Advertisement

European Spine Journal

, Volume 23, Issue 1, pp 216–225 | Cite as

Classification system of the sagittal standing alignment in young adolescent girls

  • Mieke Dolphens
  • Barbara Cagnie
  • Pascal Coorevits
  • Andry Vleeming
  • Guy Vanderstraeten
  • Lieven Danneels
Original Article

Abstract

Purpose

The purpose of this cohort study was to classify sagittal standing alignment of pre-peak height velocity (pre-PHV) girls, and to evaluate whether identified subgroups were associated with measures of spinal pain. This study further aimed at drawing attention to similarities and differences between the current postural classification and a previous system determined among pre-PHV boys.

Methods

557 pre-PHV girls [mean age, 10.6 years (SD, 0.47 years)] participated in the study. Three gross body segment orientation parameters and five specific lumbopelvic characteristics were quantified during habitual standing. Postural subgroups were determined by cluster analysis. Logistic regression was applied to assess the relationship between postural subgroups and spinal pain measures (pain and seeking care, assessed by self-administered questionnaire). Chi-square statistics, independent samples T test, and distribution-based methods were used for comparison with postural categorization in pre-PHV boys.

Results and conclusion

Among pre-PHV girls, clinically meaningful posture clusters emerged both on the gross body segment and specific lumbopelvic level. The postural subtypes identified among pre-PHV girls closely corresponded to those previously described in pre-PHV boys, thereby allowing the use of the same, working nomenclature. In contrast to previous findings among pre-PHV boys, no associations between posture clusters and spinal pain measures were significant in girls at pre-PHV age. When comparing discrete ‘global’ alignment scores across corresponding posture types, some intriguing differences were found between genders which might involve different biomechanical loading patterns. Whether habitual posture forms a risk factor for developing spinal pain up to adulthood needs evaluation in prospective multifactorial follow-up research.

