Adjustment of pelvispinal parameters preserves the constant gravity line position

There is a high variance in sagittal morphology and complaints between different subjects suffering from spinal disorders. Sagittal spinal alignment and clinical presentation are not closely related. Different parameters have been used to describe the pelvispinal morphology based on standing lateral radiographs. We conducted a study using radiography of the lumbar spine combined with force platform data to examine the correlation between pelvispinal parameters and the gravity line position. Fifty consecutive patients with a mean age of 55 years (18–84 years) were compared to normal controls. Among patients we found a statistically significant correlation between the following spinal parameters: lumbar lordosis and sacral slope (r=0.77; P<0.001), sacral slope and pelvic incidence (r=0.72; P<0.001) and pelvic tilt and overhang (r=−0.93; P<0.001). In patients and controls, the gravity line position was found to be located at 60 and 61%, respectively, of the foot length measured from the great toe, ranging from 53 to 69%, when corrected for the individual foot length. The results indicate that subjects with and without spinal disorders have their gravity line position localised within a very small range despite the high variability for lumbar lordosis and pelvic tilt

Gravitational forces and sagittal shape of the spine: Clinical estimation of their relations

The sagittal morphology of the pelvis determines the amount of lordosis needed for each individual. The proper harmony of the sagittal spinal curves allows a stable balance, economical in terms of mechanical effects and muscular energy. A previous barycentremetrical laboratory study allowed us to demonstrate that the axis of gravity of the upper body segment was located behind the lumbar vertebrae and the femoral heads, thus ensuring economy and stability. The determination of the anatomical connection of the individual gravity is thus of primary importance for the evaluation of sagittal balance. Data for 42 patients without spinal pathology, previously evaluated by barycentremetry, were used to establish a predictive equation for the application point of the gravity at the level of the third lumbar vertebra (L3). This equation, using anthropometric and radiographic pelvic and spinal parameters, was integrated into a software program called Similibary. It was applied to the same 42 subjects. These results were compared in order to validate the method. No significant difference was observed between the two techniques. This easy-to-use tool allows a personalised evaluation of the sagittal balance of the spine, both through the evaluation of the harmonious relationship between the spinal curves and the pelvis, and through the location of gravity supported by the vertebral structures in L3