medigraphic.com
ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2022, Number 4

<< Back Next >>

An Med Asoc Med Hosp ABC 2022; 67 (4)

Sagital balance in the spine: concepts and basic application

León-Vega E, Castillón-Benavides OJ, Escamilla-Gutiérrez E, Smirnov CÁI, Muñoz-Romero I, Martínez-Anda JJ, Collado OMÁ, De LRA

Language: Spanish
References: 36
Page: 293-299
PDF size: 347.48 Kb.


ABSTRACT

Sagittal balance is the harmony between the curvatures of the spine in relation to the pelvis, with the purpose of maintain an energy efficient position. To measure this relationship, various parameters are used, among which the main ones are: pelvic incidence, pelvic inclination, sacral inclination and lumbar lordosis, the latter is of great relevance as it is directly related with posture. Total spinal radiographs are an accessible tool to determine this sagittal balance. Sagittal balance alterations are divided into congenital and degenerative, which will manifest as chronic pain, fatigue, less tolerance to exercise and changes in posture that can impede the development of daily activities, an early diagnosis can help preventive treatment, resulting in a better quality of life.


REFERENCES

  1. Holck P. Cervikalcolumnas anatomi. Tidsskr den Nor Laegeforening. 2010; 130 (1): 29-32.

  2. Latarjet M, Ruiz LA. Anatomía humana. 5 ed. Buenos Aires: Editorial Panamericana; 2019.

  3. Pro EA. Anatomía Clínica. 2 ed. Buenos Aires: Editorial Panamericana; 2014.

  4. Kaplan KM, Spivak JM, Bendo JA. Embryology of the spine and associated congenital abnormalities. Spine J. 2005; 5 (5): 564-576.

  5. Tardieu C, Bonneau N, Hecquet J, Boulay C, Marty C, Legaye J et al. How is sagittal balance acquired during bipedal gait acquisition ? Comparison of neonatal and adult pelves in three dimensions. Evolutionary implications. J Hum Evol. 2013; 65 (2): 209-222. Available in: http://dx.doi.org/10.1016/j.jhevol.2013.06.002

  6. Le Huec JC, Saddiki R, Franke J, Rigal J, Aunoble S. Equilibrium of the human body and the gravity line: the basics. Eur Spine J. 2011; 20 Suppl 5: 558-563.

  7. Scheer JK, Tang JA, Smith JS, Acosta FL, Protopsaltis TS, Blondel B et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013; 19 (2): 141-159.

  8. Diebo BG, Varghese JJ, Lafage R, Schwab FJ, Lafage V. Sagittal alignment of the spine: What do you need to know? Clin Neurol Neurosurg. 2015; 139: 295-301. Available in: http://dx.doi.org/10.1016/j.clineuro.2015.10.024

  9. Berven S, Wadhwa R. Sagittal alignment of the lumbar spine. Neurosurg Clin N Am. 2018; 29 (3): 331-339. Available in: https://doi.org/10.1016/j.nec.2018.03.009

  10. Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998; 7 (2): 99-103.

  11. Alfredo Guiroy, Martín Gagliardi, Alfredo Sícoli , Nicolás Gonzalez Masanés , Alejandro Morales Ciancio , Pablo Jalón JJM. Parámetros sagitales espino-pélvicos en una población asintomática Argentina. Surg Neurol Int. 2018; 9 (Suppl 1): S36-S42.

  12. Schwab F, Lafage V, Patel A, Farcy J. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976). 2009; 34 (17): 1828-1833.

  13. Gangnet N, Pomero V, Dumas R, Skalli W, Vital JM. Variability of the spine and pelvis location with respect to the gravity line: a three-dimensional stereoradiographic study using a force platform. Surg Radiol Anat. 2003; 25 (5-6): 424-433.

  14. Legaye J, Duval-Beaupere G. Influence of a variation in the position of the arms on the sagittal connection of the gravity line with the spinal structures. Eur Spine J. 2017; 26 (11): 2828-2833.

  15. Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J. 2011; 20 Suppl 5 (Suppl 5): 609-618.

