Sagittal Plane Alignment and Deformities in Growing Children

Physiologic sagittal plane alignment in healthy children evolves with age as pelvic incidence, pelvic tilt, thoracic kyphosis, and lumbar lordosis all increasing during childhood and reach typical adult values by the adolescent years. Sagittal plane alignment in children with scoliosis demonstrates increased pelvic tilt and decreased sacral slope as compared to children without scoliosis; however, pelvic incidence, thoracic kyphosis, and lumbar lordosis are similar. A variety of etiologies including postural kyphosis, Scheuermann’s condition, congenital kyphosis, myelodysplasia, postinfectious, posttraumatic, syndromic, and postsurgical can result in alterations in the sagittal plane alignment of growing children. Each of these etiologies is unique and treatment of each of these conditions is individualized. An evolving understanding of sagittal plane alignment and of the measurement of spine growth is improving our knowledge of the effects of surgery on sagittal plane alignment in children.