Inter-Rater And Intra-Rater Reliabiliy Of Postural Analysis Software (MATLAB 7.11 R2010b)

Introduction: Posture analysis software Matlab 7.11 R2010b is commonly used as a tool for postural assessment. It is easy to use. Nonetheless, reliability studies are lacking. Methods: The study sample consisted of 25 pictures from 25 subjects, and each subject was assessed (1 day interval) by 3 blinded raters and by 1 blind rater for 3 times. Photographs of subject were coded and two variables (Lumbar lordosis and Pelvic tilt) were analyzed. Inter- and intra-rater reliabilities were calculated using intra-class correlation coefficient. Results: The intra-class correlation coefficient (ICC) was calculated. We found excellent inter-rater reliability and intra-rater reliability of Posture analysis software Matlab7.11 R2010b for both variables. Discussion: Observation posture analysis is easy but it is less reliable method. It cannot be used to measure progression of posture corrections and for research purpose. Photography method is most reliable method to evaluate posture. There are many softwares available for analysis of posture and Matlab 7.11 R2010b is one of them. In this study we found excellent inter-rater reliability and intra-rater reliability of the software. Conclusion: The postural assessment software Matlab 7.11 R2010b is having excellent inter-rater reliability and intra-rater reliability and should be considered as a reliable tool for postural assessment.

Observations on Sagittal Alignment of Lumbo-Sacral Spine in Asymptomatic Adults in Kashmir

Introduction: Sacropelvic parameters in various spine and hipdisorders have been published in various studies. We aimed tostudy the normal sacropelvic parameters and curvatures of thespine and their correlation in asymptomatic Indian adults inrelation to variations in sex and age.Material and Methods: 200 Volunteers were taken fromgeneral population with age ranging from 18-50. Patientwas made to stand and left lateral radiograph exposing C7 toS1 and both the hips with a long 30x90 cm cassette placedat 230 cm from the X-ray tube was performed by a singleradiographer to avoid bias.Results: The average LL, SS, PI, PT, and SVA values wereaverage 55.61±10.68, 38.38±8.33,47.94±10.24,10.16±6.23 and 17.27±9.72 respectively. No statistically significantdifference was observed in statistical values with regardsto sex. Our study showed that PI has significant positivecorrelations with SS, LL and PT, and also affects LL. SS hassignificant positive correlation with LL.Conclusion: The current results could contribute to not onlythe understanding of normal sagittal spinal alignment, but alsoserve as a basis for realignment strategies in young Kashmiriadults.

The Effects of Stretching and Strengthening Exercise on the Pain, Pelvic Tilt, Functional Disability Index, and Balance Ability of Patients with Chronic Lower Back Pain

PURPOSE: This study examined the effects of stretching and strengthening exercises on the pain, pelvic tilt (PT), functional disability, and balance of patients with chronic lower back pain (CLBP). METHODS: A total of 42 patients with CLBP were randomly divided randomly into either experimental group I (EG I, n=21), who received stretching exercise, or experimental group II (EG II, n=21), who received strengthening exercise. Both interventions were applied three times a week for eight weeks. Assessments were made with a visual analogue scale (VAS), PT, Oswestry disability index (ODI), and Berg's balance scale (BBS) before and after the eight weeks intervention period. A paired t-test was conducted to compare the within-group changes before and after the intervention. An independent t-test was used compare the between-group difference. The statistical significance level was set to α=0.05 for all variables. RESULTS: The EG I and II showed significant within-group changes in the VAS, PT, ODI, and BBS (p<0.05). The changes in VAS, PT, ODI, and BBS were similar regardless of the exercise form. CONCLUSION: In this study, the application of stretching and strengthening exercise for subjects who complain of CLBP was effective in changing the level of pain, PT, functional disability, and balance.

The effect of weight bearing alignment training on anterior pelvic tilt in children with cerebral palsy / 中华物理医学与康复杂志

