A study on sagittal balance disorders and structural factors in degenerative lumbar spine_West China Medical Journal

Authors：

 WANG Yi , DAI Guogang , HUANG Lei , LIU Jianwei , ZHOU Rui , WEI Hao , WANG Feng , LIAO Shichuan

Neck-shoulder and Lumbocrural Pain Division 2, Sichuan Orthopaedic Hospital, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WANG Yi, Email: 55940007@qq.com

Keywords：

Lumbar degenerative disease; Sagittal parameters; Lumbar disc degeneration; Lumbar zygapophyseal joint degeneration

DOI：

10.7507/1002-0179.201507157

Video：

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Objective To explore the relationship between imbalance in sagittal plane as well as structural factors and lumbar degenerative disease. Methods Patients diagnosed between July 2012 and May 2015 were divided into 4 groups according to corresponding diagnostic criteria: lumbar disc herniation group (LDH), lumbar disc protrusion group (LDP), degenerative lumbar spondylisthesis group (DLS) and nonspecific low back pain group (NLBP); 40 patients were included in each group according to their visiting time. All patients underwent X-ray, CT, and MRI. Sagittal parameters and evaluate degeneration level of structural factors were measured, and the difference among the groups were analyzed. Results There was statistical significance in differences of pelvic incidence (PI) and lumbar lordosis (LL) among 4 groups (P<0.05). Average PI was followed in descending order: DLS, LDP, NLBP, and LDH; average LL was followed in descending order: DLS, NLBP, LDP, and LDH. There was no statistical differences in sacral slope and pelvic tilting among 4 groups (P>0.05). The difference in the level of lumbar disc degeneration between NLBP group (which had slightest lumbar disc degeneration) and the other groups was significant (P<0.001) while no statistical differences in level and rate of lumbar disc degeneration among the other three groups was found (P>0.05). As to the level of lumbar zygapophyseal joint degeneration, there was statistical differences between NLBP group (which had the lowest level of lumbar zygapophyseal joint degeneration) and the other groups (P<0.001) while no statistical differences in the grade of lumbar zygapophyseal joint degeneration among the other three groups (P>0.05). There was statistical differences in the rate of lumbar zygapophyseal joint degeneration between LDH and DLS group (χ²=11.429,P=0.001). Conclusions Vertical lunbar spine is combined with LDH of which the level of lumbar zygapophyseal joint degeneration is minimized, while crooked lunbar spine is combined with DLS of which the level of lumbar zygapophyseal joint degeneration is maximization. NLBP has the lowest level of degeneration of lumbar disc and lumbar zygapophyseal joint degeneration.

Citation： WANG Yi, DAI Guogang, HUANG Lei, LIU Jianwei, ZHOU Rui, WEI Hao, WANG Feng, LIAO Shichuan. A study on sagittal balance disorders and structural factors in degenerative lumbar spine. West China Medical Journal, 2017, 32(4): 529-533. doi: 10.7507/1002-0179.201507157 Copy

1.	杨曦, 宋跃明. 脊柱-骨盆矢状位曲度对腰椎退变性疾病的影响. 中国脊柱脊髓杂志, 2013, 23(10): 935-939.
2.	Janssen M, Drevelle X, Humbert L, et al. Differences in male and female spino-pelvic alignment in asymptomatic young adults: a three-dimensional analysis using upright low-dose digital biplanar X-rays. Spine (Phila Pa 1976), 2009, 34(23): E826-E832.
3.	康信勇, 徐荣明.脊柱-骨盆矢状面力线参数与腰椎退行性疾病的关系. 中医正骨, 2014, 26(4): 40-42.
4.	Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J, 2011, 20(Suppl 5): 609.
5.	Barrey C, Roussouly P, Perrin G, et al. Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms. Eur Spine J, 2011, 20(Suppl 5): 626-633.
6.	中华医学会. 临床诊疗指南-骨科学分册. 北京: 人民卫生出版社, 2009.
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8.	Pfirrmann CW, Metzdorf A, Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976), 2001, 26(17): 1873-1878.
9.	Weishaupt D, Zanetti M, Boos N, et al. Mr imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol, 1999, 28(4): 215-219.
10.	范国明, 陈其昕. 龚遂良, 等. 影响正常人群骨盆入射角调节脊柱骨盆矢状面平衡的因素. 中国临床解剖学杂志, 2010, 28(4): 409-412.
11.	Mac-Thiong JM, Labelle H, Berthonnaud E, et al. Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J, 2007, 16(2): 227-234.
12.	Mac-Thiong JM, Berthonnaud E, Dimar R, et al. Sagittal alignment of the spine and pelvis during growth. Spine (Phila Pa 1976), 2004, 29(15): 1642-1647.
13.	Aono K, Kobayashi T, Jimbo S, et al. Radiographic analysis of newly developed degenerative spondylolisthesis in a mean twelve-year prospective study. Spine (Phila Pa 1976), 2010, 35(8): 887-891.
14.	刘辉, 希腊本大, 郑召民, 等. 腰椎间盘退变与脊柱-骨盆矢状面平衡的相关性. 中华医学杂志, 2013, 93(15): 1123-1128.
15.	Barrey C, Jund J, Noseda O, et al. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J, 2007, 16(9): 1459-1467.
16.	Endo K, Suzuki H, Tanaka H, et al. Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J, 2010, 19(3): 435-438.
17.	Upasani VV, Tis J, Bastrom T, et al. Analysis of sagittal alignment in thoracic and thoracolumbar curves in adolescent idiopathic scoliosis: how do these two curve types differ?. Spine (Phila Pa 1976), 2007, 32(12): 1355-1359.
18.	Labelle H, Roussouly P, Berthonnaud E, et al. Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine (Phila Pa 1976), 2004, 29(18): 2049-2054.
19.	Hanson S, Bridwell H, Rhee M, et al. Correlation of pelvic incidence with low-and high-grade isthmic spondylolisthesis. Spine (Phila Pa 1976), 2002, 27(18): 2026-2029.
20.	Boden SD, Riew KD, Yamaguchi K, et al. Orientation of the lumbar facet joints: association with degenerative disc disease. J Bone Joint Surg Am, 1996, 78(3): 403-411.
21.	Kalichman L, Suri P, Guermazi A, et al. Facet orientation and tropism: associations with facet joint osteoarthritis and degeneratives. Spine (Phila Pa 1976), 2009, 34(16): E579-E585.

