Analysis of sagittal spinal alignment in 181 asymptomatic children

STUDY DESIGN:: A cross-sectional study. OBJECTIVES:: To determine the "normal" radiographic parameters of the sagittal profile of the spine in asymptomatic children. SUMMARY OF BACKGROUND DATA:: There was consensus that cervical kyphosis is pathologic, but we suspected that the cervical kyphosis or loss of cervical lordosis is abnormal in asymptomatic children and adolescents. And we measured the pediatric sagittal profiles including the cervical lordosis for asymptomatic subjects. MATERIALS AND METHODS:: Analysis of 181 children without spinal pathology was performed. Radiographic measurements consisted of the following: cervical lordosis; thoracic kyphosis; thoracolumbar sagittal angle; thoracic apex; lumbar apex; lumbar lordosis; sacral inclination; sacral slope; pelvic tilt; and sagittal vertebral axis. RESULTS:: The mean cervical lordosis was -4.8±12.0 degrees (negative=lordotic), sagittal vertebral axis -2.1±2.4 cm, thoracic kyphosis +33.2±9.0 degrees, thoracolumbar sagittal angle 5.6±8.4 degrees, lumbar lordosis -48.8±9.0 degrees, sacral inclination 43.9±7.6 degrees, sacral slope 34.9±6.6 degrees, and pelvic tilt 9.4±6.1 degrees. One hundred nine (60.2%) patients had hypolordotic cervical spine (≥-5 degrees). Cervical kyphosis was present in 80 (44.2%) patients. CONCLUSIONS:: There is significant variability in sagittal profile of the cervical spine in asymptomatic children. Cervical kyphosis was found in approximately 40% of our study cohort.