Moon Hong Joo, Bridwell Keith H, Theologis Alekos A, Kelly Micheal P, Lertudomphonwanit Thamrong, Kim Han Jo, Lenke Lawrence G, Gupta Munish C
Department of Neurosurgery, Korea University College of Medicine, Seoul, South Korea.
Department of Orthopaedic Surgery, School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8233, St. Louis, MO, 63110, USA.
Eur Spine J. 2019 Sep;28(9):1937-1947. doi: 10.1007/s00586-019-06078-y. Epub 2019 Jul 24.
The thoracolumbar junction (TLJ) has not been explored in regard to its contribution to global sagittal alignment. This study aims to define novel sagittal parameters of the TLJ and to assess their roles within global sagittal alignment.
Included for cross-sectional, retrospective analysis were asymptomatic volunteers and symptomatic patients who had undergone operation for adult spinal deformity. Unique sagittal parameters of the TLJ were measured using the midline of the T12-L1 disk space: The TLJ orientation [TLJO; thoracolumbar tilt (TLT) and slope (TLS)]. Thoracic kyphosis (TK; T5-12), C7-S1 sagittal vertical axis (SVA), lumbar lordosis (LL; L1-S1), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured. Continuous variables were compared using the independent t test. Pearson correlations examined relationships between the parameters in each group. The asymptomatic TK was calculated using the measurement of the asymptomatic volunteer's TLJO by linear regression.
One hundred fifteen asymptomatic volunteers and 127 symptomatic patients were included. Only LL among the lumbopelvic parameters correlated with TK (asymptomatic volunteers: r = - 0.42; symptomatic patients: r = - 0.40). All the pelvic parameters have no direct correlation with TK in both groups. TLJO had stronger correlation with TK [asymptomatic volunteers: r = - 0.68 (TLS), r = 0.41 (TLT); symptomatic patients: r = - 0.56 (TLS), r = 0.44 (TLT)] than the lumbopelvic parameters. TLS correlated with LL (asymptomatic volunteers: r = 0.78; symptomatic patients: r = 0.73). Most pelvic parameters correlated with TLJO except for PI. The asymptomatic TK was estimated by the derived formula: 20.847 + TLS × (- 1.198).
The TLJO integrates the status of the lumbopelvic sagittal parameters and simultaneously correlates with thoracic and global sagittal alignment. These slides can be retrieved under Electronic Supplementary Material.
尚未探讨胸腰段交界区（TLJ）对整体矢状面排列的贡献。本研究旨在定义TLJ的新型矢状面参数，并评估它们在整体矢状面排列中的作用。
纳入无症状志愿者和接受过成人脊柱畸形手术的有症状患者进行横断面回顾性分析。使用T12-L1椎间盘间隙中线测量TLJ的独特矢状面参数：TLJ方向[TLJO；胸腰段倾斜度（TLT）和斜率（TLS）]。测量胸椎后凸（TK；T5-12）、C7-S1矢状垂直轴（SVA）、腰椎前凸（LL；L1-S1）、骶骨倾斜度（SS）、骨盆倾斜度（PT）和骨盆入射角（PI）。使用独立t检验比较连续变量。Pearson相关性分析检查每组参数之间的关系。通过线性回归，利用无症状志愿者的TLJO测量值计算无症状TK。
纳入115名无症状志愿者和127名有症状患者。在腰骶骨盆参数中，只有LL与TK相关（无症状志愿者：r = -0.42；有症状患者：r = -0.40）。两组中所有骨盆参数与TK均无直接相关性。TLJO与TK的相关性[无症状志愿者：r = -0.68（TLS），r = 0.41（TLT）；有症状患者：r = -0.56（TLS），r = 0.44（TLT）]比腰骶骨盆参数更强。TLS与LL相关（无症状志愿者：r = 0.78；有症状患者：r = 0.73）。除PI外，大多数骨盆参数与TLJO相关。通过推导公式估计无症状TK：20.847 + TLS ×（-1.198）。
TLJO整合了腰骶骨盆矢状面参数的状态，同时与胸椎和整体矢状面排列相关。这些幻灯片可在电子补充材料中获取。
