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Abstract
Objectives
We investigated whether the lumbosacral sagittal curvature have any relation to the patterns of lumbar disc degeneration.
Summary of Literature Review
Recently, there have been many studies on the correlations between the changes of lumbar disc degeneration and associated factors, such as age, gender, weight, occupation, cigarette smoking, and genetics; but, it is hard to find research into lumbosacral sagittal alignments.
Materials and Methods
This study enrolled 117 young adult patients limited by age (18-35 years), BMD (<30kg/m2), no smoking, occupation except heavy worker, no prior lumbar surgery and no combined spinal deformity. By measuring the pelvic incidence, sacral slope, lumbar tilt angle, lumbar lordosis and lumbar axis indicating the parameters of sagittal alignments, we investigated the correlation between the number and severity of lumbar disc degeneration and the number of herniated intervertebral discs.
Results
This study found a moderate correlation between pelvic incidence, sacral slope, lumbar lordosis, and the number of lumbar degenerative disc (r=-0.451, p<0.001; r=-0.433, p<0.001; r=-0.425, p<0.001). We calculated the most proper cut-off value of pelvic incidence associated with more than three segments of multiple lumbar disc degeneration, using a minimum p-value approach.
Conclusions
As pelvic incidence, sacral slope, and lumbar lordosis indicating the parameters of lumbosacral sagittal alignments get smaller, the numbers of lumbar disc degenerations and herniated intervertebral discs increase. When pelvic incidence is below 45.6 degrees, it is more likely for degenerative changes of lumbar disc to affect more than three segments.
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Fig. 1.
Methods for measuring the pelvic parameters. Pelvic incidence: angle between the perpendicular to the sacral plate at its midpoint and the line connecting this point to the middle axis of the femoral heads. Sacral slope: angle between the superior plate of S1 and a horizontal line.
Fig. 2.
Methods for measuring the spinal parameters. Lumbar lordosis (LL): angle between the upper end plates of the first lumbar vertebra (L1) and first sacrum vertebra (S1). Lumbar tilt angle (LTA): angle between the line connecting the anterosuperior edge of the L1 to the anterosuperior edge of the S1 and the vertical line.
Fig. 3.
25-year-old female patient. In standing lateral X-ray L1-S1 lordosis was checked by 68.1° and pelvic incidence by 61.7°. MRI scan showed that the lumbar spine had the one degenerated level.
Fig. 4.
Figure 4. 32-year-old female patient. In standing lateral X-ray L1-S1 lordosis was checked by 38.3° and pelvic incidence by 39.5°. MRI scan showed that the lumbar spine had the four degenerated levels.
Table 1.
Mean, Minimum, Maximum and Standard Deviations of the Parameters
Table 2.
The Mean of the Parameters in the 3 groups
| Parameters | Group I (N=43) | Group II (N=47) | Group III (N=25) | P-value (ANOVA) |
|---|---|---|---|---|
| Pelvic incidence (°) | 51.9 (±8.0) | 47.6(±7.2) | 42.1 (±8.2) | <0.001∗ |
| Sacral slope (°) | 36.0 (±6.9) | 32.7(±7.3) | 27.4 (±4.9) | <0.001∗ |
| Lumbar lordosis (°) | 50.0 (±9.3) | 44.9(±11.2) | 37.6 (±8.1) | <0.001∗ |
| Lumbar tilt angle (°) | 3.1 (±5.8) | 2.9(±4.7) | 4.6 (±5.3) | 0.431 |
| Lumbar apex | 3.6 (4.0,3.0) | 3.6(4.0,3.0) | 3.6 (4.0,3.0) | 0.946† |
| LDD score | 2.1 (3,2) | 4.1(5,4) | 6.1 (7,5) | <0.001∗† |
| BMI (kg/m2) | 23.7 (±3.1) | 23.2(±2.8) | 23.6 (±2.9) | 0.718 |
| Age | 25.5 (±4.2) | 27.6(±5.3) | 30.9 (±5.2) | <0.001∗ |
Table 3.
The HIVD(N) in the 3 groups
| HIVD(N) | Group I (N=43) | Group II (N=47) | Group III (N=25) | Total |
|---|---|---|---|---|
| 0 | 1 | 0 | 0 | 1 |
| 1 | 42 | 23 | 11 | 76 |
| 2 | 0 | 24 | 12 | 36 |
| 3 | 0 | 0 | 2 | 2 |
| Total | 43 | 47 | 25 | 115 |
Table 4.
Correlation between the sagittal parameters and lumbar disc degeneration
| Parameters | LDD(N) | LDD score | LDD score /LDD(N) | HIVD(N) | ||||
|---|---|---|---|---|---|---|---|---|
| R∗ | P† | R∗ | P† | R∗ | P† | R∗ | P | |
| Pelvic incidence | -0.451 | <0.001 | -0.396 | <0.001 | 0.058 | 0.536 | -0.210 | 0.024 |
| Sacral slope | -0.433 | <0.001 | -0.439 | <0.001 | -0.046 | 0.626 | -0.252 | 0.006 |
| Lumbar lordosis | -0.425 | <0.001 | -0.397 | <0.001 | 0.044 | 0.640 | -0.263 | 0.004 |
| Lumbar tilt angle | 0.098 | 0.297 | 0.094 | 0.316 | 0.007 | 0.942 | -0.010 | 0.918 |
| Lumbar apex | 0.009 | 0.921 | -0.037 | 0.697 | -0.092 | 0.326 | -0.070 | 0.457 |
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