Hasegawa Kazuhiro, Okamoto Masashi, Hatsushikano Shun, Caseiro Gabriel, Watanabe Kei
Niigata Spine Surgery Center, 2-5-22 Nishi-machi, Niigata City, 950-0165, Japan.
EOS imaging, Paris, France.
BMC Musculoskelet Disord. 2018 Dec 6;19(1):437. doi: 10.1186/s12891-018-2355-5.
A precise comparison of supine and standing whole spine alignment in both the coronal and sagittal planes, including the pelvic parameters, has not been reported. Furthermore, previous studies investigated positional differences in the Cobb angle only in young patients with idiopathic scoliosis. The difference in alignment has never been investigated in a population of patients with adult spinal deformity (ASD). In most cases, ASD patients are aware of the symptoms when standing and tend to stoop with back pain, whereas the symptoms disappear when lying on a bed. Therefore, it is important to elucidate the positional differences in the deformity in older adults. The purposes of this study are to establish a method for comparing whole spine alignment between supine and standing, and to clarify the positional difference of the alignment in the patients with ASD.
Twenty-four patients with ASD (mean age: 60.1 years, range 20-80 years; 24 women) were evaluated. A slot-scanning three-dimensional X-ray imager (EOS) was used to assess the whole spine in the standing position. Computed tomography was used to assess the whole spine in the supine position. The computed tomography DICOM dataset of the whole spine in the supine position was transformed to two-dimensional (coronal and sagittal) digital reconstructed radiography images. The digital reconstructed radiography images were input for three-dimensional measurement by the EOS software and compared with the standing whole spine alignment measured by EOS.
The mean intraclass correlation coefficients (supine, standing) of intra-rater / inter-rater reliabilities for the measured parameters were 0.981, 0.984 / 0.970, 0.986, respectively. The Cobb and rotation angles of the major curve, mostly the thoracolumbar area, were significantly greater in the standing position than in the supine position. Lumbar lordosis during standing was significantly kyphotic. With respect to the pelvic parameters, the sacral slope was significantly smaller in the standing position than in the supine position. Pelvic tilt and pelvic incidence were significantly greater in the standing position than in the supine position.
The lumbar to pelvic parameters and the major curve in standing position significantly deteriorate compared with the supine position in patients with ASD.
尚未有关于仰卧位和站立位时全脊柱在冠状面和矢状面的精确比对（包括骨盆参数）的报道。此外，既往研究仅调查了特发性脊柱侧凸年轻患者Cobb角的体位差异。从未在成人脊柱畸形（ASD）患者群体中研究过脊柱排列的差异。在大多数情况下，ASD患者站立时会意识到症状，且往往因背痛而弯腰，而卧床时症状会消失。因此，阐明老年人脊柱畸形的体位差异很重要。本研究的目的是建立一种比较仰卧位和站立位时全脊柱排列的方法，并阐明ASD患者脊柱排列的体位差异。
对24例ASD患者（平均年龄：60.1岁，范围20 - 80岁；24名女性）进行评估。使用缝隙扫描三维X线成像仪（EOS）评估站立位时的全脊柱。使用计算机断层扫描评估仰卧位时的全脊柱。将仰卧位时全脊柱的计算机断层扫描DICOM数据集转换为二维（冠状面和矢状面）数字重建X线摄影图像。将数字重建X线摄影图像输入EOS软件进行三维测量，并与EOS测量的站立位全脊柱排列进行比较。
测量参数的组内/组间信度的平均组内相关系数（仰卧位、站立位）分别为0.981、0.984 / 0.970、0.986。主要弯曲（大多为胸腰段）的Cobb角和旋转角在站立位时显著大于仰卧位。站立时腰椎前凸显著呈后凸。关于骨盆参数，站立位时骶骨斜率显著小于仰卧位。站立位时骨盆倾斜度和骨盆入射角显著大于仰卧位。
与仰卧位相比，ASD患者站立位时腰椎至骨盆参数及主要弯曲明显恶化。
