Retrospective cohort study.
Evaluate the effects of parity
(number of births) on measures of sagittal posture in elderly women. The long-term objective of this study is to identify and mitigate factors contributing to age-related postural deformity in older adults.
Summary of Background Data.
Adult spinal deformity is a prevalent condition that often requires costly surgical management. Females
are disproportionately represented in spinal deformity surgical cases with up to 90% of patients being women. The potential contributions of pregnancy on postural degeneration
have only begun to be acknowledged and require further study.
Two hundred eight women with standing lateral radiographs were selected from the TwinsUK register. Parity
information was extracted from questionnaires. Sagittal balance measurements (thoracic kyphosis
, lumbar lordosis
[LL], pelvic incidence
[PI]) were collected and PI-LL mismatch was calculated. One-way analysis of variance tests were done between three separate age categories for measures of sagittal balance and parity
and stepwise multivariate regression was done for PI-LL.
Both age and PI-LL mismatch significantly differed between parity
categories. PI-LL was on average 7.0° ± 2.5° greater in multiparous (3+ births) subjects than in nulliparous subjects (P
< 0.01). Parity
did not have an independent relationship with lumbar disc degeneration, lumbar bone mineral density, or any of the individual sagittal balance parameters (P
> 0.05 for all), except for PI-LL. From a subanalysis of the effect of parity
on sagittal alignment within twin pairs, we found that within pair differences in parity
associate with within pair differences in thoracic kyphosis
This study established correlations between measures of spinal curvature
in older women and parity
for the first time. Longitudinal research is required to establish a causative relationship.
Level of Evidence: 4