scholarly journals Spinal sagittal alignment and head control in patients with cerebral palsy

2020 ◽  
Vol 14 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Brice Ilharreborde ◽  
Adrien de Saint Etienne ◽  
Ana Presedo ◽  
Anne-Laure Simon
Keyword(s):  
Cerebral Palsy ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Trunk Control ◽  
Level Of Evidence ◽  
Sagittal Vertical Axis ◽  
Spinal Sagittal Alignment ◽  
Trunk Posture ◽  
Radiological Analysis

Purpose Spinal sagittal alignment restoration has been associated with improved functional outcomes and with reduced complications rates. Several limitations exist for radiological analysis in cerebral palsy (CP) patients. The goal of this study was to summarize the existing literature and report the important considerations to evaluate in a CP patient undergoing spinal surgery. Methods A retrospective radiological analysis was performed, including non-ambulant CP children with progressive scoliosis. Full-spine sitting radiographs performed pre-and postoperatively were required to measure spino-pelvic sagittal parameters. Result A total of 23 non-ambulating CP patients were included, mean age 16.0 years (standard error of the mean 0.5). Two distinct groups of patients were identified. Group 1 (61%) were patients with less trunk control (lumbar lordosis (LL) < 50°), retroverted and vertical pelvis (mean sacral slope (SS) 11.4° and pelvic tilt (PT) 38.1°) and anterior imbalance (mean sagittal vertical axis (SVA) 5.9 cm) and Group 2 (39%) were patients with better trunk control (LL > 60°, anteverted and horizontal pelvis (mean SS 49.3°, PT 9.7°) and posterior imbalance (mean SVA 5.8 cm). Postoperative measures showed significant impact of surgery with a PT reduction of 19° (p = 0.007), a mean SS increase of 15° (p = 0.04) and a LL gained of 10° (p = 0.2). Conclusion Sagittal spino-pelvic alignment in non-ambulating CP patients remains difficult to assess. The current literature is poor but our radiological study was able to define two distinct groups among Gross Motor Function Classification System (GMFCS) level V patients, based on the quality of their trunk control. All possible factors that may influence head and trunk posture should be systematically considered and optimized. Level of evidence Level IV

scholarly journals Spinal Sagittal Alignment Among Patients with Degenerative Lumbar Canal Stenosis

2021 ◽  
Vol 10 ◽  
pp. e2128
Author(s):  
Mehdi Khaleghi ◽  
Sina Abdollahzade ◽  
Sanaz Jamshidi ◽  
Nafiseh Rastgoo ◽  
Reza Rouhani ◽  
...  
Keyword(s):  
Sagittal Alignment ◽  
Vertical Axis ◽  
Neurogenic Claudication ◽  
Sacral Slope ◽  
Compensatory Mechanism ◽  
Healthy Individuals ◽  
Sagittal Vertical Axis ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
Spinal Sagittal Alignment

Background: Degenerative lumbar canal stenosis (DLS) is a common spinal pathology characterized by radicular pain and neurogenic claudication. Sagittal alignment and its indices have been affected in several spinal pathologies and may play a key role in surgical planning and outcome. In this case-control study, we aimed to assess sagittal alignment among patients with DLS compared to healthy individuals. Materials and Methods: Sixty patients DLS and 60 healthy volunteers were selected. Pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), pelvic incidence (PI), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were obtained in lateral standing X-ray radiographs. Results: Mean LL was lower in DLS patients (35.3±10.2) compared to normal controls (44.78±12.95), which was statistically significant (P <0.05). In contrast, there were no significant differences in PI, SVA, and SS between the groups. In patients with DLS, TK was lower, and PT was higher when compared to healthy individuals (P<0.05). Conclusion: Patients with DLS utilize decreased lordosis of the lumbar spine as a compensatory mechanism to decompress the thecal sac and spinal roots and improve their symptoms. Consequently, these patients recruit compensatory adjustments such as thoracic hyperkyphosis and increased PT to maintain sagittal alignment. [GMJ.2021;10:e2128]

scholarly journals Sagittal profile modifications in hybrid versus all screw technique in adolescent idiopathic scoliosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Laura Scaramuzzo ◽  
Antonino Zagra ◽  
Giuseppe Barone ◽  
Stefano Muzzi ◽  
Leone Minoia ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Thoracic Kyphosis ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Sagittal Profile ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Lenke Classification

