Department of Orthopaedic Surgery, Seoul National University Hospital, Jongrogu, Seoul, Republic of Korea.
Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
Spine (Phila Pa 1976). 2021 Mar 1;46(5):300-306. doi: 10.1097/BRS.0000000000003791.
Retrospective case-control study.
The aim of this study was to describe and compare the sagittal spinal alignment between patients with and without the ossification of the ligamentum flavum in the thoracic spine (TOLF).
Although mechanical factors play an important role in the development of TOLF, limited evidence exists on the association of sagittal spinal alignment and TOLF in the literature.
The present study assessed the preoperative sagittal alignment parameters in consecutive patients who underwent posterior decompression for TOLF in a single institution between January 2014 and December 2019. The sagittal parameters of the patients with TOLF were compared to those of the age- and sex-matched control group with lumbar spondylosis.
The TOLF group (n = 43 [23 men, 20 women]), with a mean age of 69.5 (range: 41-86) years, and the control group (n = 86) were compared. The TOLF group had a significantly smaller sacral slope (27.60 ± 7.49 vs. 30.61 ± 8.15, P = 0.045) and lumbar lordosis (36.84 ± 13.63 vs. 45.08 ± 9.90, P < 0.001) and a larger pelvic incidence minus lumbar lordosis (PI-LL, 8.06 ± 15.05 vs.1.00 ± 11.34, P = 0.004) than the control group. Moreover, the thoracic kyphosis was smaller in the TOLF group, although the difference was not statistically significant (25.73 ± 11.29 vs. 28.22 ± 9.34, P = 0.187). The TOLF group had a significantly smaller slope angle at the inflection point (11.97 ± 5.85 vs. 15.78 ± 5.62, P < 0.001) and a higher tendency to have a Roussouly type 2 morphology (46.5% vs. 36.0%, P = 0.252) than the control group.
This is the first study to describe the sagittal alignment in patients with TOLF. The TOLF group showed a hypolordotic spine with a larger PI-LL mismatch compared to the age- and sex-matched control group with lumbar spondylosis.Level of Evidence: 4.
回顾性病例对照研究。
本研究旨在描述并比较胸椎黄韧带骨化（TOLF）患者与无 TOLF 患者的矢状位脊柱排列。
尽管机械因素在 TOLF 的发展中起着重要作用，但文献中关于矢状位脊柱排列与 TOLF 之间关联的证据有限。
本研究评估了 2014 年 1 月至 2019 年 12 月在一家机构接受 TOLF 后路减压治疗的连续患者的术前矢状位排列参数。将 TOLF 组患者的矢状位参数与年龄和性别匹配的腰椎间盘突出症对照组进行比较。
TOLF 组（n=43[男 23 例，女 20 例]，平均年龄 69.5 岁[范围：41-86 岁]）与对照组（n=86）进行了比较。TOLF 组的骶骨倾斜度（27.60±7.49 比 30.61±8.15，P=0.045）和腰椎前凸（36.84±13.63 比 45.08±9.90，P<0.001）明显较小，骨盆入射角减去腰椎前凸（PI-LL）较大（8.06±15.05 比 1.00±11.34，P=0.004）。此外，TOLF 组的胸椎后凸较小，但差异无统计学意义（25.73±11.29 比 28.22±9.34，P=0.187）。TOLF 组的拐点斜率较小（11.97±5.85 比 15.78±5.62，P<0.001），且更倾向于呈现 Roussouly 2 型形态（46.5%比 36.0%，P=0.252）。
这是第一项描述 TOLF 患者矢状位排列的研究。与年龄和性别匹配的腰椎间盘突出症对照组相比，TOLF 组的脊柱呈低前凸，PI-LL 不匹配更大。
4 级。
