Labelle Hubert, Roussouly Pierre, Berthonnaud Eric, Dimnet Joannès, O'Brien Michael
Sainte-Justine Mother-Child University Health Centre, University of Montreal, Montreal, Quebec, Canada.
Spine (Phila Pa 1976). 2005 Mar 15;30(6 Suppl):S27-34. doi: 10.1097/01.brs.0000155560.92580.90.
A review article.
The purpose of this article is to review pertinent radiologic measurements for the evaluation of spino-pelvic balance in developmental spondylolisthesis, based on the experience of the Spinal Deformity Study Group.
Over the past decade, pelvic morphology has been shown to significantly influence spino-pelvic balance of the human trunk in normal and pathologic conditions. This finding has important implications for the evaluation and treatment of developmental spondylolisthesis and has fostered a renewed interest in the radiologic evaluation of spino-pelvic balance in this condition.
The lateral standing radiographs of the spine and pelvis of subjects with developmental L5-S1 spondylolisthesis were analyzed with a dedicated software allowing the calculation of the following parameters: pelvic incidence, sacral slope, pelvic tilt, L5 incidence angle, lumbosacral angle, lumbar lordosis, thoracic kyphosis, and grade of spondylolisthesis. All measurements were done by the same individual and compared to those of an adult and child reference population.
The pelvic shape, best quantified by the pelvic incidence angle, determines the position of the sacral endplate. The spine reacts to this position by adapting through lumbar lordosis, the amount of lordosis increasing as the sacral slope increases in order to balance the trunk in the upright position. Pelvic incidence, sacral slope, pelvic tilt, and lumbar lordosis are found to be significantly greater in subjects with developmental spondylolisthesis, while thoracic kyphosis is significantly lower when compared to a reference population. Furthermore, the differences between the two populations increase in a direct linear fashion as the severity of the spondylolisthesis increases, suggesting that pelvic anatomy has a direct influence on the development of a spondylolisthesis. Studies also indicate that pelvic incidence is unaffected by surgical reduction and instrumentation. Pelvic tilt, sacral slope, and thoracic kyphosis are slightly affected, while grade, L5 incidence angle, lumbosacral angle, and shape of the lumbar spine are significantly improved after surgery. A postoperative improvement in L5 incidence angle and lumbosacral angle appears correlated with a better outcome while subjects with a poor outcome have a higher preoperative grade.
Spino-pelvic balance in the sagittal plane can be considered as an open linear chain linking the head to the pelvis where the shape and orientation of each successive anatomic segment are closely related and influence the adjacent segment. Pelvic morphology and spino-pelvic balance are abnormal in developmental spondylolisthesis. These abnormalities should be quantified on lateral standing radiographs of the spine and pelvis and have important implications for the evaluation and treatment of this pathologic condition.
一篇综述文章。
本文旨在基于脊柱畸形研究小组的经验，综述用于评估发育性腰椎滑脱症中脊柱 - 骨盆平衡的相关放射学测量方法。
在过去十年中，已表明骨盆形态在正常和病理情况下对人体躯干的脊柱 - 骨盆平衡有显著影响。这一发现对发育性腰椎滑脱症的评估和治疗具有重要意义，并重新激发了人们对这种情况下脊柱 - 骨盆平衡放射学评估的兴趣。
使用专门软件分析发育性L5 - S1腰椎滑脱症患者的脊柱和骨盆站立位侧位X线片，计算以下参数：骨盆入射角、骶骨倾斜度、骨盆倾斜角、L5入射角、腰骶角、腰椎前凸、胸椎后凸和腰椎滑脱分级。所有测量均由同一人完成，并与成人和儿童参考人群的测量结果进行比较。
骨盆形态，以骨盆入射角最佳量化，决定了骶骨终板的位置。脊柱通过腰椎前凸来适应这一位置，随着骶骨倾斜度增加，前凸量增加，以便在直立位平衡躯干。发现发育性腰椎滑脱症患者的骨盆入射角、骶骨倾斜度、骨盆倾斜角和腰椎前凸显著更大，而与参考人群相比，胸椎后凸显著更低。此外，随着腰椎滑脱症严重程度增加，这两个人群之间的差异呈直接线性增加，表明骨盆解剖结构对腰椎滑脱症的发展有直接影响。研究还表明，骨盆入射角不受手术复位和内固定的影响。骨盆倾斜角、骶骨倾斜度和胸椎后凸受轻微影响，而分级、L5入射角、腰骶角和腰椎形态在术后显著改善。术后L5入射角和腰骶角的改善似乎与更好的预后相关，而预后较差的患者术前分级更高。
矢状面的脊柱 - 骨盆平衡可被视为一个开放的线性链条，将头部与骨盆相连，其中每个连续解剖节段的形状和方向密切相关并影响相邻节段。发育性腰椎滑脱症中骨盆形态和脊柱 - 骨盆平衡异常。这些异常应在脊柱和骨盆站立位侧位X线片上进行量化，对这种病理状况的评估和治疗具有重要意义。
