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
Not just alignment: body shape influences adult spinal deformity biomechanics.
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
purposeAdult spinal deformity (ASD) alters sagittal alignment and trunk centre of mass location, increasing spinal loading. Current clinical assessment of ASD primarily focuses on alignment parameters disregarding patient's body shape variability. This study aimed to evaluate the relative effects of spinal sagittal alignment and body mass distribution (i.e., body shape) on spinal loads and trunk centre of mass location in upright-posture and forward flexion.
methodsSagittal alignments of 754 patients with ASD were obtained from clinical data. Trunk mass distributions were assessed in adult male volunteers (10 healthy weight, 9 obese). Using an established musculoskeletal model of the spine, inverse dynamics simulations were performed for each combination of sagittal alignment and trunk mass distribution profile. A factorial analysis using generalised linear models elucidated the relative effects of alignment vs. body shape.
resultsSagittal alignment primarily determined the antero-posterior positioning of trunk centre of mass; body shape, its cranio-caudal location. In the healthy weight cohort, the relative effect of mass distribution on compressive loads was 14-98% in the thoracic and 42-57% in the lumbar region. In the cohort with obesity, it was 24-98% and 19-27%, for thoracic and lumbar regions, respectively. Body shape effects on shear forces were greater in dynamic forward flexion than in static upright-posture.
conclusionThe considerable impact of mass distribution on spinal loads suggests that patient body shape should be considered in ASD surgical planning to avoid segmental overloading. Future research should evaluate body shapes in patients with ASD, including females and elderly subjects.
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