3D postural balance with regard to gravity line: an evaluation in the transversal plane on 93 patients and 23 asymptomatic volunteers

Steffen, Jean-Sébastien; Obeid, Ibrahim; Aurouer, Nicolas; Hauger, Olivier; Vital, Jean-Marc; Dubousset, Jean; Skalli, Wafa

doi:10.1007/s00586-009-1249-5

Cited by 70 publications

(42 citation statements)

References 15 publications

(22 reference statements)

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“…Several clinical studies using a force plate have been performed to investigate the balance mechanism [42][43][44][45][46][47]. El Fegoun et al [43] reported a highly significant negative correlation between the gravity line and plumbline in the sagittal plane based on simultaneous assessment of fulllength freestanding spine radiographs and the floor projection of the center of pressure (gravity line), suggesting that the value of the plumbline as a marker of true postural balance must be questioned.…”

Section: Discussionmentioning

confidence: 99%

Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects

Hara¹,

Okamoto²,

et al. 2016

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Purpose To elucidate the normative values of whole body sagittal alignment and balance of a healthy population in the standing position; and to clarify the relationship among the alignment, balance, health-related quality of life (HRQOL), and age. Methods Healthy Japanese adult volunteers [n = 126, mean age 39.4 years (20-69), M/F = 30/96] with no history of spinal disease were enrolled in a cross-sectional cohort study. The Oswestry Disability Index (ODI) questionnaire was administered and subjects were scanned from the center of the acoustic meati (CAM) to the feet while standing on a force plate to determine the gravity line (GL), and the distance between CAM and GL (CAM-GL) was measured in the sagittal plane. Standard X-ray parameters were measured from the head to the lower extremities. ODI was compared among age groups stratified by decade. Correlations were investigated by simple linear regression analysis. Ideal lumbar lordosis was investigated using the least squares method. Results The present study yielded normative values for whole standing sagittal alignment including head and lower extremities in a cohort of 126 healthy adult volunteers, comparable to previous reports and thus a formula for ideal lumbar lordosis was deduced: LL = 32.9 ? 0.60 9 PI -0.23 9 age. There was a tendency of positive correlation between McGregor slope, thoracic kyphosis, PT, and age. SVA, T1 pelvic angle, sacrofemoral angle, knee flexion angle, and ankle flexion angle, but not CAM-GL, increased with age, suggesting that the spinopelvic alignment changes with age, but standing whole body alignment is compensated for to preserve a horizontal gaze. ODI tended to increase from the 40s in the domain of pain intensity, personal care, traveling, and total score. ODI weakly, but significantly positively correlated with age and PI-LL. Conclusion Whole body standing alignment even in healthy subjects gradually deteriorates with age, but is compensated to preserve a horizontal gaze. HRQOL is also affected by aging and spinopelvic malalignment.

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Section: Discussionmentioning

confidence: 99%

Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects

Hara¹,

Okamoto²,

et al. 2016

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“…16,44 The EOS system is a slot-scanning radiological device that consists of 2 x-ray sources, thereby allowing the simultaneous acquisition of 2 images. The 2 source-detector pairs are positioned orthogonally.…”

Section: Biplanar Radiographic Systemmentioning

confidence: 99%

Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity

Ferrero

Liabaud

Challier

et al. 2016

SPI

110

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OBJECT Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pelvic parameters have demonstrated the compensatory mechanisms of pelvis translation in addition to rotation. However, the mechanisms recruited for this pelvic rotation were not assessed. This study aims to analyze the relationship between spinopelvic and lower-extremity parameters and clarify the role of pelvic translation. METHODS This is a retrospective study of patients with spinal deformity and full-body EOS images. Patients with only stenosis or low-back pain were excluded. Patients were grouped according to T-1 spinopelvic inclination (T1SPi): sagittal forward (forward, > 0.5°), neutral (−6.3° to 0.5°), or backward (< −6.3°). Pelvic translation was quantified by pelvic shift (sagittal offset between the posterosuperior corner of the sacrum and anterior cortex of the distal tibia), hip extension was measured using the sacrofemoral angle (SFA; the angle formed by the middle of the sacral endplate and the bicoxofemoral axis and the line between the bicoxofemoral axis and the femoral axis), and chin-brow vertical angle (CBVA). Univariate and multivariate analyses were used to compare the parameters and correlation with the Oswestry Disability Index (ODI). RESULTS In total, 336 patients (71% female; mean age 57 years; mean body mass index 27 kg/m2) had mean T1SPi values of −8.8°, −3.5°, and 5.9° in the backward, neutral, and forward groups, respectively. There were significant differences in the lower-extremity and spinopelvic parameters between T1SPi groups. The backward group had a normal lumbar lordosis (LL), negative SVA and pelvic shift, and the largest hip extension. Forward patients had a small LL and an increased SVA, with a large pelvic shift creating compensatory knee flexion. Significant correlations existed between lower-limb parameter and pelvic shift, pelvic tilt, T-1 pelvic angle, T1SPi, and sagittal vertical axis (0.3 < r < 0.8; p < 0.001). ODI was significantly correlated with knee flexion and pelvic shift. CONCLUSIONS This is the first study to describe full-body alignment in a large population of patients with spinal pathologies. Furthermore, patients categorized based on T1SPi were found to have significant differences in the pelvic shift and lower-limb compensatory mechanisms. Correlations between lower-limb angles, pelvic shift, and ODI were identified. These differences in compensatory mechanisms should be considered when evaluating and planning surgical intervention for adult patients with spinal deformity.

