Hey Hwee Weng Dennis, Tan Kian Loong Melvin, Moorthy Vikaesh, Lau Eugene Tze-Chun, Lau Leok-Lim, Liu Gabriel, Wong Hee-Kit
University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Eur Spine J. 2018 Mar;27(3):578-584. doi: 10.1007/s00586-017-5459-y. Epub 2018 Jan 13.
To describe normal variations in sagittal spinal radiographic parameters over an interval period and establish physiological norms and guidelines for which these images should be interpreted.
Data were prospectively collected from a continuous series of adult patients with first-episode mild low back pain presenting to a single institution. The sagittal parameters of two serial radiographic images taken 6-months apart were obtained with the EOS slot scanner. Measured parameters include CL, TK, TL, LL, PI, PT, SS, and end and apical vertebrae. Chi-squared test and Wilcoxon Signed Rank test were used to compare categorical and continuous variables, respectively.
Sixty patients with a total of 120 whole-body sagittal X-rays were analysed. Mean age was 52.1 years (SD 21.2). Mean interval between the first and second X-rays was 126.2 days (SD 47.2). Small variations (< 1°) occur for all except PT (1.2°), CL (1.2°), and SVA (2.9 cm). Pelvic tilt showed significant difference between two images (p = 0.035). Subgroup analysis based on the time interval between X-rays, and between the first and second X-rays, did not show significant differences. Consistent findings were found for end and apical vertebrae of the thoracic and lumbar spine between the first and second X-rays for sagittal curve shapes.
Radiographic sagittal parameters vary between serial images and reflect dynamism in spinal balancing. SVA and PT are predisposed to the widest variation. SVA has the largest variation between individuals of low pelvic tilt. Therefore, interpretation of these parameters should be patient specific and relies on trends rather than a one-time assessment.
描述脊柱矢状位影像学参数在一段时间内的正常变化，并建立这些图像解读所需的生理规范和指导原则。
前瞻性收集了连续一系列首次发作轻度下腰痛的成年患者的数据，这些患者均就诊于同一机构。使用EOS槽式扫描仪获取间隔6个月拍摄的两张连续X线片的矢状位参数。测量参数包括CL、TK、TL、LL、PI、PT、SS以及终椎和顶椎。分别采用卡方检验和Wilcoxon符号秩检验比较分类变量和连续变量。
分析了60例患者的总共120张全身矢状位X线片。平均年龄为52.1岁（标准差21.2）。第一张和第二张X线片之间的平均间隔为126.2天（标准差47.2）。除PT（1.2°）、CL（1.2°）和SVA（2.9 cm）外，所有参数的变化均较小（<1°）。两张图像之间的骨盆倾斜度存在显著差异（p = 0.035）。基于X线片之间的时间间隔以及第一张和第二张X线片之间的时间间隔进行的亚组分析未显示出显著差异。在第一张和第二张X线片之间，胸腰椎的终椎和顶椎在矢状曲线形态方面有一致的发现。
影像学矢状位参数在连续图像之间存在差异，反映了脊柱平衡的动态变化。SVA和PT的变化最大。在骨盆倾斜度低的个体之间，SVA的变化最大。因此，对这些参数的解读应因人而异，且依赖于趋势而非一次性评估。
