Lumbosacral Parameters Research Articles

Risk Factors for Nonunion After Nonoperative Treatment for Pediatric Lumbar Spondylolysis: A Retrospective Case-Control Study

Background: Pediatric lumbar spondylolysis, a stress fracture of the lumbar spine, frequently affects young athletes, and nonoperative treatment is often the first choice of management. Because the union rate in lumbar spondylolysis is lower than that in general fatigue fractures, identifying risk factors for nonunion is essential for optimizing treatment. Purpose: To determine the risk factors for nonunion after nonoperative treatment of acute pediatric lumbar spondylolysis through multivariate analysis. Study Design: Case-control study; Level of evidence, 3. Methods: We analyzed 574 pediatric patients (mean age, 14.3 ± 1.9 years) with lumbar spondylolysis who underwent nonoperative treatment between 2015 and 2022. Nonoperative treatment included the elimination of sports activities, bracing, and weekly athletic rehabilitation, with follow-up computed tomography. Patient data, lesion characteristics, sports history, presence of spina bifida occulta at the lamina with a lesion or at the lumbosacral spine excluding the lesion level, and lumbosacral parameters were examined. Differences between the union and nonunion groups were investigated using multivariate analysis to determine the risk factors for nonunion. Results: Of the 574 patients, 81.7% achieved bone union. Multivariate analysis revealed that an L5 lesion and the progression of the main and contralateral lesion stages were significant independent risk factors for nonunion. An L5 lesion had a lower union rate than non-L5 lesions. As the main lesion progressed, the likelihood of nonunion increased significantly, and the progression of the contralateral lesion also showed a similar trend. Spina bifida occulta and lumbosacral parameters were not significant predictors of nonunion in this study. Conclusion: We identified the L5 lesion level and the progression of the main and contralateral lesion stages as independent risk factors for nonunion in pediatric lumbar spondylolysis after nonoperative treatment. These findings aid in treatment decision-making. When bone union cannot be expected with nonoperative treatment, symptomatic treatment is required without prolonged external fixation and rest, and without aiming for bone union. Individualized treatment plans are crucial based on identified risk factors.

Sagittal alignment of the cervical spine: radiographic analysis of 111 asymptomatic adolescents, a retrospective observational study

PurposeTo describe the cervical spine morphology and explore its relationship to global sagittal alignment parameters in the asymptomatic adolescent population. MethodsA total of 111 adolescent subjects were included. Sagittal alignment parameters, including C7 Slope, C2-C7 Cobb, C2-7 plumb line (PL), C2-S1 Sagittal Vertical Axis (SVA), C7-S1 SVA, T5-12 Cobb, T10-L2 Cobb, L1-S1 Cobb, pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS), were obtained from lateral radiographs. ResultsForty-four males and sixty-seven females with a mean age of 16.12 ± 2.40 years were included in this study. The mean values of C7 Slope, C2-7 Cobb and C2-7PL were 20.45 ± 8.88°, -7.72 ± 12.10°, and 13.53 ± 11.63 mm, respectively. C2-7 Cobb, C7 Slope showed significant differences between the male and female groups. Correlation analysis showed that C7 slope was significantly correlated with C2-7 Cobb (r = -0.544, P < 0.001), C2-S1 SVA (r = 0.335, P < 0.001), and C7-S1 SVA (r = 0.310, P = 0.001), but not lumbosacral parameters(L5-S1 Cobb, PI, PT, SS). Using a modified method of Toyama to describe the cervical spine morphology, there were 37 cases (33.3%) in the Lordotic group, and C7 slope, C2-7 Cobb and C2-7PL showed significant differences between groups. According to C2-C7 Cobb, there were 80 Lordotic cases (72.1%). C7 slope and C2-7PL were significantly different between the two groups.ConclusionThe cervical spine morphology of asymptomatic adolescents varies widely, from lordotic to kyphotic. Combining different classification methods provides a better understanding of the morphology of the cervical spine. C7 slope is an important predictor of global sagittal balance and C2-7PL is a key parameter for restoring cervical lordosis, which should be considered pre-operatively and for conservative treatment. Cervical regional sagittal alignment parameters are not correlated with lumbosacral parameters, and C2-7 Cobb, C7 Slope showed significant differences between males and females.

Failures of lumbosacral instrumented fusions addressing degenerative lumbar disease.

