R. Vedantam et al., COMPARISON OF STANDING SAGITTAL SPINAL ALIGNMENT IN ASYMPTOMATIC ADOLESCENTS AND ADULTS, Spine (Philadelphia, Pa. 1976), 23(2), 1998, pp. 211-215
Study Design. A retrospective examination of the spine radiographs of
88 asymptomatic adolescents was performed to analyze the indices of re
gional and segmental sagittal spinal alignment in relation to the sagi
ttal vertical axis as determined by the C7 plumb line. Objectives. To
determine the sagittal spinal alignment in asymptomatic adolescents an
d to correlate the sagittal vertical axis with the overall sagittal sp
inal balance and other indices of sagittal spinal alignment, In additi
on, to compare these results with previously established data for asym
ptomatic adults, Summary of Background Data. Previous studies of sagit
tal spinal alignment have included subjects encompassing a wide range
of ages. A previous study at the authors' institution established norm
ative data for sagital spinal alignment in asymptomatic adults. No pre
vious study has reported on the correlation between the sagittal verti
cal axis and other measurements of sagittal spinal alignment in asympt
omatic adolescents. Methods. Measurements obtained from the standing l
ateral spine radiographs of 88 asymptomatic adolescents (age range, 10
-18 years) were collected and ana lyzed using statistical methods. The
se data were compared with previously established data for asymptomati
c adults, Results. There was a striking similarity in regional thoraci
c kyphosis and lumbar lordosis between adolescents and adults. Despite
having similar regional and segmental sagittal alignments, adolescent
s had a significantly more negative sagittal vertical axis (mean, -5.6
cm) than adults (mean, -3.2 cm; P = 0.0001). Also, unlike that in adu
lts, the sagittal vertical axis in adolescents was not significantly c
orrelated with the distal segmental lumbar lordosis. The sagittal vert
ical axis in adolescents was significantly correlated with the level o
f thoracic kyphosis and the distances from the thoracic apex, lumbar a
pex, and T12 to the C7 plumb line. Sacral inclination, which is a dete
rminant of hip extension and standing pelvic rotation, was correlated
with the lumbar apex and the total and segmental lordosis, except at L
5-S1. Conclusions, Asymptomatic adolescents tend to stand in greater n
egative sagittal spinal balance than asymptomatic adults, despite simi
lar regional and segmental alignments in the thoracic and lumbar spine
. The role of hip extension, spinopelvic axis rotation, and other sagi
ttal alignment parameters in determining the sagittal vertical axis in
adolescents warrants further study.