Skip to main content
SpringerLink
Log in

Sagittal parameters of the spine: biomechanical approach

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

Abstract

According to the anatomical segmentation, spine curves are the sacral kyphosis (sacrum), lumbar lordosis (L1 to L5), thoracic kyphosis (T1 to T12) and cervical lordosis (C1 to C7). From the morphological point of view the vertebrae of a curve are not identical: from cranial to caudal and vice versa there is a progressive anatomical modification. Both curves of the thoraco-lumbar spine may be divided at the Inflexion Point where lordosis turns into kyphosis. A geometrical construct of each curve by two tangent arcs of circle allows understanding the reciprocal changes between both curves. Lumbar Lordosis is mainly dependent on SS orientation, and the top of thoracic curve on C7 is very stable over the sacrum. Thoracic curve is dependent on lumbar lordosis orientation and C7 positioning. On a reverse effect, structural changing of thoracic kyphosis may affect the shape of the lumbar lordosis and the orientation of the pelvis.

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
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Marketos SG, Skiadas P (1999) Hippocrates. The father of spine surgery. Spine (Phila Pa 1976) 24(13):1381–1387

  2. (1927) Hippocrates. On Joints. In: Capps E, Page TE, Rouse WHD, (eds) Withington ET, trans. Hippocrates: The Loeb Classical Library, vol III. W. Heinemann, London, pp 200–397

  3. (1965) Galen. Hippocrates de articulis liber et Galeni in eum commentarii quatuor. In: Kuhn CG (ed) Claudii Galeni Opera Omnia, vol XVIII. Part I. Hildesheim, G. Olms Verlag, Germany, pp 300–767

  4. Senut B, Devillers M (2008) Et le singe se mit debout. Editions Albin Michel: 157–165 (in French)

  5. Pinheiro-Franco JL, Roussouly P, Vaccaro AR (2010) Importância do Equilíbrio Sagital no Tratamento Cirúrgico da Doença Degenerativa Discal Lombar. In: Conceitos Avançados em Doença Degenerativa Discal Lombar. Pinheiro-Franco JL, Vaccaro AR, Benzel EC, Mayer H-M (eds), DiLivros Publisher (Rio de Janeiro): 277–286 (in Portuguese)

  6. 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 (Phila Pa 1976) 7(4):335–342

    Google Scholar 

  7. (1982) Hippocrates. On nature of bones. In: Littre PE (ed) Oeuvres Completes d’ Hippocrate, vol 9. A. M. Hakkert, Amsterdam. pp 162–197

  8. Roussouly P, Berthonnaud E, Dimnet J (2003) Geometrical and mechanical analysis of lumbar lordosis in an asymptomatic population: proposed classification. Rev Chir Orthop Reparatrice Appar Mot 89(7):632–639 (in French)

    PubMed  CAS  Google Scholar 

  9. Barrey C (2004) Equilibre sagittal pelvi-rachidien et pathologies lombaires dégénératives. Etude comparative à propos de 100 cas. Thèse Doctorat—Université Claude-Bernard, Lyon 1 (in French)

  10. Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18(1):40–47

    Article  PubMed  Google Scholar 

  11. 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  PubMed  CAS  Google Scholar 

  12. Duval-Beaupere G, Schmidt C, Cosson P (1992) A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng 20:451–462

    Article  PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

  14. Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupère G, Pélissier J (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15(4):415–422

    Article  PubMed  CAS  Google Scholar 

  15. Gelb DE, Lenke LG, Bridwell KH, et al. (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976) 20:1351–1358

    Google Scholar 

  16. Van Royen BJ, Toussaint HM, Kingma I et al (1998) Accuracy of the sagittal vertical axis in a standing lateral radiograph as a measurement of balance in spinal deformities. Eur Spine J 7:408–412

    Article  PubMed  Google Scholar 

  17. Vedantam R, Lenke LG, Bridwell KH et al (2000) The effect of variation in arm position on sagittal spinal alignment. Spine (Phila Pa 1976) 25:2204–2209

    Google Scholar 

  18. Kuntz C 4th, Levin LS, Ondra SL, Shaffrey CI, Morgan CJ (2007) Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine 6(2):104–112

    Article  PubMed  Google Scholar 

  19. 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 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine (Phila Pa 1976) 31(11):E320–E325

    Google Scholar 

  20. 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 (Phila Pa 1976) 19:1611–1618

  21. Jackson RP, Peterson MD, MacManus AC, Hales C (1998) Compensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients. Spine (Phila Pa 1976) 23:1750–1767

    Google Scholar 

  22. Legaye J, Hecquet J, Marty C, Duval-Beaupère G (1993) Equilibre sagittal du rachis. Relations entre bassin et courbures rachidiennes sagittales en position debout. Rachis 5:215–226

    Google Scholar 

  23. 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 7:99–103

    Article  PubMed  CAS  Google Scholar 

  24. Mac-Thiong JM, Roussouly P, Berthonnaud E, Guigui P (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine (Phila Pa 1976) 35(22):E1193–1198

    Google Scholar 

  25. Debarge R, Demey G, Roussouly P (2010) Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Eur Spine J 19(1):65–70

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None of the authors has any potential conflict of interest.

Author information

Authors and Affiliations

  1. Chirurgie de la colonne vertébrale, Croix Rouge Française, CMCR des Massues, 92 Rue Edmond Locard, 69322, Lyon Cedex 05, France

    Pierre Roussouly

  2. Department of Neurological Surgery, Samaritano Hospital, São Paulo, Brazil

    João Luiz Pinheiro-Franco

Authors
  1. Pierre Roussouly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. João Luiz Pinheiro-Franco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pierre Roussouly.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roussouly, P., Pinheiro-Franco, J.L. Sagittal parameters of the spine: biomechanical approach. Eur Spine J 20 (Suppl 5), 578 (2011). https://doi.org/10.1007/s00586-011-1924-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00586-011-1924-1

Keywords

Search

Navigation