Background: Here, we evaluated the failure to preserve or restore adequate spinopelvic alignment following lumbosacral instrumented fusions for degenerative disease.Methods: Patients undergoing lumbosacral instrumented fusions for degenerative spine disease underwent; standing lumbopelvic X-rays and lumbar MRI scans obtained both preoperatively and 1 year postoperatively. Parameters measured included lumbar lordosis (LL), L4-S1 angle, pelvic incidence (PI), and LL-PI mismatch.Results: Fifty patients were followed for 1 year following lumbopelvic fusion. There was a statistically significant difference in the L4-S1 angle between patients with good versus poor clinical outcomes at 1 year postoperative; the LL-PI mismatch showed a strong positive correlation with better outcome scores.Conclusion: Preservation of an adequate LL/other lumbosacral parameters favorably impacts patients’ outcomes following lumbosacral fusion for degenerative disease.

Characteristics of Osteoporotic Low Lumbar Vertebral Fracture and Related Lumbosacral Sagittal Imbalance.

Osteoporotic vertebral fracture (OVF) usually occurs in the thoracolumbar region and rarely affects the low lumbar region. The characteristics of osteoporotic low lumbar fracture (OLLF) have not been reported. Lumbosacral sagittal balance plays an important role in preserving the normal physiologic function of the spine. However, it is unknown how lumbosacral parameters vary in patients with OLLF. The authors retrospectively analyzed the clinical and radiologic characteristics of patients with OLLF and osteoporotic thoracolumbar vertebral fracture (OTVF) who were treated at their institution. Vertebral height, local deformity angle, and visual analog scale and Oswestry Disability Index scores were assessed preoperatively and postoperatively for both groups. The changes in lumbosacral parameters were measured for patients with OLLF. The results showed that OLLF was more likely to occur at L3 (53.66%) and that the prevalence of severe trauma (29.27%) was higher among patients with OLLF (P<.05). The most common morphologic type of the vertebrae affected by OLLF was biconcave (58.54%, P<.05). Patients who had OLLF showed an apparent increase in pelvic tilt and a decrease in local lordosis and sacral slope. Postoperatively, vertebral height, local deformity angle, and visual analog scale and Oswestry Disability Index scores were significantly improved compared with preoperative values (P<.05). Among patients with OLLF, local lordosis and sacral slope increased significantly, whereas pelvic tilt decreased significantly after percutaneous kyphoplasty. Restoration of local lordosis had a mean value of 6.29°±4.80°. These results indicate that OLLF has unique characteristics compared with OTVF and that it results in lumbosacral sagittal imbalance. Percutaneous kyphoplasty is effective and safe for the treatment of OLLF and plays an important role in postoperative improvement of sagittal imbalance. [Orthopedics. 2021;44(1):e7-e12.].

EFFECTS OF SAGITTAL BALANCE DIFFERENCES ON SPONDYLOLISTHESIS.

ABSTRACTObjectives:This study aimed to compare the lumbar lordosis (LL) and spinopelvic parameters of patients with stage 1–2 spondylolisthesis to those of the normal population and demonstrate the importance of these parameters in sagittal balance.Methods:The lumbosacral parameters on the lateral radiographs of a total of 125 patients were retrospectively compared. Lumbosacral parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LLA), L5 incidence (L5I), L5 slope (L5S), and sacral table angle (STA) were compared between groups.Results:Comparison of the parameters between groups revealed no sex-based differences (p > 0.05).Conclusions:Abnormal sagittal spinopelvic parameters are commonly examined for their effects on the development of spondylolisthesis and should be used in routine practice. We found that the low SS values in our study, unlike those of other similar studies, may be a compensatory mechanism developed to reduce pain and maintain sagittal balance. Level of Evidence II; retrospective study.

Age-related variations in global spinal alignment and sagittal balance in asymptomatic Japanese adults