Objective To evaluate the effect of weight-bearing alignment training (WBAT) in correcting anterior pelvic tilt in children with cerebral palsy.Methods Twenty-seven children with cerebral palsy and anterior pelvic tilt were recruited and randonly assigned to a WBAT group,a strengthening group and a standing group,each of 9.In addition to routine medication and rehabilitation training,the 3 groups received WBAT,strengthening training or standing training respectively for 20 minutes a day,5 times a week for 4 weeks.Before and immediately after the treatment,the subjects' anterior superior iliac spine-posterior superior iliac spine angles (ASIS-PSIS angles) were assessed along with their anterior-posterior angles (A-P angles) and distances in a 1-minute walk test.Results The WBAT group showed significant improvement in their average ASIS-PSIS angle (to 18.61 ± 3.13°),A-P angle (to 23.31±3.81°) and the distance in the 1-minute walk test after the treatment.The standing group had significant progress in improving their A-P angles (to 24.48±4.33°),and the strengthening group had significant improvement in the distance walked in the 1-minute walk test.The average improvements in the ASIS-PSIS angle and walk distance in the WBAT group were significantly better than in the other 2 groups.Conclusion WBAT is superior to strengthening and standing training in improving the ASIS-PSIS angle,A-P angle and walking ability of children with cerebral palsy and anterior pelvic tilt.

Spinopelvic Orientation on Radiographs in Various Body Postures: Upright Standing, Chair Sitting, Japanese Style Kneel Sitting, and Korean Style Cross-Legged Sitting

BACKGROUND: Several previous studies reported on the impact of upright standing and chair sitting on the sagittal spinopelvic alignment. However, there are no studies on the impact of the two Asian (Korean and Japanese) style floor-sitting positions on the sagittal spinopelvic alignment. The purpose of this study was to evaluate the impact of four different body postures (standing, chair sitting, kneel sitting, and cross-legged sitting) on the sagittal spinopelvic alignment. METHODS: Sixteen selected healthy volunteers (10 males and six females) were subjects of this pilot study. In all subjects, radiographs were taken in comfortable standing and sitting positions. All spinal curvatures including lumbar lordotic angle (LLA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured on the radiographs. RESULTS: In standing position, the average LLA, SS, PT, and PI were 37.1°, 35.3°, 15.7°, and 51.0°, respectively. In chair sitting, the average LLA, SS, PT, and PI were 17.9°, 20.3°, 28.2°, and 49.5°, respectively. In kneel sitting (Japanese style), the average LLA, SS, PT, and PI were 31.8°, 38.3°, 14.2°, and 52.5°, respectively. In cross-legged sitting (Korean style), the average LLA, SS, PT, and PI were 9.8°, 13.4°, 38.3°, and 51.7°, respectively. LLA in standing (37.1°) and kneel sitting (31.8°) were very similar. Remarkable reduction in LLA was observed in Korean-style cross-legged sitting (9.8°), and LLA in chair sitting (17.9°) was about half of that in standing. SS was similar in standing (35.3°) and kneel sitting (38.3°), and it was reduced remarkably in cross-legged sitting (13.4°). PT was largest in cross-legged sitting (38.3°), and it was similar between standing (15.7°) and kneel sitting (14.2°). PIs were similar in all positions. CONCLUSIONS: The kneel sitting position did not show significant differences with the standing position when assessed using four parameters related to the sagittal spinopelvic alignment, whereas chair sitting and cross-legged sitting positions significantly altered the spinopelvic alignment compared to the standing position.

Relationship Between Pelvic Tilt and Lumbar Disc Degeneration

STUDY DESIGN: Retrospective analysis. OBJECTIVES: To determine the relationship between pelvic tilt and lumbar disc degeneration. SUMMARY OF LITERATURE REVIEW: The shape and the spatial orientation of the pelvis determine the organization of the lumbothoracic spine. The purpose of our study was to determine the relationship between pelvic tilt and lumbar disc degeneration. MATERIALS AND METHODS: Sixty patients over 50 years of age who had undergone lumbar spine magnetic resonance imaging were recruited. In individuals between 41 and 60 years of age, the normal pelvic tilt is 14°. Patients were divided into a low pelvic tilt (PT) group (<14°) and a high pelvic tilt (PT) group (≥14°). Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. We defined grades IV and V as high-grade degeneration and the others as low-grade degeneration. Radiologic parameters and lumbar disc degeneration were compared between these 2 groups. RESULTS: In the low PT group, the average degeneration grade of each lumbar segment was 2.61 in L1-L2, 2.61 in L2-L3, 3.00 in L3-L4, 3.39 in L4-L5, and 3.84 in L5-S1. The corresponding grades in the high PT group were 2.34 in L1-L2, 2.62 in L2-L3, 3.07 in L3-L4, 3.76 in L4-L5, and 3.55 in L5-S1. The grade of degeneration of the high PT group was significantly higher than that of the low PT group for L4-L5 (p=0.031). High-grade degeneration of the L4-L5 segment was significantly more common in the high PT group (odds ratio=4.65; 95% CI, 1.406-15.381; p=0.012). CONCLUSIONS: Patients with high pelvic tilt had a higher grade of lumbar disc degeneration in the L4-L5 segment regardless of age or gender.

