Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position.
METHODS
A prospective radiographic study of 160 volunteers without symptoms of spinal disease was conducted.


OBJECTIVE
The objective of this study was to describe, quantify, and classify common variations in the sagittal alignment of the spine, sacrum, and pelvis.


BACKGROUND
Previous publications have documented the high degree of variability in the sagittal alignment of the spine. Other studies have suggested that specific changes in alignment and the characteristics of the lumbar lordosis are responsible for degenerative changes and symptomatic back pain.


METHODS
In the course of this study, anteroposterior and lateral radiographs of 160 volunteers in a standardized standing position were taken. A custom computer application was used to analyze the alignment of the spine and pelvis on the lateral radiographs. A four-part classification scheme of sagittal morphology was used to classify each patient.


RESULTS
Reciprocal relationships between the orientation of the sacrum, the sacral slope, the pelvic incidence, and the characteristics of the lumbar lordosis were evident. The global lordotic curvature, lordosis tilt angle, position of the apex, and number or lordotic vertebrae were determined by the angle of the superior endplate of S1 with respect to the horizontal axis.


CONCLUSIONS
Understanding the patterns of variation in sagittal alignment may help to discover the association between spinal balance and the development of degenerative changes in the spine.
Roussouly
Pierre
P
Department of Orthopedic Surgery, Centre Des Massues, Lyon, France. chort@cmcr-massues.com
Gollogly
Sohrab
S
Berthonnaud
Eric
E
Dimnet
Johanes
J
D000293:Adolescent; D000328:Adult; D001175:Arthrography / Q000379:methods; D005260:Female; D006801:Humans; D008141:Lordosis / Q000145:classification*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000502:physiology*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000502:physiology*; D011187:Posture / Q000502:physiology*; D011446:Prospective Studies; D012015:Reference Standards; D012447:Sacrum / Q000000981:diagnostic imaging / Q000502:physiology