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

scholarly journals Lumbar Level Significantly Influences Postoperative Global Sagittal Balance Following Pedicle Subtraction Osteotomy

2021 ◽  
pp. 219256822110325
Author(s):  
Athan G. Zavras ◽  
T. Barrett Sullivan ◽  
Navya Dandu ◽  
Howard S. An ◽  
Christopher J. DeWald ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Vertical Axis ◽  
Pedicle Subtraction Osteotomy ◽  
Current Evidence ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Lumbar Level ◽  
Global Sagittal Alignment

Study Design: Retrospective cohort study. Objectives: The current evidence regarding how level of lumbar pedicle subtraction osteotomy (PSO) influences correction of sagittal alignment is limited. This study sought to investigate the relationship of lumbar level and segmental angular change (SAC) of PSO with the magnitude of global sagittal alignment correction. Methods: This study retrospectively evaluated 53 consecutive patients with adult spinal deformity who underwent lumbar PSO at a single institution. Radiographs were evaluated to quantify the effect of PSO on lumbar lordosis (LL), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), T1-spinopelvic inclination (T1SPI), T1-pelvic alignment (TPA), and sagittal vertical axis (SVA). Results: Significant correlations were found between PSO SAC and the postoperative increase in LL ( r = 0.316, P = .021) and PT ( r = 0.352, P = .010), and a decrease in TPA ( r = −0.324, P = .018). PSO level significantly correlated with change in T1SPI ( r = −0.305, P = .026) and SVA ( r = −0.406, P = .002), with more caudal PSO corresponding to a greater correction in sagittal balance. On multivariate analysis, more caudal PSO level independently predicted a greater reduction in T1SPI (β = −3.138, P = .009) and SVA (β = −29.030, P = .001), while larger PSO SAC (β = −0.375, P = .045) and a greater number of fusion levels (β = −1.427, P = .036) predicted a greater reduction in TPA. Conclusion: This study identified a gain of approximately 3 degrees and 3 cm of correction for each level of PSO more caudal to L1. Additionally, a larger PSO SAC predicted greater improvement in TPA. While further investigation of these relationships is warranted, these findings may help guide preoperative PSO level selection.

scholarly journals Long-term effects of the Chêneau brace on coronal and sagittal alignment in adolescent idiopathic scoliosis

2015 ◽  
Vol 23 (4) ◽  
pp. 505-509 ◽  
Author(s):  
Ming-Qiao Fang ◽  
Chong Wang ◽  
Guang-Heng Xiang ◽  
Chao Lou ◽  
Nai-Feng Tian ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Long Term Effects ◽  
Sagittal Vertical Axis ◽  
Pelvic Parameters

OBJECT The aim of the present study was to retrospectively evaluate progressive correction of coronal and sagittal alignment and pelvic parameters in patients treated with a Chêneau brace. METHODS Thirty-two patients with adolescent idiopathic scoliosis (AIS) were assessed before initiation of bracing treatment and at the final follow-up. Each patient underwent radiological examinations, and coronal, sagittal, and pelvic parameters were measured. RESULTS No statistically significant modification of the Cobb angle was noted. The pelvic incidence remained unchanged in 59% of the cases and increased in 28% of the cases. The sacral slope decreased in 34% of the cases but remained unchanged in 50%. Thoracic kyphosis and lumbar lordosis were significantly decreased, whereas the sagittal vertical axis was significantly increased from a mean of -44.0 to -30.2 mm (p = 0.02). The mean pelvic tilt increased significantly from 4.5° to 8.3° (p = 0.002). CONCLUSIONS The Chêneau brace can be useful for preventing curvature progression in patients with AIS. However, the results of this study reveal high variability in the effect of brace treatment on sagittal and pelvic alignment. Treatment with the Chêneau brace may also influence sagittal global balance.

scholarly journals Sagittal alignment based on inflection point and its differences according to age groups

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902090461
Author(s):  
Moon Soo Park ◽  
Seong-Hwan Moon ◽  
Tae-Hwan Kim ◽  
Jae Keun Oh ◽  
Seung Jin Lee ◽  
...  
Keyword(s):  
Pelvic Incidence ◽  
Sagittal Plane ◽  
Sagittal Alignment ◽  
Age Groups ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Inflection Points ◽  
Lumbar Segment ◽  
Cervical Segment

