Comparison of Standing Sagittal Spinal Alignment in Asymptomatic Adolescents and Adults

Vedantam, Ravishankar; Lenke, Lawrence G.; Keeney, James A.

doi:10.1097/00007632-199801150-00012

Cited by 283 publications

(167 citation statements)

References 7 publications

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“…SVA was considered to be negative if the C7 plumb line fell behind the sacrum and positive if the C7 plumb line fell anterior to the sacrum [13]. Based on the normative data for sagittal alignment in adolescents [14][15][16], thoracic alignment was defined as normal (20°-50°), hyperkyphotic ([50°) and hypokyphotic (\20°), and accordingly, lumbar alignment was defined as normal (54°-74°), hyperlordotic ([74°) and hypolordotic (\54°) [5].…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Sagittal spinopelvic alignment in adolescent thoracic scoliosis secondary to Chiari I malformation: a comparison between the left and the right curves

et al. 2013

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Purpose To investigate whether the sagittal morphology differs between the left and right thoracic curves in patients with Chiari malformation-associated scoliosis (CMS). Methods Thirty-four patients with a left thoracic curve constituted the CM-L group, whereas 44 patients with a right thoracic curve were assigned into the CM-R group. Another cohort of 90 age-and gender-matched asymptomatic adolescents was enrolled to serve as the control group. Seven sagittal parameters were evaluated on standing lateral radiographs, including thoracic kyphosis (TK), lumbar lordosis (LL), thoracolumbar junctional kyphosis (TJK), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). Results Compared to the normal controls, the TK, LL and SS were significantly greater in the CM-L group, along with a significantly decreased PT. Similar changes in SS and PT were also demonstrated in the CM-R group, while the TK and LL were found to be relatively normal compared with the control group. Concerning CMS patients with different curve directions, significantly increased TK and LL were observed in the CM-L group, whereas all three pelvic parameters were similar for the two groups. In addition, no significant differences were noted between the three groups in PI, TJK or SVA. Moreover, the LL was strongly related to the TK and SS in all three groups, but to the PI only in the control and CM-R groups. A significant correlation was also noted between TK and SS in the CM-L group. Conclusions Significant differences in sagittal profiles indeed exist between CMS patients and healthy adolescents, as well as between CMS patients with different curve directions. In CMI patients with a left thoracic curve, compensatory alterations appear to occur in LL in response to the increased TK to maintain a balanced posture.

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Section: Radiographic Evaluationmentioning

confidence: 99%

Sagittal spinopelvic alignment in adolescent thoracic scoliosis secondary to Chiari I malformation: a comparison between the left and the right curves

et al. 2013

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“…However, it seems that discrete changes in sagittal alignment occur during growth, in order to accommodate for physiological and morphological changes. Vedentam et al [8] compared the sagittal alignment of 88 asymptomatic adolescents aged 13 ± 8 years with that of 100 asymptomatic adults aged 57 ± 11 years. The adolescent and adult cohorts presented similar LL (64°± 10°in both groups), but slightly increased TK in adolescents (38°± 10°vs.…”

Section: Sagittal Alignment and Growthmentioning

confidence: 99%

“…Clinically, global spinal balance is an important aspect of the evaluation of patients with spinal pathology and of surgical planning, and to minimize complications such as adjacent segment disease, sagittal imbalance, pseudarthrosis, and progressive deformity. Vedentam et al [8] compared the sagittal global balance between adolescents and adults based on the assessment of the horizontal distance between C7 plumbline (vertical line from the center of C7 vertebral body) and the anterosuperior corner of S1 vertebral body. They observed a significantly forward displacement of C7 plumbline from -5.6 ± 3.5 cm in adolescents to -3.2 ± 3.2 cm in adults.…”

Section: Assessment Of Sagittal Global Balancementioning

confidence: 99%

Pediatric sagittal alignment

2011

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There is a wide variation in the regional parameters used to describe the spine and sacro-pelvis in children and adolescents. There is a slight tendency for thoracic kyphosis and lumbar lordosis to increase with age. Pelvic incidence and pelvic tilt also tend to increase during growth, while sacral slope remains relatively stable. Strong knowledge of the close relationships between adjacent anatomical regions of the spine and sacro-pelvis is the key when evaluating and interpreting sagittal spino-pelvic alignment. The scheme of correlations between adjacent regional parameters needs to be preserved in order to maintain a balanced posture. The net resultant from these relationships between adjacent anatomical regions is best represented by parameters of sagittal global balance. C7 plumbline tends to move backwards from childhood to adulthood, where it stabilizes or slightly moves forward secondary to degenerative changes. C7 plumbline in front of both hip axis and center of the upper sacral endplate occurs in 29% of subjects aged 3-10 years, 12% of subjects aged between 10 and 18 years, and 14% of subjects aged 18 years or older. Therefore, although most normal subjects stand with a C7 plumbline behind the hip axis, a C7 plumbline in front of both hip axis and sacrum can be seen in normal individuals. However, progressive forward displacement of C7 plumbline should raise a suspicion for the risk of developing spinal pathology.

