Skip to main content

Advertisement

SpringerLink
Log in

Sagittal spinal alignment varies with an individual’s race: results of the multi-ethnic alignment normative study (MEANS)

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Purpose

Assess normative values of sagittal spinal and lower extremity alignment in asymptomatic volunteers of three difference races.

Methods

Asymptomatic volunteers between the ages of 18–80 years were enrolled prospectively and then analyzed retrospectively from six different centers. Volunteers included reported no significant neck or back pain, nor any known spinal disorder(s). All volunteers underwent a standing full-body or full-spine low dose stereoradiograph. Volunteers were grouped into three main races; Asian (A), Arabo-Bèrbère (B), and Caucasian (C). The Asian volunteers included in this study were from Japan and Singapore.

Results

There were statistical differences in the Age, ODI, and BMI of the volunteers from the three different races. Asian volunteers had the lowest age (A: 36.7, B: 45.5, C: 42.0) and BMI (A: 22.1, B: 27.1, C: 27.3). Pelvic morphology including pelvic incidence (A: 51.0, B: 52.0, C: 52.5, p = 0.37), pelvic tilt (A: 11.9, B: 12.3, C: 12.9, p = 0.44), and sacral slope (A: 39.1, B: 39.7, C: 39.6, p = 0.77) were similar amongst the 3 races. Regional spinal alignment was different between the groups. Thoracic Kyphosis (A: 32.9, B: 43.3, C: 40.0, p < 0.0001) and Lumbar lordosis (A: − 54.2, B: − 60.4, C: − 59.6, p < 0.0001) were lower in Asians compared to Caucasian and Arabo-Bèrbère volunteers despite having similar pelvic incidence.

Conclusion

Volunteers in the Asian group had lower lumbar lordosis and thoracic kyphosis when compared to the Arabo-Bèrbère and Caucasian groups while all groups had similar pelvic morphology. Thoracic Kyphosis had no correlation with Pelvic Incidence, while Lumbar Lordosis correlated well with both Thoracic Kyphosis and Pelvic Incidence. Thoracic kyphosis may be an independent variable in establishing adequate lumbar lordosis and varies based on an individual’s race.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Raw data are available with the authors of the submitted work.

References

  1. Terran J, Schwab F, Shaffrey CI et al (2013) The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 73(4):559–568

    Article  PubMed  Google Scholar 

  2. Smith JS, Klineberg E, Schwab F et al (2013) Change in classification grade by the SRS-Schwab Adult Spinal Deformity Classification predicts impact on health-related quality of life measures: prospective analysis of operative and nonoperative treatment. Spine (Phila Pa 1976) 38(19):1663–1671

    Article  PubMed  Google Scholar 

  3. Hu Z, Man GCW, Yeung KH et al (2020) Young investigator award winner: age- and sex-related normative value of whole-body sagittal alignment based on 584 asymptomatic Chinese adult population from age 20 to 89. Spine (Phila Pa 1976) 45(2):79–87

    Article  PubMed  Google Scholar 

  4. Zuckerman SL, Sardar ZM, Lai CS et al (2021) The odontoid-CSVL distance in a global population of asymptomatic volunteers: normative values and implications for spinal coronal alignment. Eur Spine J 30(12):3639–3646

    Article  PubMed  Google Scholar 

  5. Sardar ZM, Cerpa M, Hassan F et al (2022) Age- and gender-based global sagittal spinal alignment in asymptomatic adult volunteers: results of the multiethnic alignment normative study (MEANS). Spine (Phila Pa 1976) 47(19):1372–1381

    Article  PubMed  Google Scholar 

  6. Sardar ZM, Cerpa M, Kelly M et al (2022) Age and gender based spinopelvic and regional spinal alignment in asymptomatic adult volunteers: results of the multi-ethnic alignment normative study (MEANS). Spine (Phila Pa 1976) 47(19):1382–1390

    Article  PubMed  Google Scholar 

  7. Yukawa Y, Kato F, Suda K, Yamagata M, Ueta T, Yoshida M (2018) 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. Eur Spine J 27(2):426–432

    Article  PubMed  Google Scholar 

  8. Hyun SJ, Han S, Kim YB, Kim YJ, Kang GB, Cheong JY (2019) Predictive formula of ideal lumbar lordosis and lower lumbar lordosis determined by individual pelvic incidence in asymptomatic elderly population. Eur Spine J 28(9):1906–1913

    Article  PubMed  Google Scholar 

  9. Lee SH, Son ES, Seo EM, Suk KS, Kim KT (2015) Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment. Spine J 15(4):705–712

    Article  PubMed  Google Scholar 

  10. Choi SH, Hwang CJ, Cho JH et al (2020) The influence of spinopelvic morphologies on sagittal spinal alignment: an analysis of incidence angle of inflection points. Eur Spine J 29(4):831–839

