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Three types of sagittal alignment regarding compensation in asymptomatic adults: the contribution of the spine and lower limbs

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Abstract

Purpose

A comprehensive understanding of normative sagittal profile is necessary for adult spinal deformity. Roussouly described four sagittal alignment types based on sacral slope, lumbar lordosis, and location of lumbar apex. However, the lower limb, a newly described component of spinal malalignment compensation, is missing from this classification. This study aims to propose a full-body sagittal profile classification in an asymptomatic population based on full-body imaging.

Methods

This is a retrospective analysis of a prospective single-center study of 116 asymptomatic volunteers. Cluster analysis including all sagittal parameters was first performed, and then ANOVA was performed between sub-clusters to eliminate the non-significantly different parameters. This loop was repeated until all parameters were significantly different between each sub-cluster.

Results

Three types of full-body sagittal profiles were finalized according to cluster analysis with ten radiographic parameters: hyperlordosis type (77 subjects), neutral type (28 subjects), and compensated type (11 subjects). Radiographic parameters included knee angle, pelvic shift, pelvic angle, PT, PI–LL, C7–S1 SVA, TPA, T1 slope, C2–C7 angle, and C2–C7 SVA. Age was significantly different across compensation types, while BMI and gender were comparable. Age-matched subjects were randomly selected with 11 subjects in each type. ANOVA analysis revealed that all parameters but PT and C2–C7 angle remained significantly different.

Conclusions

The current three compensation types of full-body sagittal profiles in asymptomatic adults included significant changes from cervical region to knee, indicating that subjects should be evaluated with full-length imaging. All three types exist regardless of age, but the distribution may vary.

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Acknowledgements

The manuscript submitted does not contain information about medical device(s)/drug(s).

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Authors and Affiliations

  1. Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China

    Hongda Bao

  2. Hospital for Special Surgery, 535 East 70th Street, Belaire 4-E, New York, NY, 10021, USA

    Hongda Bao, Renaud Lafage, Barthelemy Liabaud, Jonathan Elysée, Bassel G. Diebo, Han Jo Kim, Frank Schwab & Virginie Lafage

  3. Hospital for Joint Diseases at NYU Langone Medical Center, New York, USA

    Gregory Poorman, Cyrus Jalai, Peter Passias, Aaron Buckland, Shay Bess & Thomas Errico

  4. The Spine Hospital New York-Presbyterian, New York, NY, USA

    Lawrence G. Lenke

  5. Washington University School of Medicine, St. Louis, MO, USA

    Munish Gupta

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  1. Hongda Bao
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  2. Renaud Lafage
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  3. Barthelemy Liabaud
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  15. Frank Schwab
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  16. Virginie Lafage
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Correspondence to Virginie Lafage.

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Bao, H., Lafage, R., Liabaud, B. et al. Three types of sagittal alignment regarding compensation in asymptomatic adults: the contribution of the spine and lower limbs. Eur Spine J 27, 397–405 (2018). https://doi.org/10.1007/s00586-017-5159-7

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  • DOI: https://doi.org/10.1007/s00586-017-5159-7

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