Baker Joseph F, Robertson Peter A
Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.
Department of Surgery, University of Auckland, Auckland, New Zealand.
Int J Spine Surg. 2020 Dec;14(6):949-955. doi: 10.14444/7144. Epub 2020 Dec 29.
The aim of this study was to determine the contribution of individual vertebral body lordosis to lumbar lordosis and establish the relationship of vertebral body lordosis to the pelvic incidence (PI).
One-hundred and two computed tomography (CT) scans on patients free of radiographic disease were measured for PI and segmental lordosis of both bone and disc from L1 to sacrum. Correlative analysis and analysis of variance (ANOVA) were used to identify contribution from bone and disc to lordosis.
The mean total bony lordosis was 10.8° (SD 11.5°), mean total disc lordosis was 36.3° (SD 9.9°), and mean combined lordosis was 47.1° (SD 10.0°). The mean PI of the entire cohort was 49.2° (SD 9.3°). One-way ANOVA demonstrated a significant difference between the PI strata in total bony lordosis values with a mean difference of 14.0° between low and high PI cohorts ( < .001) and also mid- and high PI cohorts of 9.9° ( = .008). Overall, distal lordosis represented 80.8% of the total lordosis. In the proximal lumbar segments, the mean contribution from bone was -4.0° (SD 6.8°) and the mean contribution from disc was 13.6° (SD 6.0°). In the distal, the mean contribution from bone was 14.7° (SD 6.5°) and from disc, 22.7° (SD 6.2°).
The contribution to lordosis from the vertebral bodies is greater in the proximal lumbar spine with increasing PI. With low PI, the proximal vertebral bodies demonstrate reduced contribution to lordosis and in some instances are kyphotic. Future research efforts should place greater emphasis on providing segmental rather than just global analysis of alignment.
Restoration of lumbar spine lordosis should take into account the variation in segmental lordosis contributions as it relates to PI.
本研究的目的是确定单个椎体前凸对腰椎前凸的贡献，并建立椎体前凸与骨盆入射角（PI）的关系。
对102例无影像学疾病患者的计算机断层扫描（CT）进行测量，以获取从L1至骶骨的PI以及骨和椎间盘的节段性前凸。采用相关分析和方差分析（ANOVA）来确定骨和椎间盘对前凸的贡献。
平均总骨前凸为10.8°（标准差11.5°），平均总椎间盘前凸为36.3°（标准差9.9°），平均联合前凸为47.1°（标准差10.0°）。整个队列的平均PI为49.2°（标准差9.3°）。单向方差分析显示，PI分层之间的总骨前凸值存在显著差异，低PI组和高PI组之间的平均差异为14.0°（P <.001），中PI组和高PI组之间的平均差异为9.9°（P =.008）。总体而言，远端前凸占总前凸的80.8%。在近端腰椎节段，骨的平均贡献为-4.0°（标准差6.8°），椎间盘的平均贡献为13.6°（标准差6.0°）。在远端，骨的平均贡献为14.7°（标准差6.5°），椎间盘的平均贡献为22.7°（标准差6.2°）。
随着PI增加，腰椎近端椎体对前凸的贡献更大。PI较低时，近端椎体对前凸的贡献减少，在某些情况下呈后凸。未来的研究应更加强调提供节段性而非仅仅是整体的对线分析。
恢复腰椎前凸应考虑与PI相关的节段性前凸贡献的变化。