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“…28 However, the mean kyphosis angle measured in the present study (21.6°) was lower than that reported from radiological measurements (34°) of young asymptomatic adults. 32 Surface measure- ments of thoracic curvature have been reported as being 14° lower on average than radiological measures made on the same individual; however, there was a strong correlation (r = 0.78) between the measurements derived using these 2 techniques. 33 Clinical observation or measurement of the thoracic kyphosis will, therefore, tend to underestimate the magnitude of, yet reflect, the true sagittal plane curvature.…”

Section: Discussionmentioning

confidence: 97%

Thoracic Spine Extension Mobility in Young Adults: Influence of Subject Position and Spinal Curvature

Edmondston¹,

Waller²,

Vallin³

et al. 2011

J Orthop Sports Phys Ther

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Mechanical pain disorders in the thoracic spine are commonly associated with impairment of mobility. 5 Thoracic spine movement limitation in individuals with mobility impairment is frequently observed in axial rotation, as well as in the sagittal plane, particularly into extension. 6 Achieving end range motion of the shoulder girdle also depends on adequate extension of the thoracic spine. 12 Consequently, observation and measurement of thoracic spine extension mobility is an important part of the physical examination of patients with thoracic spine or shoulder girdle pain disorders. Movement impairments are typically interpreted in relation to the patient's symptoms and with consideration of the expected range of motion of the region being examined. While the mechanics of thoracic motion segments have been examined in cadaveric and modeling studies, 23,26,34 few studies have examined the global and regional mobility of the thoracic spine in vivo.Normative ranges of sagittal spinal motion have been reported for the lumbar spine 4 but not for the thoracic region. This may reflect the sentiment that "extension mobility of the thoracic region is limited and usually not measured." 10 In cross-sectional studies, extension mobility in asymptomatic individuals has been variously reported as being "almost negligible," while others have recorded motion of between 20° and 40°. 18,22,35 These differences can be attributed to age, measurement technique, and the reference position from which the movement was measured.Thoracic spine mobility has been shown to decrease with increasing age, although this decline is more evident in individuals over 60 years of age. 15,22 Though several computerized spinal T T STUDY DESIGN: Cross-sectional study. T T OBJECTIVES:To examine extension mobility of the thoracic spine in young, asymptomatic adults, with particular reference to the influence of subject position and magnitude of the thoracic kyphosis. T T BACKGROUND: Impairment of thoracic extension motion is commonly associated with mechanical pain disorders in this region of the spine. Knowledge of normal thoracic mobility and the factors that may influence this motion is important in the evaluation and management of thoracic pain disorders. T T METHODS:In 40 asymptomatic adults, the total and regional thoracic extension range of motion was measured using 2-dimensional photographic image analysis. Extension mobility was measured in standing, sitting, prone, and 4-point kneeling.The association between the magnitude of the habitual thoracic kyphosis and extension mobility was also examined. T T RESULTS:When measured from the habitual standing position, the mean range of flexion was 11.5° (3.7°) and mean extension range was 8.7° T T CONCLUSION:When measured from the habitual standing position, thoracic extension range of motion in young individuals is small and poorly correlated with the magnitude of the standing thoracic kyphosis. Unloaded positions (4-point kneeling and prone), compared to positions that load the spine (standing and s...

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Comparison of Standing Sagittal Spinal Alignment in Asymptomatic Adolescents and Adults

Cited by 283 publications

References 7 publications

Sagittal spinopelvic alignment in adolescent thoracic scoliosis secondary to Chiari I malformation: a comparison between the left and the right curves

Sagittal spinopelvic alignment in adolescent thoracic scoliosis secondary to Chiari I malformation: a comparison between the left and the right curves

Pediatric sagittal alignment

Thoracic Spine Extension Mobility in Young Adults: Influence of Subject Position and Spinal Curvature

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