title: The cohort study for the determination of reference values for spinopelvic parameters (T1 pelvic angle and global tilt) in elderly volunteers.
abstract: T1 pelvic angle (TPA) and global tilt (GT) are spinopelvic parameters that account for trunk anteversion and pelvic retroversion. To investigate spinopelvic parameters, especially TPA and GT, in Japanese adults and determine norms for each parameter related to health-related quality of life (HRQOL).
  
  
  
  Six hundred and fifty-six volunteers (262 men and 394 women) aged 50-92 years (mean, 72.8 years) were enrolled in this study. The incidence of vertebral fracture, spondylolisthesis and coronal malalignment were measured. Five spinopelvic parameters (TPA, GT, sagittal vertical axis [SVA], pelvic tilt [PT], and pelvic incidence-lumbar lordosis [PI-LL]) were measured using whole spine standing radiographs. The mean values for each parameter were estimated by sex and decade of life. HRQOL measures, including the Oswestry Disability Index (ODI) and EuroQuol-5D (EQ-5D), were also obtained. Pearson's correlation coefficients were determined between each parameter and HRQOL measure. Moreover, the factors contributing to the QOL score were calculated using logistic regression with age, sex, the existence of vertebral fracture and spondylolisthesis, coronal malalignment (coronal curve >30°) and sagittal malalignment (SVA >95 mm) as explanatory variables and the presence of disability (ODI >40) as a free variable.
  
  
  
  The mean values for the spinopelvic parameters were as follows: TPA, 17.9°; GT, 23.2°; SVA, 50.2 mm; PT, 18.6°; and PI-LL, 7.5°. TPA and GT strongly correlated with each other (r = 0.990) and with the other spinopelvic parameters. TPA and GT correlated with ODI (r = 0.339, r = 0.348, respectively) and EQ-5D (r = -0.285, r = -0.288, respectively), similar to those for SVA. TPA, GT, PT, and PI-LL were significantly higher in women than in men. PT and PI-LL gradually increased with age, while TPA, GT, and SVA tended to deteriorate after the 7th decade. Based on a logistic regression analysis, the deterioration of ODI was mostly affected by the sagittal malalignment. The TPA and GT cut-off values for severe disability (ODI >40) based on linear regression modeling were 26.0° and 33.7°, respectively.
  
  
  
  We determined reference values for spinopelvic parameters in elderly volunteers. Similar to SVA, TPA and GT correlated with HRQOL. TPA, GT, PT, and PI-LL were worse in women and progressed with age.
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan. tomohiro.banno0311@gmail.com.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Banno
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Togawa
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Arima
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Yamato
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yasuda
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Oe
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Hoshino
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D017760:Bone Malalignment / Q000000981:diagnostic imaging / Q000208:ethnology / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D007564:Japan; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000473:pathology; D011187:Posture; D011788:Quality of Life; D011859:Radiography; D012016:Reference Values; D013121:Spinal Curvatures / Q000000981:diagnostic imaging / Q000208:ethnology / Q000473:pathology; D013131:Spine / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000473:pathology
keywords: Adult spinal deformity; Cohort study; Global tilt; Reference value; Spinopelvic parameter; T1-pelvic angle
references.citation: Spine (Phila Pa 1976). 2010 Dec 1;35(25):2224-31
references.pmid: 21102297
references.citation: Spine (Phila Pa 1976). 2009 Nov 1;34(23 ):E826-32
references.pmid: 19927088
references.citation: Eur Spine J. 2016 Nov;25(11):3644-3649
references.pmid: 27323962
references.citation: Spine (Phila Pa 1976). 2012 May 20;37(12 ):1077-82
references.pmid: 22045006
references.citation: Eur Spine J. 2011 Sep;20 Suppl 5:681-5
references.pmid: 21870096
references.citation: Spine (Phila Pa 1976). 2005 Sep 15;30(18):2024-9
references.pmid: 16166889
references.citation: Eur Spine J. 2010 Nov;19(11):1824-36
references.pmid: 20567858
references.citation: Spine (Phila Pa 1976). 2008 Jun 15;33(14 ):1572-8
references.pmid: 18552673
references.citation: Spine (Phila Pa 1976). 2013 Jun 1;38(13):E803-12
references.pmid: 23722572
references.citation: Spine (Phila Pa 1976). 2011 Dec 1;36(25):E1648-54
references.pmid: 21394071
references.citation: Spine (Phila Pa 1976). 1995 Jun 15;20(12 ):1351-8
references.pmid: 7676332
references.citation: Spine (Phila Pa 1976). 2014 Jul 1;39(15):1203-10
references.pmid: 25171068
references.citation: Spine (Phila Pa 1976). 2014 Dec 1;39(25):2103-7
references.pmid: 25271508
references.citation: Spine (Phila Pa 1976). 2009 Aug 1;34(17 ):E599-606
references.pmid: 19644319
references.citation: Spine (Phila Pa 1976). 2014 Jan 1;39(1):E1-6
references.pmid: 24270931
references.citation: J Bone Miner Res. 1993 Sep;8(9):1137-48
references.pmid: 8237484
references.citation: Spine (Phila Pa 1976). 2005 Mar 15;30(6):682-8
references.pmid: 15770185
references.citation: Spine (Phila Pa 1976). 2005 Feb 1;30(3):346-53
references.pmid: 15682018
references.citation: J Bone Joint Surg Am. 2014 Oct 1;96(19):1631-40
references.pmid: 25274788
references.citation: J Bone Joint Surg Am. 2005 Feb;87(2):260-7
references.pmid: 15687145
references.citation: Spine (Phila Pa 1976). 2010 May 1;35(10 ):E374-7
references.pmid: 20139806
references.citation: Eur Spine J. 2014 Jun;23 (6):1177-89
references.pmid: 24682355
references.citation: Eur Spine J. 1998;7(5):408-12
references.pmid: 9840475
references.citation: Eur Spine J. 2011 Sep;20 Suppl 5:572-7
references.pmid: 21833574
references.citation: Eur Spine J. 2014 Jul;23 (7):1400-6
references.pmid: 24610236