Spinal Sagittal Alignment Changes During Childhood

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Abstract
Background: In the past decades, it has been recognized that sagittal alignment of the spine is crucial. Although the evolution of spinal alignment with growth has previously been described, there are no data for key parameters such as the exact shapes (extent and magnitude) of spinal curvatures. The goals of this study were therefore to determine normative values of spinopelvic sagittal parameters and to explore their variation during growth, based on the analysis of a large national cohort of healthy children. Methods: The radiographic data of 1,059 healthy children were analyzed in a retrospective, multicenter study. Full spine radiographs were used to measure several sagittal parameters, such as pelvic parameters, T1-T12 thoracic kyphosis (TK), and L1-S1 lumbar lordosis (LL). TK was divided into proximal, middle, and distal parts, and LL was divided into proximal and distal parts. Patients were stratified into 5 groups according to skeletal maturity (based on age, Risser stage, and triradiate cartilage status). Results: During growth, pelvic incidence increased from 40° to 46° and pelvic tilt increased from 4° to 9° (p < 0.05), whereas sacral slope remained constant. The peak of change in pelvic parameters occurred at the beginning of pubertal growth in Group 2 (the first part of the pubertal growth spurt). TK slightly increased among groups from 39° to 41° (p = 0.005), with the peak of change occurring in Group 4 (pubertal growth deceleration). LL increased from 51° to 56° (p < 0.001), with the peak of change occurring in Group 3 (the second part of the pubertal growth spurt). Segmental analysis revealed that most of the TK and LL changes occurred in the distal TK and proximal LL, with the other parts remaining constant. Conclusions: This is one of the largest studies showing changes in sagittal alignment with growth in normal children and adolescents. We found that changes in spinal shape were cascading phenomena. At the beginning of the growth peak, pelvic incidence increased. This change in pelvic morphology led to an increase in LL, involving its proximal part. Finally, TK increased, in its distal part, at the end of pubertal growth. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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