Effects of Poor Posture On Your Body!

This was a research paper in Spine that looked into the effects of poor posture. I included comments from Dr. Murphy. We have been focusing on structural correction of abnormal postures in Portland at our clinic for the last five years. Since our move to the Beaverton / Raleigh Hills area we have incorporated a multi faceted approach to postural correction.

The Impact of Positive Sagittal Balance in Adult Spinal Deformity

Spine Volume 30(18), September 15, 2005 pp. 2024-2029
Glassman, Steven D. MD; Bridwell, Keith MD; Dimar, John R. MD; Horton, William
MD; Berven, Sigurd MD; Schwab, Frank MD

FROM ABSTRACT:
Study Design.
This study is a retrospective review of 752 patients with adult spinal deformity
enrolled in a multicenter prospective database in 2002 and 2003.
Patients with positive sagittal balance (N = 352) were further evaluated regarding
radiographic parameters and health status measures, including the Scoliosis
Research Society patient questionnaire, MOS short form-12, and Oswestry Disability
Index.

Objectives.
To examine patients with adult deformity with positive sagittal balance to define
parameters within that group that might differentially predict clinical impact.
Summary of Background Data.
In a multicenter study of 298 adults with spinal deformity, positive sagittal balance
[forward head / body] was identified as the radiographic parameter most highly
correlated with adverse health status outcomes.
Methods.
Radiographic evaluation was performed according to a standarized protocol for 36-
inch standing radiographs. [IMPORTANT: the analysis in this study was a
measurement for forward head / body done on an upright full-spine lateral
x-ray]. Magnitude of positive sagittal balance [forward head / body] and
regional sagittal Cobb angle measures were recorded.
Statistical correlation between radiographic parameters and health status measures
were performed. Potentially confounding variables were assessed.

Results.
The C7 plumb line deviation ranged from 1 to 271 mm. [about 11 inches]
All measures of health status showed significantly poorer scores as C7 plumb line
deviation increased. [WOW!]
Patients with relative kyphosis in the lumbar region had significantly more disability
than patients with normal or lordotic lumbar sagittal Cobb measures.

Conclusions.
This study shows that although even mildly positive sagittal balance is somewhat
detrimental, severity of symptoms increases in a linear fashion with progressive
sagittal imbalance.
The results also show that kyphosis is very poorly tolerated in the lumbar spine.
THESE AUTHORS ALSO NOTE:
With respects to spinal deformities, “investigators have begun to apply
reproducible evaluation techniques, including standardized radiographs, gait
analysis, and validated health status measures.”
“In a recent multicenter study of 298 adults with spinal deformity, positive
sagittal balance was identified as the radiographic parameter most highly correlated
with adverse health status outcomes.”
[Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters
and clinical symptoms in adult scoliosis. Spine 2005;30:682-8.]
“Positive sagittal balance was defined as an anterior deviation of the C7
plumb line measurement.” [Like a forward head or forward body syndrome]
“Positive sagittal balance was more significantly associated with pain and
disability than curve magnitude, curve location, or coronal imbalance.”
The purpose of this study was to examine patients with adult deformity with
positive sagittal balance [a forward head or forward body syndrome] to define
parameters within that group that might differentially predict clinical symptoms.
Patient self-assessment measures of health status collected were the Scoliosis
Research Society patient questionnaire (SRS-29), MOS short form-12 (SF-12), and
Oswestry Disability Index (ODI).
In this study, “radiographic measures of deformity were recorded based on a
standardized manual of measurement techniques.” Anteroposterior and lateral 36-
inch standing radiographs were exposed. [IMPORTANT: standing AP and lateral
full-spine 36-inch radiographs were used].
“Coronal plane parameters included major and minor curve location, curve
magnitude by Cobb angle, and coronal imbalance by C7 plumb line deviation.”
“The sagittal balance [anterior-posterior] was determined based on the
deviation of the C7 plumb line, originating at the middle of the C7 vertebral body,
from the posterior superior endplate of S1.”
“Positive sagittal balance was defined as an anterior deviation of the C7
plumb line.” [Like a forward head or forward body syndrome]

“Patient reported health status measures, including the SF-12, SRS-29, and
ODI, were analyzed to determine a relationship between type, location, or
magnitude of deformity, and overall health status, pain, and function.”

RESULTS
“Positive sagittal balance [forward head or forward body syndrome] based on
C7 plumb line deviation ranged from 1 to 271 mm (mean 57.7 ± 51.2).”
There was a high degree of correlation between positive sagittal balance and
adverse health status scores, for physical health composite score and pain domain.
[Important]
“There was clear evidence of increased pain and decreased function as the
magnitude of positive sagittal balance increased.” [Important]
“All measures of health status (SF-12, SRS-29, and ODI) showed significantly
poorer scores as C7 plumb line deviation increased.”
“There was no significant correlation between thoracic or thoracolumbar
sagittal Cobb deformity and any of the health status measures.”

DISCUSSION
An increasing number of patients with adult deformity are seeking medical care.
“Several [surgical] studies have shown that adequate restoration of sagittal
plane alignment is necessary to improve significantly clinical outcome and avoid
subsequent pseudoarthrosis.”
“Positive sagittal balance [forward head / body] has also been identified as
the radiographic parameter most highly correlated with adverse outcome measures
in unoperated adult spinal deformity.”
“This study shows that although even mildly positive sagittal balance is
somewhat detrimental, severity of symptoms increases in a linear fashion with
progressive sagittal imbalance.”
Kyphosis is “very poorly tolerated in the lumbar spine.”
“These findings emphasize the importance of thoroughly accessing sagittal
plane alignment in the treatment of spinal deformity.”
“With surgical treatment, maintenance or restoration of lumbar lordosis
appears to be critical.”

KEY POINTS FROM AUTHORS:
1) Severity of symptoms increases in a linear fashion with progressive positive
sagittal balance.
2) Relative kyphosis is very poorly tolerated in the lumbar spine.
3) The use of reproducible radiographic and clinical outcome measures facilitates
the development of more effective treatment paradigms for patients with adult
deformity.
KEY POINTS FROM DAN MURPHY:
1) The analysis in this study was a measurement for forward head / body done
on an upright full-spine lateral x-ray.
2) These authors measured the sagittal plumb line distance between the center
of C7 vertebral body with respects to the superior posterior surface of the sacrum.
3) This study showed a deterioration of health status with progressive forward
head / body sagittal balance.
4) All measures of health status showed significantly poorer scores as C7 plumb
line deviation increased forward of the sacrum.
5) Even minor forward head / body sagittal balance is detrimental.
6) The severity of symptoms increases in a linear fashion with progressive
increase of forward head / body sagittal imbalance.
7) Kyphosis is very poorly tolerated in the lumbar spine.
There was clear evidence of increased pain and decreased function as the
magnitude of forward head / body sagittal balance increased.
9) “These findings emphasize the importance of thoroughly accessing sagittal
plane alignment in the treatment of spinal deformity.”
10) Relative kyphosis is very poorly tolerated in the lumbar spine.