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Sagittal alignment based on inflection point and its differences according to age groups.

Moon Soo Park1, Seong-Hwan Moon2, Tae-Hwan Kim1

  • 1Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, Gyeonggi-do, Republic of Korea.

Journal of Orthopaedic Surgery (Hong Kong)
|February 25, 2020
PubMed
Summary

Sagittal alignment measurements using inflection points (IPs) reveal age-related changes in spinal curvature. Older adults show decreased sacral slope and lumbar angles, with increased C2 sagittal vertical axis distance.

Keywords:
bone malalignmentcervical vertebraeinflection pointlumbar vertebraespinethoracic vertebrae

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Area of Science:

  • Spinal biomechanics
  • Radiographic analysis
  • Scoliosis assessment

Background:

  • Traditional scoliosis evaluation uses end vertebrae in the coronal plane.
  • Sagittal alignment assessment traditionally relies on standard anatomical landmarks.
  • Previous studies explored sagittal alignment using inflection points (IPs).

Purpose of the Study:

  • To determine sagittal alignment based on IPs.
  • To elucidate age-related changes in sagittal alignment using IPs.

Main Methods:

  • Identified most titled vertebrae in the sagittal plane as end vertebrae for S1, thoracolumbar, and cervicothoracic IPs.
  • Measured Cobb angles (sacral slope, functional lumbar, thoracic, cervical segments) and McGregor's line.
  • Assessed C2 plumb line distances to IPs and S1.

Main Results:

  • Most common IPs were L2 (thoracolumbar) and T1 (cervicothoracic).
  • Cervicothoracic IP shifted from T2 (youngest) to C7 (oldest).
  • Sagittal angles decreased in sacral slope and functional lumbar segments; C2 SVA and thoracolumbar IP distances increased with age.

Conclusions:

  • Sagittal Cobb angles based on IPs decrease in the sacral slope and functional lumbar segments in older adults.
  • C2 SVA distance to S1 and thoracolumbar IP distance increase with age.
  • IP-based measurements offer insights into age-related spinal sagittal alignment changes.