Investigation of the spinopelvian sagittal orientation and their correlations in asymptomatic pediatric populations

In this study we took 307 asymptomatic pediatric volunteers, consisting of 167 men (54.4%) and 140 women (45.6%) between the ages of 4 and 18 with an average age of 12.49 years. The post-hoc performance analysis showed that with our sample size of 307 participants (167 males, 140 women) the study was achieved 99% performance in order to record significant gender differences and 95% performance of 0.05. For correlation analyzes between cervical and global spine parameters, the study achieved an output of 98%in order to recognize moderate correlations (R≥ 0.3).

The distribution of the radiological parameters is listed in Table 1. The average sagittal parameters of the cervical neck were as follows: -24.95 ± 7.80 ° for C0-2 Cobb, -10.31 ± 9.56 ° for C2–7 Cobb, 6.17 ± 6.42 ° for CBVA , 17.66, 17.66 ± 8.39 ° for C7S, 20.62 ± 8.49 ° for T1S and 18.13 ± 11.69 mm for C2–7 SVA. The average values ​​for the thoracic kyphosis (TK) and the lordosis (LL) were 30.28 ± 10.25 ° or – 45.23 ± 11.23 °. Spinopelvic parameters averaged as follows: 38.54 ± 9.91 ° ​​for Pi, 7.35 ± 8.81 ° for PT, 31.25 ± 8.24 ° for SS, -2.55 ± 9.18 ° for Appa, 67.91 ° ​​for PSA, -2.90 ± for T1SPI, 4.20 ± 7.10 ° for T1Pa and 2.89 ± 24.64 mm for C7-S1 SVA. Figure 2 shows age -related variations over several correlated parameters.

Cervical parameter

C0-2 Cobb-Winkel

A significant variance between age groups has been observed (-23.4 ± 7.4 °, -24.3 ± 8.5 °, -26.7 ± 5.7 °, -24.1 ± 6.8 ° and -28 , 1 ± 6.6 °; P= 0.012), especially in men (in men (P= 0.015). Differences between boys and girls were not significant in any age group.

C2-7 Cobb-Winkel:

A significant variance between the age groups has been determined (-11.4 ± 7.3 °, -13.7 ± 11.2 °, -16.0 ± 8.0 °, -8.4 ± 8.8 ° and – 9.3 ± 6.2 °; P= 0.024). The gender -specific differences in the entire data set were significant (P= 0.005).

CBVA

A significant variance was observed in the age groups (10.1 ± 7.8 °, 7.8 ± 7.5 °, 10.9 ± 3.6 °, 5.6 ± 6.4 ° and 3.8 ± 4 , 0 °; P= 0.0012), especially in men (P= 0.024). The overall gender differences were significant (P 

CSVA

A significant age group variance was found (17.5 ± 6.5 °, 13.5 ± 7.1 °, 13.5 ± 5.3 °, 19.3 ± 8.2 ° and 21.9 ± 20.0 °; P= 0.0023), especially in men (in men (P= 0.001). Differences between boys and girls were not significant within an age group.

C7S

The variance of the age group was significant (18.9 ± 7.5 °, 19.8 ± 9.3 °, 23.6 ± 7.6 °, 15.9 ± 8.0 ° and 19.6 ± 6.1 °; P= 0.015), especially in women (P= 0.036). The overall gender differences were significant (P= 0.014).

T1s

A significant variance between age groups was found (17.1 ± 5.5 °, 21.4 ± 9.8 °, 24.5 ± 6.8 °, 19.4 ± 8.1 ° and 23.6 ± 7 , 0 °; P= 0.02), especially in women (P= 0.028). Remarkable gender differences in group A (4 to 6 years aged 4 to 6 years) were observed, with men having higher T1s (12.2 ± 7.8 ° for men compared to 18.5 ± 4.4 ° for women; P= 0.043). Overall, gender -specific differences were significant (P= 0.04).

Breast and lumbar parameters

Thoracic kyphosis (TK)

No significant variance between age groups has been observed (29.2 ± 8.6 °, 29.7 ± 9.8 °, 26.5 ± 6.7 °, 30.7 ± 9.9 ° and 30.7 ± 8 , 6 °; P= 0.945). However, the gender differences were significant overall (P= 0.029).