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“…dynamic stability, is considered, it is necessary to define the GL to determine the muscle activity. Several studies have been performed using force plate measurements (Gangnet et al 2003;El Fegoun et al 2005;Schwab et al 2006;Lafage et al 2008;Mac-Thiong et al 2009;Steffen et al 2010). An increased risk of a poor ODI (> 34) was observed in patients with a C7 plumb line greater than 6 cm, a GL greater than 6 cm and a C7 plumb line anterior to the GL (Mac-Thiong et al 2009).…”

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confidence: 99%

Standing sagittal alignment of the whole axial skeleton with reference to the gravity line in humans

Hara¹,

Okamoto²,

et al. 2017

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Human beings stand upright with the chain of balance beginning at the feet, progressing to the lower limbs (ankles, knees, hip joints, pelvis), each of the spinal segments, and then ending at the cranium to achieve horizontal gaze and balance using minimum muscle activity. The details of the alignment and balance of the chain, however, are not clearly understood, due to the lack of information regarding the three‐dimensional (3D) orientation of all bony elements in relation to the gravity line (GL). We performed a clinical study to clarify the standing sagittal alignment of whole axial skeletons in reference to the GL using the EOS slot‐scanning 3D X‐ray imaging system with simultaneous force plate measurement in a healthy human population. The GL was defined as a vertical line drawn through the centre of vertical pressure measured by the force plate. The present study yielded a complete set of physiological alignment measurements of the standing axial skeleton from the database of 136 healthy subjects (a mean age of 39.7 years, 20–69 years; men: 40, women: 96). The mean offset of centre of the acoustic meati from the GL was 0.0 cm. The offset of the cervical and thoracic vertebrae was posterior to the GL with the apex of thoracic kyphosis at T7, 5.0 cm posterior to the GL. The sagittal alignment changed to lordosis at the level of L2. The apex of the lumbar lordosis was L4, 0.6 cm anterior to the GL, and the centre of the base of the sacrum (CBS) was just posterior to the GL. The hip axis (HA) was 1.4 cm anterior to the GL. The knee joint was 2.4 cm posterior and the ankle joint was 4.8 cm posterior to the GL. L4‐, L5‐ and the CBS‐offset in subjects in the age decades of 40s, 50s and 60s were significantly posterior to those of subjects in their 20s. The L5‐ and CBS‐offset in subjects in their 50s and 60s were also significantly posterior to those in subjects in their 30s. HA was never posterior to the GL. In the global alignment, there was a positive correlation between offset of C7 vertebra from the sagittal vertical axis (a vertical line drawn through the posterior superior corner of the sacrum in the sagittal plane) and age, but no correlation was detected between the centre of the acoustic meati‐GL offset and age. Cervical lordosis (CL), pelvic tilt (PT), pelvic incidence, hip extension, knee flexion and ankle dorsiflexion increased significantly with age. Our results revealed that aging induces trunk stooping, but the global alignment is compensated for by an increase in the CL, PT and knee flexion, with the main function of CL and PT to maintain a horizontal gaze in a healthy population.

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3D postural balance with regard to gravity line: an evaluation in the transversal plane on 93 patients and 23 asymptomatic volunteers

Cited by 70 publications

References 15 publications

Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects

Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects

Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity

Standing sagittal alignment of the whole axial skeleton with reference to the gravity line in humans

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