Bae Junseok, Lee Sang-Ho, Shin Sang-Ha, Seo Jin Suk, Kim Kyeong Hwan, Jang Jee-Soo
Department of Neurosurgery, Spine Health Wooridul Hospital, Seoul, Korea.
Department of Orthopedic Surgery, Spine Health Wooridul Hospital, Seoul, Korea.
Eur Spine J. 2016 May;25(5):1382-1388. doi: 10.1007/s00586-016-4382-y. Epub 2016 Jan 27.
A retrospective cross-sectional study was designed to explore the role of spinopelvic sagittal alignment in upper lumbar disc herniation (ULD) development.
A total of 207 consecutive patients who underwent surgery for single-level lumbar disc herniation [24 with ULD and 183 with lower lumbar disc herniation (LLD)] and 40 asymptomatic volunteers were enrolled. Full-length radiographs of the spine were taken to evaluate pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertical axis (SVA). The Roussouly classification was utilized to categorize all subjects according to their sagittal alignment. Spinopelvic parameters and Roussouly classification results were compared between groups.
There were significant differences in PI, SS, PT, LL, and SVA between the ULD, LLD, and control groups. PI in the ULD (40.9°) was significantly lower than in the LLD and control groups (48.8° and 47.6°, respectively). LL was significantly lower in the ULD than in the LLD (-32.4° and -40°, respectively). There were significant differences between the three groups in Roussouly types. The LLD had a significantly higher proportion (62.6 %) of type 2 lordosis (flat back), and the ULD had a higher proportion (33.3 %) of type 1 lordosis than the other groups.
This study demonstrated the importance of PI and lumbar curvature in the pathogenesis of ULD. The higher prevalence of short LL and long TK with low PI in the ULD group implies that an increased mechanical stress at this level may be one of the risk factors of ULD.
设计一项回顾性横断面研究，以探讨脊柱骨盆矢状面排列在上腰椎间盘突出症（ULD）发生发展中的作用。
共纳入207例连续接受单节段腰椎间盘突出症手术的患者[24例为ULD，183例为下腰椎间盘突出症（LLD）]以及40例无症状志愿者。拍摄全脊柱X线片，以评估骨盆入射角（PI）、骶骨倾斜角（SS）、骨盆倾斜角（PT）、胸椎后凸角（TK）、腰椎前凸角（LL）和矢状垂直轴（SVA）。采用鲁索利分类法根据矢状面排列对所有受试者进行分类。比较各组间的脊柱骨盆参数和鲁索利分类结果。
ULD组、LLD组和对照组之间的PI、SS、PT、LL和SVA存在显著差异。ULD组的PI（40.9°）显著低于LLD组和对照组（分别为48.8°和47.6°）。ULD组的LL显著低于LLD组（分别为-32.4°和-40°）。三组在鲁索利类型上存在显著差异。LLD组中2型前凸（平背）的比例显著更高（62.6%），而ULD组中1型前凸的比例高于其他组（33.3%）。
本研究证明了PI和腰椎曲度在ULD发病机制中的重要性。ULD组中短LL和长TK且低PI的患病率较高，这意味着该水平机械应力增加可能是ULD的危险因素之一。