Keywords

Posture Sagittal balance Classification Adolescent Spinal pain 

Notes

Acknowledgments

We express our gratitude to Tom Barbe and Gizem İrem Güvendik for their assistance in data collection, and to all of the school teams, local pupil guidance centers and participants for their cooperation in this study.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Dolphens M, Cagnie B, Coorevits P, Vleeming A, Danneels L (2013) Classification system of the normal variation in sagittal standing plane alignment: a study among young adolescent boys. Spine 38:E1003–E1012PubMedCrossRefGoogle Scholar
  2. 2.
    Guo J, Liu Z, Lv F et al (2012) Pelvic tilt and trunk inclination: new predictive factors in curve progression during the Milwaukee bracing for adolescent idiopathic scoliosis. Eur Spine J 21:2050–2058PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Dolphens M, Cagnie B, Coorevits P et al (2012) Sagittal standing posture and its association with spinal pain: a school-based epidemiological study of 1196 Flemish adolescents before age at peak height velocity. Spine 37:1657–1666PubMedCrossRefGoogle Scholar
  4. 4.
    Chanplakorn P, Wongsak S, Woratanarat P, Wajanavisit W, Laohacharoensombat W (2011) Lumbopelvic alignment on standing lateral radiograph of adult volunteers and the classification in the sagittal alignment of lumbar spine. Eur Spine J 20:706–712PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Dolphens M, Cagnie B, Vleeming A, Vanderstraeten G, Coorevits P, Danneels L (2012) A clinical postural model of sagittal alignment in young adolescents before age at peak height velocity. Eur Spine J 21:2188–2197PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    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
  7. 7.
    Bergoin M, Gennari J-M, Tallet J-M (2011) Taking the shoulders and pelvis into account in the preoperative classification of idiopathic scoliosis in adolescents and young adults (a constructive critique of King’s and Lenke’s systems of classification). Eur Spine J 20:1780–1787CrossRefGoogle Scholar
  8. 8.
    Smith A, O’Sullivan P, Straker L (2008) Classification of sagittal thoraco-lumbo-pelvic alignment of the adolescent spine in standing and its relationship to low back pain. Spine 33:2101–2107PubMedCrossRefGoogle Scholar
  9. 9.
    Staes F, Stappaerts K, Vertommen H, Everaert D, Coppieters M (1999) Reproducibility of a survey questionnaire for the investigation of low back problems in adolescents. Acta Paediatr 88:1269–1273PubMedCrossRefGoogle Scholar
  10. 10.
    Armijo-Olivo S, Warren S, Fuentes J, Magee DJ (2011) Clinical relevance vs. statistical significance: using neck outcomes in patients with temporomandibular disorders as an example. Man Ther 16:563–572PubMedCrossRefGoogle Scholar
  11. 11.
    Kovacs FM, Gestoso M, Gil del Real MT, López J, Mufraggi N, Méndez JI (2003) Risk factors for non-specific low back pain in children and their parents: a population based study. Pain 103:259–268PubMedCrossRefGoogle Scholar
  12. 12.
    Szpalski M, Gunzburg R, Balagué F, Nordin M, Mélot C (2002) A 2-year prospective longitudinal study on low back pain in primary school children. Eur Spine J 11:459–464PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Watson KD, Papageorgiou AC, Jones GT et al (2003) Low back pain in schoolchildren: the role of mechanical and psychosocial factors. Arch Dis Child 88:12–17PubMedCrossRefGoogle Scholar
  14. 14.
    Siivola SM, Levoska S, Latvala K, Hoskio E, Vanharanta H, Keinänen-Kiukaanniemi S (2004) Predictive factors for neck and shoulder pain: a longitudinal study in young adults. Spine 29:1662–1669PubMedCrossRefGoogle Scholar
  15. 15.
    Briggs AM, Smith AJ, Straker LM, Bragge P (2009) Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord 10:77PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Gatchel RJ, Turk DC (2008) Criticisms of the biopsychosocial model in spine care—creating and then attacking a straw person. Spine 33:2831–2836PubMedCrossRefGoogle Scholar
  17. 17.
    Balagué F, Dudler J, Nordin M (2003) Low-back pain in children. Lancet 361:1403–1404PubMedCrossRefGoogle Scholar
  18. 18.
    Ståhl M, Mikkelsson M, Kautiainen H, Häkkinen A, Ylinen J, Salminen JJ (2004) Neck pain in adolescence. A 4-year follow-up of pain-free preadolescents. Pain 110:427–431PubMedCrossRefGoogle Scholar
  19. 19.
    Vikat A, Rimpelä M, Salminen JJ, Rimpelä A, Savolainen A, Virtanen SM (2000) Neck or shoulder pain and low back pain in Finnish adolescents. Scand J Public Health 28:164–173PubMedGoogle Scholar
  20. 20.
    Racine M, Tousignant-Laflamme Y, Kloda LA, Dion D, Dupuis G, Choinière M (2012) A systematic literature review of 10 years of research on sex-gender and pain perception—part 2: do biopsychosocial factors alter pain sensitivity differently in women an men? Pain 153:619–635PubMedCrossRefGoogle Scholar
  21. 21.
    Keogh E, Eccleston C (2006) Sex differences in adolescent chronic pain and pain-related coping. Pain 123:275–284PubMedCrossRefGoogle Scholar
  22. 22.
    O’Sullivan PB, Smith AJ, Beales DJ, Straker LM (2011) Association of biopsychosocial factors with degree of slump sitting posture and self-report of back pain in adolescents: a cross-sectional study. Phys Ther 91:470–483PubMedCrossRefGoogle Scholar
  23. 23.
    Guimond S, Massrieh W (2012) Intricate correlation between body posture, personality trait and incidence of body pain: a cross-referential study report. PLoS ONE 7:e37450PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Mieke Dolphens
    • 1
  • Barbara Cagnie
    • 1
  • Pascal Coorevits
    • 2
  • Andry Vleeming
    • 1
    • 3
  • Guy Vanderstraeten
    • 1
    • 4
  • Lieven Danneels
    • 1
  1. 1.Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Artevelde University CollegeGhent UniversityGhentBelgium
  2. 2.Department of Public Health and Research in Advanced Medical Informatics and Telematics, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
  3. 3.Department of Anatomy, Medical FacultyUniversity of New England College of Osteopathic MedicineBiddefordUSA
  4. 4.Department of Physical and Rehabilitation Medicine, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium

Personalised recommendations