Abstract
Purpose
Ethnic differences in spino-pelvic parameters among a healthy population are poorly defined in the literature. The purpose of this study was to document sagittal spino-pelvic parameters in a sample of African Americans and to compare them with previously reported data for Caucasians and Asians.
Methods
African American individuals without spine pathology who had standing lateral radiographs were identified. Radiographs were measured to determine the following parameters: lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). Data of adult subjects were compared with those previously published for Caucasians (n = 709) and Asians (n = 312).
Results
These measurements (LL, PI, PT, and SS) obtained for the 36 African American subjects aged 18 years or older [15 men and 21 women; mean age 26.6 ± 8.7 range (18–53)] The mean LL, PI, PT and SS values were 57.2°, 57.7°, 15.9° and 41.4°, respectively. A comparative analysis showed the means values for PI was greater in the African American than in Caucasian (57.7° vs. 52.6°, p = 0.007), and than in Asian (57.7° vs. 48.7°, p < 0.001). The linear regression model for the LL as a function of PI were “predict LL = 0.41 × PI + 33.7” in African American, “predict LL = 0.58 × PI + 24.3” in Caucasian, and “predict LL = 0.54 × PI + 22.0” in Asian, respectively.
Conclusion
Significant differences in sagittal spino-pelvic parameters among races were seen. These differences should be considered when planning surgical reconstruction for spinal surgery.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Similar content being viewed by others
References
Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 30:346–353
Le Huec JC, Aunoble S, Philippe L, Nicolas P (2011) Pelvic parameters: origin and significance. Eur Spine J 20(Suppl 5):564–571. https://doi.org/10.1007/s00586-011-1940-1
Legaye J, Duval-Beaupere G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103
O’Brien M, Kuklo T, Blanke K, Lenke L (2005) Spinal deformity study group radiographic measurement manual. Medtronic Sofamor Danek USA Inc., Memphis
Philippot R, Wegrzyn J, Farizon F, Fessy MH (2009) Pelvic balance in sagittal and Lewinnek reference planes in the standing, supine and sitting positions. Orthop Traumatol Surg Res 95:70–76. https://doi.org/10.1016/j.otsr.2008.01.001
Yamato Y, Hasegawa T, Kobayashi S, Yasuda T, Togawa D, Arima H, Oe S, Iida T, Matsumura A, Hosogane N, Matsumoto M, Matsuyama Y (2016) Calculation of the target lumbar lordosis angle for restoring an optimal pelvic tilt in elderly patients with adult spinal deformity. Spine (Phila Pa 1976) 41:E211–E217. https://doi.org/10.1097/brs.0000000000001209
Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, DeWald C, Mehdian H, Shaffrey C, Tribus C, Lafage V (2012) Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 37:1077–1082. https://doi.org/10.1097/brs.0b013e31823e15e2
Rose PS, Bridwell KH, Lenke LG, Cronen GA, Mulconrey DS, Buchowski JM, Kim YJ (2009) Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine (Phila Pa 1976) 34:785–791. https://doi.org/10.1097/brs.0b013e31819d0c86
Mac-Thiong JM, Roussouly P, Berthonnaud E, Guigui P (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine (Phila Pa 1976) 35:E1193–E1198. https://doi.org/10.1097/brs.0b013e3181e50808
Lee CS, Chung SS, Kang KC, Park SJ, Shin SK (2011) Normal patterns of sagittal alignment of the spine in young adults radiological analysis in a Korean population. Spine (Phila Pa 1976) 36:E1648–E1654. https://doi.org/10.1097/brs.0b013e318216b0fd
Yamato Y, Matsuyama Y, Hasegawa T, Togawa D, Kobayashi S, Yasuda T (2013) Spino-pelvic Alignment in Adult Spinal Deformity and Corrective Surgery. Spine Spinal Cord (Jp) 26:653–658
Lonner BS, Auerbach JD, Sponseller P, Rajadhyaksha AD, Newton PO (2010) Variations in pelvic and other sagittal spinal parameters as a function of race in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 35:E374–E377. https://doi.org/10.1097/brs.0b013e3181bb4f96
Ames CP, Smith JS, Scheer JK, Bess S, Bederman SS, Deviren V, Lafage V, Schwab F, Shaffrey CI (2012) Impact of spinopelvic alignment on decision making in deformity surgery in adults: A review. J Neurosurg Spine 16:547–564. https://doi.org/10.3171/2012.2.SPINE11320
Mac-Thiong JM, Roussouly P, Berthonnaud E, Guigui P (2011) Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults. Eur Spine J 20(Suppl 5):572–577. https://doi.org/10.1007/s00586-011-1923-2
Mac-Thiong JM, Berthonnaud E, Dimar JR 2nd, Betz RR, Labelle H (2004) Sagittal alignment of the spine and pelvis during growth. Spine (Phila Pa 1976) 29:1642–1647
Yoshida G, Yasuda T, Togawa D, Hasegawa T, Yamato Y, Kobayashi S, Arima H, Hoshino H, Matsuyama Y (2014) Craniopelvic alignment in elderly asymptomatic individuals: analysis of 671 cranial centers of gravity. Spine (Phila Pa 1976) 39:1121–1127. https://doi.org/10.1097/brs.0000000000000360
Oe S, Togawa D, Nakai K, Yamada T, Arima H, Banno T, Yasuda T, Kobayasi S, Yamato Y, Hasegawa T, Yoshida G, Matsuyama Y (2015) The influence of age and sex on cervical spinal alignment among volunteers aged over 50. Spine (Phila Pa 1976) 40:1487–1494. https://doi.org/10.1097/brs.0000000000001071
