Ogawa Takahisa, Fukushima Kazuyuki, Niimi Miyuki, Schermann Haggai, Motoyoshi Takayuki, Moross Janelle, Hashimoto Motonori, Hirai Takashi, Fujiwara Takeo, Okawa Atsushi, Kurosa Yoshiro, Yoshii Toshitaka
Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo 113-8510, Japan.
Department of Orthopedic Surgery, Saku General Hospital Saku Medical Center, Nagano 385-0051, Japan.
J Clin Med. 2023 Feb 9;12(4):1393. doi: 10.3390/jcm12041393.
It may be difficult to define what would constitute an abnormal spinal sagittal alignment. The same degree of malalignment may be found both in patients with pain and disability and in asymptomatic individuals. This study focuses on elderly farmers who characteristically have a kyphotic spine, in addition to local residents. It questions whether these patients experience cervical and lower back symptoms, respectively, more often than elderly people who never worked on a farm and do not have a kyphotic deformity. Previous research could have been biased by sampling patients who came to a spine clinic for treatment, whereas this study sampled asymptomatic elderly who may or may not have had kyphosis.
We studied 100 local residents at their annual health checkup (22 farmers and 78 non-farmers) with a median age of 71 years (range 65-84 years). Spinal radiographs were used to measure sagittal vertical axis, lumbar lordosis, thoracic kyphosis and other measurements of sagittal malalignment. Back symptoms were measured using Oswestry Disability Index (ODI) and Neck Disability Index (NDI). The association between alignment measures and back symptoms were calculated by bivariate comparison between patient groups and by Pearson's correlation.
About 55% of farmers and 35% of non-farmers had abnormal radiographs (i.e., vertebral fracture). Farmers had higher measurements of sagittal vertical axis (SVA), compared to non-farmers, when measured from C7 (median 24.4 mm vs. 9.15 mm, = 0.04) and from C2 (47.65 vs. 25.3, = 0.03). Lumbar lordosis (LL) and thoracic kyphosis (TK) were significantly decreased in farmers vs. non-farmers (37.5 vs. 43.5, = 0.04 and 32.5 vs. 39, = 0.02, respectively). The ODI was likely to be higher among farmers compared to non-farmers while NDI scores showed no significant difference between farmers and non-farmers (median 11.7 vs. 6.0, = 0.06 and median 13 vs. 12, = 0.82, respectively). In terms of correlation among spinal parameters, LL had a higher correlation with SVA, but TK had less correlation with SVA among farmers compared to non-farmers. There was no significant correlation between disability scores and measurements of sagittal alignment.
Farmers had higher measurements of sagittal malalignment, characterized by loss of LL, decreased TK and an increased forward translation of cervical vertebrae relative to sacrum. ODI was likely to higher in farmers compared to non-farmers although the association did not reach a significant level. These results probably indicate that the gradual development of spinal malalignment in agricultural workers does not result in excess morbidity compared to controls.
很难界定何为异常的脊柱矢状面排列。在有疼痛和残疾的患者以及无症状个体中都可能发现相同程度的排列不齐。本研究除了关注当地居民外，还聚焦于典型的脊柱后凸的老年农民。研究质疑这些患者是否比从未务农且无脊柱后凸畸形的老年人更常出现颈部和下背部症状。以往的研究可能因选取到脊柱诊所接受治疗的患者而存在偏差，而本研究选取的是可能有或没有脊柱后凸的无症状老年人。
我们在100名当地居民年度健康体检时对其进行了研究（22名农民和78名非农民），他们的年龄中位数为71岁（范围65 - 84岁）。使用脊柱X线片测量矢状垂直轴、腰椎前凸、胸椎后凸以及其他矢状面排列不齐的指标。使用Oswestry功能障碍指数（ODI）和颈部功能障碍指数（NDI）来测量背部症状。通过患者组间的双变量比较以及Pearson相关性分析来计算排列指标与背部症状之间的关联。
约55%的农民和35%的非农民有异常的X线片表现（即椎体骨折）。从C7测量时，农民的矢状垂直轴（SVA）测量值高于非农民（中位数24.4毫米对9.15毫米，P = 0.04），从C2测量时也是如此（47.65对25.3，P = 0.03）。与非农民相比，农民的腰椎前凸（LL）和胸椎后凸（TK）显著降低（分别为37.5对43.5，P = 0.04和32.5对39，P = 0.02）。农民的ODI可能高于非农民，而NDI评分在农民和非农民之间无显著差异（中位数分别为11.7对6.0，P = 0.06和中位数13对12，P = 0.82）。就脊柱参数之间的相关性而言，与非农民相比，农民中LL与SVA的相关性更高，但TK与SVA的相关性更低。残疾评分与矢状面排列测量值之间无显著相关性。
农民的矢状面排列不齐测量值更高，其特征为LL丢失、TK降低以及颈椎相对于骶骨向前移位增加。农民的ODI可能高于非农民，尽管这种关联未达到显著水平。这些结果可能表明，与对照组相比，农业工人脊柱排列不齐的逐渐发展并未导致发病率过高。
