Effect of Spino-Pelvic Sagittal Balance on Degree of Disk Degeneration in the Lumbar Spine

Abstract

Introduction Recent studies have focused on spino-pelvic sagittal balance. Changes in sagittal balance could alter the load on the spine and may affect spinal mobility. Increasing recognition of the clinical impacted that sagittal alignment has on back pain and adjacent segment degeneration. But recent studies focused only on the effects of lumbar sagittal alignment to the disk degeneration. The relationship between spino-pelvic sagittal balance and lumbar disk degeneration has yet to be determined. The objective of this research was to study the effect of spino-pelvic sagittal balance on degree of disk degeneration in the lumbar spine. Materials and Methods The lumbar spine magnetic resonance imaging (MRI) and whole spine X-ray of 32 patients (13 males and 19 females) with a mean age of 57.92 years (range: 25 to 84 years) were retrospectively evaluated. Patients with history of prior spinal surgery, serious congenital anomalies, infection, spinal trauma, tumorn or ankylosing spondylitis were excluded from the study. In every patient, spino-pelvic sagittal parameters such as sagittal vertical axis (SVA), thoracic Kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), C7 tilt (C7T), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), spino-sacral angle (SSA), spino-pelvic angle (SPA), T1 spiono-pelvic inclination (T1-SPI), and T9 spino-pelvic inclination (T9-SPI) were measured in the whole spine X-ray to evaluate the sagittal balance. And lumbar intervertebral disk degeneration grade for each level (L1/2, L2/3, L3/4, L4/5 and L5/S1) was assessed using the lumbar MRI according to the Pfirrmann grading. The relationship between sagittal parameters and disk degeneration grade was analyzed. Results There was significant correlation between SVA and disk degeneration grade in level L5/S1 ( r = 0.565, p = 0.003) but not significant correlation in level L1/2, L2/3, L3/4 or L4/5. Similarly, significant correlation has been determined between C7T and degree of disk degeneration at the level of L5/S1 ( r = 0.557, p = 0.004), between PT and L2/3 ( r = 0.519, p = 0.008), between SSA and L5/S1 ( r = 0.466, p = 0.019), between SPA and L2/3 ( r = 0.466, p = 0.019), and between T1-SPI and L5/S1 ( r = 0.398, p = 0.049). No significant effect was detected for the degree of disk degeneration with the changes in spino-pelvic parameters like TK, TLK, LL, PI, SS, and T9-SPI. Conclusion Spino-pelvic parameters such as SVA, C7T, SSA, and T1-SPI may have effects on the degeneration of L5/S1 disk. And parameters such as SPA and PT may have effects on the degeneration of L2/3 disk. Changes in spino-pelvic parameters may influence the degree of disk degeneration, but all the parameters are not equally involved in the degree of disk degeneration. I confirm having declared any potential conflict of interest for all authors listed on this abstract No Disclosure of Interest None declared