Natural history of the aging spine: a cross-sectional analysis of spinopelvic parameters in the asymptomatic population

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OBJECTIVE

There have been numerous studies demonstrating increased pain and disability when patients’ spinopelvic parameters fall outside of certain accepted ranges. However, these values were established based on patients suffering from spinal deformities. It remains unknown how these parameters change over a lifetime in asymptomatic individuals. The goal of this study was to define a range of spinopelvic parameters from asymptomatic individuals.

METHODS

Sagittal scoliosis radiographs of 210 asymptomatic patients were evaluated. All measurements were reviewed by 2 trained observers, supervised by a trained clinician. The following parameters and relationships were measured or calculated: cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sagittal vertical axis (SVA), cervical SVA (cSVA), and T1 slope, TK/LL, truncal inclination, pelvic tilt (PT), LL−PI, LL/PI, and T1 slope/PI. Patients were stratified by decade of life, and regression analysis was performed to delineate the relationship between each consecutive age group and the aforementioned parameters.

RESULTS

Cervical lordosis (R2 = 0.61), thoracic kyphosis (R2 = 0.84), SVA (R2 = 0.88), cSVA (R2 = 0.51), and T1 slope (R2 = 0.77) all increase with age. Truncal inclination (R2 = 0.36) and T1 slope/CL remain stable over all decades (R2 = 0.01). LL starts greater than PI, but in the 6th decade of life, LL becomes equal to PI and in the 7th decade becomes smaller than PI (R2 = 0.96). The ratio of TK/LL is stable until the 7th decade of life (R2 = 0.81), whereas PT is stable until the 6th decade (R2 = 0.92).

CONCLUSIONS

This study further refines the generally accepted LL = PI + 10° by showing that patients under the age of 50 years should have more LL compared to PI, whereas after the 5th decade the relationship is reversed. SVA was not as sensitive across age groups, exhibiting a marked increase only in the 7th decade of life. Given the reliable increase of CL with age, and the stability of T1 slope/CL, this represents another important relationship that should be maintained when performing cervical deformity/fusion surgery. This study has important implications for evaluating adult patients with spinal deformities and for establishing corrective surgical goals.

ABBREVIATIONS CL = cervical lordosis; cSVA = cervical SVA; LL = lumbar lordosis; PI = pelvic incidence; PJK = proximal junctional kyphosis; PT = pelvic tilt; SVA = sagittal vertical axis; TK = thoracic kyphosis; T1-SPi = T1-spinopelvic inclination.
Article Information

Contributor Notes

Correspondence Luke Macyszyn: University of California, Los Angeles, CA. lmacyszyn@mednet.ucla.edu.INCLUDE WHEN CITING Published online September 27, 2019; DOI: 10.3171/2019.7.SPINE181164.Disclosures Dr. Ames reports consultant relationships with DePuy Synthes, Medtronic, Stryker, Medicrea, K2M, and Biomet Zimmer; receipt of royalties from Stryker, Biomet Zimmer Spine, DePuy Synthes, NuVasive, Next Orthosurgical, K2M, and Medicrea; receipt of research support from Titan Spine, DePuy Synthes, and ISSG; being on the editorial board of Operative Neurosurgery; receipt of grant funding from ISSG; and being on the executive committee of Global Spinal Analytics.
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