Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY.
Department of Orthopaedic Surgery, Washington University, St. Louis, MO.
Spine (Phila Pa 1976). 2022 Oct 1;47(19):1382-1390. doi: 10.1097/BRS.0000000000004415. Epub 2022 Jun 29.
Spinal alignment can have a significant impact on a patient's overall quality of life. Predicting the ideal sagittal spinal alignment of a specific individual is still a difficult task. The Multi-Ethnic Alignment Normative Study (MEANS) investigated skeletal alignment, including the spine and lower extremities, of the largest multi-ethnic cohort of asymptomatic adult volunteers. In this analysis, the authors aim to assess normative values of spinopelvic parameters and the regional cervical, thoracic, and lumbar spinal alignment in asymptomatic volunteers stratified by age and sex.
Asymptomatic volunteers between ages 18 and 80 years were enrolled prospectively from centers in France, Japan, Singapore, Tunisia, and the United States. Volunteers included reported no significant neck or back pain (Visual Analog Scale ≤2), nor any known spinal disorder(s). All volunteers underwent a standing full-body or full-spine low-dose stereoradiograph.
MEANS consisted of 468 volunteers with a mean age of 40.4±14.8 years. Mean cervical lordosis from C2 to C7 was -0.4±12.7°. The T1-slope averaged 23.0±7.9° and showed strong correlation ( r =0.87) with the C7-slope mean of 19.8±8.6°. Thoracic kyphosis (TK) from T4 to T12 showed a mean of 37.4±10.9°. Average L1-S1 lumbar lordosis (LL) was -57.4±11.3°. The mean pelvic incidence (PI) measured 52.0±10.7° and pelvic tilt was 12.5±7.3°. Sacral slope averaged 39.5±8.2°. The average PI-LL was -5.4±10.7°. Approximately 60% of volunteers met the PI-LL criteria within ±10°, 8.3% were ≥10°, while 32.1% were ≤-10°. LL showed moderate correlation with PI ( r =0.53) and TK ( r =0.50), while there was no correlation between TK and PI. Multiple linear regression including PI, TK, and age resulted in the following equation LL=14.6+0.57 (PI)+0.57 (TK)-0.2 (age) ( r =0.75).
LL did not change with increasing age in asymptomatic volunteers. However, TK did increase with age leading to an increase in T1-slope and a compensatory increase in cervical lordosis. TK did not correlate with PI and was an independent variable in the prediction of LL.
Level II-prospective cohort study.
脊柱对线可能对患者的整体生活质量产生重大影响。预测特定个体的理想矢状位脊柱对线仍然是一项艰巨的任务。多民族脊柱对线研究（MEANS）调查了最大的多民族无症状成年志愿者队列的骨骼对线，包括脊柱和下肢。在这项分析中，作者旨在评估无症状志愿者的脊柱骨盆参数的正常值，并按年龄和性别分层评估颈椎、胸椎和腰椎的区域性脊柱对线。
从法国、日本、新加坡、突尼斯和美国的中心前瞻性招募了年龄在 18 至 80 岁之间的无症状志愿者。志愿者报告没有明显的颈部或背部疼痛（视觉模拟量表≤2），也没有任何已知的脊柱疾病。所有志愿者均接受站立位全身体或全脊柱低剂量立体摄影检查。
MEANS 由 468 名平均年龄为 40.4±14.8 岁的无症状志愿者组成。C2 至 C7 的颈椎前凸平均值为-0.4±12.7°。T1 斜率平均为 23.0±7.9°，与 19.8±8.6°的 C7 斜率平均值呈强相关性（ r =0.87）。T4 至 T12 的胸椎后凸（TK）平均为 37.4±10.9°。L1-S1 腰椎前凸（LL）的平均为-57.4±11.3°。测量的骨盆入射角（PI）平均值为 52.0±10.7°，骨盆倾斜度为 12.5±7.3°。骶骨斜率平均为 39.5±8.2°。PI-LL 的平均为-5.4±10.7°。大约 60%的志愿者符合 PI-LL 标准，即±10°，8.3%的志愿者为≥10°，而 32.1%的志愿者为≤-10°。LL 与 PI（ r =0.53）和 TK（ r =0.50）呈中度相关，而 TK 与 PI 之间无相关性。包括 PI、TK 和年龄的多元线性回归得出以下方程：LL=14.6+0.57（PI）+0.57（TK）-0.2（年龄）（ r =0.75）。
在无症状志愿者中，LL 不会随年龄增长而变化。然而，TK 确实随年龄增长而增加，导致 T1 斜率增加和颈椎前凸增加。TK 与 PI 不相关，是 LL 的独立预测变量。
Ⅱ级-前瞻性队列研究。
