Qiu Weipeng, Sun Zhuoran, Zhou Siyu, Chen Zimu, Han Gengyu, Zou Da, Zhao Yi, Chen Ze, Qi Qiang, Li Weishi
Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
Spine (Phila Pa 1976). 2025 Jul 1;50(13):916-923. doi: 10.1097/BRS.0000000000005189. Epub 2024 Oct 15.
A cross-sectional cohort study.
To present a normative value reference of spinal segmental inclination stratified by age and pelvic incidence (PI), and to clarify the impact of segmental inclination on spinal sagittal morphology.
Thoracolumbar segmental inclination has been shown to correlate with the clinical outcomes of adult spinal deformity surgery. However, there currently exists no normative value reference in a large sample of asymptomatic population.
Asymptomatic adult volunteers were enrolled from the community. All volunteers underwent a standing full-spine anteroposterior and lateral radiograph. Lumbar tilt (LT) and thoracic tilt (TT) were measured to quantify the segmental inclination of the lumbar and thoracic spine. Regional curvature, global balance, and thoracolumbar apex were analyzed across different age and PI groups. The correlation between sagittal parameters and age was analyzed using Pearson correlation tests.
A total of 618 volunteers were included with a mean age of 38.7 ± 17.1 years (range 18-82 yr). As age increased, the LT and TT significantly increased ( P <0.001). The LT was significantly correlated with PI (r=0.410, P <0.001), with the low PI group exhibiting a greater negative LT. The TT remained constant across different PI groups. Compared with the young and middle-aged groups, the thoracic apex and lumbar apex were located more caudally in the elderly group ( P <0.001). Subjects with a more caudal lumbar apex exhibited a greater negative LT, and those with a more caudal thoracic apex exhibited a greater positive TT.
The thoracic spine naturally adapts to a relatively neutral position, yet it tends to tilt forward with aging. The physiological lumbar inclination is predominantly determined by the PI value with a slight backward tilt and tends to counteract the anterior truncal inclination with advanced age. Physiological segmental inclination should be considered in spinal surgical planning.
一项横断面队列研究。
给出按年龄和骨盆入射角（PI）分层的脊柱节段倾斜度的正常参考值，并阐明节段倾斜度对脊柱矢状面形态的影响。
胸腰段节段倾斜度已被证明与成人脊柱畸形手术的临床结果相关。然而，目前在大量无症状人群中尚无正常参考值。
从社区招募无症状成年志愿者。所有志愿者均接受站立位全脊柱前后位和侧位X线片检查。测量腰椎倾斜度（LT）和胸椎倾斜度（TT）以量化腰椎和胸椎的节段倾斜度。分析不同年龄和PI组的局部曲度、整体平衡和胸腰段顶点。使用Pearson相关检验分析矢状面参数与年龄之间的相关性。
共纳入618名志愿者，平均年龄为38.7±17.1岁（范围18 - 82岁）。随着年龄增长，LT和TT显著增加（P<0.001）。LT与PI显著相关（r = 0.410，P<0.001），低PI组的LT负值更大。不同PI组的TT保持恒定。与中青年组相比，老年组的胸段顶点和腰段顶点位置更靠下（P<0.001）。腰段顶点位置更靠下的受试者LT负值更大，胸段顶点位置更靠下的受试者TT正值更大。
胸椎自然适应相对中立的位置，但随着年龄增长会趋于前倾。生理性腰椎倾斜度主要由PI值决定，有轻微后倾，且随着年龄增长倾向于抵消躯干前倾。在脊柱手术规划中应考虑生理性节段倾斜度。
