Spinopelvic alignment and lumbar vertebral shape in children: associations with structural spinal abnormalities and body composition in the generation R study

Marleen M. van den Heuvel; Nathalie E. Griffioen; Hakim C. Achterberg; Edwin H. G. Oei; Jeroen J. M. Renkens; Sita M. A. Bierma-Zeinstra; Marienke van Middelkoop

doi:10.1007/s00586-021-07054-1

Spinopelvic alignment and lumbar vertebral shape in children: associations with structural spinal abnormalities and body composition in the generation R study

Marleen M. van den Heuvel^*, Nathalie E. Griffioen, Hakim C. Achterberg, Edwin H. G. Oei, Jeroen J. M. Renkens, Sita M. A. Bierma-Zeinstra, Marienke van Middelkoop

^*Corresponding author for this work

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Abstract

Purpose: To investigate the spinopelvic alignment and vertebral shape in children, and associations with body composition and structural spinal abnormalities on magnetic resonance imaging (MRI). Methods: We performed a cross-sectional study embedded in the Generation R Study, a prospective population-based birth cohort. Pelvic incidence and vertebral concavity ratios for each lumbar level were determined on sagittal MRI images in 9-year-old children, and structural spinal abnormalities were scored semi-quantitatively. The BMI-SD score was calculated, and body composition was assessed using DXA scans. Associations of pelvic incidence and vertebral concavity ratios with structural abnormalities and body composition measures were assessed using (multilevel) regression analyses. Results: This study included 522 participants (47.7% boys), aged 9.9 years (IQR 9.7–10.0). The mean pelvic incidence was 36.6° (SD 8.0). Vertebral concavity ratios ranged from 0.87 to 0.90, with significantly lower ratios for boys compared to girls. Associations were found for a larger pelvic incidence with decreased disc height [OR 1.03 (95% CI 1.02–1.05)], and a pelvic incidence in the lowest tertile with less disc bulging [OR 0.73 (95% CI 0.56–0.95)]. Increased vertebral concavity ratio was associated with decreased disc height [OR 14.16 (95% CI 1.28–157.13)]. Finally, increased fat-free mass index was associated with a smaller pelvic incidence [adjusted OR 0.85 (95% CI 0.07–1.63)]. Conclusion: The mean pelvic incidence of 9-year-old children is 36.6° on supine MRI images, and a slightly concave shape of the lumbar vertebrae is seen. Spinopelvic alignment is associated with structural spinal abnormalities, and might itself be influenced by the children’s body composition.

Original language	English
Pages (from-to)	248-257
Number of pages	10
Journal	European Spine Journal
Volume	31
Issue number	2
Early online date	19 Nov 2021
DOIs	https://doi.org/10.1007/s00586-021-07054-1
Publication status	Published - Feb 2022

Bibliographical note

Funding Information:
The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam area, Rotterdam, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR-MDC), Rotterdam. We gratefully acknowledge the contribution of children and parents, general practitioners, hospitals, midwives, and pharmacies in Rotterdam. The general design of the Generation R Study is made possible by financial support from the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam, ZonMw, the Netherlands Organisation for Scientific Research (NWO), and the Ministry of Health, Welfare and Sport. The work of MH was financially supported by a EUR Fellowship grant from the Erasmus University Rotterdam. Also, we thank Paul Roos for developing the SpineMarker software during his research internship.

Funding Information:
The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam area, Rotterdam, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR-MDC), Rotterdam. We gratefully acknowledge the contribution of children and parents, general practitioners, hospitals, midwives, and pharmacies in Rotterdam. The general design of the Generation R Study is made possible by financial support from the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam, ZonMw, the Netherlands Organisation for Scientific Research (NWO), and the Ministry of Health, Welfare and Sport. The work of MH was financially supported by a EUR Fellowship grant from the Erasmus University Rotterdam. Also, we thank Paul Roos for developing the SpineMarker software during his research internship.

Funding Information:
SB reports consulting fees from Pfizer, personal fees from OARSI Congress, personal fees from Osteoarthritis & Cartilage, grants from The Netherlands Organisation for Health Research and Development, and grants from Dutch Arthritis Association, outside the submitted work. other authors declare no conflict of interest.

Publisher Copyright:
© 2021, The Author(s).

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Spinopelvic alignment and lumbar vertebral shape in children associations with structural spinal abnormalities and body composition in the generation R studyFinal published version, 1.04 MBLicence: CC BY

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van den Heuvel, M. M., Griffioen, N. E., Achterberg, H. C., Oei, E. H. G., Renkens, J. J. M., Bierma-Zeinstra, S. M. A., & van Middelkoop, M. (2022). Spinopelvic alignment and lumbar vertebral shape in children: associations with structural spinal abnormalities and body composition in the generation R study. European Spine Journal, 31(2), 248-257. https://doi.org/10.1007/s00586-021-07054-1