Purpose: We have always used the standard anatomical landmark vertebrae to measure the sagittal alignment. Instead, scoliosis has been evaluated by the end vertebrae in the coronal plane. There have been clinical studies to investigate sagittal alignment on the end vertebrae of inflection points (IPs). The purpose is to determine sagittal alignment based on IPs and to elucidate the changes while considering age groups. Methods: We identified the most titled vertebrae in the sagittal plane to define the end vertebrae of S1, thoracolumbar and cervicothoracic IPs and to measure the Cobb angles of sacral slope, functional lumbar, thoracic, cervical segment between them, and the McGregor’s line, and the IP distances from the C2 plumb line to the point bisecting the upper end plate of the IPs, in addition to S1. Results: The most common thoracolumbar and cervicothoracic IPs were L2 and T1, respectively. However, the next most common cervicothoracic IP changed from T2 in the youngest to C7 in the oldest age group. The sagittal angles decreased at the sacral slope and functional lumbar segment but not the functional thoracic segment and functional cervical segment. Similarly, the distance increased at the C2 sagittal vertical axis (SVA) distance to S1 and thoracolumbar IP distance but not at the cervicothoracic IP distance. There was no difference in the pelvic incidence among age groups. Conclusion: The sagittal Cobb angles based on the IPs decreased at the sacral slope and functional lumbar segment in the older adults. Consequently, the C2 SVA distance to S1 and thoracolumbar IP distance increased.

The Effect of Lumbar Spinal Muscle on Spinal Sagittal Alignment

Neurosurgery ◽  
2016 ◽  
Vol 79 (6) ◽  
pp. 847-855 ◽  
Author(s):  
Hyo Sub Jun ◽  
Ji Hee Kim ◽  
Jun Hyong Ahn ◽  
In Bok Chang ◽  
Joon Ho Song ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Elderly Patients ◽  
Thoracic Kyphosis ◽  
Pelvic Tilt ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Magnetic Resonance Images ◽  
Paraspinal Muscle ◽  
Sagittal Vertical Axis ◽  
Spinal Sagittal Alignment

Abstract BACKGROUND: The majority of earlier studies of the parameters of sagittal balance did not consider the influence of spinal muscles on spinal sagittal alignment. OBJECTIVE: To analyze the relationship between the paraspinal muscle (quantity and quality) and sagittal alignment in elderly patients. METHODS: We reviewed 50 full-spine lateral standing radiographs and lumbar magnetic resonance images of elderly patients at a single center. The radiographic parameters examined were thoracic kyphosis, lumbar lordosis (LL), sagittal vertical axis, pelvic tilt, sacral slope, and pelvic incidence (PI). The lumbar muscularity (LM; quantity) and fatty degeneration ratio (FD; quality) in the paraspinal muscle were measured at the L3 level on magnetic resonance images. The relationships between the parameters, LM, and FD were analyzed with the Pearson correlation coefficient and multiple linear regression. RESULTS: Pearson analysis demonstrated that the FD had significant correlations with age (r = 0.393), thoracic kyphosis (r = −0.559), pelvic tilt (r = 0.430), sagittal vertical axis (r = 0.488), and PI − LL (r = 0.479, P &lt; .05), and a close negative correlation was found between the FD and LL (r = −0.505, P &lt; .01). The LM had significant correlations with the LL (r = 0.342) and PI − LL (r = −0.283, P &lt; .05). Regression models that controlled for confounding factors such as body mass index confirmed the correlations between the above parameters and FD (P &lt; .05). CONCLUSION: The quality of the paraspinal muscle could be one of the various factors that influence sagittal balance.

scholarly journals Improvement in cervical lordosis and sagittal alignment after vertebral body sliding osteotomy in patients with cervical spondylotic myelopathy and kyphosis

2020 ◽  
Vol 33 (3) ◽  
pp. 307-315 ◽  
Author(s):  
Dong-Ho Lee ◽  
Choon Sung Lee ◽  
Chang Ju Hwang ◽  
Jae Hwan Cho ◽  
Jae-Woo Park ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Cervical Spondylotic Myelopathy ◽  
Sagittal Alignment ◽  
Japanese Orthopaedic Association ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
Segmental Lordosis

