Lee Chang-Hyun, Chung Chun Kee, Jang Jee-Soo, Kim Sung-Min, Chin Dong-Kyu, Lee Jung-Kil
Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2017 Mar;60(2):125-129. doi: 10.3340/jkns.2016.0607.001. Epub 2017 Mar 1.
Lumbar degenerative kyphosis (LDK) is a subgroup of the flat-back syndrome and is most commonly caused by unique life styles, such as a prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Unfortunately, LDK has been used as a byword for degenerative sagittal imbalance, and this sometimes causes confusion. The aim of this review was to evaluate the exact territory of LDK, and to introduce another appropriate term for degenerative sagittal deformity. Unlike what its name suggests, LDK does not only include sagittal balance disorder of the lumbar spine and kyphosis, but also sagittal balance disorder of the whole spine and little lordosis of the lumbar spine. Moreover, this disease is closely related to the occupation of female farmers and an outdated Asian life style. These reasons necessitate a change in the nomenclature of this disorder to prevent misunderstanding. We suggest the name "primary degenerative sagittal imbalance" (PDSI), which encompasses degenerative sagittal misalignments of unknown origin in the whole spine in older-age patients, and is associated with back muscle wasting. LDK may be regarded as a subgroup of PDSI related to an occupation in agriculture. Conservative treatments such as exercise and physiotherapy are recommended as first-line treatments for patients with PDSI, and surgical treatment is considered only if conservative treatments failed. The measurement of spinopelvic parameters for sagittal balance is important prior to deformity corrective surgery. LDK can be considered a subtype of PDSI that is more likely to occur in female farmers, and hence the use of LDK as a global term for all degenerative sagittal imbalance disorders is better avoided. To avoid confusion, we recommend PDSI as a newer, more accurate diagnostic term instead of LDK.
腰椎退行性后凸（LDK）是平背综合征的一个亚组，最常见的病因是独特的生活方式，如农业劳作时长期蹲姿以及在地面上进行日常生活活动。不幸的是，LDK一直被用作退行性矢状面失衡的代名词，这有时会导致混淆。本综述的目的是评估LDK的确切范畴，并引入另一个更合适的术语来描述退行性矢状面畸形。与名称所暗示的不同，LDK不仅包括腰椎矢状面平衡紊乱和后凸，还包括整个脊柱的矢状面平衡紊乱以及腰椎前凸减小。此外，这种疾病与女性农民的职业和过时的亚洲生活方式密切相关。这些原因使得有必要改变这种疾病的命名以避免误解。我们建议使用“原发性退行性矢状面失衡”（PDSI）这一名称，它涵盖了老年患者整个脊柱不明原因的退行性矢状面排列不齐，且与背部肌肉萎缩有关。LDK可被视为与农业职业相关的PDSI的一个亚组。对于PDSI患者，建议将运动和物理治疗等保守治疗作为一线治疗方法，仅在保守治疗失败时才考虑手术治疗。在进行畸形矫正手术之前，测量用于矢状面平衡的脊柱骨盆参数很重要。LDK可被认为是PDSI的一种亚型，更易发生于女性农民，因此最好避免将LDK用作所有退行性矢状面失衡疾病的通用术语。为避免混淆，我们推荐使用PDSI作为一个更新的、更准确的诊断术语来替代LDK。
