Correlations between the sagittal plane parameters of the spine and pelvis and lumbar disc degeneration

Abstract

BackgroundStudies have shown that lumbar disc herniation, degenerative lumbar instability, and other degenerative lumbar spinal diseases are often secondary to disc degeneration. By studying the intervertebral disc, researchers have clarified the pathological changes involved in intervertebral disc degeneration but have ignored the roles of biomechanical factors in the development of disc degeneration. This study aims to investigate the relationships among the location, scope, and extent of lumbar disc degeneration and sagittal spinal-pelvic parameters.MethodsA retrospective analysis was performed on the clinical data of 284 patients with lumbar degenerative disc diseases (lumbar disc herniation and degenerative lumbar instability) from January 2013 to December 2016. Statistics were calculated for the following: (1.) patients’ general information: name, sex, age, height, and weight. (2.) Measurements of sagittal parameters from total spinal radiographs: thoracic kyphosis (TK), Lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), sagittal vertical axis (SVA), T1 tilt angle (TA), and T1 pelvic angle (TPA). (3.) Location, scope, extent, and overall degree of lumbar disc degeneration. Parameters were analyzed in groups by sex, PI, and SVA, and a correlation analysis was performed for the location, scope, extent, and overall degree of lumbar intervertebral disc degeneration with 8 spinal-pelvic sagittal parameters.ResultsThe mean ages of the male and female patient groups were 59.00 and 53.28 years old, respectively (P < 0.05). The PT, location, scope, and overall degree of degradation were significantly different between the sexes (P < 0.05). Linear correlation analysis results showed that the overall degree and extent of degradation (r = 0.788, P < 0.01), LL and SS (r = 0.737, P < 0.01), PI and PT (r = 0.607, P < 0.01), and TPA and PT (r = 0.899, P < 0.01) were strongly correlated. The location values were 4.08 ± 0.72 in patients with PI≤50° and 3.62 ± 0.94 in patients with PI> 50° (P = 0.018). Different SVASVA groups differed in their overall degree of degeneration (P = 0.002).ConclusionsThe location of lumbar intervertebral disc degeneration is affected by spinal-pelvic sagittal morphology. Populations with small PI values tend to exhibit degeneration at the L4/5 and L5/S1 discs, and populations with large PI values tend to exhibit degeneration at the L3/4 and L4/5 discs. The SVA value and the overall degree of lumbar disc degeneration are positively correlated.

Restoring lumbar lordosis: a systematic review of controlled trials utilizing Chiropractic Bio Physics^® (CBP^®) non-surgical approach to increasing lumbar lordosis in the treatment of low back disorders

“…In both trials this treatment effect was lost, where these patient’s pain and flexibility measures regressed towards baseline, pre-treatment values. The regression of symptoms in the comparative groups likely results from the persistence of the lumbar spine structural hypolordosis deformity, which will exert continuous pathologic and histologic changes in the associated soft tissues 36 , 37 , 38 ) . The fact that this ‘symptom regression trend’ was not demonstrated to occur in the groups receiving lordosis improvement with LET is concerning.…”

The different compensatory mechanism of sagittal spinopelvis in patients with LDH and patients with spondylolisthesis

“…Previous studies [5,19,20] have demonstrated the correlations of sagittal spinopelvis both in normal population and spinal degenerative diseases. Our results showed that significantly positive correlations were found between PI and LL, PI and SS, LL and SS in either patients with LDH or SPL or normal subjects, the trends between PI and LL, PI and SS are decrease, and between LL and SS is increase.…”

“…Lumbar disc herniation (LDH) and spondylolisthesis (SPL) are becoming more and more common in clinical practice. Although sagittal spinopelvic unbalance was found in both patients with LDH and SPL [1][2][3][4][5][6][7][8][9]. To our knowledge, few studies focusing on the differences of spinopelvic alignment between patients with LDH and patients with SPL were reported [1,2].…”

Different spinal subtypes with varying characteristics of lumbar disc degeneration at specific level with age: a study based on an asymptomatic population

“…The fully upright posture of humans requires coordination of all parts to form different spine sagittal patterns and develop different biomechanical characteristics [10,11]. Therefore, when investigating the biomechanics of the spine, we tend to consider the spine as a whole.…”