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Chiropractic Research Review

Parameters of Spinopelvic Alignment

Radiographic parameters for "congruent" spinopelvic balance over the hips and changes in sagittal alignments over time have not been defined. This study addresses the need for a standardized measurement technique for spinal alignments and a quantitative pelvic morphology.

In this study, 75 volunteers (44 men / 31 women, average age: 39 years) had 36-inch standing lateral radiographs of the thoracolumbar spine and the pelvis taken that included both hips.

Thirty volunteers had a second radiograph taken five to six years later. Radiographic measurements were made using the pelvic radius technique. This required locating a midpoint between the approximate centers of both femoral heads to establish a pelvic hip axis. A line between the hip axis and the posterior superior corner of S1 for the pelvic radius was drawn and measured for length. Angles were measured from the pelvic radius to tangents along the vertebral endplates on the 105 films with an electronic digital readout device. These angles included PR-S1 for pelvic morphology and PR-T12 for total lumbopelvic lordosis. A pelvic angle was measured from a vertical line through the hip axis to the pelvic radius. This angle gave the sagittal alignment for the pelvis over the hips. Longitudal measurements between radiographs were compared for minimum and maximum change. Significant statistical correlations for the measurements were carefully studied to determine potentially important clinical relationships. In addition, thoracic kyphosis / lumbar lordosis ratios were assessed.

Results: "Congruent" spinopelvic alignment could be defined by the following four parameters using the pelvic radius technique:

* total lumbopelvic lordosis incorporating complementary angles for lumbosacral lordosis and pelvic morphology;
* centered pelvic alignment over the hips as determined by the pelvic angle;
* compensated spinal balance with a sagittal plumbline from the center of the T4 body, posterior to the hip axis and the center of L4 vertebral body; and
* concordant T4-T12 kyphosis / PR-T12 lordosis ratio.

The authors suggest: "The significant correlation between pelvic morphology and lumbar lordosis should be considered in the assessment of sagittal spinal alignment."

Note: This article clearly describes and demonstrates the lateral lumbopelvic radiographic measurements. The text also contains measurements of sagittal spinopelvic alignment of a small group of healthy subjects.

Jackson RP, Hales C. Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine 2000: 25(21), pp 2808-2815

Chiropractic Research Review

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