Advertisement

European Spine Journal

, Volume 22, Supplement 6, pp 834–841 | Cite as

Compensatory mechanisms contributing to keep the sagittal balance of the spine

  • Cédric Barrey
  • Pierre Roussouly
  • Jean-Charles Le Huec
  • Gennaro D’Acunzi
  • Gilles Perrin
Original Article

Abstract

Introduction

Aging spine is characterized by facet joints arthritis, degenerative disc disease, bone remodeling and atrophy of extensor muscles resulting in a progressive kyphosis of the lumbar spine.

Objective

The aim of this paper is to describe the different compensatory mechanisms for patients with severe degenerative lumbar spine.

Material and methods

According to the severity of the imbalance, three stages are observed: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permit to limit the consequences of loss of lumbar lordosis on global sagittal alignment and therefore contribute to keep the sagittal balance of the spine.

Results

The basic concept is to extend adjacent segments of the kyphotic spine allowing for compensation of the sagittal unbalance but potentially inducing adverse effects.

Conclusion

Finally, we propose a three-step algorithm to analyze the global balance status and take into consideration the presence of the compensatory mechanisms in the spinal, pelvic and lower limb areas.

Keywords

Sagittal balance Pelvis Spinal alignment Lumbar lordosis Degenerative disc disease Lumbar kyphosis 

Abbreviations

LL

Lumbar lordosis

PI

Pelvic incidence

PT

Pelvic tilt

SS

Sacral slope

TK

Thoracic kyphosis

Notes

Acknowledgments

We express our gratitude to Ms Chantal Silarakis, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, France, for her assistance in paper’s translation.

Conflict of interest

None.

References

  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.
    Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases: a comparative study about 85 cases. Eur Spine J 16:1459–1467PubMedCrossRefGoogle 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 20:1351–1358PubMedGoogle Scholar
  7. 7.
    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
  8. 8.
    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
  9. 9.
    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
  10. 10.
    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
  11. 11.
    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
  12. 12.
    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 15:384–390PubMedCrossRefGoogle Scholar
  13. 13.
    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
  14. 14.
    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 33:1572–1578PubMedCrossRefGoogle Scholar
  15. 15.
    Lamartina C, Berjano P, Petruzzi M, Sinigaglia A, Casero G, Cecchinato R, Damilano M, Bassani R (2012) Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J 21(Suppl):27–31CrossRefGoogle Scholar
  16. 16.
    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
  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.
    Obeid I, Hauger O, Aunoble S, Bourghli A, Pellet N, Vital JM (2011) Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee. Eur Spine J 20(Suppl 5):681–685PubMedCrossRefGoogle Scholar
  19. 19.
    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
  20. 20.
    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
  21. 21.
    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 sagittal alignment of 153 asymptomatic volunteers. Spine 31:E320–E325PubMedCrossRefGoogle Scholar
  22. 22.
    Schuller S, Charles YP, Steib JP (2011) Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis. Eur Spine J 20:713–719PubMedCrossRefGoogle Scholar
  23. 23.
    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
  24. 24.
    Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y (1988) Lumbar degenerative kyphosis: clinical, radiological and epidemiological studies. Spine 13:1317–1326PubMedCrossRefGoogle Scholar
  25. 25.
    Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–87PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Cédric Barrey
    • 1
    • 2
    • 5
  • Pierre Roussouly
    • 3
  • Jean-Charles Le Huec
    • 4
  • Gennaro D’Acunzi
    • 1
  • Gilles Perrin
    • 1
  1. 1.Department of Neurosurgery C and Spine SurgeryNeurological HospitalLyonFrance
  2. 2.Laboratory of BiomechanicsENSAM, Arts et Metiers ParisTechParisFrance
  3. 3.Department of Orthopaedic SurgeryClinique médico-chirurgicale des MassuesLyonFrance
  4. 4.Department of Orthopedic SurgeryUniversity HospitalBordeauxFrance
  5. 5.LyonFrance

Personalised recommendations