Liu Hui, Shrivastava Shilabant Rajesh, Zheng Zhao-min, Wang Jian-ru, Yang Hao, Li Ze-min, Wang Tai-ping, Wang Hua, Utsab Shrestha
Department of Spine Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Zhonghua Yi Xue Za Zhi. 2013 Apr 16;93(15):1123-8.
To elucidate the relationship between spino-pelvic sagittal balance parameters and lumbar intervertebral disc degeneration of each segment through retrospective analysis in lumbar degeneration patients.
Retrospective analysis was conducted for the follow-up data in 126 patients with lumbar degenerative disease from July 2009 to June 2012. There were 38 cases with whole spine plates and 88 cases with lumbar plates. All of them received magnetic resonance imaging (MRI) scans. Through software Image J, the following spino-pelvic sagittal balance parameters were measured: sagittal vertical axis (SVA, distance between C7 plumb line and posterior upper corner of S1 endplate), thoracic kyphosis (TK, T5-T12 Cobb angle), thoracolumbar kyphosis (TLK, T10-L2 Cobb angle), lumbar lordosis (LL, L1-L5 Cobb angle), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), T1 spino-pelvic inclination (T1-SPI), T9 spino-pelvic inclination (T9-SPI), spino-sacral angle (SSA), spino-pelvic angle (SPA) and C7 tilt (C7T). Based on the grading system of Pfirrmann et al, the intervertebral disc degeneration grades were acquired for each lumbar segment. According to the normal range of previous studies, each spino-pelvic sagittal balance parameter was classified into 3 groups, i.e. Group A (less than normal), Group B (normal) and Group C (more than normal). All statistical analyses were performed to compare the differences of each lumbar segment/intervertebral disc degeneration among groups by one-way ANOVA test via SPSS 18.0. And P-value < 0.05 was deemed significant.
PI had a significant impact on the L5/S1 disc degeneration. And L5/S1 disc degeneration had a significant impact on sagittal balance. Among 57 cases of large PI, LL, PT, SS, SVA, C7T, SPA in L5/S1 of mild-to-moderate and severe degeneration groups was 36.91 ± 14.93 and 29.71 ± 11.30 (P = 0.045), 18.82 ± 8.27 and 25.18 ± 10.19 (P = 0.012), 39.45 ± 8.82 and 34.57 ± 8.88 (P = 0.042), 23.04 ± 26.63 and 62.15 ± 33.82 (P = 0.002), 88.85 ± 3.13 and 83.98 ± 4.62 (P = 0.003), 157.88 ± 11.20 and 147.75 ± 13.98 (P = 0.043) respectively. TLK in L1/L2 with mild-to-moderate and severe degeneration groups was 4.59 ± 7.81 and 14.91 ± 14.75 (P = 0.026). All of L1/L2, L2/L3 and L3/L4 disc degeneration had a significant impact on SPA. SPA in L1/L2, L2/L3, and L3/L4 with mild-to-moderate and severe degeneration groups was 158.47 ± 11.97 and 147.84 ± 12.72 (P = 0.031), 159.91 ± 10.78 and 148.75 ± 13.17 (P = 0.024), 158.46 ± 10.86 and 148.61 ± 13.93 (P = 0.047) respectively.
With an important impact on lumbar disc degeneration, PI, either too big or too small, may predispose to the occurrences of lumbar disc degeneration. L5/S1 disc degeneration has a significant impact on pelvis postural parameters (PT, SS). L5/S1 degeneration is a key causative factor of pelvic posterior rotation and compensatory process. L5/S1 disc degeneration has an important impact on pelvis overall parameters (SVA, SPA, C7T). And the degeneration of L5/S1 is a key cause of trunk imbalance.
通过对腰椎退变患者的回顾性分析，阐明脊柱 - 骨盆矢状面平衡参数与各节段腰椎间盘退变之间的关系。
对2009年7月至2012年6月期间126例腰椎退行性疾病患者的随访资料进行回顾性分析。其中全脊柱钢板固定患者38例，腰椎钢板固定患者88例。所有患者均接受磁共振成像（MRI）扫描。通过Image J软件测量以下脊柱 - 骨盆矢状面平衡参数：矢状垂直轴（SVA，C7铅垂线与S1终板后上角之间的距离）、胸椎后凸（TK，T5 - T12 Cobb角）、胸腰段后凸（TLK，T10 - L2 Cobb角）、腰椎前凸（LL，L1 - L5 Cobb角）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、T1脊柱 - 骨盆倾斜角（T1 - SPI）、T9脊柱 - 骨盆倾斜角（T9 - SPI）、脊柱 - 骶骨角（SSA）、脊柱 - 骨盆角（SPA）和C7倾斜角（C7T）。根据Pfirrmann等人的分级系统，获取每个腰椎节段的椎间盘退变等级。根据以往研究的正常范围，将每个脊柱 - 骨盆矢状面平衡参数分为3组，即A组（低于正常）、B组（正常）和C组（高于正常）。通过SPSS 18.0软件进行单因素方差分析，比较各组间各腰椎节段/椎间盘退变的差异。P值<0.05被认为具有统计学意义。
PI对L5/S1椎间盘退变有显著影响。并且L5/S1椎间盘退变对矢状面平衡有显著影响。在57例PI较大的患者中，轻度至中度和重度退变组L5/S1的LL、PT、SS、SVA、C7T、SPA分别为36.91±14.93和29.71±11.30（P = 0.045），18.82±8.27和25.18±10.19（P = 0.012），39.45±8.82和34.57±8.88（P = 0.042），23.04±26.63和62.15±33.82（P = 0.002），88.85±3.13和83.98±4.62（P = 0.003），157.88±11.20和147.75±13.98（P = 0.043）。轻度至中度和重度退变组L1/L2的TLK分别为4.59±7.81和14.91±14.75（P = 0.026）。L1/L2、L2/L3和L3/L4椎间盘退变均对SPA有显著影响。轻度至中度和重度退变组L1/L2、L2/L3和L3/L4的SPA分别为158.47±11.97和147.84±12.72（P = 0.031），159.91±10.78和148.75±13.17（P = 0.024），158.46±10.86和148.61±13.93（P = 0.047）。
PI对腰椎间盘退变有重要影响，过大或过小都可能易导致腰椎间盘退变的发生。L5/S1椎间盘退变对骨盆姿势参数（PT、SS）有显著影响。L5/S1退变是骨盆后旋及代偿过程的关键致病因素。L5/S1椎间盘退变对骨盆整体参数（SVA、SPA、C7T）有重要影响。并且L5/S1退变是躯干失衡的关键原因。