Basic Pelvic Parameters Associated with Lumbar Degenerative Disease: Review Article

STUDY DESIGN: Literature review. OBJECTIVES: The aim of this study was to present updated information on the basic pelvic parameters associated with lumbar degenerative disease. SUMMARY OF LITERATURE REVIEW: Sagittal imbalance has been known to be related to a poor prognosis in almost all adult spine problems, including lumbar degenerative disease. MATERIALS AND METHODS: Review of the relevant literature. RESULTS: Pelvic incidence is a morphologic parameter of the pelvis. It influences lumbar lordosis and thoracic kyphosis, and determines the limitations of pelvic retroversion in sagittal imbalance. Pelvic tilt is a positional parameter of the pelvis, indicating the degree of compensation for sagittal imbalance. A C7-sagittal vertical axis >5 cm, pelvic tilt >20°, and pelvic incidence-lumbar lordosis mismatch are known to be independent factors predictive of poor outcomes. CONCLUSIONS: The C7-sagittal vertical axis, pelvic tilt, and pelvic incidence-lumbar lordosis mismatch should be considered when surgery is planned for a patient with degenerative lumbar disease.

Clinical Implications of Spino-pelvic Parameters for the Outcome of Spinal Surgery for Lumbar Degenerative Diseases

STUDY DESIGN: A review of the literature. OBJECTIVES: To discuss how to evaluate, interpret, and utilize measurements of spino-pelvic alignment before and after spinal surgery in patients with lumbar degenerative disease. SUMMARY OF LITERATURE REVIEW: Various spino-pelvic parameters are currently utilized in the evaluation of spinal patients; however, interpretation of these parameters is not easy. MATERIALS AND METHODS: Each spino-pelvic parameter and factors affecting its value, and how to interpret and utilize the spino-pelvic parameters before and after spinal surgery were discussed for patients with lumbar degenerative disease with and without sagittal spinal deformity. RESULTS: Sagittal modifiers in the SRS-Schwab classification including pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), and pelvic tilt (PT) are widely accepted in the evaluation of lumbar degenerative disease with sagittal deformity. Surgery for sagittal realignment is meant to restore both the SVA and PT by restoring the LL in reference to the PI. However, patients with an extremely high SVA and PT or those with a high SVA and low PT can end up with postoperative residual malalignment. In patients without deformity, PI-LL mismatch (> 10°) should be highlighted and should be actively corrected by restoring the lordosis of the pathologic segment. CONCLUSIONS: Sagittal modifiers are beneficial for their simplicity and comprehensibility; however, they are insufficient for evaluating sub-regional spinal deformity. Spino-pelvic parameters can be useful for evaluating spinal patients in a clinical setting, but the measurements are greatly affected by confounding factors such as poor patient posture, unqualified testers, and manual measurement techniques.

Postural Changes during First Pregnancy.

Aims: The precise changes in postures of each part of the spine of primigravid women are still ambiguous. This study aimed to find out the spinal curvature and pelvic tilt changes during the first pregnancy. Study Design: Observational longitudinal study (Cohort study). Place and Duration of Study: The study was conducted at a hospital clinic in Iran, between April 2014 and December 2014. Methodology: Thirty primigravid women at the first, second and third trimesters of pregnancy were recruited in this cohort study and their lumbar and thoracic curves changes and pelvic inclination angles were studied and compared with 18 age-BMI matched non-pregnant women. The curves were measured by use of a flexible ruler and the pelvic inclination angle was measured by a pelvic inclinometer device. Before starting the main study, the reliability and repeatability of the measuring tools were confirmed in this study (ICC>0.87). A one-way ANOVA and independent t-test were used for statistical analysis. Results: Marked increased curvature and inclination angles were revealed as pregnancy advanced (P<0.05). The lumbar lordosis significantly increased when the first trimester was compared with the second and third ones. The thoracic curvature showed significantly increased curvature between the first and third and between the second and third trimesters. None of the lumbar or thoracic curve showed significantly difference between the control group and pregnant women during the first trimester of pregnancy. Although ten weeks pregnancy increased lumbar lordosis and thoracic kyphosis (4.2%, 8%, respectively), but it was not significant when compared with no pregnant women. The pelvic inclination angle showed to be more sensitive than spinal curvatures as it showed significant increase within all trimesters and when compared to the control group. Interestingly, it increased nearly 2.5 times more at the end of pregnancy (236%). Conclusion: The present study showed a significant increase in most variables that became higher as the months of pregnancy increased. The results might help clinicians for prescribing suitable exercises or spinal orthoses during pregnancy. More research is recommended in this area in women intending to get pregnant.

