Department of Physiatry, Hospital for Special Surgery, New York, NY.
Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.
PM R. 2018 May;10(5):501-506. doi: 10.1016/j.pmrj.2017.09.012. Epub 2017 Oct 6.
Spondylolysis with and without anterolisthesis is the most common cause of structural back pain in children and adolescents, but few predictive factors have been confirmed. An association between abnormal sacropelvic orientation and both spondylolysis and spondylolisthesis has been supported in the literature. Sacral slope and other sacropelvic measurements are easily accessible variables that could aid clinicians in assessing active adolescents with low back pain, particularly when the diagnosis of spondylolysis is suspected.
To examine the relationship between sacral slope and symptomatic spondylolysis in a cohort of active adolescents.
Case-control retrospective study.
Academic outpatient physiatry practice.
Seventy-four patients of primarily adolescent age (between 12 and 22 years old) with a chief complaint of low back pain and presence of lateral radiographs of the lumbar spine were enrolled. Cases (n = 37) were defined as subjects with evidence of spondylolysis on both radiograph and magnetic resonance imaging of the lumbar spine. Controls (n = 37) were defined as subjects without spondylolysis.
Using a single sagittal radiograph, taken with the patient standing, a fellowship-trained interventional spine physiatrist measured the sacral slope of each subject (angle between the superior plate of S1 and a horizontal reference on sagittal imaging of the lumbosacral spine). Ages and genders were collected from medical records.
The primary outcome was mean sacral slope. Mean sacral slope of cases was compared with mean sacral slope of controls with the Student t-test.
Ages ranged from 12 to 22 for both groups, with no significant differences in age between the groups (cases: 16.8 ± 2.3 years; controls: 17.7 ± 2.7 years). The patients with spondylolysis (cases) consisted of 29 male and 8 female patients, whereas those without spondylolysis (controls) consisted of 15 male and 21 female patients (gender details for 1 patient were not available). The mean sacral slope among cases was 42.4°, whereas the mean sacral slope among controls was 37.4°. The difference achieved significance (P = .014).
The interdependence of positional parameters, such as sacral slope, with anatomic parameters, such as pelvic incidence, can affect lumbar lordosis and therefore upright positioning and loading of the spine. Sacral slope may be an important variable for clinicians to consider when caring for young athletes with low back pain, particularly when the index of suspicion for spondylolysis is high.
IV.
伴有或不伴有前滑脱的峡部裂是儿童和青少年结构性腰痛的最常见原因，但很少有预测因素得到证实。文献中支持骶骨倾斜度与峡部裂和滑脱之间存在关联。骶骨斜率和其他骶髂测量值是易于获得的变量，当怀疑峡部裂时，这些变量可以帮助临床医生评估有腰痛的活跃青少年，特别是当怀疑峡部裂时。
在一组活跃的青少年中检查骶骨斜率与症状性峡部裂之间的关系。
病例对照回顾性研究。
学术门诊物理治疗实践。
共纳入 74 名主要为青少年（12 至 22 岁之间）的患者，其主要抱怨为腰痛，并拍摄了腰椎侧位 X 光片。病例（n=37）定义为腰椎 X 光和磁共振成像均有峡部裂证据的受试者。对照组（n=37）定义为无峡部裂的受试者。
使用站立位拍摄的单张矢状位 X 光片，由经过 fellowship培训的介入脊柱物理治疗师测量每位受试者的骶骨斜率（S1 上板与腰骶脊柱矢状位成像上的水平参考之间的夹角）。从病历中收集年龄和性别。
主要结局指标为平均骶骨斜率。用学生 t 检验比较病例组和对照组的平均骶骨斜率。
两组年龄均为 12 至 22 岁，两组之间年龄无显著差异（病例组：16.8±2.3 岁；对照组：17.7±2.7 岁）。有峡部裂的患者（病例组）包括 29 名男性和 8 名女性，而无峡部裂的患者（对照组）包括 15 名男性和 21 名女性（1 名患者的性别信息不详）。病例组的平均骶骨斜率为 42.4°，对照组的平均骶骨斜率为 37.4°。差异有统计学意义（P=0.014）。
位置参数（如骶骨斜率）与解剖参数（如骨盆入射角）的相互依赖性会影响腰椎前凸，从而影响脊柱的直立姿势和负重。当怀疑有峡部裂时，骶骨斜率可能是临床医生在治疗有腰痛的年轻运动员时需要考虑的一个重要变量。
IV。
