Jang Jee-Soo, Lee Sang-Ho, Min Jun-Hong, Han Kyoung-Mi
Department of Neurosurgery, Gimpo Airport Wooridul Spine Hospital, Seoul, Korea.
Spine (Phila Pa 1976). 2007 Nov 15;32(24):2694-9. doi: 10.1097/BRS.0b013e31815a590b.
Retrospective study of a consecutive patient series.
To review the radiographic classification of patients with sagittal imbalance due to lumbar degenerative kyphosis (LDK) and to determine correlation between thoracic and lumbar curve.
Lumbar degenerative kyphosis is one of the common spinal deformities in Asian countries, especially Korea and Japan. However, there have been few studies regarding the classification and treatment of this disease.
Seventy-eight patients with LDK were analyzed and classified according to the standing lateral whole spine findings. Total lumbar lordosis (L1-S1), thoracic kyphosis (T5-T12), sacral slope, thoracolumbar angle (T11-L1), and sagittal vertical axis (SVA) were measured on the lateral view of the whole spine. Spinal curve deformities were classified into 2 groups according to the thoracolumbar (T-L) junction angle: flat or lordotic angle (Group 1; N = 53) and kyphotic angle (Group 2; N = 25).
In Group 1, significant correlations between the thoracic and lumbar curves (r = 0.772, P < 0.0001), and between the lumbar curve and sacral slope (r = 0.785, P < 0.0001) were observed. By this result, Group 1 was classified as sagittal thoracic compensated group. In contrast, In Group 2, no correlation was found between the thoracic and lumbar curves in the decompensated group (r = 0.179, P = 0.391), but we found a significant correlation between lordosis and sacral slope (r = 0.442, P = 0.027). By this result, Group 2 was classified as sagittal thoracic decompensated group. There was significant difference in SVA between 2 groups (P = 0.020).
The angle of the thoracolumbar junction is an important parameter in determining whether a sagittal thoracic compensatory mechanism exists in LDK. We assumed that existence of a compensatory mechanism in the proximal spine is central to the determination of the fusion levels in the treatment of LDK.
对连续患者系列进行回顾性研究。
回顾因腰椎退行性后凸（LDK）导致矢状面失衡患者的影像学分类，并确定胸段和腰段曲线之间的相关性。
腰椎退行性后凸是亚洲国家，尤其是韩国和日本常见的脊柱畸形之一。然而，关于这种疾病的分类和治疗的研究很少。
根据站立位全脊柱侧位片表现对78例LDK患者进行分析和分类。在全脊柱侧位片上测量腰椎前凸（L1-S1）、胸椎后凸（T5-T12）、骶骨倾斜度、胸腰段角（T11-L1）和矢状垂直轴（SVA）。根据胸腰段（T-L）交界角将脊柱曲线畸形分为两组：平角或前凸角（第1组；N = 53）和后凸角（第2组；N = 2）。
在第1组中，观察到胸段和腰段曲线之间存在显著相关性（r = 0.772，P < 0.0001），以及腰段曲线和骶骨倾斜度之间存在显著相关性（r = 0.785，P < 0.0001）。根据这一结果，第1组被分类为矢状面胸椎代偿组。相比之下，在第2组中，失代偿组的胸段和腰段曲线之间未发现相关性（r = 0.179，P = 0.391），但我们发现前凸和骶骨倾斜度之间存在显著相关性（r = 0.442，P = 0.027）。根据这一结果，第2组被分类为矢状面胸椎失代偿组。两组之间的SVA存在显著差异（P = 0.020）。
胸腰段交界角是确定LDK患者矢状面胸椎代偿机制是否存在的重要参数。我们认为近端脊柱存在代偿机制是确定LDK治疗中融合节段的关键。