Influência da porção extensora do músculo glúteo máximo sobre a inclinação da pelve antes e depois da realização de um protocolo de fadiga / Influences of the extensor portion of the gluteus maximus muscle on pelvic tilt before and after the performance of a fatigue protocol

INTRODUÇÃO: Há carência na literatura de dados que determinem qual a influência da porção extensora do músculo glúteo máximo na inclinação da pelve no plano sagital e, portanto, na estabilidade lombar. OBJETIVOS: Verificar a influência da porção extensora do músculo glúteo máximo sobre a inclinação da pelve. MÉTODOS: Foram recrutadas 10 voluntárias jovens, saudáveis, com índices de massa corpórea (IMC's) menores que 24,9 kg/m² e com dismetria real de membros inferiores (MMII) inferior a 1 cm. Foram avaliados o IMC, o perímetro pélvico e o comprimento dos MMII e, posteriormente, os graus de inclinação das hemipelves e a assimetria entre elas pela análise de uma fotografia em perfil ortostático usando o SAPO (Software para Avaliação Postural). Em seguida, a porção extensora do músculo glúteo máximo do lado dominante foi induzido à fadiga, após a qual foram determinadas novamente a inclinação das hemipelves e a assimetria entre elas. Testes de Pearson r e teste t de student foram realizados no nível de significância α=0,05. RESULTADOS: Não houve correlação entre as variáveis de confusão e a assimetria dos ângulos das hemipelves. O ângulo da hemipelve apresentou modificação significativa do lado dominante (t=3,760; p=0,004). CONCLUSÕES: A fadiga da porção extensora do músculo glúteo máximo pode gerar um aumento do ângulo de inclinação da pelve homolateral.

INTRODUCTION: There is a lack of data in the literature for determining the influences of the extensor portion of the gluteus maximus muscle on pelvic tilting and, thus, on lumbar stability. OBJECTIVES: To assess the influences of the extensor portion of the gluteus maximus muscle on pelvic tilt. METHODS: Ten healthy young subjects were recruited, with a body mass index (BMI) below 24.9 kg/m² and leg length discrepancy below 1 cm. The BMI, pelvic perimeter and lower-limb lengths were assessed and, subsequently, the degrees of hemi-pelvic tilt and asymmetry between them were analyzed using lateral view photographs of the subjects in a standing position, using SAPO (Software for Postural Assessment). Next, fatigue was induced in the extensor portion of the gluteus maximus muscle on the dominant side, and after that the hemi-pelvic tilt and the asymmetry between the hemi-pelvises were reassessed. The Pearson r and Student t tests were conducted at the significance level of α=0.05. RESULTS: There were no significant correlations between the confounding variables and asymmetry of the hemi-pelvic angles. There were significant changes in the hemi-pelvic angle of the dominant side (t=3.760; p=0.004). CONCLUSIONS: Fatigue in the extensor portion of the gluteus maximus muscle can generate increases in the tilt angle of the ipsilateral pelvis.

Effectiveness of a Pre-Operative Lateral Decubitus Position Radiologic Examination Using a Goniometer and Rod in THRA

PURPOSE: For inserting an acetabular cup with the correct inclination angle, we checked the pelvic tilts using the lateral decubitus position X-ray and a goniometer and pointer. The accuracy of the cup inclination at the targeted angles was evaluated after insertion of the cup at an adjusted angle with using a goniometer and pointer. MATERIALS AND METHODS: Between January 2008 and December 2009, 56 hips in 50 patients who underwent total hip replacement arthroplasty (THRA) were enrolled. The mean age at the time of surgery was 63.8 years. There were 31 male patients (36 hips) and 19 female patients (20 hips). The preoperative diagnoses included osteonecrosis of the femoral head in 27 hips, secondary osteoarthritis in 10 hips and femoral neck fracture in 14 hips. The preoperative pelvic tilts were evaluated according to the lateral decubitus position X-ray with using a goniometer and pointer. The target inclination angle was 40degrees for 27 hips that underwent ceramic-on-ceramic THRA. The target inclination angle was 45degrees for the 29 hips that underwent ceramic-on-polyethylene THRA. The inclination of the cup was evaluated after inserting the acetabular cup at the adjusted angle using a goniometer and pointer. RESULTS: The mean inclination angle of the acetabular cup was 39.3degrees for the ceramic-on-ceramic THRA and 44.4degrees for the ceramic-on-polyethylene THRA. There were no significant differences between the 40degrees and 45degrees (P=0.059, P=0.071). CONCLUSION: The pelvic tilt can be evaluated by checking the lateral decubitus X-ray with a goniometer and pointer. Insertion of an acetabular cup at the adjusted angle could be a credible method for reducing the variability of cup inclination.

