• Eur Spine J · Mar 2018

    Normal variation in sagittal spinal alignment parameters in adult patients: an EOS study using serial imaging.

    • Hey Hwee Weng Dennis HWD 0000-0003-1506-8553 University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, , Kian Loong Melvin Tan, Vikaesh Moorthy, Eugene Tze-Chun Lau, Leok-Lim Lau, Gabriel Liu, and Hee-Kit Wong.
    • University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore. dennis_hey@nuhs.edu.sg.
    • Eur Spine J. 2018 Mar 1; 27 (3): 578-584.

    PurposeTo describe normal variations in sagittal spinal radiographic parameters over an interval period and establish physiological norms and guidelines for which these images should be interpreted.MethodsData were prospectively collected from a continuous series of adult patients with first-episode mild low back pain presenting to a single institution. The sagittal parameters of two serial radiographic images taken 6-months apart were obtained with the EOS® slot scanner. Measured parameters include CL, TK, TL, LL, PI, PT, SS, and end and apical vertebrae. Chi-squared test and Wilcoxon Signed Rank test were used to compare categorical and continuous variables, respectively.ResultsSixty patients with a total of 120 whole-body sagittal X-rays were analysed. Mean age was 52.1 years (SD 21.2). Mean interval between the first and second X-rays was 126.2 days (SD 47.2). Small variations (< 1°) occur for all except PT (1.2°), CL (1.2°), and SVA (2.9 cm). Pelvic tilt showed significant difference between two images (p = 0.035). Subgroup analysis based on the time interval between X-rays, and between the first and second X-rays, did not show significant differences. Consistent findings were found for end and apical vertebrae of the thoracic and lumbar spine between the first and second X-rays for sagittal curve shapes.ConclusionsRadiographic sagittal parameters vary between serial images and reflect dynamism in spinal balancing. SVA and PT are predisposed to the widest variation. SVA has the largest variation between individuals of low pelvic tilt. Therefore, interpretation of these parameters should be patient specific and relies on trends rather than a one-time assessment.

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