European Spine Journal

, 20:578

Sagittal parameters of the spine: biomechanical approach

Review Article

Abstract

According to the anatomical segmentation, spine curves are the sacral kyphosis (sacrum), lumbar lordosis (L1 to L5), thoracic kyphosis (T1 to T12) and cervical lordosis (C1 to C7). From the morphological point of view the vertebrae of a curve are not identical: from cranial to caudal and vice versa there is a progressive anatomical modification. Both curves of the thoraco-lumbar spine may be divided at the Inflexion Point where lordosis turns into kyphosis. A geometrical construct of each curve by two tangent arcs of circle allows understanding the reciprocal changes between both curves. Lumbar Lordosis is mainly dependent on SS orientation, and the top of thoracic curve on C7 is very stable over the sacrum. Thoracic curve is dependent on lumbar lordosis orientation and C7 positioning. On a reverse effect, structural changing of thoracic kyphosis may affect the shape of the lumbar lordosis and the orientation of the pelvis.

Keywords

Sagittal balance Spine curves Lordosis Thoracic kyphosis Geometrical analysis 

References

  1. 1.
    Marketos SG, Skiadas P (1999) Hippocrates. The father of spine surgery. Spine (Phila Pa 1976) 24(13):1381–1387Google Scholar
  2. 2.
    (1927) Hippocrates. On Joints. In: Capps E, Page TE, Rouse WHD, (eds) Withington ET, trans. Hippocrates: The Loeb Classical Library, vol III. W. Heinemann, London, pp 200–397Google Scholar
  3. 3.
    (1965) Galen. Hippocrates de articulis liber et Galeni in eum commentarii quatuor. In: Kuhn CG (ed) Claudii Galeni Opera Omnia, vol XVIII. Part I. Hildesheim, G. Olms Verlag, Germany, pp 300–767Google Scholar
  4. 4.
    Senut B, Devillers M (2008) Et le singe se mit debout. Editions Albin Michel: 157–165 (in French)Google Scholar
  5. 5.
    Pinheiro-Franco JL, Roussouly P, Vaccaro AR (2010) Importância do Equilíbrio Sagital no Tratamento Cirúrgico da Doença Degenerativa Discal Lombar. In: Conceitos Avançados em Doença Degenerativa Discal Lombar. Pinheiro-Franco JL, Vaccaro AR, Benzel EC, Mayer H-M (eds), DiLivros Publisher (Rio de Janeiro): 277–286 (in Portuguese)Google Scholar
  6. 6.
    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 (Phila Pa 1976) 7(4):335–342Google Scholar
  7. 7.
    (1982) Hippocrates. On nature of bones. In: Littre PE (ed) Oeuvres Completes d’ Hippocrate, vol 9. A. M. Hakkert, Amsterdam. pp 162–197Google Scholar
  8. 8.
    Roussouly P, Berthonnaud E, Dimnet J (2003) Geometrical and mechanical analysis of lumbar lordosis in an asymptomatic population: proposed classification. Rev Chir Orthop Reparatrice Appar Mot 89(7):632–639 (in French)PubMedGoogle Scholar
  9. 9.
    Barrey C (2004) Equilibre sagittal pelvi-rachidien et pathologies lombaires dégénératives. Etude comparative à propos de 100 cas. Thèse Doctorat—Université Claude-Bernard, Lyon 1 (in French)Google Scholar
  10. 10.
    Berthonnaud E, 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 Tech 18(1):40–47PubMedCrossRefGoogle Scholar
  11. 11.
    Janik TJ, Harrison DD, Cailliet R, Troyanovich SJ, Harrison DE (1998) Can the sagittal lumbar curvature be closely approximated by an ellipse? J Orthop Res 16:766–770PubMedCrossRefGoogle Scholar
  12. 12.
    Duval-Beaupere G, Schmidt 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
  13. 13.
    Duval-Beaupère G, Legaye J (2004) Composante sagittale de la statique rachidienne. Rev Rhum 71:105–119CrossRefGoogle Scholar
  14. 14.
    Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupère G, Pélissier J (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15(4):415–422PubMedCrossRefGoogle Scholar
  15. 15.
    Gelb DE, Lenke LG, Bridwell KH, et al. (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976) 20:1351–1358Google Scholar
  16. 16.
    Van Royen BJ, Toussaint HM, Kingma I et al (1998) Accuracy of the sagittal vertical axis in a standing lateral radiograph as a measurement of balance in spinal deformities. Eur Spine J 7:408–412PubMedCrossRefGoogle Scholar
  17. 17.
    Vedantam R, Lenke LG, Bridwell KH et al (2000) The effect of variation in arm position on sagittal spinal alignment. Spine (Phila Pa 1976) 25:2204–2209Google Scholar
  18. 18.
    Kuntz C 4th, Levin LS, Ondra SL, Shaffrey CI, Morgan CJ (2007) Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine 6(2):104–112PubMedCrossRefGoogle Scholar
  19. 19.
    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 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine (Phila Pa 1976) 31(11):E320–E325Google Scholar
  20. 20.
    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 (Phila Pa 1976) 19:1611–1618Google Scholar
  21. 21.
    Jackson RP, Peterson MD, MacManus 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 (Phila Pa 1976) 23:1750–1767Google Scholar
  22. 22.
    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
  23. 23.
    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
  24. 24.
    Mac-Thiong JM, Roussouly P, Berthonnaud E, Guigui P (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine (Phila Pa 1976) 35(22):E1193–1198Google Scholar
  25. 25.
    Debarge R, Demey G, Roussouly P (2010) Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Eur Spine J 19(1):65–70PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Chirurgie de la colonne vertébraleCroix Rouge Française, CMCR des MassuesLyon Cedex 05France
  2. 2.Department of Neurological SurgerySamaritano HospitalSão PauloBrazil

Personalised recommendations