Khalifé Marc, Lafage Renaud, Ferrero Emmanuelle, Elysée Jonathan, Assi Ayman, Gille Olivier, Finoco Mikael, Skalli Wafa, Guigui Pierre, Vergari Claudio, Lafage Virginie
Department of Orthopedic Surgery, Hôpital Européen Georges Pompidou, Paris, France.
Université Paris-Cité, Paris, France.
Spine (Phila Pa 1976). 2025 Aug 1;50(15):1074-1080. doi: 10.1097/BRS.0000000000005152. Epub 2024 Sep 5.
Retrospective study of a multicentric prospective database.
This study aimed to describe the relative contribution of vertebral bodies versus discs to lumbar lordosis and its variation with age and pelvic incidence.
While studies sought to determine the physiological magnitude and distribution of lumbar lordosis, data regarding its anatomical composition is lacking.
This study included healthy volunteers with full-body stereoradiographs in free-standing position, without lumbosacral transitional vertebra, or age under 18. The following parameters were analyzed: age, sex, pelvic incidence (PI), and lumbar lordosis (LL). Posterior heights and sagittal Cobb angles between the upper and lower endplate for each lumbar disc and each vertebral body were measured from L1 to S1. Ratios of contribution to LL were calculated for each disc and vertebral body. The cohort was divided into four age groups and four PI groups.
Six hundred forty-five subjects were included, mean age was 37.6±16.3, 51% of females. There was a significant decrease in total lumbar disc lordosis with age (-48.9±9.7° to -42.9±10.2°), occurring in lower LL. Vertebral bodies were significantly more kyphotic in Seniors than Youngs (-8.9±8.4° vs. -5.0±9.4°, P=0.03 ), driven by a significant increase in kyphosis of L1 and L2 bodies. Vertebral body contribution to LL significantly increased between groups as PI increased, from a median of 8.0% to 20.5% ( P<0.001 ). This decrease in disc contribution in favor of vertebral bodies mainly took place in lower LL.
This study highlights the importance of vertebral contribution to lumbar lordosis, ranging from 8% to 21% among PI groups. Lumbar lordosis decreased with aging through decreased disc lordosis in the lower lumbar spine and increased body kyphosis in the upper lumbar spine. These results may help surgeons in the assessment of sagittal alignment and the selection of operative technique to achieve surgical correction.
对一个多中心前瞻性数据库的回顾性研究。
本研究旨在描述椎体与椎间盘对腰椎前凸的相对贡献及其随年龄和骨盆入射角的变化。
虽然已有研究试图确定腰椎前凸的生理大小和分布，但缺乏关于其解剖结构组成的数据。
本研究纳入了在站立位进行全身立体放射摄影的健康志愿者，排除腰骶部移行椎或年龄在18岁以下者。分析以下参数：年龄、性别、骨盆入射角（PI）和腰椎前凸（LL）。从L1至S1测量每个腰椎间盘和每个椎体上下终板之间的后缘高度和矢状面Cobb角。计算每个椎间盘和椎体对LL的贡献比例。将队列分为四个年龄组和四个PI组。
纳入645名受试者，平均年龄37.6±16.3岁，女性占51%。随着年龄增长，腰椎间盘总前凸显著降低（从-48.9±9.7°降至-42.9±10.2°），出现在较低的LL节段。老年人椎体的后凸明显大于年轻人（-8.9±8.4°对-5.0±9.4°，P=0.03），主要由L1和L2椎体后凸显著增加所致。随着PI增加，椎体对LL的贡献在组间显著增加，从中位数8.0%增至20.5%（P<0.001）。椎间盘贡献减少而椎体贡献增加主要发生在较低的LL节段。
本研究强调了椎体对腰椎前凸贡献的重要性，在PI组中占8%至21%。腰椎前凸随年龄增长而降低，原因是下腰椎间盘前凸减少和上腰椎椎体后凸增加。这些结果可能有助于外科医生评估矢状面排列并选择手术技术以实现手术矫正。
