2. Sagittal alignment of the spine is changing!
Evolution theories
Life cycles

3. Sagittal alignment Planning of the 3D reconstruction of the spine
Normative data about the sagittal plane
Segmental sagittal plane analysis
To describe the normative data of the sagittal plane on pediatric age population
To document the evolution of sagittal alignment with growth

4. Pediatric vs. adults Greater thoracic kyphosis Smaller lumbar lordosis
Especially upper 3 segments hypolordotic
More kyphotic thoracolumbar region
3.6o-9.8o
More forward sagittal vertical axis
Lower sacral inclination
Lordosis
Kyphosis

5. Non-ambulatory patient?

6. Purpose Describe normative values in sitting position
Document evolution of alignment with growth
The purpose of this study is to describe the normative values of spinal sagittal alignment in the pediatric population, and document the evolution of sagittal alignment with growth in a sitting position.
Knowing the relationship between age and sagittal alignment in sitting child will allow precise patient-based preoperative planning

7. Materials & Methods Between 3-16 age Group 1 (3-6 ages)
114 children (54 female, 60 male)
NO musculoskeletal abnormality
Group 1 (3-6 ages)
Group 2 (7-9 ages)
Group 3 (10-12 ages)
Group 4 (13-16 ages)
30” Lateral X-ray with the arms flexed 30°on sitting position
54 female 60 male totally 114 children without musculoskeletal abnormality between the ages of 3 to 16 years were studied and grouped in to 4
Between 3-6 ages children named as group 1 between 7-9 ages named as 2 between ages grouped 3 finally between ages children named as group 4
A minimum of 7 (at least 3 from each sex) children were in each age group.

8. Materials & Methods Segmental angulations from T1–T2 to L5–S1
Global kyphosis (T1–T12) and lordosis (L1–S1)
Segmental angulations of T2–T5, T10– T12, T10– L2, and L4–S1 levels
Sacral slope and offsets

9. Results
Global kyphosis and lordosis angles are different in sitting positon
Smaller thoracic kyphosis and lumbar lordosis
Alignment (both segmental and global) is changing with age
Statistically significant differences
T2-T5, T5–T6, L1–L2, L4–S1, L5-S1, lumbar lordosis and sacral slope

10. Results

11. Conclusion Homo computericus Children is not miniature of adults
Sitting and standing alignments are not same
Less kyphosis and lordosis
These findings should be considered in preoperative planning of young non-ambulatory patients
However, patients with upper extremity weakness/paralysis
Self catheterization and hygiene
Requires more kyphosis
SOLUTION???
Homo computericus