TY - JOUR
T1 - Redefining global spinal balance
T2 - Normative values of cranial center of mass from a prospective cohort of asymptomatic individuals
AU - Sugrue, Patrick A
AU - McClendon, Jamal
AU - Smith, Timothy R.
AU - Halpin, Ryan J.
AU - Nasr, Fadi F.
AU - O'Shaughnessy, Brian A.
AU - Koski, Tyler Robert
PY - 2013/3/15
Y1 - 2013/3/15
N2 - STUDY DESIGN. Prospective radiographical analysis of cranial center of mass (CCOM), C2, and C7 plumb lines in young and elderly asymptomatic individuals. OBJECTIVE. To establish a normal range for craniosagittal balance for both young and elderly asymptomatic individuals. SUMMARY OF BACKGROUND DATA. Global sagittal balance must account for the position of the head in relation to the spine and pelvis. The C7 plumb line defines thoracolumbar sagittal balance and has been shown to have significant impact on patient outcomes. However, the C7 plumb line fails to take into consideration the position of the head in relation to the pelvis. METHODS. A total of 100 asymptomatic 20- to 40-year-old patients and 100 asymptomatic 60- to 80-year-old patients were enrolled. Standing plain radiographs of 14 × 36 in were obtained. CCOM, C2, and C7 plumb lines were drawn and measured from the superoposterior endplate of S1. RESULTS. A total of 78 asymptomatic 20- to 40-year-old patients and 62 asymptomatic 60- to 80-year-old patients had adequate radiographs. The mean plumb line values in the 20- to 40-year-old patients and 60- to 80-year-old patients, respectively, were as follows; CCOM 9.0 mm (SD, 31.5 mm) and 41.2 mm (SD, 35.7 mm); C2 -2.7 mm (SD, 32.7 mm) and 32.1 mm (SD, 33.6 mm); and C7 -16.4 mm (SD, 31.5 mm) and 10.6 mm (SD, 27.8 mm). One-way analysis of variance and Student t tests confirmed that these mean plumb line values were significantly different between young and elderly patients (P < 0.001). The change at each level over time was highly correlated with the other levels (r > 0.97; P < 0.001) as did the degree of change between groups (r > 0.90, P < 0.001). CONCLUSION. Spinopelvic alignment in conjunction with CCOM has increased our understanding of spinal balance by including the head and may better represent true global spinal balance. CCOM is an easily measured parameter by using the nasion-inion technique.
AB - STUDY DESIGN. Prospective radiographical analysis of cranial center of mass (CCOM), C2, and C7 plumb lines in young and elderly asymptomatic individuals. OBJECTIVE. To establish a normal range for craniosagittal balance for both young and elderly asymptomatic individuals. SUMMARY OF BACKGROUND DATA. Global sagittal balance must account for the position of the head in relation to the spine and pelvis. The C7 plumb line defines thoracolumbar sagittal balance and has been shown to have significant impact on patient outcomes. However, the C7 plumb line fails to take into consideration the position of the head in relation to the pelvis. METHODS. A total of 100 asymptomatic 20- to 40-year-old patients and 100 asymptomatic 60- to 80-year-old patients were enrolled. Standing plain radiographs of 14 × 36 in were obtained. CCOM, C2, and C7 plumb lines were drawn and measured from the superoposterior endplate of S1. RESULTS. A total of 78 asymptomatic 20- to 40-year-old patients and 62 asymptomatic 60- to 80-year-old patients had adequate radiographs. The mean plumb line values in the 20- to 40-year-old patients and 60- to 80-year-old patients, respectively, were as follows; CCOM 9.0 mm (SD, 31.5 mm) and 41.2 mm (SD, 35.7 mm); C2 -2.7 mm (SD, 32.7 mm) and 32.1 mm (SD, 33.6 mm); and C7 -16.4 mm (SD, 31.5 mm) and 10.6 mm (SD, 27.8 mm). One-way analysis of variance and Student t tests confirmed that these mean plumb line values were significantly different between young and elderly patients (P < 0.001). The change at each level over time was highly correlated with the other levels (r > 0.97; P < 0.001) as did the degree of change between groups (r > 0.90, P < 0.001). CONCLUSION. Spinopelvic alignment in conjunction with CCOM has increased our understanding of spinal balance by including the head and may better represent true global spinal balance. CCOM is an easily measured parameter by using the nasion-inion technique.
KW - Cranial center of mass
KW - Deformity
KW - Sagittal balance
KW - Spinal alignment
UR - http://www.scopus.com/inward/record.url?scp=84875581344&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84875581344&partnerID=8YFLogxK
U2 - 10.1097/BRS.0b013e318273a1c0
DO - 10.1097/BRS.0b013e318273a1c0
M3 - Article
C2 - 22986836
AN - SCOPUS:84875581344
SN - 0362-2436
VL - 38
SP - 484
EP - 489
JO - Spine
JF - Spine
IS - 6
ER -