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Sex-dependent evolution of whole-body postural alignment with age

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Abstract

Purpose

The goal of this study was to explore sex-related variations of global alignment parameters and their distinct evolution patterns across age groups.

Methods

This multicentric retrospective study included healthy volunteers with full-body biplanar radiographs in free-standing position. All radiographic data were collected from 3D reconstructions: global and lower limb parameters, pelvic incidence (PI) and sacral slope (SS). Lumbar lordosis (LL), thoracic kyphosis (TK) and cervical lordosis (CL) were also assessed as well as the lumbar and thoracic apex, and thoracolumbar inflexion point. The population was divided into five 5 age groups: Children, Adolescents, Young, Middle-Aged and Seniors.

Results

This study included 861 subjects (53% females) with a mean age of 34 ± 17 years. Mean PI was 49.6 ± 11.1 and mean LL was − 57.1 ± 11.6°. Females demonstrated a PI increase between Young and Middle-Aged groups (49 ± 11° vs. 55 ± 12°, p < 0.001) while it remained stable in males. SS and LL increased with age in females while remaining constant in males between Children and Middle-aged and then significantly decreased for both sexes between Middle-Aged and Seniors. On average, lumbar apex, inflexion point, and thoracic apex were located one vertebra higher in females (p < 0.001). After skeletal maturity, males had greater TK than females (64 ± 11° vs. 60 ± 12°, p = 0.04), with significantly larger CL (-13 ± 10° vs. -8 ± 10°, p = 0.03). All global spinal parameters indicated more anterior alignment in males.

Conclusion

Males present more anteriorly tilted spine with age mainly explained by a PI increase in females between Young and Middle-Aged, which may be attributed to childbirth. Consequently, SS and LL increased before decreasing at senior age.

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Acknowledgements

The authors thank the SOFCOT (French Society for orthopedic surgery) for the research grant allocated to Marc Khalifé.

Author information

Authors and Affiliations

  1. Orthopaedic Surgery Department, Spine Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris, 75015, France

    Marc Khalifé, Pierre Guigui & Emmanuelle Ferrero

  2. Université Paris-Cité, Paris, France

    Marc Khalifé, Pierre Guigui & Emmanuelle Ferrero

  3. Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, Paris, 75013, France

    Marc Khalifé, Wafa Skalli, Valérie Attali, Rémi Valentin & Claudio Vergari

  4. Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon

    Ayman Assi

  5. INSERM. UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France

    Valérie Attali & Rémi Valentin

  6. Service des Pathologies du Sommeil (Département “R3S”), Hôpitaux Universitaires Pitié Salpêtrière – Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France

    Valérie Attali & Rémi Valentin

  7. Orthopaedic Surgery Department, Spine Unit, Pellegrin University Hospital, pl. Amélie Raba Léon, Bordeaux, 33000, France

    Olivier Gille

  8. Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York City, NY, USA

    Virginie Lafage

  9. Department of orthopaedics, Hospital for Special Surgery, New York City, NY, USA

    Han-Jo Kim

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  1. Marc Khalifé
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  2. Wafa Skalli
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Correspondence to Marc Khalifé.

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Khalifé, M., Skalli, W., Assi, A. et al. Sex-dependent evolution of whole-body postural alignment with age. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08323-5

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