Necessity of Whole Spine Standing Lateral Radiograph in Adults over 50 Years Old Who Have Degenerative Lumbar Disease - Comparison with Supine Lumbar Lateral Radiograph -

Whoan Jeang Kim; Kun Young Park; Hwan Il Sung; Jae Yun Ku; Won Jo Kwon; Chang Kyu Park; Won Sik Choy

doi:10.4184/jkss.2014.21.2.76

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Kim, Park, Sung, Ku, Kwon, Park, and Choy: Necessity of Whole Spine Standing Lateral Radiograph in Adults over 50 Years Old Who Have Degenerative Lumbar Disease - Comparison with Supine Lumbar Lateral Radiograph -

Original Article

Journal of Korean Spine Surg 2014;21(2):76-83.

Published online: 21 June 2014

DOI: https://doi.org/10.4184/jkss.2014.21.2.76

Necessity of Whole Spine Standing Lateral Radiograph in Adults over 50 Years Old Who Have Degenerative Lumbar Disease - Comparison with Supine Lumbar Lateral Radiograph -

Whoan Jeang Kim, M.D., Kun Young Park, M.D., Hwan Il Sung, M.D., Jae Yun Ku, M.D., Won Jo Kwon, M.D., Chang Kyu Park, M.D., Won Sik Choy, M.D.

Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea

Corresponding author: Whoan Jeang Kim, M.D. Department of Orthopedic Surgery, Eulji University Hospital, 95, Dunsanseo-ro, Seo-gu, Daejeon 302-799, Korea TEL: +82-42-611-3267, FAX: +82-42-259-1289 E-mail: hjkim@eulji.ac.kr

Received 28 December 2012 Revised 13 February 2013 Accepted 2 June 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Cross-sectional study.

Objectives

Sagittal imbalance cannot be predicted depending on the degree of lumbar lordosis. Thus, we tried to evaluate the necessity of whole spine standing lateral radiograph through comparison of the spinal and pelvic parameter between supine lumbar lateral radiograph and whole spine standing lateral radiograph.

Summary of the Literature Review

No studies in the literature compare supine lumbar lateral radiograph and whole spine standing lateral radiograph.

Materials and Methods

We randomly selected 50 males and 50 females among the patients over the age of 50 who visited our hospital for outpatient due to degenerative lumbar disease. Lumbar lordosis (sLL/wLL), sacral slope (sSS/wSS), and pelvic tilt (sPT/ wPT) were measured and compared respectively by supine lumbar lateral radiograph and whole spine standing lateral radiograph. We categorized as group AI (sLL<30˚) and group AII (sLL≥30˚) by supine lumbar lateral radiograph and analyzed them. We also categorized as group BI (SVA≤5 cm) and group BII (SVA>5 cm) by whole spine standing lateral radiograph and analyzed them.

Results

There were no statistical difference in lumbar lordosis (sLL/wLL: 35.1˚/37.7˚) and pelvic parameter (sSS/wSS: 32˚/31.7˚, sPT/ wPT: 24.3˚/24.2˚. sPI/wPI: 56.3˚/58.2˚) between supine lumbar lateral radiograph and whole spine standing lateral radiograph, and there were also no statistical difference between two groups (group AI & AII) in SVA, lumbar lordosis and pelvic parameter. Pelvic parameter compared by supine lumbar lateral radiograph and whole spine standing lateral radiograph based on sagittal balance was no significant difference, but lumbar lordosis appeared statistical difference.

Conclusion

Sagittal imbalance appears quite a lot in patients with degenerative lumbar disease and supine lateral radiograph can’t reflect the whole sagittal imbalance. So, whole spine standing lateral radiograph should be performed routinely to analyze the sagittal alignment.

Keywords: Degenerative lumbar disease, Supine lumbar lateral radiograph, Whole spine standing lateral radiograph, Sagittal balance

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Figures and Tables%

Fig. 1.

Fits-on-clavicle position (A, B) or cross-arm position (C, D) is recommended during taking radiographs.

Fig. 2.

Spinal & Pelvic parameters. LL: lumbar lordosis, SS: Sacral slope, SVA: Sagittal vertical axis, PI: Pelvic incidence, PT: Pelvic tilt.

Fig. 3.

A 53-year-old man's supine lumbar lateral radiograph (A) and whole spine lateral radiograph with SVA ≤ 5 cm (B).

Fig. 4.

A 75-year-old woman's supine lumbar lateral radiograph (A) and whole spine lateral radiograph with SVA > 5 cm (B).

Table 1.

Supine lumbar lateral radiograph vs whole spine lateral radiograph

	Supine Lumbar Lateral Radiograph	Whole spine Lateral Radiograph	p-value
LL	35.1˚(±14.4˚)	37.7˚(±16.8˚)	0.170
SS	32˚(±9.6˚)	31.7˚(±9.8˚)	0.085
PT	24.3˚(±10.2˚)	24.2˚(±11.1˚)	0.132

Table 2.

Spine & pelvic parameter(˚) vs SVA(cm)

	p-value
sLL* and SVA	0.612
sSS and SVA	0.820
sPT and SVA	0.510

^∗ sLL lumbar lordosis on supine lumbar lateral radiograph.

sSS sacral slope on whole spine standing lateral radiograph.

sPT pelvic tilt on whole spine standing lateral radiograph.

Table 3.

Lumbar lordosis(˚) & SVA(cm) in AI and AII

	sLL*	wLL	p-value
AI (<30˚)	20.0˚(±7.6˚)	23.5˚(±13.5)	0.520
AII (≥30˚)	43.5˚(±9.6˚)	45.7˚(±12.7)	0.174

^∗ sLL lumbar lordosis on supine lumbar lateral radiograph.

wLL lumbar lordosis on whole spine standing lateral radiograph.

Table 4.

BI vs BII

		BI (SVA≤5 cm)			BII (SVA>5 cm)
	Supine	Whole spine	p-value	Supine	Whole spine	p-value
LL	37˚(±14˚)	43.6˚(±14˚)	0.023	31.9˚(±16.7˚)	28.1˚(±16.8˚)	0.044
SS	33.3˚(±8.3˚)	33.3˚(±8.2˚)	0.309	29.9˚(±11.2˚)	29.2˚(±11.7˚)	0.201
PT	21.5˚(±9.1˚)	21.1˚(±8.1˚)	0.121	29.0˚(±10.5˚)	29.1˚(±13.5˚)	0.330

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