.05 for DSPL); loss of lumbar lordosis after matching according to pelvic incidence (P < 0.0005 for DH, DDD and DSPL); decrease of sacral slope after matching according to pelvic incidence (P = 0.001 for DH, P < 0.0005 for DDD and P < 0.0005 for DSPL). Measurement of the pelvic incidence and matching according to this parameter between each group of patients and the control group permitted to understand variations of spino-pelvic parameters in a population of patients.


Sagittal balance Pelvis shape Pelvic incidence Spinal alignment Lumbar lordosis Lumbar herniation Spondylolisthesis 


  1. 1.
    Barrey C (2004) Equilibre sagittal pelvi-rachidien et pathologies lombaires dégénératives. Etude comparative à propos de 100 cas (in French). Thèse de Médecine. Université Claude Bernard, LyonGoogle Scholar
  2. 2.
    Berlemann U, Jeszenszky, Buhler D, Harms J (1998) Facet joint remodelling in degenerative spondylolisthesis: an investigation of joint orientation and tropism. Eur Spine J 7:376–380PubMedCrossRefGoogle Scholar
  3. 3.
    Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18:40–47PubMedCrossRefGoogle Scholar
  4. 4.
    During J, Goudfrooij H, Keessen W, Beeker TW, Crowe A (1985) Towards standards for posture. Postural characteristics of the lower back system in normal and pathologic conditions. Spine 10:83–87PubMedCrossRefGoogle Scholar
  5. 5.
    Duval-Beaupère G, Legaye J (2004) Composante sagittale de la statique rachidienne (in French). Rev Rhum 71:105–119CrossRefGoogle Scholar
  6. 6.
    Gelb DE, Lenke LG, Bridwell KH, Blanke K, MacEnery KW (1995) An analysis of sagittal spinal aligment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358PubMedCrossRefGoogle Scholar
  7. 7.
    Guigui P, Levassor N, Rillardon L, Wodecki P, Cardinne L (2003) Valeur physiologique des paramètres pelviens et rachidiens de l’équilibre sagittal du rachis. Analyse d’une série de 250 volontaires (in French). Rev Chir Orthop 89:496–506PubMedGoogle Scholar
  8. 8.
    Izumi Y, Kumano K (2001) Analysis of sagittal lumbar alignment before and after posterior instrumentation: risk factor for adjacent unfused segment. Eur J Orthop Surg Traum 1:9–13CrossRefGoogle Scholar
  9. 9.
    Jackson RP, MacManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex and size. Spine 19:1611–1618PubMedCrossRefGoogle Scholar
  10. 10.
    Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine 25:575–586PubMedCrossRefGoogle Scholar
  11. 11.
    Kobayashi T, Atsuta Y, Matsuno T, Takeda N (2004) A longitudinal study of congruent sagittal spinal alignment in an adult cohort. Spine 29:671–676PubMedCrossRefGoogle Scholar
  12. 12.
    Korovessis PG, Stamatakis MV, Baikousis AG (1998) Reciprocal angulation of vertebral bodies in the sagittal plane in a asymptomatic greek population. Spine 23:700–704PubMedCrossRefGoogle Scholar
  13. 13.
    Korovessis PG, Dimas A, Iliopoulos P, Lambiris E (2002) Correlative analysis of lateral vertebral radiographic variables and medical outcomes study short-form health survey: a comparative study in asymptomatic volunteers versus patients with low back pain. J Spinal Disord Tech 15:384–390PubMedGoogle Scholar
  14. 14.
    Kumar MN, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319PubMedCrossRefGoogle Scholar
  15. 15.
    Lazennec JY, Ramare S, Arafati N, Laudet CG, Gorin M, Roger B, Hansen S, Saillant G, Maurs L, Trabelsi R (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9:47–55PubMedCrossRefGoogle Scholar
  16. 16.
    Legaye J, Hecquet J, Marty C, Duval-Beaupère G (1993) Equilibre sagittal du rachis. Relations entre bassin et courbures rachidiennes sagittales en position debout. Rachis 5:215–226Google Scholar
  17. 17.
    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 7:99–103PubMedCrossRefGoogle Scholar
  18. 18.
    Mangione P, Senegas J (1997) L’équilibre rachidien dans le plan sagittal (in French). Rev Chir Orthop 83:22–32PubMedGoogle Scholar
  19. 19.
    Marnay T (1988) Equilibre du rachis et du bassin. Cahiers d’enseignement de la SOFCOT. Elsevier, Paris, pp 281–313Google Scholar
  20. 20.
    Matsunaga S, Sakou T, Morizono Y, Masuda A, Demirtas AM (1990) Natural history of degenerative spondylolisthesis. Pathogenesis and natural course of the slippage. Spine 15:1204–1210PubMedCrossRefGoogle Scholar
  21. 21.
    Morel E, Vialle R, Rillardon L, Guigui P (2004) Analyse de l’équilibre sagittal du rachis dans les spondylolisthésis dégénératifs. Deuxièmes Journées du Rachis de Paris. In: Sauramps medical, Paris, pp 107–118Google Scholar
  22. 22.
    Rajnics P, Templier A, Skalli W, Lavaste F, Illes T (2002) The importance of spinopelvic parameters in patients with lumbar disc lesions. Int Orthop 26:104–108PubMedCrossRefGoogle Scholar
  23. 23.
    Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353PubMedCrossRefGoogle Scholar
  24. 24.
    Roussouly P, Gollogly S, Noseda O, Berthonnaud E, Dimnet J (2006) The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumbline: a radiographic study of the sagiital alignment of 153 asymptomatic volunteers. Spine 31:E320–E325PubMedCrossRefGoogle Scholar
  25. 25.
    Stagnara P, De Mauroy JC, Dran G, Gonon G, Costanzo G, Dimnet J, Pasquet A (1982) Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine 7:335–342PubMedCrossRefGoogle Scholar
  26. 26.
    Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–87PubMedCrossRefGoogle Scholar
  27. 27.
    Vital JM, Gille O, Gangnet N (2004) Equilibre sagittal et applications cliniques (in French). Rev Rhum 71:120–128CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Cédric Barrey
    • 1
    • 4
  • Jérôme Jund
    • 2
  • Olivier Noseda
    • 3
  • Pierre Roussouly
    • 3
  1. 1.Department of NeurosurgeryHôpital Neurochirurgical P. WertheimerLyonFrance
  2. 2.Department of BiostatisticsCentre Hospitalier de la Région AnnecienneAnnecyFrance
  3. 3.Department of Orthopedic SurgeryClinique médico-chirurgicale des MassuesLyonFrance
  4. 4.LyonFrance

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