Background: 

In the past decades, it has been recognized that sagittal alignment of the spine is crucial. Although the evolution of spinal alignment with growth has previously been described, there are no data for key parameters such as the exact shapes (extent and magnitude) of spinal curvatures. The goals of this study were therefore to determine normative values of spinopelvic sagittal parameters and to explore their variation during growth, based on the analysis of a large national cohort of healthy children.

Methods: 

The radiographic data of 1,059 healthy children were analyzed in a retrospective, multicenter study. Full spine radiographs were used to measure several sagittal parameters, such as pelvic parameters, T1-T12 thoracic kyphosis (TK), and L1-S1 lumbar lordosis (LL). TK was divided into proximal, middle, and distal parts, and LL was divided into proximal and distal parts. Patients were stratified into 5 groups according to skeletal maturity (based on age, Risser stage, and triradiate cartilage status).

Results: 

During growth, pelvic incidence increased from 40° to 46° and pelvic tilt increased from 4° to 9° (p < 0.05), whereas sacral slope remained constant. The peak of change in pelvic parameters occurred at the beginning of pubertal growth in Group 2 (the first part of the pubertal growth spurt). TK slightly increased among groups from 39° to 41° (p = 0.005), with the peak of change occurring in Group 4 (pubertal growth deceleration). LL increased from 51° to 56° (p < 0.001), with the peak of change occurring in Group 3 (the second part of the pubertal growth spurt). Segmental analysis revealed that most of the TK and LL changes occurred in the distal TK and proximal LL, with the other parts remaining constant.

Conclusions: 

This is one of the largest studies showing changes in sagittal alignment with growth in normal children and adolescents. We found that changes in spinal shape were cascading phenomena. At the beginning of the growth peak, pelvic incidence increased. This change in pelvic morphology led to an increase in LL, involving its proximal part. Finally, TK increased, in its distal part, at the end of pubertal growth.

Level of Evidence: 

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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儿童期脊柱矢状位变化：1,059 名健康儿童的全国队列分析结果

背景： 

在过去的几十年中，人们已经认识到脊柱的矢状对齐是至关重要的。尽管之前已经描述了脊柱排列与生长的演变，但没有关键参数的数据，例如脊柱弯曲的确切形状（范围和大小）。因此，本研究的目标是根据对全国大型健康儿童队列的分析，确定脊柱骨盆矢状面参数的标准值，并探索它们在生长过程中的变化。

方法： 

在一项回顾性多中心研究中分析了 1,059 名健康儿童的影像学数据。全脊柱 X 光片用于测量几个矢状面参数，例如骨盆参数、T1-T12 胸椎后凸 (TK) 和 L1-S1 腰椎前凸 (LL)。TK分为近端、中部和远端，LL分为近端和远端。根据骨骼成熟度（基于年龄、Risser 分期和三放射软骨状态）将患者分为 5 组。

结果： 

在生长过程中，骨盆倾斜度从 40° 增加到 46°，骨盆倾斜度从 4° 增加到 9° (p < 0.05)，而骶骨倾斜度保持不变。骨盆参数变化的高峰发生在第 2 组的青春期生长开始时（青春期生长突增的第一部分）。TK 在各组之间从 39° 略微增加到 41° (p = 0.005)，变化的峰值发生在第 4 组（青春期生长减速）。LL 从 51° 增加到 56° (p < 0.001)，变化的峰值出现在第 3 组（青春期生长突增的第二部分）。分段分析显示大部分 TK 和 LL 变化发生在远端 TK 和近端 LL，其他部分保持不变。

结论： 

这是最大型的研究之一，显示了正常儿童和青少年的矢状面排列随生长而变化。我们发现脊柱形状的变化是级联现象。在生长高峰初期，骨盆发病率增加。骨盆形态的这种变化导致 LL 增加，涉及其近端部分。最后，TK 在其远端部分在青春期生长结束时增加。

证据等级： 

预后等级 IV。有关证据等级的完整描述，请参阅作者须知。