J Korean Soc Spine Surg.  2010 Jun;17(2):66-73. 10.4184/jkss.2010.17.2.66.

Variations in Sagittal Spinopelvic Parameters According to the Lumbar Spinal Morphology in Healthy Korean Young Men

• Ahn YJ
• Kim YB
• Kang KB
• Lee SW
• Kim Y

• KMID: 1459270
• DOI: http://doi.org/10.4184/jkss.2010.17.2.66

Abstract

STUDY DESIGN: This is a prospective radiographic study.
OBJECTIVES
We wanted to describe and quantify the common variations in the sagittal lumbar spine. SUMMARY OF THE LITERATURE REVIEW: No previous study of the spinopelvic parameters with a large cohort of asymptomatic young men was performed on subjects with the same ethnic background.
MATERIALS AND METHODS
166 young males without disease, trauma or a history of operation on the spine or lower extremities were included. The sagittal standing radiographs of the whole spine on 36 inch film were taken. The distances from the plumb line of C7, T12, the lumbar apex and the bicoxofemoral head to the posterosuperior corner of the sacrum were measured. Thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, the segmental vertebral slopes, the sacral slope and the pelvic incidence were measured. Groups 1 and 2 were classified by having a sacral slope less than 35degrees (group 1: apex below L4, group 2: above L4). Group 3 had a sacral slope between 35degrees and 45degrees, and group 4 had a sacral slope greater than 45degrees.
RESULTS
The average age was 21.8 years (range: 19~26 years). Group 1 contained 37 cases, group 2 had 44, group 3 had 62 and group 4 had 23. Thoracolumbar kyphosis was significantly increased in group 1 and lumbar lordosis and pelvic incidence were increased in groups 3 and 4. Thoracic kyphosis and the vertebral slope of T12 did not demonstrate any difference between the groups.
CONCLUSION
The sagittal spinopelvic parameters showed significant changes according to the morphology of the lower lumbar spine. Understanding the patterns of variation in the spinopelvic parameters may help surgeons to plan treatment for various spinal lesions.

Keyword

Lumbar; Sagittal balance; Lordosis; Sacral slope; Classification

MeSH Terms

Animals
Cohort Studies
Head
Humans
Incidence
Kyphosis
Lordosis
Lower Extremity
Male
Prospective Studies
Sacrum
Spine

Figure

• 

  Fig.1. A four-part classification of the normal variation in the sagittal spinopelvic alignment in the standing position. Group 1. Sacral slope is less than 35° and the apex of lumbar lordosis is below L4 center. Group 2. Sacral slope is less than 35° and the apex of lumbar lordosis is above L4 base. Group 3 includes subjects with sacral slope from 35° to 45°, and Group 4 with sacral slope above 45°.

• 

  Fig.2. The method of measuring the sagittal parameters. (A) The distances from the plumbs of C7 (a), T12 (b), Lumbar apex (c) and bicoxofemoral (d) to the posterosuperior corner of sacrum are measured. A positive value means forward transition and a negative value means backward transition. (B) The vertebral slopes are measured in T5 upper end plate (UEP), T10 UEP, T12 lower end plate (LEP), L2 LEP, L4 UEP. A positive value means vertebral slope is below the horizontal line. (C) The angular parameters are given by vertebral slopes. Thoracic kyphosis (TK, T5 UEP - T12 LEP), thoracolumbar kyphosis (TLK, T10 UEP - L2 LEP), total lumbar lordosis (LL, T12 LEP – S1 UEP) are measured. (D) Sacral slope (SS) and pelvic incidence (PI) are measured for the pelvic parameters.

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