Changes in Spinopelvic Parameters Between Standing and Sitting Postures: A Systematic Review and Meta-analysis.

ABSTRACT

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To report the ratio-of-differences between standing and sitting. To understand how sex and age influence these differences. SUMMARY OF BACKGROUND DATA Currently, spinal deformity surgery aims to realign the sagittal profile of the spine with-reference-to the standing posture resulting in overcorrection. New studies report significant disparities between standing and sitting spinal alignment. METHODS: A comprehensive search and review of the published literature was performed on 4 platforms in accordance with the PRISMA 2009 checklist by 2 authors independently. RESULTS: From 753 abstracts extracted from the databases, 38 papers involving 5423 patients were identified. sagittal vertical axis was more positive in sitting, with a pooled mean difference of 29.5 mm (95% CI 17.9-41.0). Pelvic tilt (PT) was larger in sitting, with a pooled mean difference of 16.7 degrees (95% CI 12.5-20.9), and a pooled odds ratio of 1.2(95% CI1.1-1.3. P =0.001). Sacral Slope (SS) was smaller and lumbar lordosis (LL) was less lordotic in sitting, with a pooled mean difference of 15.0 degrees (95% CI 11.918.1) and 21.1 degrees (95% CI14.5-27.8), respectively, and a pooled odds ratio of 0.7 (95% CI 0.6-0.8. P <0.001) and 0.7 (95% CI0.6-0.7, P <0.001), respectively. Pelvic incidence and thoracic kyphosis was similar in sitting. Subgroup meta-analysis comparing odd ratio of standing to sitting showed Among younger patients (age younger than 50), the PT and LL pooled odds-ratios were 1.4 and 0.7, respectively. Among older patients (age older than or equal to 50), the PT and LL pooled odds-ratios were 1.1 and 0.8, respectively. Among female patients, the SS pooled odds ratio was 0.6. Among male patients, the SS pooled odds ratio was 0.7. CONCLUSION: When comparing sitting to standing, it gives a more positive sagittal vertical axis, a smaller SS and LL, and a larger PT. pelvic incidence and thoracic kyphosis remained similar. Younger and female patients have pronounced differences in SS, PT, and LL, suggesting the existence of age and sex variations, and its role to be considered when planning for spinal realignment surgeries. Clinical outcome studies are required to ascertain the impact of these findings.