European Spine Journal

, Volume 28, Issue 6, pp 1286–1295 | Cite as

Head to pelvis alignment of adolescent idiopathic scoliosis patients both in and out of brace

  • Claudio VergariEmail author
  • Isabelle Courtois
  • Eric Ebermeyer
  • Raphael Pietton
  • Houssam Bouloussa
  • Raphael Vialle
  • Wafa Skalli
Original Article



To determine the short-term effect of bracing of adolescent idiopathic scoliotic (AIS) patients on the relationships between spinopelvic parameters related to balance, by comparing their in and out-of-brace geometry and versus healthy subjects.


Forty-two AIS patients (Cobb angle 29° ± 12°, ranging from 16° to 61°) with a prescription of orthotic treatment were included retrospectively and prospectively. They all underwent biplanar radiography and 3D reconstruction of the spine and pelvis before bracing as well as less than 9 months after bracing. Eighty-three age-matched healthy adolescents were also included as control group and underwent biplanar radiography and 3D reconstruction.


Sacral slope was higher in AIS than healthy patients (p = 0.005). Bracing induced large changes of pelvic tilt (between − 9° and 9°), although patients’ sagittal spinopelvic alignment tended to remain within the normality corridors defined by the healthy patients. Patients had flatter backs compared to healthy subjects and bracing further reduced their spinal curves. The head tended to remain above the pelvis in-brace.


Analysis of sagittal alignment from head to pelvis showed that bracing further flattened the patients’ backs and induced large compensating reorientations of the pelvis. Sagittal balance should be included in the planning and evaluation of brace treatment, since it could play a role in its outcome.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


AIS Bracing Brace effect Sagittal balance Compensation 



The authors are grateful to the BiomecAM chair program on subject-specific musculoskeletal modelling (with the support of ParisTech and Yves Cotrel Foundations, Société Générale, Covea and Proteor) and to the DHU MAMUTH for funding. We are also grateful to Ms Fay Manning for her technical support.

Compliance with ethical standards

Conflict of interest

Wafa Skalli holds patents related to the EOS system and associated 3D reconstruction methods, with no personal financial benefit (royalties rewarded for research and education). Raphael Vialle received consulting fees from EOS Imaging unrelated to this study.

Supplementary material

586_2019_5981_MOESM1_ESM.pptx (458 kb)
Supplementary file1 (PPTX 458 kb)
586_2019_5981_MOESM2_ESM.mp4 (420 kb)
Online Resource 1: Changes of the spine, head and pelvis of a patient from pre-brace to in-brace (MP4 420 kb)