Banno T, Togawa D, Arima H, Hasegawa T, Yamato Y, Kobayashi S, Yasuda T, Oe S, Hoshino H, Matsuyama Y (2016) The cohort study for the determination of reference values for spinopelvic parameters (T1 pelvic angle and global tilt) in elderly volunteers. Eur Spine J. https://doi.org/10.1007/s00586-016-4411-x
Schwab F, Lafage V, Patel A, Farcy JP (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976) 34:1828–1833. https://doi.org/10.1097/brs.0b013e3181a13c08
Weinberg DS, Morris WZ, Gebhart JJ, Liu RW (2015) Pelvic incidence: an anatomic investigation of 880 cadaveric specimens. Eur Spine J. https://doi.org/10.1007/s00586-015-4317-z
Zarate-Kalfopulos B, Romero-Vargas S, Otero-Camara E, Correa VC, Reyes-Sanchez A (2012) Differences in pelvic parameters among Mexican, Caucasian, and Asian populations. J Neurosurg Spine 16:516–519. https://doi.org/10.3171/2012.2.SPINE11755
Hanson P, Magnusson SP, Simonsen EB (1998) Differences in sacral angulation and lumbosacral curvature in black and white young men and women. Acta Anat (Basel) 162:226–231
Zakharia F, Basu A, Absher D, Assimes TL, Go AS, Hlatky MA, Iribarren C, Knowles JW, Li J, Narasimhan B, Sidney S, Southwick A, Myers RM, Quertermous T, Risch N, Tang H (2009) Characterizing the admixed African ancestry of African Americans. Genome Biol 10:R141. https://doi.org/10.1186/gb-2009-10-12-r141
Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupere G, Pelissier J (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422. https://doi.org/10.1007/s00586-005-0984-5
Vrtovec T, Janssen MM, Likar B, Castelein RM, Viergever MA, Pernus F (2012) A review of methods for evaluating the quantitative parameters of sagittal pelvic alignment. Spine J 12:433–446. https://doi.org/10.1016/j.spinee.2012.02.013
Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 87:260–267. https://doi.org/10.2106/JBJS.D.02043
Mangione P, Gomez D, Senegas J (1997) Study of the course of the incidence angle during growth. Eur Spine J 6:163–167
Marty C, Boisaubert B, Descamps H, Montigny JP, Hecquet J, Legaye J, Duval-Beaupere G (2002) The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients. Eur Spine J 11:119–125. https://doi.org/10.1007/s00586-001-0349-7
Jentzsch T, Geiger J, Bouaicha S, Slankamenac K, Nguyen-Kim TD, Werner CM (2013) Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine. BMC Med Imaging 13:34. https://doi.org/10.1186/1471-2342-13-34
Legaye J (2014) Influence of age and sagittal balance of the spine on the value of the pelvic incidence. Eur Spine J 23:1394–1399. https://doi.org/10.1007/s00586-014-3207-0
Acknowledgements
No other person aside from the authors made substantial contributions to conception, design, acquisition of data, or analysis and interpretation of data, or was involved in drafting the manuscript or revising it critically for important intellectual content. No funding was received for the design, in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. No language editor or scientific (medical) writer was involved in the preparation of the manuscript. The manuscript submitted does not contain information about medical devices or drugs. This study was reviewed and approved by the Institutional Review Board of the University of Louisville.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Relevant financial activities outside the submitted work: board membership, consultancy, employment, grants, payment for lectures, travel/accommodations/meeting expenses, patents, royalties, and stocks. HA has nothing to disclose. JRD, SDG and LYC are employees of Norton Healthcare. Nuvasive provided funds directly to database company. No funds are paid directly to Individual or Individual’s Institution 06/2012-04/2015. JRD receives consulting fees, holds patents and receives royalties from Medtronic; is on the editorial review board of JBJS Highlights, Spine, Spine Deformity, JAAOS and Global Spine; is a member of the SRS Board. SDG received research grants from Norton Healthcare; receives consulting fees, holds patents from and receives royalties from Medtronic. YY, YM, JM and PR have nothing to disclose. LYC is a Member, Editorial Advisory Board, Spine and Spine Journal, University of Louisville Institutional Review Board, Scoliosis Research Society Research Committee; receives research funds from Orthopedic Research and Educational Fund, Norton Healthcare, Scoliosis Research Society; received funds for travel from Association for Collaborative Spine Research, University of Southern Denmark, University of Louisville; consulting fees from Washington University at St. Louis.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Arima, H., Dimar, J.R., Glassman, S.D. et al. Differences in lumbar and pelvic parameters among African American, Caucasian and Asian populations. Eur Spine J 27, 2990–2998 (2018). https://doi.org/10.1007/s00586-018-5743-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-018-5743-5