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06.06.2017 | Original Article

Three types of sagittal alignment regarding compensation in asymptomatic adults: the contribution of the spine and lower limbs

verfasst von: Hongda Bao, Renaud Lafage, Barthelemy Liabaud, Jonathan Elysée, Bassel G. Diebo, Gregory Poorman, Cyrus Jalai, Peter Passias, Aaron Buckland, Shay Bess, Thomas Errico, Lawrence G. Lenke, Munish Gupta, Han Jo Kim, Frank Schwab, Virginie Lafage

Erschienen in: European Spine Journal | Ausgabe 2/2018

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Abstract

Purpose

A comprehensive understanding of normative sagittal profile is necessary for adult spinal deformity. Roussouly described four sagittal alignment types based on sacral slope, lumbar lordosis, and location of lumbar apex. However, the lower limb, a newly described component of spinal malalignment compensation, is missing from this classification. This study aims to propose a full-body sagittal profile classification in an asymptomatic population based on full-body imaging.

Methods

This is a retrospective analysis of a prospective single-center study of 116 asymptomatic volunteers. Cluster analysis including all sagittal parameters was first performed, and then ANOVA was performed between sub-clusters to eliminate the non-significantly different parameters. This loop was repeated until all parameters were significantly different between each sub-cluster.

Results

Three types of full-body sagittal profiles were finalized according to cluster analysis with ten radiographic parameters: hyperlordosis type (77 subjects), neutral type (28 subjects), and compensated type (11 subjects). Radiographic parameters included knee angle, pelvic shift, pelvic angle, PT, PI–LL, C7–S1 SVA, TPA, T1 slope, C2–C7 angle, and C2–C7 SVA. Age was significantly different across compensation types, while BMI and gender were comparable. Age-matched subjects were randomly selected with 11 subjects in each type. ANOVA analysis revealed that all parameters but PT and C2–C7 angle remained significantly different.

Conclusions

The current three compensation types of full-body sagittal profiles in asymptomatic adults included significant changes from cervical region to knee, indicating that subjects should be evaluated with full-length imaging. All three types exist regardless of age, but the distribution may vary.

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Titel: Three types of sagittal alignment regarding compensation in asymptomatic adults: the contribution of the spine and lower limbs
verfasst von: Hongda Bao
Renaud Lafage
Barthelemy Liabaud
Jonathan Elysée
Bassel G. Diebo
Gregory Poorman
Cyrus Jalai
Peter Passias
Aaron Buckland
Shay Bess
Thomas Errico
Lawrence G. Lenke
Munish Gupta
Han Jo Kim
Frank Schwab
Virginie Lafage
Publikationsdatum: 06.06.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 2/2018
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5159-7

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Three types of sagittal alignment regarding compensation in asymptomatic adults: the contribution of the spine and lower limbs