Coronal plane trunk asymmetry is associated with whole-body sagittal alignment in healthy young adolescents before pubertal peak growth

• Published in: European spine journal Vol. 27; no. 2; pp. 448 - 457
• Main Authors: Dolphens, Mieke, Vleeming, Andry, Castelein, René, Vanderstraeten, Guy, Schlösser, Tom, Plasschaert, Frank, Danneels, Lieven
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2018; Springer Nature B.V
• Subjects: Adolescent; Adolescents; Asymmetry; Body Height - physiology; Body length; Body mass index; Child; Cross-Sectional Studies; Female; Handedness; Humans; Kyphosis; Kyphosis - diagnostic imaging; Kyphosis - pathology; Lordosis - diagnostic imaging; Lordosis - pathology; Lumbar Vertebrae - anatomy & histology; Lumbar Vertebrae - diagnostic imaging; Male; Medicine; Medicine & Public Health; Neurosurgery; Original Article; Postural Balance - physiology; Posture; Posture - physiology; Prospective Studies; Radiography; Sacrum; Sacrum - anatomy & histology; Sacrum - diagnostic imaging; Scoliosis; Scoliosis - diagnostic imaging; Scoliosis - pathology; Spine - anatomy & histology; Spine - diagnostic imaging; Surgical Orthopedics; Thorax; Torso - anatomy & histology; Spinal curvatures; Growth and development; Postural balance; Scoliosis; Posture
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-017-5156-x

Purpose To investigate coronal plane trunk asymmetry (TA) and its association with sagittal postural alignment in healthy subjects before pubertal peak growth. Methods In this cross-sectional baseline study, 1190 healthy pre-peak growth velocity subjects were included. Coronal plane TA was evaluated using back surface topography. Whole-body sagittal alignment (previously validated and objectively classified as neutral, sway-back or leaning-forward) and sagittal spinopelvic profile (trunk lean, lumbar lordosis, thoracic kyphosis, sacral inclination and length of the posteriorly inclined thoracolumbar segment) were determined, as were height, proportion of trunk to body length, body mass index, generalized joint laxity, and handedness. Results Logistic regression analysis yielded overall sagittal posture class to be independently associated with coronal plane TA: having a leaning-forward posture associated with a nearly three times higher odds of coronal TA ( p  < 0.001) compared to neutrals. A sway-back was 2.2 times more likely to show TA ( p  = 0.016) than a neutral, yet only in boys. Significant associations with coronal TA were also found for trunk lean, thoracic kyphosis and body mass index. These correlations, however, were gender and posture class specific. The spinal region where asymmetry is seen, varies according to the whole-body sagittal alignment type: primary thoracic curves were the most frequent in leaning-forwards, whereas primary curves in the lumbar or declive thoracolumbar segment were the most common in sway-backs. Conclusions In immature spines without known scoliosis, coronal plane TA is associated with whole-body sagittal alignment. It is more often seen in non-neutral than neutral sagittal posture types. Whether adolescent idiopathic scoliosis is related with postural characteristics before pubertal growth peak, should be addressed in future prospective studies.