Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan.
Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan.
Eur Spine J. 2024 Aug;33(8):2952-2959. doi: 10.1007/s00586-024-08378-4. Epub 2024 Jun 26.
Spinopelvic sagittal alignment is crucial for assessing balance and determining treatment efficacy in patients with adult spinal deformity (ASD). Only a limited number of reports have addressed spinopelvic parameters and lumbosacral transitional vertebrae (LSTV). Our primary objective was to study spinopelvic sagittal parameter changes in patients with LSTV. A secondary objective was to investigate clinical symptoms and quality of life (QOL) in patients with LSTV.
In this study, we investigated 371 participants who had undergone medical check-ups for the spine. LSTV was evaluated using Castellvi's classification, and patients were divided into LSTV+ (type II-IV, L5 vertebra articulated or fused with the sacrum) and LSTV- groups. After propensity score matching for demographic data, we analyzed spinopelvic parameters, sacroiliac joint degeneration, clinical symptoms, and QOL for these two participant groups. Oswestry Disability Index (ODI) scores and EQ-5D (EuroQol 5 dimensions) indices were compared between the two groups.
Forty-four patients each were analyzed in the LSTV + and LSTV- groups. The LSTV + group had significantly greater pelvic incidence (52.1 ± 11.2 vs. 47.8 ± 10.0 degrees, P = 0.031) and shorter pelvic thickness (10.2 ± 0.9 vs. 10.7 ± 0.8 cm, P = 0.018) compared to the LSTV- group. The "Sitting" domain of ODI (1.1 ± 0.9 vs. 0.6 ± 0.7, P = 0.011) and "Pain/Discomfort" domain of EQ-5D (2.0 ± 0.8 vs. 1.6 ± 0.7, P = 0.005) were larger in the LSTV + group.
There was a robust association between LSTV and pelvic sagittal parameters. Clinical symptoms also differed between the two groups in some domains. Surgeons should be aware of the relationship between LSTV assessment, radiographic parameters and clinical symptoms.
脊柱骨盆矢状面平衡对于评估成人脊柱畸形（ASD）患者的平衡和确定治疗效果至关重要。只有少数报告涉及脊柱骨盆参数和腰骶部过渡性椎体（LSTV）。我们的主要目的是研究 LSTV 患者脊柱骨盆矢状面参数的变化。次要目标是研究 LSTV 患者的临床症状和生活质量（QOL）。
本研究共纳入 371 例接受脊柱体检的患者。采用 Castellvi 分类法评估 LSTV，将患者分为 LSTV+（II-IV 型，L5 椎体与骶骨关节或融合）和 LSTV-组。对人口统计学数据进行倾向评分匹配后，我们分析了这两组患者的脊柱骨盆参数、骶髂关节退变、临床症状和生活质量。比较两组患者的 Oswestry 残疾指数（ODI）评分和 EQ-5D（欧洲五维健康量表）指数。
LSTV+组和 LSTV-组各有 44 例患者被纳入分析。LSTV+组骨盆入射角显著增大（52.1±11.2 度比 47.8±10.0 度，P=0.031），骨盆厚度显著减小（10.2±0.9 厘米比 10.7±0.8 厘米，P=0.018）。LSTV+组 ODI 的“坐”域（1.1±0.9 比 0.6±0.7，P=0.011）和 EQ-5D 的“疼痛/不适”域（2.0±0.8 比 1.6±0.7，P=0.005）均较大。
LSTV 与骨盆矢状面参数之间存在显著关联。两组患者在某些领域的临床症状也存在差异。外科医生应意识到 LSTV 评估、影像学参数和临床症状之间的关系。
