Sagittal spinal alignment deviation in the general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry

Publication date: Available online 26 June 2018
Source:The Spine Journal
Author(s): Masashi Uehara, Jun Takahashi, Shota Ikegami, Ryosuke Tokida, Hikaru Nishimura, Noriko Sakai, Hiroyuki Kato
Background contextIt is widely recognized that sagittal spinal alignment changes with age. However, there are presently no clear benchmarks for such values or those for the cervical spine in the general population. Quality epidemiological studies are needed to establish standards for spinal alignment deviation.ObjectivesIn this study of an aged Japanese population, we employed random sampling from the basic resident registry of a rural town for subject selection to determine reference values of sagittal spinal alignment including the cervical spine.Study designJapanese resident cohort study based on a municipal registry.Patient sampleA total of 413 aged people randomly sampled from the resident registry of a rural Japanese town.Outcome measuresAll subjects underwent a whole spine lateral radiograph for measurement of sagittal spinal alignment parameters.MethodsRegistered citizens of 50 to 89 years old were targeted for this survey. We established 8 groups based on age (50′s, 60′s, 70′s, and 80′s) and gender (male and female) after random sampling from the resident registry of Obuse town in 2014. A total of 413 people (203 males and 210 females) were enrolled. Radiographic parameters of sagittal spinal alignment of the cohort were measured and analyzed. Funding for this study was provided by the Japan Orthopaedics and Traumatology Research Foundation (10,000 USD), the Japanese Orthopaedic Association (5,000 USD), the Japanese Society for Musculoskeletal Medicine (40,000 USD), and the Nakatomi Foundation (15,000 USD).ResultsGlobal spinal alignments became more misaligned with age for both genders. Sagittal vertical axis (SVA) forward shift was significantly more frequent in 80′s males and 70′s females, and SVA in 80′s females was a mean of 66 mm forward of that of 50′s females. Cervical protrusion was markedly greater in 60′s males onwards. In women, lumbar lordosis and posterior pelvic inclination were noticeable from a younger age than in men. The amount of pelvic tilt misalignment in female subjects was approximately 10 years earlier than their male counterparts.ConclusionsThis first resident cohort of Japanese individuals determined average spinal alignment parameters by age and gender. Spinal balance generally shifts forward as age increases. A forward shift in the upper cervical spine occurs first in men, while lumbopelvic alignment shift occurs first in women.



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