ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
CT morphometric analysis of thoracic vertebrae and pelvic parameters: implications for kyphosis and postural balance.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo investigate the relationship between thoracic vertebral morphometry and pelvic parameters, clarify their role in sagittal balance, and assess their predictive value for thoracic kyphosis and postural imbalance.
methodThoracic CT images obtained between January/2002 and August/2025 were retrospectively reviewed, including 120 patients (60 with kyphosis, 60 controls). Variables comprised vertebral body and total vertebral volumes, spinous process morphometry, Cobb angle, pelvic incidence, sacral slope, pelvic tilt, and indices of pelvic symmetry, including distance and height differences between anterior superior iliac spines and femoral head centres. Statistical analyses included inter-group comparisons, correlations, logistic regression, and receiver operating characteristic evaluation.
resultsThe kyphosis group showed significantly greater pelvic incidence (58.9° vs. 50.9°), sacral slope (47.0° vs. 38.6°), and Cobb angle (47.9° vs. 29.2°) (all p < 0.01). Marked asymmetry was observed, with higher femoral head centre (13.0 mm vs. 1.6 mm) and anterior superior iliac spine height differences (12.9 mm vs. 2.0 mm) (p < 0.001). ROC analysis identified femoral head height difference > 5.1 mm (AUC = 0.812; sensitivity 80%, specificity 73%), anterior superior iliac spine height difference > 3.8 mm (AUC = 0.795), and sacral slope > 42.7° (AUC = 0.731) as reliable thresholds for predicting kyphosis. Pelvic incidence, sacral slope, Cobb angle, and asymmetry increased significantly in participants aged ≥ 60 years.
conclusionCombined assessment of thoracic and pelvic morphometry showed that sagittal balance cannot be explained by angular measures alone. Simple indices such as femoral head and iliac spine height differences offer high predictive value for kyphosis and may guide as useful radiographic markers for identifying individuals at risk.
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