European Spine Journal

, Volume 27, Issue 2, pp 448–457 | Cite as

Coronal plane trunk asymmetry is associated with whole-body sagittal alignment in healthy young adolescents before pubertal peak growth

  • Mieke Dolphens
  • Andry Vleeming
  • René Castelein
  • Guy Vanderstraeten
  • Tom Schlösser
  • Frank Plasschaert
  • Lieven Danneels
Original Article



To investigate coronal plane trunk asymmetry (TA) and its association with sagittal postural alignment in healthy subjects before pubertal peak growth.


In this cross-sectional baseline study, 1190 healthy pre-peak growth velocity subjects were included. Coronal plane TA was evaluated using back surface topography. Whole-body sagittal alignment (previously validated and objectively classified as neutral, sway-back or leaning-forward) and sagittal spinopelvic profile (trunk lean, lumbar lordosis, thoracic kyphosis, sacral inclination and length of the posteriorly inclined thoracolumbar segment) were determined, as were height, proportion of trunk to body length, body mass index, generalized joint laxity, and handedness.


Logistic regression analysis yielded overall sagittal posture class to be independently associated with coronal plane TA: having a leaning-forward posture associated with a nearly three times higher odds of coronal TA (p < 0.001) compared to neutrals. A sway-back was 2.2 times more likely to show TA (p = 0.016) than a neutral, yet only in boys. Significant associations with coronal TA were also found for trunk lean, thoracic kyphosis and body mass index. These correlations, however, were gender and posture class specific. The spinal region where asymmetry is seen, varies according to the whole-body sagittal alignment type: primary thoracic curves were the most frequent in leaning-forwards, whereas primary curves in the lumbar or declive thoracolumbar segment were the most common in sway-backs.


In immature spines without known scoliosis, coronal plane TA is associated with whole-body sagittal alignment. It is more often seen in non-neutral than neutral sagittal posture types. Whether adolescent idiopathic scoliosis is related with postural characteristics before pubertal growth peak, should be addressed in future prospective studies.


Posture Postural balance Spinal curvatures Scoliosis Growth and development 



We are indebted to the pupils, parents and staff of the schools and pupil guidance centers for taking part in this study.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest. The authors had full control of all primary data. The authors agree to allow the journal to review our data if requested.

Supplementary material

586_2017_5156_MOESM1_ESM.pdf (12 kb)
Supplementary material 1 (PDF 12 kb)
586_2017_5156_MOESM2_ESM.pdf (12 kb)
Supplementary material 2 (PDF 12 kb)
586_2017_5156_MOESM3_ESM.pdf (72 kb)
Supplementary material 3 (PDF 72 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
  2. 2.Department of Anatomy, Medical Faculty, Center of Excellence in NeuroscienceUniversity of New EnglandBiddefordUSA
  3. 3.Department of Orthopaedic SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
  4. 4.Department of Physical and Rehabilitation Medicine, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
  5. 5.Department of Orthopedics and TraumatologyGhent University HospitalGhentBelgium

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