European Spine Journal

, Volume 22, Issue 11, pp 2414–2420 | Cite as

Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis

  • Jean-Luc ClémentEmail author
  • Anne Geoffray
  • Fatima Yagoubi
  • Edouard Chau
  • Federico Solla
  • Ioana Oborocianu
  • Virginie Rampal
Original Article



Sagittal spine and pelvic alignment of adolescent idiopathic scoliosis (AIS) is poorly described in the literature. It generally reports the sagittal alignment with regard to the type of curve and never correlated to the thoracic kyphosis. The objective of this study is to investigate the relationship between thoracic kyphosis, lumbar lordosis and sagittal pelvic parameters in thoracic AIS.


Spinal and pelvic sagittal parameters were evaluated on lateral radiographs of 86 patients with thoracic AIS; patients were separated into hypokyphosis group (n = 42) and normokyphosis group (n = 44). Results were statistically analyzed. The lumbar lordosis was lower in the hypokyphosis group, due to the low proximal lordosis. The thoracic kyphosis was not correlated with any pelvic parameters but with the proximal lordosis. The pelvic incidence was correlated with sacral slope, pelvic tilt, lumbar lordosis and highly correlated with distal lumbar lordosis in the two groups. There was a significant linear regression between thoracic kyphosis and proximal lordosis and between pelvic incidence and distal lordosis.


We can consider that the proximal part of the lordosis depends on the thoracic kyphosis and the distal part depends on the pelvic incidence. The hypokyphosis in AIS is independent of the pelvic parameters and could be described as a structural parameter, characteristic of the scoliotic deformity.


Adolescent idiopathic scoliosis Thoracic hypokyphosis Lumbar lordosis Pelvic incidence Sagittal pelvic Spinal parameters 


Conflict of interest



  1. 1.
    Schwab F, Lafage V, Patel A et al (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine 34:1828–1833PubMedCrossRefGoogle Scholar
  2. 2.
    Duval-Beaupère G, Schmidt C, Cosson P (1992) Abarycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng 20:451–462PubMedCrossRefGoogle Scholar
  3. 3.
    Legaye J, Hecquet J, Marty C et al (1993) Sagittal equilibration of the spine: relationship between pelvis and sagittal spinal curves in the standing position (in French). Rachis 5:215–226Google Scholar
  4. 4.
    Mangione P, Sénégas J (1997) Normal and pathologic sagittal balance of the spine and pelvis (in French). Rev Chir Orthop 83:22–32PubMedGoogle Scholar
  5. 5.
    Legaye J, Duval-Beaupère G, Hecquet J et al (1998) Pelvic incidence: a fundamental pelvic parameter for three dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103PubMedCrossRefGoogle Scholar
  6. 6.
    Marty C, Boisbaubert B, Descamps H et al (2002) The sagittal anatomy of the sacrum among young adults, infants and spondylolisthesis patients. Eur Spine J 11:119–125PubMedCrossRefGoogle Scholar
  7. 7.
    Rajnics P, Templier A, Skalli W et al (2002) The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord 15:24–30CrossRefGoogle Scholar
  8. 8.
    Roussouly P, Berthonnaud E, Dimmet J (2003) Geometrical and mechanical analysis of lumbar lordosis in an asymptomatic population: proposed classification (in French). Rev Chir Orthop 89:632–639PubMedGoogle Scholar
  9. 9.
    Boulay C, Tardieu C, Hecquet J et al (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422PubMedCrossRefGoogle Scholar
  10. 10.
    Gelb DE, Lenke LG, Bridwell KH et al (1995) An analysis of sagittal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358PubMedGoogle Scholar
  11. 11.
    Jackson RP, Peterson MD, MacMamus AC et al (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 23:1750–1767PubMedCrossRefGoogle Scholar
  12. 12.
    Vaz G, Roussouly P, Berthonaud E et al (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–87PubMedCrossRefGoogle Scholar
  13. 13.
    Kobayashi T, Atsuta Y, Matsuno T et al (2004) A longitudinal study of congruent sagittal spinal alignment in an adult cohort. Spine 29:671–676PubMedCrossRefGoogle Scholar
  14. 14.
    Öhlen G, Aaro S, Bylund P (1988) The sagittal configuration and mobility of the spine in idiopathic scoliosis. Spine 13:413–416PubMedCrossRefGoogle Scholar
  15. 15.
    Raso VJ, Russell GC, Hill DL et al (1991) Thoracic lordosis in idiopathic scoliosis. J Pediatr Orthop 11:599–602PubMedGoogle Scholar
  16. 16.
    Mac-Thiong JM, Labelle H, Charlebois M et al (2003) Sagittal plans analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type. Spine 28:1404–1409PubMedGoogle Scholar
  17. 17.
    Upasani V, Tis J, Bastrom T et al (2007) Analysis of sagittal alignment in thoracic and thoracolumbar curves in adolescent idiopathic scoliosis. How do these two curve types differ. Spine 32:1355–1359PubMedCrossRefGoogle Scholar
  18. 18.
    Lonner BS, Auerbach JD, Sponseller P et al (2010) Variations in pelvic and other sagittal parameters as a function of race in adolescent idiopathic scoliosis. Spine 35:E374–E377PubMedGoogle Scholar
  19. 19.
    Hanson DS, Bridwell KH, Rhee JM et al (2002) Correlation of pelvic incidence with low-grade and high-grade isthmic spondylolisthesis. Spine 27:2026–2029PubMedCrossRefGoogle Scholar
  20. 20.
    Mac-Thiong JM, Berthonaud E, Dinar JR et al (2004) Sagittal alignment of the spine and pelvis during growth. Spine 29:1642–1647PubMedCrossRefGoogle Scholar
  21. 21.
    Mac-Thiong JM, Labelle H, Berthonnaud E et al (2007) Sagittalspinopelvic balance in normal children and adolescents. Eur Spine J 16:227–234PubMedCrossRefGoogle Scholar
  22. 22.
    Mendoza-Lattes S, Ries Z, Gao Y et al (2010) Natural history of spinoplevic alignment differs from symptomatic deformity of the spine. Spine 35:E792–E798PubMedCrossRefGoogle Scholar
  23. 23.
    Yong Q, Zhen L, Zezhang Z et al (2012) Comparison of sagittal spinopelvic alignment in Chinese adolescents with and without idiopathic thoracic scoliosis. Spine 37:E714–E720PubMedCrossRefGoogle Scholar
  24. 24.
    Roussouly P, Labelle H, Rouissi J et al (2013) Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults. Eur Spine J 22(suppl 2):S203–S215PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jean-Luc Clément
    • 1
    Email author
  • Anne Geoffray
    • 2
  • Fatima Yagoubi
    • 3
  • Edouard Chau
    • 1
  • Federico Solla
    • 1
  • Ioana Oborocianu
    • 1
  • Virginie Rampal
    • 1
  1. 1.Department of Paediatric Orthopaedic Surgery and Scoliosis SurgeryHôpital Pédiatrique CHU LENVALNiceFrance
  2. 2.Department of Paediatric RadiologyHôpital LenvalNiceFrance
  3. 3.Department of Medical ResearchHôpital Pédiatrique CHU LENVALNiceFrance

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