Ge R L, Liang Y, Xu S
Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China.
Spinal Surgery, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Yi Xue Za Zhi. 2024 Apr 2;104(13):1036-1042. doi: 10.3760/cma.j.cn112137-20231027-00913.
To explore the effect of degenerative thoracolumbar kyphosis (DTLK) on the sagittal alignment of the spine, as well as the impact on spinal parameters and imbalance secondary to thoracolumbar kyphosis. A case-control study. A total of 128 DTLK patients who aged over 50 years [thoracolumbar kyphosis (TLK)>15°] treated in Peking University People's Hospital from January 2018 to December 2021 (DTLK group) were retrospectively included in this study. Other 73 contemporaneous patients with lumbar spinal stenosis or disc herniation without thoracolumbar kyphosis (TLK=0°±15°) were enrolled into the control group. The following parameters were obtained on spine X-ray: TLK, thoracic kyphosis (TK), lumbar lordosis (LL) and sagittal vertical axis (SVA). In addition, the osteoporosis (OP) was evaluated by dual-emission X-ray absorptiometry (DXA), and the L/S disc signal grading (Pfirrmann grading) was evaluated on MRI. Based on the age, the Lafage formula SVA=2× (age-55)+25 was used to distinguish balance/imbalance, and the DTLK patients were divided into balanced and an imbalanced group, the characteristics and influencing factors of the loss of sagittal balance in this population were clarified, and the interaction among various parts of the spine under a state of balance was analyzed too. The TK (30.0°±13.5° vs 24.2°±7.4°) and TLK (26.6°±9.7° vs 6.0°±6.6°) in the DTLK group were both larger than those in control group while LL was smaller (34.4°±17.7° vs 44.2°±10.3°) (all <0.001). TK was correlated to TLK (=0.234, =0.008) and LL (=0.539, <0.001) in DTLK group. LL loss was positively correlated to L/S disc signal reduction (=0.253, =0.044). LL loss [=1.04(1.01-1.08)] and OP [=3.97(1.09, 14.50)] were influencing factors for the occurrence of imbalance in DTLK patients. The influencing factors for TK in DTLK balance group were LL (β=0.572, <0.001) and age (β=0.351, =0.045). The positive influencing factor for TK in imbalanced group is LL (β=0.209, =0.015), and the impact is weaker than balanced group. Loss of LL and osteoporosis are more likely to cause imbalance and kyphosis in DTLK patients. In DTLK balance group, the proximal spine is regulated by lumbar spine, and the synergistic effect between the two parts maintains balance.
探讨退变性胸腰椎后凸畸形（DTLK）对脊柱矢状位排列的影响，以及对胸腰椎后凸继发的脊柱参数和失衡的影响。一项病例对照研究。回顾性纳入2018年1月至2021年12月在北京大学人民医院接受治疗的128例年龄超过50岁[胸腰椎后凸（TLK）>15°]的DTLK患者（DTLK组）。同期纳入另外73例无胸腰椎后凸（TLK = 0°±15°）的腰椎管狭窄症或椎间盘突出症患者作为对照组。通过脊柱X线获得以下参数：TLK、胸椎后凸（TK）、腰椎前凸（LL）和矢状垂直轴（SVA）。此外，采用双能X线吸收法（DXA）评估骨质疏松症（OP），并在MRI上评估腰/骶椎间盘信号分级（Pfirrmann分级）。根据年龄，使用拉法热公式SVA = 2×（年龄 - 55）+ 25来区分平衡/失衡，并将DTLK患者分为平衡组和失衡组，阐明该人群矢状位平衡丧失的特征和影响因素，并分析平衡状态下脊柱各部分之间的相互作用。DTLK组的TK（30.0°±13.5°对24.2°±7.4°）和TLK（26.6°±9.7°对6.0°±6.6°）均大于对照组，而LL较小（34.4°±17.7°对44.2°±10.3°）（均<0.001）。DTLK组中TK与TLK（= 0.234，= 0.008）和LL（= 0.539，<0.001）相关。LL丢失与腰/骶椎间盘信号降低呈正相关（= 0.253，= 0.044）。LL丢失[= 1.04（1.01 - 1.08）]和OP[= 3.97（1.09，14.50）]是DTLK患者发生失衡的影响因素。DTLK平衡组中TK的影响因素为LL（β = 0.572，<0.001）和年龄（β = 0.351，= 0.045）。失衡组中TK的正性影响因素为LL（β = 0.209，= 0.015），且影响弱于平衡组。LL丢失和骨质疏松症更易导致DTLK患者失衡和后凸。在DTLK平衡组中，近端脊柱受腰椎调节，两部分之间的协同作用维持平衡。
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