Gravity Line and Spino-Pelvic Parameters: Age Related Changes Among Asymptomatic Adult Volunteers

Introduction: Although work by several authors has placed emphasis on global balance in the setting of spinal deformity, the relationship of spino-pelvic parameters related to this concept remains poorly defined. Using the force plate device and radiographic measurement, this study aimed to define the relationship between these parameters and the location of the gravity line (GL) in asymptomatic adult population.

Materials and Methods: 75 asymptomatic adult volunteers were recruited and subdivided by age (18-40, 41-60, >61). Full-length free-standing AP and lateral radiographs were obtained with simultaneous assessment of the force plate gravity line (GL) location. The latter was projected on each x-ray to compute distance between anatomical components and GL and correlate its location with radiological parameters. Age related changes were investigated using ANOVA with Bonferroni-Dunn Post-Hoc test.

Results: Radiographic measurements revealed strong correlations between trunk global inclination and distance from S1 to the GL (r=0.7), sacral slope and pelvic incidence (r=0.78), distance from the bi-femoral head axis to the GL and S1 to the GL (r=0.73), and sacral slope and lordosis (r=0.89). With advancing age, the GL location with respect to the heels does not change and a global spino-pelvic regulatory mechanism appears to maintain this posture: trunk global inclination shifts forward, pelvic tilt increases, and the pelvis shifts toward the heels, increasing its distance from the GL.

Discussion: This study demonstrates the importance of pelvic parameters and trunk inclination in the regulation of the GL location. The relationship between the gravity line, pelvic parameters, and overall spinal alignment may emerge as essential in the evaluation of spinal deformity. Further investigation in this field may lead to a formula of balance that can assist in optimal planning of corrective procedures for spinal deformity.