Wang Tao, Ma Lei, Yang Da-Long, Wang Hui, Zhang Di, Zhang Ying-Ze, Ding Wen-Yuan
Department of Spinal Surgery, The Third Hospital of Hebei Medical University Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China.
Medicine (Baltimore). 2017 Apr;96(14):e6593. doi: 10.1097/MD.0000000000006593.
A retrospective study aims to explore differences in spinopelvic sagittal alignment between thoracolumbar disc herniation (TLD) and lower lumbar disc herniation (LLD).A total of 185 patients included 26 with TLD and 129 with LLD and 30 asymptomatic volunteers in normal group (NG). Each individual took full spine X-ray to evaluate pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), TK+LL+PI, TK/LL, and sacrum-femoral-pubic symphysis (SFP). The Roussouly classification was used to categorize all subjects according to their sagittal alignment. Spinopelvic parameters and Roussouly classification results were compared between groups.PI (51.0°), SS (30.5°), and LL (42.0°) in the TLD were significantly higher than those in the LLD (47°, 27°, 33°, respectively). However, TK (30.0°), TK/LL (0.75), and TK+LL+PI (40.0°) in the TLD were significantly lower than these in the LLD (33.0°, 1.07, 47.2°, respectively) and the similar trend between TLD and NG (34.3°, 0.93, 48.5°, respectively). But LL (42.0°) in the TLD was significantly higher than in the NG (35°). Roussouly types among 3 groups were marked differences. The LLD had a higher rate (59.7%) of type II lordosis (flat back), and the TLD had a higher rate (61.5%) of type III lordosis than other groups.This study implied that patients with TLD have higher LL, lower TK, TK/LL, and TK+LL+PI than LLD patients. We inferred that high LL combined with low TK may be the prospective factors of TLD.
一项回顾性研究旨在探讨胸腰椎间盘突出症（TLD）与下腰椎间盘突出症（LLD）之间脊柱骨盆矢状位排列的差异。总共185例患者，其中26例为TLD患者，129例为LLD患者，30例无症状志愿者作为正常组（NG）。每位受试者均拍摄全脊柱X线片以评估骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、腰椎前凸（LL）、胸椎后凸（TK）、TK + LL + PI、TK/LL以及骶骨 - 股骨 - 耻骨联合（SFP）。采用鲁索利分类法根据矢状位排列对所有受试者进行分类。比较各组之间的脊柱骨盆参数和鲁索利分类结果。
TLD组的PI（51.0°）、SS（30.5°）和LL（42.0°）显著高于LLD组（分别为47°、27°、33°）。然而，TLD组的TK（30.0°）、TK/LL（0.75）和TK + LL + PI（40.0°）显著低于LLD组（分别为33.0°、1.07、47.2°），且TLD组与NG组（分别为34.3°、0.93、48.5°）之间存在相似趋势。但TLD组的LL（42.0°）显著高于NG组（35°）。三组之间的鲁索利类型存在显著差异。LLD组II型前凸（平背）的发生率较高（59.7%），而TLD组III型前凸的发生率高于其他组（61.5%）。
本研究表明，TLD患者的LL较高，TK、TK/LL和TK + LL + PI低于LLD患者。我们推断高LL合并低TK可能是TLD的潜在因素。
