European Spine Journal

, Volume 27, Issue 2, pp 426–432 | Cite as

Normative data for parameters of sagittal spinal alignment in healthy subjects: an analysis of gender specific differences and changes with aging in 626 asymptomatic individuals

  • Yasutsugu Yukawa
  • Fumihiko Kato
  • Kota Suda
  • Masatsune Yamagata
  • Takayoshi Ueta
  • Munehito Yoshida
Original Article



This study aims to establish normative data for parameters of spino-pelvic and spinal sagittal alignment, gender related differences and age-related changes in asymptomatic subjects.


A total of 626 asymptomatic volunteers from Japanese population were enrolled in this study, including 50 subjects at least for each gender and each decade from 3rd to 8th. Full length, free-standing spine radiographs were obtained. Cervical lordosis (CL; C3–7), thoracic kyphosis (TK; T1–12), lumbar lordosis (LL; T12–S1), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and sagittal vertical axis (SVA) were measured.


The average values (degrees) are 4.1 ± 11.7 for CL, 36.0 ± 10.1 for TK, 49.7 ± 11.2 for LL, 53.7 ± 10.9 for PI, 14.5 ± 8.4 for PT, and 39.4 ± 8.0 for SS. Mean SVA is 3.1 ± 12.6 mm. Advancing age caused an increase in CL, PT and SVA, and a decrease in LL and SS. There was a significant gender difference in CL, TK, LL, PI, PT and SVA. From 7th decade to 8th decade, remarkable decrease of LL & TK and increase of PT were seen. A large increase of SVA was also seen between 60’ and 70’.


Standard values of spino-pelvic sagittal alignment were established in each gender and each decade from 20’ to 70’. A remarkable change of spino-pelvic sagittal alignment was seen from 7th decade to 8th decade in asymptomatic subjects.


Standard value Spine radiograph Spinopelvic sagittal alignment Gender difference Age-related change 



This study was supported by institutional funds and by grant research funds, which are intended for promoting hospital functions, of the Japan Labor Health and Welfare Organization (Kawasaki, Japan). No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryWakayama Medical UniversityWakayamaJapan
  2. 2.Department of Orthopedic SurgeryChubu Rosai HospitalNagoyaJapan
  3. 3.Department of Orthopedic SurgeryHokkaido Chuo Rosai Hospital Sekison CenterBibaiJapan
  4. 4.Department of Orthopedic SurgeryChiba Rosai HospitalIchiharaJapan
  5. 5.Department of Orthopedic SurgerySpinal Injuries CenterIizukaJapan

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