1. 杨曦, 宋跃明. 脊柱-骨盆矢状位曲度对腰椎退变性疾病的影响. 中国脊柱脊髓杂志, 2013, 23(10): 935-939.
2. Janssen M, Drevelle X, Humbert L, et al. Differences in male and female spino-pelvic alignment in asymptomatic young adults: a three-dimensional analysis using upright low-dose digital biplanar X-rays. Spine (Phila Pa 1976), 2009, 34(23): E826-E832.
3. 康信勇, 徐荣明.脊柱-骨盆矢状面力线参数与腰椎退行性疾病的关系. 中医正骨, 2014, 26(4): 40-42.
4. Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J, 2011, 20(Suppl 5): 609.
5. Barrey C, Roussouly P, Perrin G, et al. Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms. Eur Spine J, 2011, 20(Suppl 5): 626-633.
6. 中华医学会. 临床诊疗指南-骨科学分册. 北京: 人民卫生出版社, 2009.
7. 陈孝平. 外科学(下册). 2版. 北京: 人民卫生出版社, 2010.
8. Pfirrmann CW, Metzdorf A, Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976), 2001, 26(17): 1873-1878.
9. Weishaupt D, Zanetti M, Boos N, et al. Mr imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol, 1999, 28(4): 215-219.
10. 范国明, 陈其昕. 龚遂良, 等. 影响正常人群骨盆入射角调节脊柱骨盆矢状面平衡的因素. 中国临床解剖学杂志, 2010, 28(4): 409-412.
11. Mac-Thiong JM, Labelle H, Berthonnaud E, et al. Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J, 2007, 16(2): 227-234.
12. Mac-Thiong JM, Berthonnaud E, Dimar R, et al. Sagittal alignment of the spine and pelvis during growth. Spine (Phila Pa 1976), 2004, 29(15): 1642-1647.
13. Aono K, Kobayashi T, Jimbo S, et al. Radiographic analysis of newly developed degenerative spondylolisthesis in a mean twelve-year prospective study. Spine (Phila Pa 1976), 2010, 35(8): 887-891.
14. 刘辉, 希腊本大, 郑召民, 等. 腰椎间盘退变与脊柱-骨盆矢状面平衡的相关性. 中华医学杂志, 2013, 93(15): 1123-1128.
15. Barrey C, Jund J, Noseda O, et al. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J, 2007, 16(9): 1459-1467.
16. Endo K, Suzuki H, Tanaka H, et al. Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J, 2010, 19(3): 435-438.
17. Upasani VV, Tis J, Bastrom T, et al. Analysis of sagittal alignment in thoracic and thoracolumbar curves in adolescent idiopathic scoliosis: how do these two curve types differ?. Spine (Phila Pa 1976), 2007, 32(12): 1355-1359.
18. Labelle H, Roussouly P, Berthonnaud E, et al. Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine (Phila Pa 1976), 2004, 29(18): 2049-2054.
19. Hanson S, Bridwell H, Rhee M, et al. Correlation of pelvic incidence with low-and high-grade isthmic spondylolisthesis. Spine (Phila Pa 1976), 2002, 27(18): 2026-2029.
20. Boden SD, Riew KD, Yamaguchi K, et al. Orientation of the lumbar facet joints: association with degenerative disc disease. J Bone Joint Surg Am, 1996, 78(3): 403-411.
21. Kalichman L, Suri P, Guermazi A, et al. Facet orientation and tropism: associations with facet joint osteoarthritis and degeneratives. Spine (Phila Pa 1976), 2009, 34(16): E579-E585.

West China Medical Journal

A study on sagittal balance disorders and structural factors in degenerative lumbar spine

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