@article{7fdc7f95bbe54aadbf67268ca41a2dbf,

title = "Spinopelvic alignment and lumbar vertebral shape in children: associations with structural spinal abnormalities and body composition in the generation R study",

abstract = "Purpose: To investigate the spinopelvic alignment and vertebral shape in children, and associations with body composition and structural spinal abnormalities on magnetic resonance imaging (MRI). Methods: We performed a cross-sectional study embedded in the Generation R Study, a prospective population-based birth cohort. Pelvic incidence and vertebral concavity ratios for each lumbar level were determined on sagittal MRI images in 9-year-old children, and structural spinal abnormalities were scored semi-quantitatively. The BMI-SD score was calculated, and body composition was assessed using DXA scans. Associations of pelvic incidence and vertebral concavity ratios with structural abnormalities and body composition measures were assessed using (multilevel) regression analyses. Results: This study included 522 participants (47.7% boys), aged 9.9 years (IQR 9.7–10.0). The mean pelvic incidence was 36.6° (SD 8.0). Vertebral concavity ratios ranged from 0.87 to 0.90, with significantly lower ratios for boys compared to girls. Associations were found for a larger pelvic incidence with decreased disc height [OR 1.03 (95% CI 1.02–1.05)], and a pelvic incidence in the lowest tertile with less disc bulging [OR 0.73 (95% CI 0.56–0.95)]. Increased vertebral concavity ratio was associated with decreased disc height [OR 14.16 (95% CI 1.28–157.13)]. Finally, increased fat-free mass index was associated with a smaller pelvic incidence [adjusted OR 0.85 (95% CI 0.07–1.63)]. Conclusion: The mean pelvic incidence of 9-year-old children is 36.6° on supine MRI images, and a slightly concave shape of the lumbar vertebrae is seen. Spinopelvic alignment is associated with structural spinal abnormalities, and might itself be influenced by the children{\textquoteright}s body composition.",

author = "{van den Heuvel}, {Marleen M.} and Griffioen, {Nathalie E.} and Achterberg, {Hakim C.} and Oei, {Edwin H. G.} and Renkens, {Jeroen J. M.} and Bierma-Zeinstra, {Sita M. A.} and {van Middelkoop}, Marienke",

note = "Funding Information: The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam area, Rotterdam, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR-MDC), Rotterdam. We gratefully acknowledge the contribution of children and parents, general practitioners, hospitals, midwives, and pharmacies in Rotterdam. The general design of the Generation R Study is made possible by financial support from the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam, ZonMw, the Netherlands Organisation for Scientific Research (NWO), and the Ministry of Health, Welfare and Sport. The work of MH was financially supported by a EUR Fellowship grant from the Erasmus University Rotterdam. Also, we thank Paul Roos for developing the SpineMarker software during his research internship. Funding Information: The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam area, Rotterdam, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR-MDC), Rotterdam. We gratefully acknowledge the contribution of children and parents, general practitioners, hospitals, midwives, and pharmacies in Rotterdam. The general design of the Generation R Study is made possible by financial support from the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam, ZonMw, the Netherlands Organisation for Scientific Research (NWO), and the Ministry of Health, Welfare and Sport. The work of MH was financially supported by a EUR Fellowship grant from the Erasmus University Rotterdam. Also, we thank Paul Roos for developing the SpineMarker software during his research internship. Funding Information: SB reports consulting fees from Pfizer, personal fees from OARSI Congress, personal fees from Osteoarthritis & Cartilage, grants from The Netherlands Organisation for Health Research and Development, and grants from Dutch Arthritis Association, outside the submitted work. other authors declare no conflict of interest. Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2022",

month = feb,

doi = "10.1007/s00586-021-07054-1",

language = "English",

volume = "31",

pages = "248--257",

journal = "European Spine Journal",

issn = "0940-6719",

publisher = "Springer-Verlag",

number = "2",

}

van den Heuvel, MM, Griffioen, NE, Achterberg, HC , Oei, EHG , Renkens, JJM , Bierma-Zeinstra, SMA & van Middelkoop, M 2022, 'Spinopelvic alignment and lumbar vertebral shape in children: associations with structural spinal abnormalities and body composition in the generation R study', European Spine Journal, vol. 31, no. 2, pp. 248-257. https://doi.org/10.1007/s00586-021-07054-1

Spinopelvic alignment and lumbar vertebral shape in children: associations with structural spinal abnormalities and body composition in the generation R study. / van den Heuvel, Marleen M.; Griffioen, Nathalie E.; Achterberg, Hakim C. et al.

In: European Spine Journal, Vol. 31, No. 2, 02.2022, p. 248-257.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Spinopelvic alignment and lumbar vertebral shape in children: associations with structural spinal abnormalities and body composition in the generation R study

AU - van den Heuvel, Marleen M.

AU - Griffioen, Nathalie E.

AU - Achterberg, Hakim C.

AU - Oei, Edwin H. G.

AU - Renkens, Jeroen J. M.

AU - Bierma-Zeinstra, Sita M. A.