  16. Roussouly P, Nnadi C. Sagittal plane deformity : an overview of interpretation and management. Eur Spine J. 2010; 19: 1824-1836.

  17. Mac-Thiong JM, Transfeldt EE, Mehbod AA, Perra JH, Denis F, Garvey TA et al. Can C7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine (Phila Pa 1976). 2009; 34 (15): E519-527.

  18. Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C. Sagittal alignment of spine and pelvis regulated by pelvic incidence : standard values and prediction of lordosis. Eur Spine J. 2006; 15 (4): 415-422.

  19. Asai Y, Tsutsui S, Oka H, Yoshimura N, Hashizume H, Yamada H et al. Sagittal spino-pelvic alignment in adults: the Wakayama spine study. PLoS One. 2017; 12 (6): e0178697.

  20. Legaye J. The femoro-sacral posterior angle : an anatomical sagittal pelvic parameter usable with dome-shaped sacrum. Eur Spine J. 2007; 16: 219-225.

  21. Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A. Sagittal balance of the spine. Eur Spine J. 2019; 28 (9): 1889-1905. Available in: https://doi.org/10.1007/s00586-019-06083-1

  22. Klineberg E, Schwab F, Smith JS, Gupta MC, Lafage V, Bess S. Sagittal spinal pelvic alignment. Neurosurg Clin N Am. 2013; 24 (2): 157-162. Available in: http://dx.doi.org/10.1016/j.nec.2012.12.003

  23. Jean L. Influence of age and sagittal balance of the spine on the value of the pelvic incidence. 2014; 23 (7): 1394-1399.

  24. Decker S, Müller CW, Omar M, Krettek C, Schwab F, Trobisch PD. Sagittal balance of the spine - clinical importance and radiographic assessment. Z Orthop Unfall. 2016; 154 (2): 128-133.

  25. Jang J, Lee S, Min J. Influence of lumbar lordosis restoration on thoracic curve and sagittal position in lumbar degenerative kyphosis patients. 2009; 34 (3): 280-284.

  26. Been E, Kalichman L. Lumbar lordosis. Spine J. 2014; 14 (1): 87-97. Available in: http://dx.doi.org/10.1016/j.spinee.2013.07.464

  27. Bailey JF, Shefi S, Soudack M, Kramer PA, Been E. Development of pelvic incidence and lumbar lordosis in children and adolescents. The Anatomical RecordVolume. 2019; 302 (12): 2132-2139.

  28. Celestre PC, Dimar JR, Glassman SD. Spinopelvic Parameters: Lumbar Lordosis, Pelvic Incidence, Pelvic Tilt, and Sacral Slope: What Does a Spine Surgeon Need to Know to Plan a Lumbar Deformity Correction? Neurosurg Clin N Am. 2018; 29 (3): 323-329. Available in: https://doi.org/10.1016/j.nec.2018.03.003

  29. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976). 2005; 30 (3): 346-353.

  30. Roussouly P, Huec J Le. Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J. 2013; 22 Suppl 6 (Suppl 6): S834-841.

  31. Tomé-bermejo F, Tsirikos AI. Conceptos actuales sobre la enfermedad de Scheuermann : presentación clínica , diagnóstico y controversias sobre su tratamiento. Rev Esp Cir Ortop Traumatol. 2012; 56 (6):

  32. Z AS, Carlos J, Prieto R, C JW, Leiter F, F SS et al. Espondiloartritis anquilosante : revisión de hallazgos imagenológicos en la columna. 2016; 22 (4):

  33. Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am. 2005; 87 (2): 260-267.

  34. Berthonnaud E, Dimnet J, Roussouly P, Labelle H. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech. 2005; 18 (1): 40-47.

  35. Obeid I, Boissière L, Yilgor C, Larrieu D, Pellisé F, Alanay A et al. Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J. 2016; 25 (11): 3644-3649.

  36. Yilgor C, Sogunmez N, Boissiere L, Yavuz Y, Obeid I, Kleinstück F et al. Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am. 2017; 99 (19): 1661-1672.



EVIDENCE LEVEL

III




2020     |     www.medigraphic.com