Lordose Lumbal (LL)

A significant variance in the age groups was observed in the age groups (-52.2 ± 12.8 °, -42.2 ± 12.8 °, -48.5 ± 9.3 °, -46.0 ± 11.8 ° and -39.5 ± 7.1 °; PP

Spinopelvic parameter

Sacral tendency (SS)

A significant variance between age groups was observed (34.9 ± 8.6 °, 28.0 ± 8.5 °, 33.2 ± 7.5 °, 31.2 ± 8.4 ° and 28.5 ± 5 , 3 °; P= 0.00011), significant in both men (significant (in both menP= 0.001) and women (P= 0.003). Differences between boys and girls were not significant in any age group.

Beckenkippen (PT)

A significant variance between age groups was found (3.7 ± 6.9 °, 6.6 ± 9.0 °, 12.3 ± 5.0 °, 9.0 ± 9.9 ° and 8.9 ± 7 , 7 °; P= 0.01), especially in women (P= 0.044). The general gender differences were significant (P= 0.009).

Becking incidence (PI)

The variance of the age group was significant (39.1 ± 9.6 °, 34.5 ± 8.4 °, 45.6 ± 6.0 °, 39.9 ± 11.0 ° and 37.5 ± 8.1 °; P= 0.05). Differences between boys and girls were not significant in any age group.

Appa

No significant variance between age groups has been observed (-5.7 ± 13.4 °, -1.8 ± 10.8 °, 1.2 ± 10.5 °, -1.6 ± 8.6 ° and -3 , 8 ± 7.4 °; P= 0.46). Differences between boys and girls were not significant in any age group.

PSA

A significant variance between age groups was found (75.1 ± 7.2 °, 67.0 ± 15.8 °, 71.4 ± 6.8 °, 67.1 ± 6.6 ° and 65.2 ± 7 , 0 °; P= 0.0034), especially in men (P= 0.028). Differences between boys and girls were not significant in any age group.

T1spi

The age group variance was significant (-2.9 ± 2.9 °, -3.8 ± 2.8 °, -1.9 ± 4.0 °, -3.1 ± 4.2 ° and -1.9 ± 3.2 °; P= 0.137), especially in men (in men (P 

T1Pa

No significant variance between age groups has been observed (1.0 ± 6.7 °, 3.0 ± 7.2 °, 6.3 ± 5.7 °, 4.8 ± 7.2 ° and 6.0 ± 5.4 °; P= 0.063). Differences between boys and girls were not significant in any age group.

Table 2 shows the distribution of the spinopelvic parameters across different groups, which are categorized by pelvic dumps (PT). There were no remarkable differences in CSVA, C0-2 COBB, CBVA and C7-S1 SVA between the two PT-based groups. When looking at the entire sagittal alignment of the spine, significant differences were observed in subjects with negative PT. Especially in the negative PT group it was found that the participants were younger and smaller values ​​for Appa, PI and T1Pa, while PSA, SS, LL, TK, T1S, C7S, C2-7 Cobb and T1SPI were larger.

Roussouly categorized six different pelvic balance types using the center of the sacral 1 superior end plate, the hip axis and the C7 soldering line as reference points, the interaction between the pelvis and spine is emphasized. For our study, this classification for simple analysis was deleted in two main categories. Becken rivals (PT) in front of the thigh head, which shows a negative value, is classified as a group N (negative group). Conversely, the group P (positive group) comprises all other cases. Group P consists of 252 people who make up 82.08% of the study population. In Group P, men and women make up 127 (50.4%) or 125 (49.6%). Group N with a PT value below zero comprises 55 participants or 17.91% of the total sample. In Group N, men (38, 69.09%) are the majority, followed by women (17, 30.91%).