OBJECTIVEVertebral body sliding osteotomy (VBSO) is a safe, novel technique for anterior decompression in patients with multilevel cervical spondylotic myelopathy. Another advantage of VBSO may be the restoration of cervical lordosis through multilevel anterior cervical discectomy and fusion (ACDF) above and below the osteotomy level. This study aimed to evaluate the improvement and maintenance of cervical lordosis and sagittal alignment after VBSO.METHODSA total of 65 patients were included; 34 patients had undergone VBSO, and 31 had undergone anterior cervical corpectomy and fusion (ACCF). Preoperative, postoperative, and final follow-up radiographs were used to evaluate the improvements in cervical lordosis and sagittal alignment after VBSO. C0–2 lordosis, C2–7 lordosis, segmental lordosis, C2–7 sagittal vertical axis (SVA), T1 slope, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and Japanese Orthopaedic Association scores were measured. Subgroup analysis was performed between 15 patients with 1-level VBSO and 19 patients with 2-level VBSO. Patients with 1-level VBSO were compared to patients who had undergone 1-level ACCF.RESULTSC0–2 lordosis (41.3° ± 7.1°), C2–7 lordosis (7.1° ± 12.8°), segmental lordosis (3.1° ± 9.2°), and C2–7 SVA (21.5 ± 11.7 mm) showed significant improvements at the final follow-up (39.3° ± 7.2°, 13° ± 9.9°, 15.2° ± 8.5°, and 18.4 ± 7.9 mm, respectively) after VBSO (p = 0.049, p < 0.001, p < 0.001, and p = 0.038, respectively). The postoperative segmental lordosis was significantly larger in 2-level VBSO (18.8° ± 11.6°) than 1-level VBSO (10.3° ± 5.5°, p = 0.014). The final segmental lordosis was larger in the 1-level VBSO (12.5° ± 6.2°) than the 1-level ACCF (7.2° ± 7.6°, p = 0.023). Segmental lordosis increased postoperatively (p < 0.001) and was maintained until the final follow-up (p = 0.062) after VBSO. However, the postoperatively improved segmental lordosis (p < 0.001) decreased at the final follow-up (p = 0.045) after ACCF.CONCLUSIONSNot only C2–7 lordosis and segmental lordosis, but also C0–2 lordosis and C2–7 SVA improved at the final follow-up after VBSO. VBSO improves segmental cervical lordosis markedly through multiple ACDFs above and below the VBSO level, and a preserved vertebral body may provide more structural support.

scholarly journals Effect of lumbar laminectomy on spinal sagittal alignment: a systematic review

2021 ◽  
Author(s):  
Juho Hatakka ◽  
Katri Pernaa ◽  
Juho Rantakokko ◽  
Inari Laaksonen ◽  
Mikhail Saltychev
Keyword(s):  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
Sagittal Alignment ◽  
Surgical Techniques ◽  
Vertical Axis ◽  
Effect Sizes ◽  
Decompressive Surgery ◽  
Systematic Bias ◽  
Sagittal Vertical Axis ◽  
Spinal Sagittal Alignment

Abstract Purpose Positive spinal sagittal alignment is known to correlate with pain and disability. The association between lumbar spinal stenosis and spinal sagittal alignment is less known, as is the effect of lumbar decompressive surgery on the change in that alignment. The objective was to study the evidence on the effect of lumbar decompressive surgery on sagittal spinopelvic alignment. Methods The Cochrane Controlled Trials Register (CENTRAL), Medline, Embase, Scopus and Web of Science databases were searched in October 2019, unrestricted by date of publication. The study selection was performed by two independent reviewers. The risk of systematic bias was assessed according to the NIH Quality Assessment Tool. The data were extracted using a pre-defined standardized form. Results The search resulted in 807 records. Of these, 18 were considered relevant for the qualitative analysis and 15 for the meta-synthesis. The sample size varied from 21 to 89 and the average age was around 70 years. Decompression was mostly performed on one or two levels and the surgical techniques varied widely. The pooled effect sizes were most statistically significant but small. For lumbar lordosis, the effect size was 3.0 (95% CI 2.2 to 3.7) degrees. Respectively, for pelvic tilt and sagittal vertical axis, the effect sizes were − 1.6 (95% CI .2.6 to − 0.5) degrees and − 9.6 (95% CI − 16.0 to − 3.3) mm. Conclusions It appears that decompression may have a small, statistically significant but probably clinically insignificant effect on lumbar lordosis, sagittal vertical axis and pelvic tilt.

scholarly journals Analysis of global spine sagittal parameters in cervical spondylotic patients and asymptomatic subjects