Factors Affecting Clinical Results after Corrective Osteotomy for Lumbar Degenerative Kyphosis

STUDY DESIGN: This study is a prospective, clinical study for lumbar degenerative kyphosis. PURPOSE: To determine the factors affecting postoperative clinical outcomes in patients who undergo corrective osteotomy for lumbar degenerative kyphosis. OVERVIEW OF LITERATURE: Only a small number of studies have reported clinical results for surgery for lumbar degenerative kyphosis. There are almost no studies about prognostic factors that predict postoperative clinical results. METHODS: This study involved 25 patients who were diagnosed with lumbar degenerative kyphosis and who underwent corrective osteotomy following gait analysis. A pedicle subtraction osteotomy was done at the third lumbar vertebra (L 3). Regarding the fusion level, surgery was done within a range from T10 proximally to S1 distally. Of these, for rigid fixation of a distal part, an iliac screw was used. Pain was evaluated using a 10-point pain scale and a questionnaire about activities. We also evaluated cosmesis and subjective satisfaction using a modified version of the Scoliosis Research Society Outcome-22 (SRS-22) instrument. This assessment was done using a 5-point scale which was designed by us. We assigned patients to group A (good clinical outcomes) if their postoperative pain score was lower than 4 (of 10 points) and if scores indicating activity, cosmesis and subjective satisfaction were higher than 11 (of 15 points). All other patients were assigned to group B (poor clinical outcomes). RESULTS: Clinical outcomes were good in 64% of patients (16/25) and poor in 36% (9/25). Regarding cosmesis and subjective satisfaction, there were significant differences between the two groups. There were also significant differences in physical factors of individual patients such as body mass index (BMI): 23.78 +/- 2.79 in group A and 26.44 +/- 2.75 in group B. On gait analysis, there was a significant difference in the dynamic pelvic tilt: 7.5 +/- 3.3degrees in group A and 11.72 +/- 1.89degrees in group B. CONCLUSIONS: There is no correlation between preoperative degree of kyphotic deformity and clinical outcomes. The degree of anterior rotation of pelvic tilt does not change significantly; rather, compensatory mechanisms of the pelvis and BMI were found to have more influence. Because neither the degree of satisfaction with clinical outcomes nor the increased activity was relatively higher, a more sincere decision should be made before recommending corrective osteotomy for degenerative lumbar kyphosis.

Change of Pelvic Tilt before and after Gait in Patients with Lumbar Degenerative Kyphosis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to verify the value of radiography and gait analysis to analyze the changes of the pelvic tilt before and after gait in the patients with LDK. Summary of Literature Review: Patients with lumbar degenerative kyphosis show dynamic changes that are closely associated with the motion of pelvis. MATERIALS AND METHODS: We analyzed 18 lumbar degenerative kyphosis patients who didn't have multiple vertebral compressio fractures, a past history of spinal surgery or surgery for degenerative arthritis of the knee or hip, and obesity which causes marker errors on the gait analysis. Pelvic tilt was statistically evaluated by utilizing radiographs and dynamically utilizing the gait analysis. The linear parameters of the gait cycle and the kinematic data were obtained from the gait analysis. RESULTS: The LDK patients'mean walking velocity was 80.7 cm/s, and it was largely decreased to 65% of the normal value. The cause of the decreased walking velocity was a decrease of stride length, and not a decrease of cadence. The mean static pelvic tilt in the gait analysis was -1.3+/-8.0degrees , and there were 8 cases of anterior tilt and 10 cases of posterior tilt. The mean pelvic tilt during gait was 12.5+/-8.2degrees , and there were 17 cases of anterior tilt and 1 case of posterior tilt. It was statistically significant difference (p<0.05) between the mean static pelvic tilt in gait analysis and the mean pelvic tilt during gait and the Pearson's correlation coefficient was -0.88. CONCLUSIONS: Though there was no statistical significance, we observed anterior pelvic rotation after gait on the radiographs. As fatigue of the pelvic extensor muscles increases during gait, anterior pelvis tilt increases with statistical significance on the gait analysis. Therefore, we feel gait analysis is useful for evaluating the dynamic change of the pelvic tilt in patients with LDK.

