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Segmental patterns of sagittal spinal curvatures in children screened for scoliosis: Kyphotic angulation at the thoracolumbar region and the mortice joint
Author(s) -
Kiel A. W.,
Burwell R. G.,
Moulton A.,
Purdue M.,
Webb J. K.,
Wojcik A. S.
Publication year - 1992
Publication title -
clinical anatomy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.667
H-Index - 71
eISSN - 1098-2353
pISSN - 0897-3806
DOI - 10.1002/ca.980050503
Subject(s) - sagittal plane , medicine , pelvic tilt , cobb angle , scoliosis , lumbar , radiography , orthodontics , tilt (camera) , spinal curvatures , anatomy , geometry , surgery , mathematics
Abstract This paper reports a segmental analysis of the lateral spinal radiographs of 37 children referred to hospital in a school screening study of 4,890 school children aged 12–13 years. On each lateral radiograph a line was drawn along the posterior surface of each vertebral body from T5‐L5 and the angle of this line from the vertical was recorded. After measuring the scoliosis curve (Cobb) angle and using conventional criteria for diagnosis, three groups of patients are defined, namely, 1) a control group (average scoliosis curve angle (Cobb) of 5°, n = 14), 2) a group with lumbar curves (average Cobb angle 21°, n = 7), and 3) a group with thoracic curves (average Cobb angle 19 degrees, n = 10). Individual lateral spinal profiles are also analyzed. The findings show: (1) In the control group, there are different degrees of vertical backward tilt (declivity) from T7–L3, with a maximum tilt at T12 (mean 26°). The most vertical vertebrae are T6 and L4, with forward tilting (proclivity) at each of (T5 and L5.2) In the lumbar curve group, the segmental sagittal tilt is not significantly different from that in the control group. The mean declivity at T12 is 25°. (3) In the thoracic curve group, the segmental sagittal tilt is significantly less than that in the control group at each of T10–L1. The mean declivity at T12 is 17°. A more vertical T12 is associated with a larger Cobb angle. (4) The individual sagittal spinal profiles of the thoracic curve group (but no other group) show lordosis in the region of the lateral spinal curve (scoliosis) and a kyphotic angulation at an average of three vertebrae below the apical vertebrae of the scoliosis curve. (5) It is suggested that as a thoracic lordoscoliosis develops, the appearance of a kyphotic angulation in the thoracolumbar and upper lumbar spine is determined by the compressibility of each disc in relation to the length of the articular processes at the corresponding level. Where the combination of disc weakness to facet length is most adverse, forward flexion occurs, as in a spinal fracture, to produce the kyphotic angulation. © 1992 Wiley‐Liss, Inc.