2020 ◽  
Author(s):  
Liang Zhu ◽  
Xiaojun Ma ◽  
Qiang Shen ◽  
Bao Sun ◽  
Qiang Fu
Keyword(s):  
Cervical Spondylosis ◽  
Lumbar Lordosis ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Normal Group ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Thoracic Inlet ◽  
Global Sagittal Alignment ◽  
Sagittal Parameters

Abstract Background: Degenerative changes associated with cervical spondylotic can result in a change of normal sagittal alignment, and this may be the initial change of kyphosis and sagittal imbalance. Few studies have analyzed the correlations between the cervical spine lordosis and global spine balance in patients with cervical spondylotic. This study is applied to investigate the characteristics and relationships of cervical and global sagittal parameters in normal adults and cervical spondylotic patients. Methods: We reviewed 46 asymptomatic control subjects (normal group, NG) and 48 cervical spondylotic patients (cervical spondylotic group, CSG), who had both cervical MRI and global radiographs obtained together, between January 2016 and September 2018. Data includes C1-2 angle, C2–7 lordosis (CL), T1 slope (T1S), thoracic inlet angle (TIA), C2–7 sagittal vertical axis (CSVA), sagittal vertical axis(SVA), thoracic-kyphosis(TK), thoracic-lumbar lordosis(TL), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The values were presented as the mean ± standard deviation. Student t-test and Pearson’s correlation coefficient were used for statistical analysis. Probability values less than 0.05 were considered statistically significant. Results: 1.Comparison of global sagittal parameters between the normal group and cervical spondylosis group. A total of 48 cervical spondylotic patients with an average age of 57.91±9.58 and 46 healthy people with an average age of 28.00±8.09 were recruited in our study. CL in the NG was significantly lower than CSG (P<0.05), while TK and TL were significantly lower than in the CSG(P< 0.01). However, a comparison of the NG and CSG yielded no significant differences in C1-2, TIA, TIS, LL, PT, PI, SS, CSVA, and SVA. 2.The relationship between cervical and global sagittal alignment. CL positively correlated with T1S (r=0.433) and TK (r=0.335) while negatively correlated with CSVA (r=-0.309) in cervical spondylosis group. TIA has positively correlated with T1S (r=0.376 in NG and r=0.416 in CSG) and no correlated with other parameters in both groups. Conclusions Cervical spondylosis causes changes in sagittal parameters of the cervical and thoracic spine but does not affect on lumbar and pelvic parameters. TIA is a relative constant parameter, not affected by cervical spondylotic.

scholarly journals The Pelvic Incidence Stratified Sagittal Spinopelvic Alignment in Asymptomatic Chinese Population With Different Age Groups

2021 ◽  
pp. 219256822198964
Author(s):  
Siyu Zhou ◽  
Zhuoran Sun ◽  
Wei Li ◽  
Da Zou ◽  
Weishi Li
Keyword(s):  
Chinese Population ◽  
Pelvic Incidence ◽  
Sagittal Alignment ◽  
Age Groups ◽  
Vertical Axis ◽  
Elderly Subjects ◽  
Sagittal Vertical Axis ◽  
Cross Sectional ◽  
Sagittal Parameters ◽  
Very High

Study Design: Cross-sectional study. Objective: To provide the age- and pelvic incidence-related variations of sagittal alignment in asymptomatic Chinese population. Methods: This study recruited asymptomatic adult subjects. All subjects undertook the standing whole spinal radiograph and the sagittal parameters were measured: sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI) and pelvic tilt (PT). All subjects were divided into young, middle aged and elderly groups, then each age group was further divided into 5 subgroups (very low, low, average, high and very high) based on PI values. The relations between PI, age and other parameters were evaluated. The differences in sagittal parameters of each PI subgroup were compared. Results: 546 subjects were included with an average age of 38.6 years (18 to 81). The number of subjects over 70 years and with very low PI was relatively small. The average of PI, TPA, PT and LL were 45.9° ± 8.4°, 6.4° ± 6.2°, 11.9° ± 6.6° and 49.2° ± 10.1°, respectively. SVA, TPA, TK and PT increased with age ( P < 0.05), while SVA, TPA, PT, PI-LL also increased with PI ( P < 0.05). LL, PT, TPA, PI-LL and LL-TK were different among the 5 PI subgroups ( P < 0.05). However, the values of LL in elderly subjects with high and very high PI were similar. Conclusion: The age- and PI-related variations in sagittal alignment of Chinese population were provided. The sagittal parameters were significantly influenced by age and PI. The individual pelvic morphology should be carefully considered during the assessment and restoration of sagittal balance.

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