Correlation of Pelvic Parameters with Isthmic Spondylolisthesis

STUDY DESIGN: A retrospective radiological evaluation. PURPOSE: To verify that PI is related with progression of IS as well as development of IS and to assess the differences of pelvic parameters between the L4 & L5 IS, as well as between single & two level IS. OVERVIEW OF LITERATURE: High pelvic incidence (PI) has been known to be related with development of IS. However, the previous studies were limited to just L5 spondylolisthesis or there was no differentiation between L4 & L5 spondylolisthesis METHODS: Sixty five IS patients and 30 persons as a control group participated the study. Among the 65 patients, 30 had L4 IS, 30 had L5 IS and 5 had bi-level IS. We used the whole spine lateral radiographs to measure the slip percentage, the pelvic tilt (PT) and the pelvic incidence (PI), and we compared them between the normal control group and the IS patients, as well as between single-level and bi-level spondylolisthesis, and we investigated the correlation between the degree of slip of spondylolisthesis and the pelvic parameters. RESULTS: The averages of the PT, PI and lumbar lordosis (LL) in the control group and the IS group were 11.0degrees vs 21.4degrees (p0.05). On comparison between the single-level IS group and the bilevel IS group, there was a significant difference of the PT and PI (p<0.05), and the slip percentage had a correlation with only the PI among all the pelvic parameters (Spearman's r=0.293, p=0.023). There was a significant correlation of the degree of slip with the PI for the L5 single level IS, but not with the L4 single level IS (r=0.362, p=0.05). CONCLUSIONS: The high pelvic incidence can be a factor of L4 & L5 spondylolysis and it may have an influence on the slip progression in patients with L5 isthmic spondylolisthesis, but not on the slip progression in patients with L4 IS. Yet other factors seem to have an influence on the slip progression in patients with L4 isthmic spondylolisthesis.

Significance of Pelvic Incidence in the Development of Abnormal Sagittal Alignment / 대한정형외과학회잡지

PURPOSE: Under the assumption that the pelvic incidence influences the development of an abnormal curvature, this study examined the relationship between the pelvic incidence and the development of an abnormal curvature. MATERIALS AND METHODS: Twenty-two adults with a normal curvature and seventy-nine adults with an abnormal curvature were enrolled in this study. All subjects were older than fifty years of age at the time of the study. The patients were classified based on the alignment of the spine and the strategic vertebrae as follows: extension of the lordosis of the lumbar spine to the upper part of the thoracolumbar transitional portion (Group 1), kyphosis on the lower lumbar area but an extension of the lordosis from the upper lumbar area to the upper part of the thoracolumbar transitional portion (Group 2), extension of the kyphosis from the thoracic spine to the lower lumbar area (Group 3), the presence of lordosis on the lower lumbar portion but an extension of the kyphosis from the upper lumbar portion to the upper portion of the thoracolumbar area (Group 4). In each group, the interrelationship between the sagittal alignment, pelvic tilt, sacral slope and pelvic incidence were evaluated, and the changes in the numerical figures were compared and analyzed. RESULTS: In the normal group the average pelvic incidence was 52.5 degrees. The average pelvic incidence was higher in groups 1 and 2 (61.6 and 58.5 degrees, respectively) than in groups 3 and 4 (44.5 and 47.2 degrees, respectively) (p<0.001). The average sacral slope was 31.5 in the normal group, 34.5 in group 1, 25.1 in group 4, 20.1 in group 2, and 9.2 in group 3. In groups 1 and 2, group 2 showed a lower sacral slope compared with group 1 (p<0.001). In groups 3 and 4, group 4 had a larger sacral slope than group 3 (p<0.001). The average pelvic tilt was 21 in the normal group. Groups 2 and 3 showed a larger pelvic tilt (38.4 and 35.3, respectively) than that of groups 1 and 4 (27.1 and 22.1, respectively). CONCLUSION: In the elderly with an abnormal lordotic curve, the sagittal alignment of the spine is associated with the pelvic tilt, sacral slope and pelvic incidence, in a similar manner to that in normal adults with a normal lordotic curve. Therefore, measuring these figureswould help in making an estimate of the perspective changes in the sagittal alignment of spine.