Advertisement

European Spine Journal

, Volume 19, Issue 5, pp 760–767 | Cite as

3D postural balance with regard to gravity line: an evaluation in the transversal plane on 93 patients and 23 asymptomatic volunteers

  • Jean-Sebastien Steffen
  • Ibrahim Obeid
  • Nicolas Aurouer
  • Olivier Hauger
  • Jean-Marc Vital
  • Jean Dubousset
  • Wafa Skalli
Original Article

Abstract

Relevance of posture assessment has been reported in case of spine disorders. This study explores the interest in quantifying posture using 3D reconstruction from biplanar X-rays in free standing position and a force plate. 93 patients consulting for spine disorders were divided (‘3D deformity’, ‘sagittal imbalance’ and ‘mild deformity’) and compared with 23 asymptomatic volunteers. Registration of the gravity line (GL) in reconstruction yielded transversal position of the center of acoustic meati (CAM) T1, T4, T9, L3, S1 and hip axis (HA) with regard to GL. Transversal position of CAM and L3 appeared as relevant parameters to discriminate patients from volunteers. Sagittal inclination of the axis linking the CAM to HA was correlated with position of the CAM to GL (r = 0.92 for patients). In conclusion, observing posture in 3D with regard to GL provides clinical relevant information. CAM-HA inclination may improve postural evaluation without force plate.

Keywords

Postural balance Alignment Spine disorders Gravity line 3D reconstruction 

Notes

Acknowledgments

The authors thank all the team of the ‘service de chirurgie orthopedique et traumatologique B’, of the Pellegrin Hospital in Bordeaux for their sharing of point of view and the staff in charge of the EOS™ exams at the Pellegrin Hospital. The Authors also acknowledge the team of the Laboratoire de Biomécanique Arts et Metiers ParisTech, particularly Pr Thourot, and C. Fedelich for their technical help in the platform design and data collection for volunteers, and Virginie Lafage, from New York University Hospital, for her review of the text and fruitful discussion. Biospace med company is acknowledged for its support.

References

  1. 1.
    Dubousset J (1994) The pediatric spine: principles and practice. Raven Press, New YorkGoogle Scholar
  2. 2.
    Jackson RP, Peterson MD, McManus AC, Hales C (1998) Compensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients. Spine 23:1750–1767CrossRefPubMedGoogle Scholar
  3. 3.
    Gelb DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358PubMedGoogle Scholar
  4. 4.
    Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029CrossRefPubMedGoogle Scholar
  5. 5.
    Jackson RP, Phipps T, Hales C, Surber J (2003) Pelvic lordosis and alignment in spondylolisthesis. Spine 28:151–160CrossRefPubMedGoogle Scholar
  6. 6.
    El Fegoun AB, Schwab F, Gamez L, Champain N, Skalli W, Farcy J (2005) Center of gravity and radiographic posture analysis: a preliminary review of adult volunteers and adult patients affected by scoliosis. Spine 30:1535–1540CrossRefPubMedGoogle Scholar
  7. 7.
    Roussouly P, Gollogly S, Noseda O, Berthonnaud E, Dimnet J (2007) The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the c7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine 31:E320–E325. doi: /10.1097/01.brs.0000218263.58642.ff CrossRefGoogle Scholar
  8. 8.
    Gangnet N, Pomero V, Dumas R, Skalli W, Vital JM (2003) Variability of the spine and pelvis location with respect to the gravity line: a three-dimensional stereoradiographic study using a force platform. Surg Radiol Anat 25:424–433CrossRefPubMedGoogle Scholar
  9. 9.
    Vital JM, Senegas J (1986) Anatomical bases of the study of the constraints to which the cervical spine is subject in the sagittal plane. A study of the center of gravity of the head. Surg Radiol Anal 8:169–173CrossRefGoogle Scholar
  10. 10.
    Schwab F, Lafage V, Boyce R, Skalli W, Farcy J (2006) Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine 31:E959–E967CrossRefPubMedGoogle Scholar
  11. 11.
    Lafage V, Schwab F, Skalli W, Hawkinson N, Gagey PM, Ondra S, Farcy JP (2008) Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine 33:1572–1578CrossRefPubMedGoogle Scholar
  12. 12.
    Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 30:682–688CrossRefPubMedGoogle Scholar
  13. 13.
    Gangnet N, Dumas R, Pomero V, Mitulescu A, Skalli W, Vital JM (2006) Three-dimensional spinal and pelvic alignment in an asymptomatic population. Spine 31:E507–E512CrossRefPubMedGoogle Scholar
  14. 14.
    Faro F, Marks MC, Pawelek J, Newton PO (2004) Evaluation of a functional position for lateral radiograph acquisition in adolescent idiopathic scoliosis. Spine 29:2284–2289CrossRefPubMedGoogle Scholar
  15. 15.
    Humbert L, De Guise JA, Aubert B, Godbout B, Skalli W (2009) 3d reconstruction of the spine from biplanar X-rays using transversal and longitudinal inferences. Med Biol Eng Comput 31:681–687Google Scholar
  16. 16.
    Mitton D, Deschenes S, Laporte S, Godbout B, Bertrand S, De Guise J, Skalli W (2006) 3D reconstruction of the pelvis from bi-planar radiography. Comput Methods Biomech Biomed Eng 9:1–5CrossRefGoogle Scholar
  17. 17.
    Dubousset J, Charpak G, Dorion I, Skalli W, Lavaste F, Deguise J, Kalifa G, Ferey S (2005) A new 2d and 3d imaging approach to musculoskeletal physiology and pathology with low-dose radiation and the standing position: the eos system. Bull Acad Natl Med 189:287–297PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Jean-Sebastien Steffen
    • 1
  • Ibrahim Obeid
    • 2
  • Nicolas Aurouer
    • 2
  • Olivier Hauger
    • 3
  • Jean-Marc Vital
    • 2
  • Jean Dubousset
    • 1
  • Wafa Skalli
    • 1
  1. 1.Laboratoire de Biomecanique Arts et Metiers ParisTech CNRSParisFrance
  2. 2.Service de Chirurgie orthopedique et traumatologique BBordeauxFrance
  3. 3.Service d’imagerie diagnostique et therapeutique de l’adulteBordeauxFrance

Personalised recommendations