Khalifé Marc, Vergari Claudio, Lafage Renaud, Elysée Jonathan, Finoco Mikael, Gille Olivier, Assi Ayman, Skalli Wafa, Lafage Virginie, Ferrero Emmanuelle
Department of Orthopedic surgery, Georges Pompidou European Hospital, Paris, France.
Paris-Cité University, Paris, France.
Spine (Phila Pa 1976). 2025 Aug 1;50(15):1081-1089. doi: 10.1097/BRS.0000000000005187. Epub 2024 Oct 15.
Retrospective study of a multicentric prospective database.
This study aimed to determine, in a cohort of healthy volunteers, the impact of sacralized lumbosacral transitional vertebra (LSTV) on spinal alignment according to its grade, particularly regarding lumbar lordosis magnitude and distribution, and the implications for spinopelvic parameters measurement.
There is little data regarding spinopelvic alignment assessment in LSTV patients.
This study included healthy volunteers with full-body stereoradiographs in free-standing position aged over 18. Castellvi grade, pelvic parameters (measured on S1 and L5), L1-S1 lumbar lordosis (LL), and segmental lordosis for each disc and vertebral body, thoracic kyphosis, cervical lordosis, lower limb, and global alignment parameters were assessed. Castellvi I and II were considered as low-grade and Castellvi III and IV as high-grade LSTV. Alignment parameters between no-LSTV, low-grade, and high-grade LSTV were compared. Propensity score matching was used to match PI in No-LSTV and low-grades. Spinopelvic parameters measured on S1 in the no-LSTV group and on L5 in the high-grades were compared.
Seven hundred thirteen subjects were included, of whom 23 low-grades and 27 high-grades. The mean pelvic incidence was 51.0±11.0°, and the mean age was 37.5±16.2 years. LL distribution was different between groups, with an apex and inflexion point significantly higher in high grade ( P<0.001 ). Kyphosis in the LSTV segment was compensated for by a steeper increase of LL above L5 in the high-grades. Low-grades and PI-matched no-LSTV presented similar alignment parameters. There were minor differences in parameters measured on S1 in no-LSTV and no L5 in high-grades.
Subjects with low-grade LSTV present similar alignment as PI-matched no-LSTV subjects and S1 should be taken as reference to measure spinopelvic parameters. High-grade LSTV subjects have kyphotic L5-S1 segment with more cranial lumbar apex and thoracolumbar inflexion point. In these subjects, spinopelvic parameters should be measured on L5.
对一个多中心前瞻性数据库进行回顾性研究。
本研究旨在确定在一组健康志愿者中，骶化型腰骶部移行椎（LSTV）根据其分级对脊柱排列的影响，特别是关于腰椎前凸的大小和分布，以及对脊柱骨盆参数测量的影响。
关于LSTV患者脊柱骨盆排列评估的数据很少。
本研究纳入了年龄超过18岁、站立位有全身立体X线片的健康志愿者。评估Castellvi分级、骨盆参数（在S1和L5上测量）、L1 - S1腰椎前凸（LL）以及每个椎间盘和椎体的节段性前凸、胸椎后凸、颈椎前凸、下肢和整体排列参数。Castellvi I级和II级被视为低级别LSTV，Castellvi III级和IV级为高级别LSTV。比较无LSTV、低级别和高级别LSTV之间的排列参数。使用倾向得分匹配法对无LSTV组和低级别组进行匹配。比较无LSTV组在S1上测量的脊柱骨盆参数和高级别组在L5上测量的参数。
共纳入713名受试者，其中23名低级别和27名高级别。平均骨盆倾斜角为51.0±11.0°，平均年龄为37.5±16.2岁。各组之间LL分布不同，高级别组的顶点和转折点明显更高（P<0.001）。高级别组中，LSTV节段的后凸通过L5以上LL更陡峭的增加得到代偿。低级别组和倾向得分匹配的无LSTV组呈现相似的排列参数。无LSTV组在S1上测量的参数与高级别组在L5上测量的参数存在微小差异。
低级别LSTV受试者与倾向得分匹配的无LSTV受试者具有相似的排列，应将S1作为测量脊柱骨盆参数的参考。高级别LSTV受试者的L5 - S1节段有后凸，腰椎顶点和胸腰段转折点更靠上。对于这些受试者，应在L5上测量脊柱骨盆参数。