    Article  PubMed  Google Scholar 

  11. Zhu Z, Xu L, Zhu F et al (2014) Sagittal alignment of spine and pelvis in asymptomatic adults: norms in Chinese populations. Spine (Phila Pa 1976) 39(1):E1–E6

    Article  PubMed  Google Scholar 

  12. Mac-Thiong JM, Roussouly P, Berthonnaud E, Guigui P (2011) Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults. Eur Spine J 20(Suppl 5):572–577

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lee CS, Chung SS, Kang KC, Park SJ, Shin SK (2011) Normal patterns of sagittal alignment of the spine in young adults radiological analysis in a Korean population. Spine (Phila Pa 1976) 36(25):E1648-1654

    Article  PubMed  Google Scholar 

  14. Merrill RK, Kim JS, Leven DM et al (2018) Differences in Fundamental Sagittal Pelvic Parameters Based On Age, Sex, And Race. Clin Spine Surg 31(2):E109–E114

    Article  PubMed  Google Scholar 

  15. Stagnara P, De Mauroy JC, Dran G et al (1982) Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine (Phila Pa 1976) 7(4):335–342

    Article  CAS  PubMed  Google Scholar 

  16. Jackson RP, McManus 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. A prospective controlled clinical study. Spine (Phila Pa 1976) 19(14):1611–1618

    Article  CAS  PubMed  Google Scholar 

  17. Pesenti S, Lafage R, Stein D et al (2018) The amount of proximal lumbar lordosis is related to pelvic incidence. Clin Orthop Relat Res 476(8):1603–1611

    Article  PubMed  PubMed Central  Google Scholar 

  18. Korovessis PG, Stamatakis MV, Baikousis AG (1998) Reciprocal angulation of vertebral bodies in the sagittal plane in an asymptomatic Greek population. Spine (Phila Pa 1976) 23(6):700–704 (discussion 704-705)

    Article  CAS  PubMed  Google Scholar 

  19. Bassani T, Galbusera F, Luca A, Lovi A, Gallazzi E, Brayda-Bruno M (2019) Physiological variations in the sagittal spine alignment in an asymptomatic elderly population. Spine J 19(11):1840–1849

    Article  PubMed  Google Scholar 

  20. Barrey C, Roussouly P, Le Huec JC, D’Acunzi G, Perrin G (2013) Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 22(Suppl 6):S834-841

    Article  PubMed  Google Scholar 

  21. Hasegawa K, Okamoto M, Hatsushikano S, Shimoda H, Ono M, Watanabe K (2016) Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects. Eur Spine J 25(11):3675–3686

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

EOS imaging supported the multicentric collaborative group by providing the 3D parameters for the MEANS cohort and a web-based solution for image review.

Funding

Authors did not receive any funding from EOS imaging relative to this work.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, 5141 Broadway, 3FW, New York, NY, 10034, USA

    Zeeshan M. Sardar & Lawrence Lenke

  2. Division of Orthopedics and Scoliosis, Rady Children’s Hospital, San Diego, CA, USA

    Michael Kelly

  3. Spine Unit 2, Surgical Research Lab, Bordeaux University Hospital, Bordeaux, France

    Jean-Charles Le Huec & Stephane Bourret

  4. Niigata Spine Surgery Center, Niigata City, Japan

    Kazuhiro Hasegawa

  5. Department of Orthopedic Surgery, National University Hospital (Singapore), 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore

    Hee-Kit Wong, Gabriel Liu & Hwee Weng Dennis Hey

  6. Institut Kassab D’orthopédie, Ksar Said La Manouba, Tunis, Tunisia

    Hend Riahi

Authors
  1. Zeeshan M. Sardar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean-Charles Le Huec
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephane Bourret
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuhiro Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hee-Kit Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gabriel Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hwee Weng Dennis Hey
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hend Riahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lawrence Lenke
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ZMS, MK, J-CLH, SB, KH, H-KW, GL, HWDH, HR, LL: contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work. ZMS, MK, J-CLH, SB, KH, H-KW, GL, HWDH, HR, LL: drafted the work or revised it critically for important intellectual content. ZMS, MK, J-CLH, SB, KH, H-KW, GL, HWDH, HR, LL: approved the version to be published. ZMS, MK, J-CLH, SB, KH, H-KW, GL, HWDH HR, LL: agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Zeeshan M. Sardar.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest related to the submitted work.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sardar, Z.M., Kelly, M., Le Huec, JC. et al. Sagittal spinal alignment varies with an individual’s race: results of the multi-ethnic alignment normative study (MEANS). Spine Deform 11, 1355–1362 (2023). https://doi.org/10.1007/s43390-023-00719-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-023-00719-5

Keywords

Search

Navigation