Skip to main content
Log in

Normative values for the spine shape parameters using 3D standing analysis from a database of 268 asymptomatic Caucasian and Japanese subjects

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Sagittal balance analysis has gained importance and the measure of the radiographic spinopelvic parameters is now a routine part of many interventions of spine surgery. Indeed, surgical correction of lumbar lordosis must be proportional to the pelvic incidence (PI). The compensatory mechanisms [pelvic retroversion with increased pelvic tilt (PT) and decreased thoracic kyphosis] spontaneously reverse after successful surgery.

Materials and methods

This study is the first to provide 3D standing spinopelvic reference values from a large database of Caucasian (n = 137) and Japanese (n = 131) asymptomatic subjects.

Results

The key spinopelvic parameters [e.g., PI, PT, sacral slope (SS)] were comparable in Japanese and Caucasian populations. Three equations, namely lumbar lordosis based on PI, PT based on PI and SS based on PI, were calculated after linear regression modeling and were comparable in both populations: lumbar lordosis (L1–S1) = 0.54*PI + 27.6, PT = 0.44*PI − 11.4 and SS = 0.54*PI + 11.90.

Conclusion

We showed that the key spinopelvic parameters obtained from a large database of healthy subjects were comparable for Causasian and Japanese populations. The normative values provided in this study and the equations obtained after linear regression modeling could help to estimate pre-operatively the lumbar lordosis restoration and could be also used as guidelines for spinopelvic sagittal balance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Vedantam R, Lenke LG, Keeney JA, Bridwell KH (1998) Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults. Spine (Phila Pa 1976) 23:211–215

    Article  CAS  Google Scholar 

  2. Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–87

    Article  CAS  PubMed  Google Scholar 

  3. Hammerberg EM, Wood KB (2003) Sagittal profile of the elderly. J Spinal Disord Tech 16:44–50

    Article  PubMed  Google Scholar 

  4. 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 (Phila Pa 1976) 20:1351–1358

    Article  CAS  Google Scholar 

  5. Lazennec JY, Ramare S, Arafati N, Laudet CG, Gorin M, Roger B et al (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9:47–55

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Le Huec JC, Saddiki R, Franke J, Rigal J, Aunoble S (2011) Equilibrium of the human body and the gravity line: the basics. Eur Spine J 20:558–563

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dubousset J (2011) Reflections of an orthopaedic surgeon on patient care and research into the condition of scoliosis. J Pediatr Orthop 31:S1–S8

    Article  PubMed  Google Scholar 

  8. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30:2024–2029

    Article  Google Scholar 

  9. Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G (2006) An analysis of sagittal spinal alignment following long adult lumbar instrumentation and fusion to L5 or S1: can we predict ideal lumbar lordosis? Spine (Phila Pa 1976) 31:2343–2352

    Article  Google Scholar 

  10. Smith JS, Bess S, Shaffrey CI, Burton DC, Hart RA, Hostin R et al (2012) Dynamic changes of the pelvis and spine are key to predicting postoperative sagittal alignment after pedicle subtraction osteotomy: a critical analysis of preoperative planning techniques. Spine (Phila Pa 1976) 37:845–853

    Article  Google Scholar 

  11. Godde S, Fritsch E, Dienst M, Kohn D (2003) Influence of cage geometry on sagittal alignment in instrumented posterior lumbar interbody fusion. Spine (Phila Pa 1976) 28:1693–1699

    Google Scholar 

  12. Goldstein JA, Macenski MJ, Griffith SL, McAfee PC (2001) Lumbar sagittal alignment after fusion with a threaded interbody cage. Spine (Phila Pa 1976) 26:1137–1142

    Article  CAS  Google Scholar 

  13. Stephens GC, Yoo JU, Wilbur G (1996) Comparison of lumbar sagittal alignment produced by different operative positions. Spine (Phila Pa 1976); 21: 1802–1806; discussion 1807

  14. Tribus CB, Belanger TA, Zdeblick TA (1999) The effect of operative position and short-segment fusion on maintenance of sagittal alignment of the lumbar spine. Spine (Phila Pa 1976) 24:58–61

    Article  CAS  Google Scholar 

  15. Le Huec JC, Faundez A, Dominguez D, Hoffmeyer P, Aunoble S (2015) Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop 39:87–95

    Article  PubMed  Google Scholar 

  16. 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 16:766–770

    Article  CAS  PubMed  Google Scholar 

  17. 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 (Phila Pa 1976) 30:346–353

    Article  Google Scholar 

  18. 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 16:1459–1467

    Article  PubMed  PubMed Central  Google Scholar 

  19. Guigui P, Levassor N, Rillardon L, Wodecki P, Cardinne L (2003) Physiological value of pelvic and spinal parameters of sagital balance: analysis of 250 healthy volunteers. Rev Chir Orthop Reparatrice Appar Mot 89:496–506

    CAS  PubMed  Google Scholar 

  20. Schwab F, Lafage V, Boyce R, Skalli W, Farcy JP (2006) Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine (Phila Pa 1976) 31:E959–E967

    Article  Google Scholar 

  21. Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 87:260–267

    Article  PubMed  Google Scholar 

  22. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    CAS  PubMed  Google Scholar 

  23. Asher M, Min Lai S, Burton D, Manna B (2003) The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis. Spine (Phila Pa 1976) 28:63–69

    Article  Google Scholar 

  24. Le Huec JC, Leijssen P, Duarte M, Aunoble S (2011) Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique. Eur Spine J 20(Suppl 5):669–680

    Article  PubMed  PubMed Central  Google Scholar 

  25. Legaye J, Duval-Beaupere G (2005) Sagittal plane alignment of the spine and gravity: a radiological and clinical evaluation. Acta Orthop Belg 71:213–220

    PubMed  Google Scholar 

  26. Schwab F, Lafage V, Patel A, Farcy JP (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976) 34:1828–1833

    Article  Google Scholar 

  27. Gottfried ON, Daubs MD, Patel AA, Dailey AT, Brodke DS (2009) Spinopelvic parameters in postfusion flatback deformity patients. Spine J 9:639–647

    Article  PubMed  Google Scholar 

  28. Jang JS, Lee SH, Min JH, Maeng DH (2009) Influence of lumbar lordosis restoration on thoracic curve and sagittal position in lumbar degenerative kyphosis patients. Spine (Phila Pa 1976) 34:280–284

    Article  Google Scholar 

  29. Roussouly P, Pinheiro-Franco JL (2011) Sagittal parameters of the spine: biomechanical approach. Eur Spine J 20(Suppl 5):578–585

    Article  PubMed  PubMed Central  Google Scholar 

  30. Duval-Beaupère G, Legaye J (2004) Composante saggitale de la statique rachidienne. Rev Rhum 71:105–119

    Article  Google Scholar 

  31. Nunez-Pereira S, Hitzl W, Bullmann V et al (2015) Sagittal balance of the cervical spine: an analysis of occipitocervical and spinopelvic interdependence, with C-7 slope as a marker of cervical and spinopelvic alignment. J Neurosurg Spine (United States) 23(1):p16–p23

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jean Charles Le Huec.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Le Huec, J.C., Hasegawa, K. Normative values for the spine shape parameters using 3D standing analysis from a database of 268 asymptomatic Caucasian and Japanese subjects. Eur Spine J 25, 3630–3637 (2016). https://doi.org/10.1007/s00586-016-4485-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4485-5

Keywords

Navigation