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
Normal spino-pelvic alignment in healthy adolescents: defining the PI-SS relationship and laying the foundations for pre-operative sagittal planning.
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
purposeSurgical treatment of adolescent spinal deformities requires accurate pre-operative planning. Few studies confirmed that sagittal alignment restoration is crucial to reduce the risk of early degeneration, yet sagittal alignment targets are lacking in adolescents. No predictive formula for ideal sacral slope (SS
methodsFull-spine standing biplanar X-rays were analyzed. PI, SS and pelvic tilt (PT) were measured. Three regression models (linear, polynomial, and logarithmic) were generated to describe the PI-SS relationship. The adult-derived model by Yilgor et al. was also applied to the study cohort. Accuracy and precision of all models were assessed globally and within PI-based subgroups. External validation was performed using a previously published dataset.
resultsA total of 122 patients (mean age 14 years) were included. Logarithmic and polynomial models achieved the best fit within the study cohort (R² = 0.63 and 0.63). The Yilgor et al. model showed substantially lower fit (R² = 0.39) and systematic underestimation of SS in intermediate and high PI subgroups. The linear model performed best within the external validation cohort showing the best goodness-of-fit, accuracy, precision, and robustness. The Yilgor model again showed systematic SS underestimation and higher errors.
conclusionOur results suggest that the formula SS
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