  1. 1.
    Dubousset J (2018) Definition of adolescent idiopathic scoliosis—pathogenesis of idiopathic scoliosis. In: Weinstein SL, Dubousset J (eds) Machida M. Springer, Tokyo, pp 1–25Google Scholar
  2. 2.
    Le Huec JC, Gille O, Fabre T (2018) Sagittal balance and spine-pelvis relation: a French speciality? Orthop Traumatol Surg Res 104:551–554. CrossRefGoogle Scholar
  3. 3.
    Barrey C, Roussouly P, Le Huec JC et al (2013) Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 22:834–841. CrossRefGoogle Scholar
  4. 4.
    Vedantam R, Lenke LG, Keeney JA, Bridwell KH (1998) Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults. Spine (Phila Pa 1976) 23:211–215CrossRefGoogle Scholar
  5. 5.
    Le Huec JC, Hasegawa K (2016) Normative values for the spine shape parameters using 3D standing analysis from a database of 268 asymptomatic Caucasian and Japanese subjects. Eur Spine J 25:3630–3637. CrossRefGoogle Scholar
  6. 6.
    Schwab F, Lafage V, Patel A, Farcy JP (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine 34:1828–1833. CrossRefGoogle Scholar
  7. 7.
    Legaye J, Duval-Beaupère G (2005) Sagittal plane alignment of the spine and gravity a radiological and clinical evaluation. Acta Orthop Belg 71:213–220. Google Scholar
  8. 8.
    Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–87. CrossRefGoogle Scholar
  9. 9.
    Vialle R, Levassor N, Rillardon L et al (2005) Radiographic Analysis of the Sagittal Alignment and Balance of the Spine in Asymptomatic Subjects. J Bone Jt Surg 87:260–267. CrossRefGoogle Scholar
  10. 10.
    Lafage V, Schwab F, Vira S et al (2011) Spino-pelvic parameters after surgery can be predicted: a preliminary formula and validation of standing alignment. Spine (Phila Pa 1976) 36:1037–1045CrossRefGoogle Scholar
  11. 11.
    Roussouly P, Labelle H, Rouissi J, Bodin A (2013) Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults. Eur Spine J 22:203–215. CrossRefGoogle Scholar
  12. 12.
    Alzakri A, Vergar C, Van den Abbeele M, Gille O, Skalli W, Obeid I (2019) Global sagittal alignment and proximal junctional kyphosis in adolescent idiopathic scoliosis. Spine Deform 7(2):236–244. CrossRefGoogle Scholar
  13. 13.
    Glassman SD, Bridwell K, Dimar JR et al (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029CrossRefGoogle Scholar
  14. 14.
    Lazennec J-Y, Ramaré S, Arafati N et al (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9:47–55. CrossRefGoogle Scholar
  15. 15.
    Kumar M, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319. CrossRefGoogle Scholar
  16. 16.
    Dubousset J, Charpak G, Dorion I et al (2005) A new 2D and 3D imaging approach to musculoskeletal physiology and pathology with low-dose radiation and the standing position: the EOS system. Bull Acad Natl Med 189:287–300Google Scholar
  17. 17.
    Courvoisier A, Drevelle X, Vialle R et al (2013) 3D analysis of brace treatment in idiopathic scoliosis. Eur Spine J 22:2449–2455. CrossRefGoogle Scholar
  18. 18.
    Lebel DE, Al-Aubaidi Z, Shin E-J et al (2013) Three dimensional analysis of brace biomechanical efficacy for patients with AIS. Eur Spine J 22:2445–2448. CrossRefGoogle Scholar
  19. 19.
    Clin J, Aubin C-E, Parent S et al (2010) Comparison of the biomechanical 3D efficiency of different brace designs for the treatment of scoliosis using a finite element model. Eur Spine J 19:1169–1178. CrossRefGoogle Scholar
  20. 20.
    Negrini S, Donzelli S, Aulisa AG et al (2018) 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord 13:3. CrossRefGoogle Scholar
  21. 21.
    Lonstein JE, Carlson JM (1984) The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Jt Surg Am 66:1061–1071CrossRefGoogle Scholar
  22. 22.
    Humbert L, De Guise JA, Aubert B et al (2009) 3D reconstruction of the spine from biplanar X-rays using parametric models based on transversal and longitudinal inferences. Med Eng Phys 31:681–687. CrossRefGoogle Scholar
  23. 23.
    Amabile C, Pillet H, Lafage V et al (2016) A new quasi-invariant parameter characterizing the postural alignment of young asymptomatic adults. Eur Spine J 25:3666–3674. CrossRefGoogle Scholar
  24. 24.
    Coe D (2009) Fisher matrices and confidence ellipses: a quick-start guide and software. arXiv:09064123
  25. 25.
    Conover WJ, Iman RL (1982) Analysis of covariance using the rank transformation. Biometrics 38:715–724. CrossRefGoogle Scholar
  26. 26.
    Zaina F, Donzelli S, Lusini M, Negrini S (2012) Correlation between in-brace radiographic correction and short time brace results. Scoliosis 7:1. CrossRefGoogle Scholar
  27. 27.
    Clin J, Aubin C-É, Sangole A et al (2010) Correlation between immediate in-brace correction and biomechanical effectiveness of brace treatment in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 35:1706–1713. CrossRefGoogle Scholar
  28. 28.
    Vital JM, Senegas J (1986) Anatomical bases of the study of the constraints to which the cervical spine is subject in the sagittal plane a study of the center of gravity of the head. Surg Radiol Anat 8:169–173. CrossRefGoogle Scholar
  29. 29.
    Dubousset J (2011) Reflections of an orthopaedic surgeon on patient care and research into the condition of scoliosis. J Pediatr Orthop 31:S1–S8. CrossRefGoogle Scholar
  30. 30.
    Amabile C, Le Huec J-C, Skalli W (2018) Invariance of head-pelvis alignment and compensatory mechanisms for asymptomatic adults older than 49 years. Eur Spine J 27:458–466. CrossRefGoogle Scholar
  31. 31.
    Guo J, Liu Z, Lv F et al (2012) Pelvic tilt and trunk inclination: new predictive factors in curve progression during the Milwaukee bracing for adolescent idiopathic scoliosis. Eur Spine J 21:2050–2058. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.LBM/Institut de Biomécanique Humaine Georges CharpakArts et Métiers ParisTechParisFrance
  2. 2.Unite RachisCHU - Hopital BellevueSaint-ÉtienneFrance
  3. 3.Department of Pediatric Orthopaedics, Armand Trousseau HospitalSorbonne UniversityParisFrance
  4. 4.Spine Surgery DepartmentKaiser Oakland Medical CenterOaklandUSA

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