Natural history of the aging spine: a cross-sectional analysis of spinopelvic parameters in the asymptomatic population

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>There have been numerous studies demonstrating increased pain and disability when patients’ spinopelvic parameters fall outside of certain accepted ranges. However, these values were established based on patients suffering from spinal deformities. It remains unknown how these parameters change over a lifetime in asymptomatic individuals. The goal of this study was to define a range of spinopelvic parameters from asymptomatic individuals.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Sagittal scoliosis radiographs of 210 asymptomatic patients were evaluated. All measurements were reviewed by 2 trained observers, supervised by a trained clinician. The following parameters and relationships were measured or calculated: cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sagittal vertical axis (SVA), cervical SVA (cSVA), and T1 slope, TK/LL, truncal inclination, pelvic tilt (PT), LL−PI, LL/PI, and T1 slope/PI. Patients were stratified by decade of life, and regression analysis was performed to delineate the relationship between each consecutive age group and the aforementioned parameters.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Cervical lordosis (R<jats:sup>2</jats:sup> = 0.61), thoracic kyphosis (R<jats:sup>2</jats:sup> = 0.84), SVA (R<jats:sup>2</jats:sup> = 0.88), cSVA (R<jats:sup>2</jats:sup> = 0.51), and T1 slope (R<jats:sup>2</jats:sup> = 0.77) all increase with age. Truncal inclination (R<jats:sup>2</jats:sup> = 0.36) and T1 slope/CL remain stable over all decades (R<jats:sup>2</jats:sup> = 0.01). LL starts greater than PI, but in the 6th decade of life, LL becomes equal to PI and in the 7th decade becomes smaller than PI (R<jats:sup>2</jats:sup> = 0.96). The ratio of TK/LL is stable until the 7th decade of life (R<jats:sup>2</jats:sup> = 0.81), whereas PT is stable until the 6th decade (R<jats:sup>2</jats:sup> = 0.92).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This study further refines the generally accepted LL = PI + 10° by showing that patients under the age of 50 years should have more LL compared to PI, whereas after the 5th decade the relationship is reversed. SVA was not as sensitive across age groups, exhibiting a marked increase only in the 7th decade of life. Given the reliable increase of CL with age, and the stability of T1 slope/CL, this represents another important relationship that should be maintained when performing cervical deformity/fusion surgery. This study has important implications for evaluating adult patients with spinal deformities and for establishing corrective surgical goals.</jats:p></jats:sec>

Establishing a Method for Quantifying Spinal Curvature during Videofluoroscopic Swallow Studies: Applying the Modified Cobb Angle to Healthy Young and Older Adults

“…In addition, we found significant differences in curvature between younger and older healthy participants. More specifically, consistent with the existing spinal cord literature, cervical vertebrae two to four appear to increase in curvature with age [22][23][24][35][36][37][38].…”

“…Upon analyzing 21 studies, the authors found curvature was not significantly different between symptomatic and asymptomatic individuals, and age was not significantly associated with amount of lordotic cervical curvature. Interestingly, other studies have found that the angle of cervical lordosis tends to increase with age [34][35][36][37]. The parameter of interest for all of these studies was cervical lordosis -where the spine is curving posteriorly (see the image to the left of Figure 1).…”

The change of sagital balance after PKP for patients with osteoporotic vertebral compression

“…In this study, within 2 days after PKP, SVA decreased, ll and SSA increased, but after long-term followup, we found that with the increase of patients' age, SVA increased gradually, but there was no significant change in VAS score and ODI score, which indicated that sagittal kyphosis can be a natural trend of human degeneration (13). Nevertheless, with the SVA increases and the body leans forward, the pressure on the anterior column of the spine increases, and then the possibility of secondary vertebral fractures may increases significantly (18).…”

“…As a result, PKP could not only stable the fractured vertebra body and reveal the severe pain immediately, but also restore the vertebral body height and correct the local kyphosis by inflating of the balloon (6,9,10). However, there is no study investigate the influence of PKP on the (12)(13)(14). In patients with severe sagittal imbalance of entire spine, posterior rotation of the pelvis around the hip joint takes place to compensate for sagittal imbalance even to a small extent and that this compensatory mechanism leads to a decrease in sacral slope and an increase in pelvic tilt.…”

Computed Tomographic Assessment of Age- and Gender-Specific Sagittal Lumbopelvic Alignment in a Japanese Population

“…6 It is generally recognized that lumbopelvic parameters vary depending on age and gender. [7][8][9][10][11][12] However, there has been no study clarifying detailed age-and gender-specific values of CT-evaluated lumbopelvic parameters. Therefore, this study was designed to understand how spinopelvic alignment in the supine position changes age dependently in each gender.…”