Correlation between the neck -sagittal alignment and global spine -Sagittal orientation

Table 3; Fig. 3 shows the correlation between the sagittal alignment of the cervical Sagittal and the global alignment of the spine. Significant correlations between age and the following parameters were found: PSA (R= -0.17, P= 0.00), pt (R= 0.17, P= 0.00), LL (R= -0.19, P= 0.00), T1S (R= 0.11, P= 0.00), CSVA (R= 0.19, P= 0.00), C2-7 Cobb (R= -0.14, P= 0.01), C0-2 Cobb (R= 0.13, P= 0.02), CBVA (R= -0.25, P= 0.00), C7-S1 SVA (R= 0.22, P= 0.00), T1SPI (R= 0.14, P= 0.01) and T1Pa (((R= 0.18, P= 0.00).

Significant correlations between Appa and the following parameters were also observed: PSA (R= -0.48, P= 0.00), SS (R= -0.23, P= 0.00), pt (R= 0.43, P= 0.00), Pi (R= 0.17, P= 0.00), LL (R= -0.16, P= 0.01), C2-7 Cobb (R= -0.15, P= 0.01), C7-S1 SVA (R= 0.21, P= 0.00) and T1Pa (((R= 0.4, P= 0.00). Figure 4 shows the analysis of parameters that are associated with PT.

For PSA, significant correlations with SS were found (R= 0.22, P= 0.00), pt (R= -0.73, P= 0.00), Pi (R= -0.4, P= 0.00), LL (R= 0.19, P= 0.00), C2-7 Cobb (R= 0.12, P= 0.03), C7-S1 SVA (R= -0.22, P= 0.00), T1SPI (R= 0.14, P= 0.01) and T1Pa (((R= -0.48, P= 0.00).

Significant correlations were between SS and PT (R= -0.3, P= 0.00), Pi (R= 0.6, P= 0.00), LL (R= 0.78, P= 0.00), T1SPI (R= 0.16, P= 0.01) and T1Pa (((R= -0.22, P= 0.00).

PT showed significant correlations with PI (R= 0.56, P= 0.00), LL (R= -0.27, P= 0.00), TK (R= -0.13, P= 0.03), C7-S1 SVA (R= 0.17, P= 0.00), T1SPI (R= -0.29, P= 0.00) and T1Pa (((R= 0.66, P= 0.00).

Pi was significant with LL (correlatedR= 0.45, P= 0.00), C2-7 Cobb (R= -0.12, P= 0.04), C7-S1 SVA (R= 0.13, P= 0.02) and T1Pa (((R= 0.35, P= 0.00).

LL had significant correlations with TK (R= 0.38, P= 0.00), C7-S1 SVA (R= -0.25, P= 0.00) and T1Pa (((R= -0.34, P= 0.00).

TK was significantly correlated with T1S (R= 0.59, P= 0.00), C7S (R= 0.59, P= 0.00), CSVA (R= 0.3, P= 0.00), C2-7 Cobb (R= 0.25, P= 0.00) and T1Pa (((R= -0.18, P= 0.00).

T1S showed significant correlations with C7S (R= 0.87, P= 0.00), CSVA (R= 0.32, P= 0.00), C2-7 Cobb (R= 0.42, P= 0.00), CBVA (R= -0.25, P= 0.00), C7-S1 SVA (R= 0.39, P= 0.00) and T1SPI (R= 0.27, P= 0.00).

C7S was significant with CSVA (CSVA () correlated (R= 0.32, P= 0.00), C2-7 Cobb (R= 0.45, P= 0.00), C0-2 Cobb (R= 0.12, P= 0.04), CBVA (R= -0.24, P= 0.00), C7-S1 SVA (R= 0.35, P= 0.00) and T1SPI (R= 0.25, P= 0.00).

Significant correlations were between CSVA and C0-2 Cobb (Cobb (R= 0.21, P= 0.00), C7-S1 SVA (R= 0.23, P= 0.00) and T1SPI (R= 0.16, P= 0.00).

C2-7 Cobb had significant correlations with CBVA (R= -0.32, P= 0.00), C7-S1 SVA (R= 0.13, P= 0.02) and T1SPI (R= 0.12, P= 0.03).

Significant correlations were found between C0-2 Cobb and CBVA (CBVA ()R= -0.28, P= 0.00).

CBVA showed significant correlations with C7-S1 SVA (R= -0.14, P= 0.01).

Finally, significant correlations between C7-S1 SVA and T1SPI (foundR= 0.75, P= 0.00) and T1Pa (R= 0.39, P= 0.00).