AU - van Middelkoop, Marienke

N1 - Funding Information: The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam area, Rotterdam, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR-MDC), Rotterdam. We gratefully acknowledge the contribution of children and parents, general practitioners, hospitals, midwives, and pharmacies in Rotterdam. The general design of the Generation R Study is made possible by financial support from the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam, ZonMw, the Netherlands Organisation for Scientific Research (NWO), and the Ministry of Health, Welfare and Sport. The work of MH was financially supported by a EUR Fellowship grant from the Erasmus University Rotterdam. Also, we thank Paul Roos for developing the SpineMarker software during his research internship. Funding Information: The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam area, Rotterdam, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR-MDC), Rotterdam. We gratefully acknowledge the contribution of children and parents, general practitioners, hospitals, midwives, and pharmacies in Rotterdam. The general design of the Generation R Study is made possible by financial support from the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam, ZonMw, the Netherlands Organisation for Scientific Research (NWO), and the Ministry of Health, Welfare and Sport. The work of MH was financially supported by a EUR Fellowship grant from the Erasmus University Rotterdam. Also, we thank Paul Roos for developing the SpineMarker software during his research internship. Funding Information: SB reports consulting fees from Pfizer, personal fees from OARSI Congress, personal fees from Osteoarthritis & Cartilage, grants from The Netherlands Organisation for Health Research and Development, and grants from Dutch Arthritis Association, outside the submitted work. other authors declare no conflict of interest. Publisher Copyright: © 2021, The Author(s).

PY - 2022/2

Y1 - 2022/2

N2 - Purpose: To investigate the spinopelvic alignment and vertebral shape in children, and associations with body composition and structural spinal abnormalities on magnetic resonance imaging (MRI). Methods: We performed a cross-sectional study embedded in the Generation R Study, a prospective population-based birth cohort. Pelvic incidence and vertebral concavity ratios for each lumbar level were determined on sagittal MRI images in 9-year-old children, and structural spinal abnormalities were scored semi-quantitatively. The BMI-SD score was calculated, and body composition was assessed using DXA scans. Associations of pelvic incidence and vertebral concavity ratios with structural abnormalities and body composition measures were assessed using (multilevel) regression analyses. Results: This study included 522 participants (47.7% boys), aged 9.9 years (IQR 9.7–10.0). The mean pelvic incidence was 36.6° (SD 8.0). Vertebral concavity ratios ranged from 0.87 to 0.90, with significantly lower ratios for boys compared to girls. Associations were found for a larger pelvic incidence with decreased disc height [OR 1.03 (95% CI 1.02–1.05)], and a pelvic incidence in the lowest tertile with less disc bulging [OR 0.73 (95% CI 0.56–0.95)]. Increased vertebral concavity ratio was associated with decreased disc height [OR 14.16 (95% CI 1.28–157.13)]. Finally, increased fat-free mass index was associated with a smaller pelvic incidence [adjusted OR 0.85 (95% CI 0.07–1.63)]. Conclusion: The mean pelvic incidence of 9-year-old children is 36.6° on supine MRI images, and a slightly concave shape of the lumbar vertebrae is seen. Spinopelvic alignment is associated with structural spinal abnormalities, and might itself be influenced by the children’s body composition.

AB - Purpose: To investigate the spinopelvic alignment and vertebral shape in children, and associations with body composition and structural spinal abnormalities on magnetic resonance imaging (MRI). Methods: We performed a cross-sectional study embedded in the Generation R Study, a prospective population-based birth cohort. Pelvic incidence and vertebral concavity ratios for each lumbar level were determined on sagittal MRI images in 9-year-old children, and structural spinal abnormalities were scored semi-quantitatively. The BMI-SD score was calculated, and body composition was assessed using DXA scans. Associations of pelvic incidence and vertebral concavity ratios with structural abnormalities and body composition measures were assessed using (multilevel) regression analyses. Results: This study included 522 participants (47.7% boys), aged 9.9 years (IQR 9.7–10.0). The mean pelvic incidence was 36.6° (SD 8.0). Vertebral concavity ratios ranged from 0.87 to 0.90, with significantly lower ratios for boys compared to girls. Associations were found for a larger pelvic incidence with decreased disc height [OR 1.03 (95% CI 1.02–1.05)], and a pelvic incidence in the lowest tertile with less disc bulging [OR 0.73 (95% CI 0.56–0.95)]. Increased vertebral concavity ratio was associated with decreased disc height [OR 14.16 (95% CI 1.28–157.13)]. Finally, increased fat-free mass index was associated with a smaller pelvic incidence [adjusted OR 0.85 (95% CI 0.07–1.63)]. Conclusion: The mean pelvic incidence of 9-year-old children is 36.6° on supine MRI images, and a slightly concave shape of the lumbar vertebrae is seen. Spinopelvic alignment is associated with structural spinal abnormalities, and might itself be influenced by the children’s body composition.

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U2 - 10.1007/s00586-021-07054-1

DO - 10.1007/s00586-021-07054-1

M3 - Article

SN - 0940-6719

VL - 31

SP - 248

EP - 257

JO - European Spine Journal

JF - European Spine Journal

IS - 2

ER -

Spinopelvic alignment and lumbar vertebral shape in children: associations with structural spinal abnormalities and body composition in the generation R study

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