The Vertical Projection of the Sum of the Ground Reactive Forces of a Standing Patient Is Not the Same as the C7 Plumb Line

Roussouly, Pierre; Gollogly, Sohrab; Noseda, Olivier; Berthonnaud, Éric; Dimnet, Johanes

doi:10.1097/01.brs.0000218263.58642.ff

Cited by 208 publications

(134 citation statements)

References 24 publications

(30 reference statements)

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“…Angular parameter is represented by the spino-sacral angle (SSA) and the ratio corresponds to the C7 plumbline/sacro-femoral distance ratio (C7/SFD). These two parameters have already been reported and validated [1,21].…”

Section: Global Balance Evaluationmentioning

confidence: 79%

Compensatory mechanisms contributing to keep the sagittal balance of the spine

Barrey

Roussouly

Huec³

et al. 2013

Eur Spine J

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376

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Introduction Aging spine is characterized by facet joints arthritis, degenerative disc disease, bone remodeling and atrophy of extensor muscles resulting in a progressive kyphosis of the lumbar spine. Objective The aim of this paper is to describe the different compensatory mechanisms for patients with severe degenerative lumbar spine. Material and methods According to the severity of the imbalance, three stages are observed: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permit to limit the consequences of loss of lumbar lordosis on global sagittal alignment and therefore contribute to keep the sagittal balance of the spine. Results The basic concept is to extend adjacent segments of the kyphotic spine allowing for compensation of the sagittal unbalance but potentially inducing adverse effects.Conclusion Finally, we propose a three-step algorithm to analyze the global balance status and take into consideration the presence of the compensatory mechanisms in the spinal, pelvic and lower limb areas.

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Section: Global Balance Evaluationmentioning

confidence: 79%

Compensatory mechanisms contributing to keep the sagittal balance of the spine

Barrey

Roussouly

Huec³

et al. 2013

Eur Spine J

Self Cite

376

244

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“…Roussouly [7] defined a mathematical formula associating SSA angle and sacral slope: SSA = 0.96SS ? 97°.…”

Section: Discussionmentioning

confidence: 99%

“…2); this is an intrinsic parameter [7]. In a balanced spine, SSA is extremely strongly correlated with the sacral slope angle (R = 0.91, P \ 0.001) according to Roussouly [7] and this could be an important parameter in analysis of the study population.…”

Section: Sagittal Balance Parametersmentioning

confidence: 91%

Sagittal balance parameters influence indications for lumbar disc arthroplasty or ALIF

et al. 2011

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Chronic lower back pain is a potentially incapacitating condition associated with disc degeneration. Although therapy is primarily pharmaceutical, surgery comprising arthrodesis constitutes an alternative. Anterior intersomatic lumbar arthrodesis (ALIF, anterior interbody lumbar fusion) is the reference approach, although total disc arthroplasty may also be undertaken. Analysis of pelvic and spinal parameters provides the best indication of sagittal balance. Materials and methods This was a prospective study in a continuous series of 99 patients presenting chronic lower back pain due to disc disease. Pelvic incidence, sacral slope, pelvic tilt, spino-sacral angle (SSA) and the four back types in the Roussouly classification were studied in radiographs of the whole spine under load using an EOS imaging system. Results The pre-operative SSA value for the study population was 126.09°± 8.45°and the mean spine tilt angle was 90°compared with 95°in healthy subjects. Following surgery, the SSA was considerably increased in the discal arthroplasty, resulting in a significantly more balanced spinal position. In the group of patients undergoing arthrodesis using the ALIF technique, no such significant improvement was found despite the use of a lordosis cage. We showed that in cases of low pelvic incidence, it was necessary to maintain a Roussouly type 1 or 2 back without increasing lordosis. The results demonstrated the value of L4-L5 disc prostheses in these subjects. L5-S1 arthrodesis seemed a more suitable approach for treating patients with elevated sacral slope (back type 3 or 4). This new type of analysis of sagittal parameters should be performed prior to all surgical procedures involving lumbar prostheses.

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“…The distance from the radiographic source to the film was maintained at 230 cm for all exposures and the edges of the radiographic film were square in respect to the horizontal and vertical axes. The films were digitized with a commercially available optical scanner (VIDARVXR-8, Vidar Systems Inc., USA) [5]. In order to reduce any inaccuracy caused by head motion, patients were asked to stand in comfortable position and gaze horizontally.…”

Section: Methodsmentioning

confidence: 99%

“…2b based on Cobb's measurement. Additional radiological parameters included pelvic incidence (PI) [6], sacral slope (SS) [6], pelvic tilt (PT) [6], spinal sacral angle (SSA) [5], ratio of hip to C7/hip to sacrum [5] (Fig. 3), Roussouly sagittal classifications [7], Lenke Curve Type, Lenke Lumbar Modifier [8].…”

Section: Methodsmentioning

confidence: 99%

Analysis of the cervical spine sagittal alignment in young idiopathic scoliosis: a morphological classification of 120 cases

Silvestre

Mouton

et al. 2013

Eur Spine J

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Purpose To analyze the relationship between the cervical spine and global spinal-pelvic alignment in young patients with idiopathic scoliosis based on a morphological classification, and to postulate the hypothesis that cervical kyphosis is a part of cervico-thoracic kyphosis in them. Methods 120 young patients with idiopathic scoliosis were recruited retrospectively between 2006 and 2011. The following values were measured and calculated: cervical angles (CA), cervico-thoracic angles (CTA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), spinal sacral angle (SSA), hip to C7/hip to sacrum, thoracic kyphosis (TK), lumbar lordosis (LL), Roussouly sagittal classification, Lenke Type Curve and Lumbar Modifier. The cervical curves were classified as lordosis, straight, sigmoid and kyphosis. They were categorized into four groups as cervical non-kyphosis group (CNK Group), cervical kyphosis group (CK Group), cervical-middle-thoracic kyphosis group (CMTK Group), and cervical-lower-thoracic kyphosis group (CLTK Group) according to their morphological characters of sagittal alignments. All parameters were compared and analyzed among groups. Results The incidence of cervical kyphosis was 40 % (48/ 120). The CA and the CTA were in significant correlation (r = 0.854, P = 0.00). The cervical spine alignments were revealed to be significantly different among groups (r = 85.04, P = 0.00). Significant differences among groups in CA, CTA and TK were also detected. A strong correlation between the group type and Lenke Lumbar Modifier was still seen (P \ 0.05). Fisher's exact test revealed that the individual vertebral body kyphosis and wedging were directly related to the overall cervical kyphosis (P = 0.00, respectively). Conclusion The cervical kyphosis is correlated with global sagittal alignment, and is a part of cervico-thoracic sagittal deformity in young patients with idiopathic scoliosis. Despite the deformity in cervical alignment, the global spine could still be well-balanced with spontaneous adjustment. The correlation between our grouping based on the morphological characteristics of the sagittal alignments and Lenke Lumbar Modifier suggests that the coupled motion principle be appropriate to explain the modifications both in coronal and sagittal planes.

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The Vertical Projection of the Sum of the Ground Reactive Forces of a Standing Patient Is Not the Same as the C7 Plumb Line

Abstract: We speculate that this information will be very helpful in evaluating symptomatic spinal disease in the context of the overall alignment of the spine and pelvis.

Cited by 208 publications

References 24 publications

Compensatory mechanisms contributing to keep the sagittal balance of the spine

Compensatory mechanisms contributing to keep the sagittal balance of the spine

Sagittal balance parameters influence indications for lumbar disc arthroplasty or ALIF

Analysis of the cervical spine sagittal alignment in young idiopathic scoliosis: a morphological classification of 120 cases

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