Jentzsch Thorsten, Geiger James, König Matthias A, Werner Clément M L
Department of Surgery, Division of Trauma Surgery, University Hospital Zuerich, Zuerich, Switzerland.
Clin Spine Surg. 2017 Apr;30(3):129-135. doi: 10.1097/BSD.0b013e3182aab266.
A retrospective study.
Our study opted to clarify the remaining issues of lumbar lordosis (LL) with regard to (1) its physiological values, (2) age, (3) sex, and (4) facet joint (FJ) arthritis and orientation using computed tomography (CT) scans.
Recent studies have questioned whether LL really decreases with age, but study sample sizes have been rather small and mostly been based on x-rays. As hyperlordosis increases the load transferred through the FJs, it seems plausible that hyperlordosis may lead to FJ arthritis at the lower lumbar spine.
We retrospectively analyzed the CT scans of 620 individuals, with a mean age of 42.5 (range, 14-94) years, who presented to our traumatology department and underwent a whole-body CT scan, between 2008 and 2010. LL was evaluated between the superior endplates of L1 and S1. FJs of the lumbar spine were evaluated for arthritis and orientation between L2 and S1.
(1) The mean LL was 49.0 degrees (SD 11.1 degrees; range, 11.4-80.1 degrees). (2) LL increased with age and there was a significant difference in LL in our age groups (30 y and below, 31-50, 51-70, and ≥71 y and above) (P=0.02). (3) There was no significant difference in LL between females and males (50 and 49 degrees) (P=0.17). (4) LL showed a significant linear association with FJ arthritis [P=0.0026, OR=1.022 (1.008-1.036)] and sagittal FJ orientation at L5/S1 (P=0.001). In a logistic regression analysis, the cutoff point for LL was 49.4 degrees.
This is the largest CT-based study on LL and FJs. LL significantly increases with age. As a novelty finding, hyperlordosis is significantly associated with FJ arthritis and sagittal FJ orientation at the lower lumbar spine. Thus, hyperlordosis may present with back pain and patients may benefit from surgical correction, for example, in the setting of trauma.
一项回顾性研究。
本研究旨在通过计算机断层扫描（CT）来阐明腰椎前凸（LL）在以下方面的遗留问题：（1）其生理值，（2）年龄，（3）性别，以及（4）小关节（FJ）关节炎和方向。
最近的研究对LL是否真的随年龄增长而降低提出了质疑，但研究样本量相当小，且大多基于X线。由于腰椎前凸增加了通过FJ传递的负荷，腰椎前凸可能导致下腰椎FJ关节炎似乎是合理的。
我们回顾性分析了2008年至2010年间到我们创伤科就诊并接受全身CT扫描的620例患者的CT扫描结果，这些患者的平均年龄为42.5岁（范围14 - 94岁）。在L1和S1的上终板之间评估LL。在L2和S1之间评估腰椎FJ的关节炎和方向。
（1）平均LL为49.0度（标准差11.1度；范围11.4 - 80.1度）。（2）LL随年龄增长而增加，且我们的年龄组（30岁及以下、31 - 50岁、51 - 70岁以及≥71岁及以上）的LL存在显著差异（P = 0.02）。（3）女性和男性的LL无显著差异（分别为50度和49度）（P = 0.17）。（4）LL与FJ关节炎[P = 0.0026，比值比=1.022（1.008 - 1.036）]以及L5/S1处的矢状面FJ方向显著线性相关（P = 0.001）。在逻辑回归分析中，LL的截断点为49.4度。
这是关于LL和FJ的基于CT的最大规模研究。LL随年龄显著增加。作为一个新发现，腰椎前凸与下腰椎FJ关节炎和矢状面FJ方向显著相关。因此，腰椎前凸可能导致背痛，患者可能从手术矫正中获益，例如在创伤情况下。
