Junseok Bae1, Sang-Ho Lee1, Sang-Ha Shin1, Jin Suk Seo1, Kyeong Hwan Kim2, Jee-Soo Jang3. 1. Department of Neurosurgery, Spine Health Wooridul Hospital, Seoul, Korea. 2. Department of Orthopedic Surgery, Spine Health Wooridul Hospital, Seoul, Korea. 3. Department of Neurosurgery, Suwon Nanoori Spine Hospital, 259, Jungbu-daero, Yeongtong-gu, Suwon-si, Gyeonggi-do, Korea. spinejjs@naver.com.
Abstract
PURPOSE: A retrospective cross-sectional study was designed to explore the role of spinopelvic sagittal alignment in upper lumbar disc herniation (ULD) development. METHODS: A total of 207 consecutive patients who underwent surgery for single-level lumbar disc herniation [24 with ULD and 183 with lower lumbar disc herniation (LLD)] and 40 asymptomatic volunteers were enrolled. Full-length radiographs of the spine were taken to evaluate pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertical axis (SVA). The Roussouly classification was utilized to categorize all subjects according to their sagittal alignment. Spinopelvic parameters and Roussouly classification results were compared between groups. RESULTS: There were significant differences in PI, SS, PT, LL, and SVA between the ULD, LLD, and control groups. PI in the ULD (40.9°) was significantly lower than in the LLD and control groups (48.8° and 47.6°, respectively). LL was significantly lower in the ULD than in the LLD (-32.4° and -40°, respectively). There were significant differences between the three groups in Roussouly types. The LLD had a significantly higher proportion (62.6 %) of type 2 lordosis (flat back), and the ULD had a higher proportion (33.3 %) of type 1 lordosis than the other groups. CONCLUSIONS: This study demonstrated the importance of PI and lumbar curvature in the pathogenesis of ULD. The higher prevalence of short LL and long TK with low PI in the ULD group implies that an increased mechanical stress at this level may be one of the risk factors of ULD.
PURPOSE: A retrospective cross-sectional study was designed to explore the role of spinopelvic sagittal alignment in upper lumbar disc herniation (ULD) development. METHODS: A total of 207 consecutive patients who underwent surgery for single-level lumbar disc herniation [24 with ULD and 183 with lower lumbar disc herniation (LLD)] and 40 asymptomatic volunteers were enrolled. Full-length radiographs of the spine were taken to evaluate pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertical axis (SVA). The Roussouly classification was utilized to categorize all subjects according to their sagittal alignment. Spinopelvic parameters and Roussouly classification results were compared between groups. RESULTS: There were significant differences in PI, SS, PT, LL, and SVA between the ULD, LLD, and control groups. PI in the ULD (40.9°) was significantly lower than in the LLD and control groups (48.8° and 47.6°, respectively). LL was significantly lower in the ULD than in the LLD (-32.4° and -40°, respectively). There were significant differences between the three groups in Roussouly types. The LLD had a significantly higher proportion (62.6 %) of type 2 lordosis (flat back), and the ULD had a higher proportion (33.3 %) of type 1 lordosis than the other groups. CONCLUSIONS: This study demonstrated the importance of PI and lumbar curvature in the pathogenesis of ULD. The higher prevalence of short LL and long TK with low PI in the ULD group implies that an increased mechanical stress at this level may be one of the risk factors of ULD.
Authors: John T Martin; Benjamin Wesorick; Alexander B Oldweiler; Andrzej S Kosinski; Adam P Goode; Louis E DeFrate Journal: JOR Spine Date: 2022-04-23
Authors: Camila Oda Yamazato; Gustavo Ribeiro; Fabio Chaud de Paula; Ramon Oliveira Soares; Paulo Santa Cruz; Michel Kanas Journal: Rev Bras Ortop (Sao Paulo) Date: 2021-12-13