Fasser Marie-Rosa, Furrer Pascal R, Fisler Luca, Urbanschitz Lukas, Snedeker Jess G, Farshad Mazda, Widmer Jonas
Spine Biomechanics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
Front Bioeng Biotechnol. 2025 Mar 18;13:1444540. doi: 10.3389/fbioe.2025.1444540. eCollection 2025.
Degenerative changes in the lumbar spine may affect many structures, among them the intervertebral discs and the facet joints. The individual load distribution within the spine linked to posture and mass distribution is a probable cause of disease. This study had a dual aim: first, to systematically summarize previously reported associations between sagittal balance parameters and the occurrence of lumbar spine degeneration. Second, to complement these insights with additional biomechanical findings meant to elucidate the link between spine load and alignment as well as selected demographic descriptors.
A systematic literature search was performed on PubMed to identify clinical studies that quantified the association between spinal alignment and the occurrence of disc herniation, disc degeneration, facet joint degeneration, and spondylolisthesis. Further, a previously published musculoskeletal model was used to link sagittal spinal alignment and subject characteristics to joint loading within the lumbar spine for a cohort of 144 subjects.
The literature review yielded 49 publications evaluating the relationship between spinal alignment and the occurrence of pathologies in the lumbar spine. The results indicate that a straight spine might negatively affect the health status of the intervertebral disc, likely because of a lack of damping and associated high compressive loads. These loads further show a major dependence on body weight. On the other hand, facet degeneration and spondylolisthesis may be linked to higher anterior-posterior shear forces acting on the relevant spinal structures because of a generally more sagittally curved spine. A straight lumbar spine is more likely to stress the disc, whereas highly curved spines with a high pelvic incidence are more likely to stress the posterior structures. The biggest influencing factors on the resulting force and consequently potentially the wear of the anatomical structures are the intervertebral inclination from an anatomical point of view and the weight from a demographic point of view.
Information concerning spinal loading resulting from spinal alignment and body descriptors could impact both conservative treatment and operative planning for patients afflicted by spine disease through targeted changes in posture.
腰椎的退行性改变可能会影响许多结构，其中包括椎间盘和小关节。与姿势和质量分布相关的脊柱内个体负荷分布可能是疾病的一个原因。本研究有两个目的：第一，系统总结先前报道的矢状面平衡参数与腰椎退变发生之间的关联。第二，用额外的生物力学研究结果补充这些见解，以阐明脊柱负荷与排列之间的联系以及选定的人口统计学描述指标。
在PubMed上进行了系统的文献检索，以确定量化脊柱排列与椎间盘突出、椎间盘退变、小关节退变和椎体滑脱发生之间关联的临床研究。此外，使用一个先前发表的肌肉骨骼模型，将矢状面脊柱排列和受试者特征与144名受试者队列的腰椎关节负荷联系起来。
文献综述产生了49篇评估脊柱排列与腰椎病理发生之间关系的出版物。结果表明，笔直的脊柱可能会对椎间盘的健康状况产生负面影响，可能是因为缺乏缓冲以及相关的高压缩负荷。这些负荷进一步显示出对体重的主要依赖性。另一方面，由于脊柱矢状面通常弯曲度更大，小关节退变和椎体滑脱可能与作用于相关脊柱结构的更高的前后剪切力有关。笔直的腰椎更有可能使椎间盘受力，而骨盆倾斜度高的高度弯曲脊柱更有可能使后部结构受力。从解剖学角度来看，椎间倾斜度，从人口统计学角度来看，体重，是对合力以及因此对解剖结构潜在磨损影响最大的因素。
关于脊柱排列和身体描述指标所导致的脊柱负荷的信息，可能会通过针对性的姿势改变，影响脊柱疾病患者的保守治疗和手术规划。
