{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:10:03Z","timestamp":1790802603539,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,1,27]],"date-time":"2017-01-27T00:00:00Z","timestamp":1485475200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Anatomy"],"published-print":{"date-parts":[[2017,5]]},"abstract":"Abstract<\/jats:title>\n \n Human beings stand upright with the chain of balance beginning at the feet, progressing to the lower limbs (ankles, knees, hip joints, pelvis), each of the spinal segments, and then ending at the cranium to achieve horizontal gaze and balance using minimum muscle activity. The details of the alignment and balance of the chain, however, are not clearly understood, due to the lack of information regarding the three\u2010dimensional (3D) orientation of all bony elements in relation to the gravity line (\n GL<\/jats:styled-content>\n ). We performed a clinical study to clarify the standing sagittal alignment of whole axial skeletons in reference to the\n GL<\/jats:styled-content>\n using the\n EOS<\/jats:styled-content>\n slot\u2010scanning 3D X\u2010ray imaging system with simultaneous force plate measurement in a healthy human population. The\n GL<\/jats:styled-content>\n was defined as a vertical line drawn through the centre of vertical pressure measured by the force plate. The present study yielded a complete set of physiological alignment measurements of the standing axial skeleton from the database of 136 healthy subjects (a mean age of 39.7 years, 20\u201369 years; men: 40, women: 96). The mean offset of centre of the acoustic meati from the\n GL<\/jats:styled-content>\n was 0.0 cm. The offset of the cervical and thoracic vertebrae was posterior to the\n GL<\/jats:styled-content>\n with the apex of thoracic kyphosis at T7, 5.0 cm posterior to the\n GL<\/jats:styled-content>\n . The sagittal alignment changed to lordosis at the level of L2. The apex of the lumbar lordosis was L4, 0.6 cm anterior to the\n GL<\/jats:styled-content>\n , and the centre of the base of the sacrum (\n CBS<\/jats:styled-content>\n ) was just posterior to the\n GL<\/jats:styled-content>\n . The hip axis (HA) was 1.4 cm anterior to the\n GL<\/jats:styled-content>\n . The knee joint was 2.4 cm posterior and the ankle joint was 4.8 cm posterior to the\n GL<\/jats:styled-content>\n . L4\u2010, L5\u2010 and the\n CBS<\/jats:styled-content>\n \u2010offset in subjects in the age decades of 40s, 50s and 60s were significantly posterior to those of subjects in their 20s. The L5\u2010 and\n CBS<\/jats:styled-content>\n \u2010offset in subjects in their 50s and 60s were also significantly posterior to those in subjects in their 30s. HA was never posterior to the\n GL<\/jats:styled-content>\n . In the global alignment, there was a positive correlation between offset of C7 vertebra from the sagittal vertical axis (a vertical line drawn through the posterior superior corner of the sacrum in the sagittal plane) and age, but no correlation was detected between the\u00a0centre of the acoustic meati\u2010\n GL<\/jats:styled-content>\n offset and age. Cervical lordosis (\n CL<\/jats:styled-content>\n ), pelvic tilt (\n PT<\/jats:styled-content>\n ), pelvic incidence, hip\u00a0extension, knee flexion and ankle dorsiflexion increased significantly with age. Our results revealed that\u00a0aging induces trunk stooping, but the global alignment is compensated for by an increase in the CL, PT and knee flexion, with the main function of\n CL<\/jats:styled-content>\n and\n PT<\/jats:styled-content>\n to maintain a horizontal gaze in a healthy population.\n <\/jats:p>","DOI":"10.1111\/joa.12586","type":"journal-article","created":{"date-parts":[[2017,1,27]],"date-time":"2017-01-27T02:34:23Z","timestamp":1485484463000},"page":"619-630","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":132,"title":["Standing sagittal alignment of the whole axial skeleton with reference to the gravity line in humans"],"prefix":"10.1111","volume":"230","author":[{"given":"Kazuhiro","family":"Hasegawa","sequence":"first","affiliation":[{"name":"Niigata Spine Surgery Center Niigata 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