Moon Bong Ju, Ryu Dal Sung, Kim Byeongwoo, Ha Yoon, Yoon Seung Hwan, Kim Keung Nyun, Chin Dong Kyu, Lee Jung-Kil
Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju.
Department of Neurosurgery, Inha University School of Medicine, Inha University Hospital, Incheon.
Medicine (Baltimore). 2020 Mar;99(11):e19551. doi: 10.1097/MD.0000000000019551.
Sagittal imbalance is a multifactorial complex deformity that can arise from a variety of causes such as spinal stenosis, sarcopenia, vertebral fracture, and neuromuscular diseases. Furthermore, there is lack of research regarding spinal and general conditions that precede the development of sagittal imbalance. Our aim was to evaluate aggravating factors, such as natural history, for sagittal imbalance in a cohort comprising elderly individuals by conducting various examinations.We recruited 96 participants who had a sagittal vertical axis (SVA) larger than 50 mm in a sagittal imbalance study. Finally, 69 participants were followed up and enrolled this study after 2 years. We evaluated full spine radiographs, magnetic resonance imaging (MRI), bone mineral density, and health-related quality of life from patients survey and analyzed factors associated with aggravation of sagittal imbalance. Aggravation was defined by an SVA > 30 mm and T1 pelvic angle (T1PA) > 3° in the third year compared to SVA and T1PA values of the first year.Eighteen participants of the follow-up group had a sagittal imbalance aggravation. According to the deformity severity in the first-year evaluations, the marked deformity group (38 participants) defined as Schwab classification had 11 (28.9%) participants presenting with sagittal imbalance aggravation. These participants had larger mean values of Schwab sagittal modifiers and T1PA compared with the nonaggravation participants. Logistic regression analysis showed a higher pelvic incidence (PI) (OR = 1.201, 95% CI = 1.015-1.422, P = .033) and a small multifidus (MF) volume (OR = 0.991, 95% CI = 0.983-1.000, P = .043) correlated with sagittal imbalance aggravation.From the follow-up group, 18 (26%) subjects of total 69 participants presented a deteriorated sagittal imbalance. A higher PI and smaller MF volume correlated with the aggravation of sagittal imbalance. We should consider that high PI and small MF volume are associated with aggravation of sagittal imbalance.
矢状面失衡是一种多因素导致的复杂畸形，可由多种原因引起，如椎管狭窄、肌肉减少症、椎体骨折和神经肌肉疾病。此外，关于矢状面失衡发生前的脊柱及全身状况的研究较少。我们的目的是通过进行各种检查，评估包括老年人在内的队列中矢状面失衡的加重因素，如自然病史。在一项矢状面失衡研究中，我们招募了96名矢状垂直轴（SVA）大于50mm的参与者。最后，69名参与者在2年后接受随访并纳入本研究。我们评估了患者的全脊柱X线片、磁共振成像（MRI）、骨密度以及与健康相关的生活质量，并分析了与矢状面失衡加重相关的因素。加重的定义为与第一年的SVA和T1骨盆角（T1PA）值相比，第三年SVA>30mm且T1PA>3°。随访组中有18名参与者出现矢状面失衡加重。根据第一年评估中的畸形严重程度，施瓦布分类定义的明显畸形组（38名参与者）中有11名（28.9%）参与者出现矢状面失衡加重。与未加重的参与者相比，这些参与者的施瓦布矢状面修正值和T1PA平均值更大。逻辑回归分析显示，较高的骨盆倾斜度（PI）（OR=1.201，95%CI=1.015-1.422，P=0.033）和较小的多裂肌（MF）体积（OR=0.991，95%CI=0.983-1.000，P=0.043）与矢状面失衡加重相关。在随访组的69名参与者中，有18名（26%）受试者的矢状面失衡恶化。较高的PI和较小的MF体积与矢状面失衡加重相关。我们应该考虑到高PI和小MF体积与矢状面失衡加重有关。
