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Abstract
Objectives
The purpose of this study was to assess the effect of sagittal spino-pelvic alignment on the clinical symptoms of thoracolumbar kyphosis (TLK; T10-L2 Cobb's angle >20°) in osteoporotic patients.
Summary of Literature Review
Few studies have investigated the clinical symptoms and radiological features of TLK caused by de-generative changes. There is also controversy over whether clinical symptoms will deteriorate in patients with TLK or which treatment should be chosen according to the degree of TLK.
Materials and Methods
From May 2005 to May 2016, we reviewed 75 patients who were diagnosed with TLK (T10-L2 Cobb's angle >20°) and osteoporosis. Patients were excluded from the study if they had neurological symptoms, underlying spinal disorders, or unstable vertebral fractures. Fifty patients with TLK due to an osteoporotic vertebral compression fracture (group F) and 25 patients with senile TLK (group S) were assessed by clinical symptoms and radiological parameters. Thoracolumbar kyphosis angle and sagittal vertical axis (SVA) were also analyzed. Clinical symptoms were assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI).
Results
There were no significant differences in clinical symptoms (VAS, ODI) and radiological parameters between groups F and S, or according to the degree of TLK (20°-30°, 30°-40°, >40°). Clinical symptoms were significantly more severe in patients with sagittal imbalance (SVA >5 cm) than in those with sagittal balance.
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Fig. 1.
Schema displaying Cobb's method of classifying thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, and sagittal vertical axis. Pelvic parameters (pelvic tilt, sacral slope, and pelvic incidence) are also shown on the lateral whole spine. TK: thoracic kyphosis, TLK: thoracolumbar kyphosis, LL: lumbar lordosis, SS: sacral slope, PT: pelvic tilt, PI: pelvic incidence, SVA: sagittal vertical axis.
Fig. 2.
Example of a post-osteoporotic vertebral compression fracture thoracolumbar kyphosis patient with sagittal balance. The patient was 84 years old and had thoracolumbar kyphosis due to a previous T12 osteoporotic compression fracture. The relevant parameters in this patient were: PT: 35°, SS: 26°, TLK: 46°, SVA: 5 cm, VAS: 4, ODI: 40%. TLK: thoracolumbar kyphosis, SS: sacral slope, PT: pelvic tilt, SVA: sagittal vertical axis, VAS: visual analogue scale, ODI: Oswestry Disability Index.
Fig. 3.
Example of a senile thoracolumbar kyphosis patient with sagittal balance. She was 77 years old, with the following values of the relevant parameters. PT: 36°, SS: 20°, TLK: 50°, SVA: 2 cm, VAS: 3, ODI: 36%. TLK:thoracolumbar kyphosis, SS: sacral slope, PT: pelvic tilt, SVA: sagittal vertical axis, VAS: visual analogue scale, ODI: Oswestry Disability Index.
Fig. 4.
Example of a post-osteoporotic vertebral compression fracture thoracolumbar kyphosis patient with imbalance. (A) At baseline, the patient was 84 years old and had thoracolumbar kyphosis due to a previous L1 compression fracture. She had the following values of the relevant parameters. PT: 25°, SS:15°, TLK: 28°, SVA: 6 cm, VAS: 4, ODI: 28%. (B) After 2 years of conservative treatment, the values changed to: PT: 31°, SS: 9°, TLK: 34°, SVA: 10 cm. Her clinical outcomes had deteriorated to a VAS of 7 and an ODI of 42%. TLK: thoracolumbar kyphosis, SS: sacral slope, PT: pelvic tilt, SVA: sagittal vertical axis, VAS: visual analogue scale, ODI: Oswestry Disability Index.
Table 1.
Average values of clinical measurements in post-osteoporotic vertebral compression fracture thoracolumbar kyphosis group (F group) and senile thoracolumbar kyphosis group (S group) at last follow-up.
| F group (N=50) | S group (N=25) | p-value | |
|---|---|---|---|
| VAS | 4.7 ± 2.4 | 4.2 ± 2.1 | 0.75 |
| ODI (%) | 36.2 ± 20.2 | 35.6 ± 18.7 | 0.23 |
Table 2.
Average values of clinical measurements and incidence of sagittal imbalance according to thoracolumbar kyphosis angle at last follow-up.
Table 3.
Average values of clinical measurements in sagittal balance groups and sagittal imbalance groups at last follow-up.
| Sagittal balance (N=32) | Sagittal imbalance (N=43) | p-value | |
|---|---|---|---|
| Age (yr) | 71.3±5.2 | 74.7±8.1 | 0.09 |
| Gender (M:F) | 1:3.1 | 1:3.2 | 0.98 |
| BMI (kg/m2) | 23.3±3.4 | 22.7±4.2 | 0.07 |
| BMD (T-score) | −3.0±0.6 | −3.1±0.8 | 0.23 |
| VAS | 3.6±1.7 | 5.2±2.4 | 0.02∗ |
| ODI (%) | 31.5±15.7 | 39.4±19.2 | 0.01∗ |
Table 4.
Average values of spinopelvic parameters in post-osteoporotic vertebral compression fracture thoracolumbar kyphosis (F group) and senile thoracolumbar kyphosis (S group) at last follow-up.
Table 5.
Average values of radiologic parameters in patient with sagittal imbalance.
| Initial | Last follow-up | p-value | |
|---|---|---|---|
| LL (°) | 15.6±4.8 | 14.2±5.2 | 0.741 |
| TK (°) | 16.8±7.4 | 13.3±4.6 | 0.021∗ |
| TLK (°) | 35.9±15.3 | 44.3±17.6 | 0.012∗ |
| SVA (cm) | 9.2±4.3 | 12.6±6.2 | 0.037∗ |
| PI (°) | 50.6±19.3 | 50.4±20.2 | 0.878 |
| SS (°) | 25.4±12.2 | 20.8±12.8 | 0.037∗ |
| PT (°) | 25.2±10.5 | 29.6±11.3 | 0.029∗ |
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