Kim Youngbae B, Kim Yongjung J, Ahn Young-Joon, Kang Gyu-Bok, Yang Jae-Hyuk, Lim Hyungtae, Lee Seung-Won
Department of Orthopedic Surgery, Seoul Veterans Hospital, 6-2 Dunchon-dong, Gangdong-gu, Seoul, 134-791, Korea.
Eur Spine J. 2014 Jul;23(7):1400-6. doi: 10.1007/s00586-014-3236-8. Epub 2014 Mar 9.
The purpose of this study was to compare the sagittal spinopelvic parameters between young normal asymptomatic adults and older normal asymptomatic adults without localized segmental disc degeneration.
Standing sagittal radiographs of the whole spine including the pelvis in 342 adult male volunteers (Group 1: n = 184, average age 21.2 years, range 19-28 vs. Group 2: n = 158, average age 63.8 years, range 53-79) were analyzed prospectively. Volunteers with history of spine operation, spinal disease, chronic pain in their back or legs, scoliosis, spondylolisthesis, 1-3 segmental disc space narrowing, and/or compression fractures in radiographs were excluded. The following parameters were included: thoracic kyphosis between T5 upper endplate (UEP) and T12 lower endplate (LEP), thoracolumbar kyphosis (T10 UEP - L2 LEP), T12 LEP-horizontal (H) angle (minus denotes EP above the H line), lumbar lordosis (T12 LEP - S1 UEP), lower lumbar lordosis (L4 UEP - S1 UEP), sacral slope, pelvic incidence and distances from C7 plumb/T12 plumb to the postero-superior endplate of S1. Group 2 (old men group) demonstrated larger thoracic kyphosis (30.1° ± 8.6° vs. 21.1° ± 7.8° in Group 1, P < 0.001), thoracolumbar kyphosis (10.0° ± 7.5° vs. 2.8° ± 7.1° in Group 1, P < 0.001), total lumbar lordosis at T12-S1 (57.3° ± 8.8° vs. 52.2° ± 9.2° in Group 1, P < 0.001), lower lumbar lordosis at L4-S1 (39.4° ± 6.7° vs. 32.4° ± 6.4° in Group 1, P < 0.001), a higher ratio of lower to total lumbar lordosis (69.5 ± 11.6 vs. 62.7 ± 10.6 % in Group 1, P < 0.001) and T12 LEP-H angle (-20.4° ± 5.7° vs. -15.7° ± 5.1° in Group 1, P < 0.001). There were no significant differences in sacral slope (36.5° ± 7.3° in Group 1 vs. 36.8° ± 6.7° in Group 2, P = 0.67) and pelvic incidence (46.5° ± 7.7° in Group 1 vs. 48.2° ± 8.5° in Group 2, P = 0.06). There was no significant difference in the measurement of distance from C7 plumb to the postero-superior endplate of S1 (-0.7 ± 2.4 cm in Group 1 vs. -0.3 ± 2.7 cm in Group 2, P = 0.197). However, the distance from T12 plumb to the postero-superior endplate of S1 (-0.7 ± 1.7 cm in Group 1 vs. -2.2 ± 1.7 cm in Group 2, P < 0.001) demonstrated a significant difference.
The old men group demonstrated a significant increase in thoracic kyphosis, thoracolumbar kyphosis, total and lower lumbar lordosis, a higher ratio of lower to total lumbar lordosis, and a longer distance from T12 plumb to the postero-superior endplate of S1 without changes in sacral slope and global sagittal balance.
本研究的目的是比较年轻正常无症状成年人与无局部节段性椎间盘退变的老年正常无症状成年人之间的矢状位脊柱-骨盆参数。
前瞻性分析了342名成年男性志愿者（第1组：n = 184，平均年龄21.2岁，范围19 - 28岁；第2组：n = 158，平均年龄63.8岁，范围53 - 79岁）包括骨盆的全脊柱站立位矢状位X线片。排除有脊柱手术史、脊柱疾病、腰或腿部慢性疼痛、脊柱侧弯、椎体滑脱、1 - 3节段椎间盘间隙变窄和/或X线片显示压缩性骨折的志愿者。纳入以下参数：T5上端椎（UEP）至T12下端椎（LEP）之间的胸椎后凸、胸腰段后凸（T10 UEP - L2 LEP）、T12 LEP水平（H）角（负值表示EP在H线以上）、腰椎前凸（T12 LEP - S1 UEP）、下腰椎前凸（L4 UEP - S1 UEP）、骶骨倾斜度、骨盆入射角以及从C7铅垂线/T12铅垂线至S1后上终板的距离。第2组（老年男性组）显示出更大的胸椎后凸（30.1°±8.6°，第1组为21.1°±7.8°，P < 0.001）、胸腰段后凸（10.0°±7.5°，第1组为2.8°±7.1°，P < 0.001）、T12 - S1节段的总腰椎前凸（57.3°±8.8°，第1组为52.2°±9.2°，P < 0.001）、L4 - S1节段的下腰椎前凸（39.4°±6.7°，第1组为32.4°±6.4°，P < 0.001）、下腰椎前凸与总腰椎前凸的更高比例（69.5±11.6，第1组为62.7±10.6%，P < 0.001）以及T12 LEP - H角（-20.4°±5.7°，第1组为-15.7°±5.1°，P < 0.001）。骶骨倾斜度（第1组为36.5°±7.3°，第2组为36.8°±6.7°，P = 0.67）和骨盆入射角（第1组为46.5°±7.7°，第2组为48.2°±8.5°，P = 0.06）无显著差异。从C7铅垂线至S1后上终板的距离测量无显著差异（第1组为-0.7±2.4 cm，第2组为-0.3±2.7 cm，P = 0.197）。然而，从T12铅垂线至S1后上终板的距离（第1组为-0.7±1.7 cm，第2组为-2.2±1.7 cm，P < 0.001）显示出显著差异。
老年男性组显示胸椎后凸、胸腰段后凸、总腰椎前凸和下腰椎前凸显著增加，下腰椎前凸与总腰椎前凸的比例更高，且从T12铅垂线至S1后上终板的距离更长，而骶骨倾斜度和整体矢状位平衡无变化。
