Sagittal spinal alignment deviation in the general elderly population: a Japanese cohort survey randomly sampled from a basic resident registry

Spine J. 2019 Feb;19(2):349-356. doi: 10.1016/j.spinee.2018.06.346. Epub 2018 Jun 26.


Background context: It is widely recognized that sagittal spinal alignment changes with age. However, there are presently no clear benchmarks for such values or those for the cervical spine in the general population. Quality epidemiological studies are needed to establish standards for spinal alignment deviation.

Objectives: In this study of an aged Japanese population, we employed random sampling from the basic resident registry of a rural town for subject selection to determine reference values of sagittal spinal alignment including the cervical spine.

Study design: Japanese resident cohort study based on a municipal registry.

Patient sample: A total of 413 aged people randomly sampled from the resident registry of a rural Japanese town.

Outcome measures: All subjects underwent a whole spine lateral radiograph for measurement of sagittal spinal alignment parameters.

Methods: Registered citizens of 50 to 89 years old were targeted for this survey. We established eight groups based on age (50s, 60s, 70s, and 80s) and gender (male and female) after random sampling from the resident registry of Obuse town in 2014. A total of 413 people (203 males and 210 females) were enrolled. Radiographic parameters of sagittal spinal alignment of the cohort were measured and analyzed. Funding for this study was provided by the Japan Orthopaedics and Traumatology Research Foundation (10,000 USD), the Japanese Orthopaedic Association (5,000 USD), the Japanese Society for Musculoskeletal Medicine (40,000 USD), and the Nakatomi Foundation (15,000 USD).

Results: Global spinal alignments became more misaligned with age for both genders. Sagittal vertical axis (SVA) forward shift was significantly more frequent in 80s males and 70s females, and SVA in 80s females was a mean of 66 mm forward of that of 50s females. Cervical protrusion was markedly greater in 60s males onwards. In women, lumbar lordosis and posterior pelvic inclination were noticeable from a younger age than in men. The amount of pelvic tilt misalignment in female subjects was approximately 10 years earlier than their male counterparts.

Conclusions: This first resident cohort of Japanese individuals determined average spinal alignment parameters by age and gender. Spinal balance generally shifts forward as age increases. A forward shift in the upper cervical spine occurs first in men, whereas lumbopelvic alignment shift occurs first in women.

Keywords: Adult spine; Age; Epidemiological study; Gender; Normative value; Resident cohort; Spinal alignment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Humans
  • Japan
  • Lordosis / diagnostic imaging
  • Lordosis / epidemiology*
  • Male
  • Radiography
  • Registries / statistics & numerical data*
  • Sex Factors
  • Spine / diagnostic imaging*
  • Spine / growth & development