title: Craniopelvic alignment in elderly asymptomatic individuals: analysis of 671 cranial centers of gravity.
abstract: METHODS
  Prospective radiographical analysis using the cranial center of gravity (CCG) of sagittal vertical axis (SVA) in elderly asymptomatic individuals.
  
  
  OBJECTIVE
  To determine sex differences and age-related correlations of CCG and relationships between CCG and other spinopelvic parameters/health-related quality of life (HRQOL) measures.
  
  
  BACKGROUND
  Few studies have investigated CCG in a relatively large sample of elderly asymptomatic individuals.
  
  
  METHODS
  Six hundred seventy-one healthy participants older than 50 years (mean age, 72.9 yr; range, 50-92 yr) were enrolled. Whole-spine standing radiographs were obtained. The following radiographical measurements were obtained: (1) CCG-C7 SVA, (2) C7-SVA, (3) CCG-SVA, (4) C2-C7 lordosis angle, (5) thoracic kyphosis, (6) lumbar lordosis, (7) pelvic incidence, and (8) sacral slope. HRQOL measures included the EuroQol-5D and Oswestry Disability Index. Pearson product-moment correlation coefficients were calculated between pairs of radiographical measures and HRQOL.
  
  
  RESULTS
  Sex differences were observed in CCG-C7 SVA, CCG-SVA, C2-C7 Cobb angle, thoracic kyphosis, and pelvic incidence. Three SVA parameters (CCG-C7 SVA, C7-SVA, CCG-SVA) rapidly increased between seventh and ninth decades and were approximately 40, 80, and 120 mm, respectively, in the ninth decade. Age-related correlations were observed for all parameters without pelvic incidence, and the CCG measurement correlated the most with age. Furthermore, CCG-SVA correlated with other spinopelvic measurements and HRQOL.
  
  
  CONCLUSIONS
  Age-related changes and sex difference in craniopelvic alignment were analyzed. Craniopelvic alignment became rapidly positive with age, particularly in the eighth decade. The CCG measurement correlated the most with age and may be a useful index marker of global spinal balance in decision making for surgical treatment of adult deformity involving cervical and thoracolumbar lesions.
  
  
  METHODS
  4.
authors.affiliation: *Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan; and †Department of Orthopedic Surgery, Hamamatsu Medical University, Hamamatsu, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Yoshida
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yasuda
authors.forename: Daisuke
authors.initials: D
authors.lastname: Togawa
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Yu
authors.initials: Y
authors.lastname: Yamato
authors.forename: Sho
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Arima
authors.forename: Hironobu
authors.initials: H
authors.lastname: Hoshino
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging*; D011187:Posture / Q000502:physiology*; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D012727:Sex Characteristics; D012886:Skull / Q000000981:diagnostic imaging*; D013131:Spine / Q000000981:diagnostic imaging*