Objectives: The global spinal sagittal alignment varies widely among healthy individuals as it is affected by not only race, but also aging. We investigated age-related changes in the spinal alignment in asymptomatic Japanese individuals.Methods: The subjects comprised 220 individuals without any spine-related neurological symptoms or treatment history thereof who visited our outpatient clinic. Lateral radiographs of the whole spine were taken for all subjects in the standing position. Based on the images obtained, spino-pelvic parameters were calculated using Jackson’s method so as to analyze any correlations with age.Results: TIA, TK, and C2–C7A were found to markedly increase with age from late middle age (P < 0.05). No correlation with aging was found for lumbosacral parameters or sagittal balance (P > 0.05). However, there were 22 subjects (10%) with C7SVA > 50 mm, with those aged 70 years or older accounting for half of this subpopulation. Sagittal balance tended to be retained even in elderly subjects if lumbosacral lordosis was large enough to compensate for thoracic kyphosis. A very strong correlation was found between the L1 slope and whole-spine sagittal balance (P < 0.0001, r = −0.497).Conclusions: Increases in cervicothoracic curvature occurring along with thoracic deformation underlie age-related changes in the spine. In contrast, the lumbosacral spine compensates in such a manner so as to maintain the sagittal balance. The whole-spine sagittal balance can deteriorate if the compensatory changes in the lumbosacral spine are insufficient. The L1 slope is a central parameter that defines the whole-spine sagittal balance.Abbreviations: PI; pelvic incidence; SS; sacral slope; PT; pelvic tilt; LL; lumbar lordosis; C7SVA; C7 sagittal vertical axis; SSA; spinosacral angle; TK; thoracic kyphosis; C2–C7SVA; C2–C7 sagittal vertical axis; C2–C7A; C2–C7 Angle; TIA; thoracic inlet angle; NT; neck tilt.

Differences of Sagittal Lumbosacral Parameters between Patients with Lumbar Spondylolysis and Normal Adults.

Background:Recent studies have suggested an association between elevated pelvic incidence (PI) and the development of lumbar spondylolysis. However, there is still lack of investigation for Han Chinese people concerning the normal range of spinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population.Methods:A total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force (Beijing, China) were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A: 36 patients with simple lumbar spondylolysis, and Subgroup B: 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis (slip percentage <30%). Altogether 207 healthy adults were chosen as the control group. All patients and the control group took lumbosacral lateral radiographs. Seven sagittal lumbosacral parameters, including PI, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), L5 incidence, L5 slope, and sacral table angle (STA), were measured in the lateral radiographs. All the parameters aforementioned were compared between the two subgroups and between the spondylolysis group and the control group with independent-sample t-test.Results:There were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher (P < 0.05) in the spondylolysis group than those in the control group, but STA was lower (P < 0.001) in the spondylolysis group.Conclusions:Current study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population.

Correlation between Lumbopelvic and Sagittal Parameters and Health Related Quality of Life in Adults with Lumbosacral Spondylolisthesis

Introduction The impact of sagittal plane imbalance has been demonstrated for adult deformity and pediatric spondylolisthesis. The association between lumbopelvic parameters, global sagittal balance, and health status has not been well-defined in adults with lumbosacral spondylolisthesis. The role for deformity reduction in lumbosacral spondylolisthesis in the adult has not been well-defined. The purpose of this study is to evaluate the impact of sagittal alignment and lumbosacral parameters on health status in adults with L5-S1 spondylolisthesis. Methods Secondary analysis of data from a multicenter, prospective study. Health status measures included SF-12 and SRS-30. Radiographic predictor variables included: C7 sagittal vertical axis deviation (SVA), T1 and T9 spinopelvic inclinations, pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), slip angle, Meyerding slip grade, and Labele classification. Pearson's correlations were calculated between each radiographic parameter and health status measure. Results Forty-five patients were included (male 15, female 30; average age 40.5 ± 18.7) as summarized in Table 1 . For low-grade slips, SVA had strong negative correlations with SF12-MCS, SRS-30 appearance, mental, and satisfaction domains (−0.57, −0.60, −0.58, −0.53, respectively; p &lt; 0.05). PI had strong negative correlations with SRS-30 total, mental, and subscore domains (−0.57, −0.53, −0.57, respectively; p≤0.05). SS also had a strong negative correlation with SF12-MCS (−0.61; p = 0.02), while thoracic kyphosis had a strong positive correlation with SRS-activity (0.62; p = 0.02). For high-grade slips, slip angle had a moderate negative correlation with SF12-MCS (−0.36; p = 0.05). SVA had strong negative correlations with SF12-PCS, SRS-30 appearance, activity domains (−0.48, −0.48, 0.45; p &lt; 0.05) and a moderate negative correlation with SRS-30 subscore (−0.37; p &lt; 0.05). T1PI had a moderate negative correlation with SF12-PCS and SRS-22 appearance (−0.37, −0.36; p≤0.05). Conclusion Lumbosacral spondylolisthesis in adults negatively impacts mental and physical HRQoL. While HRQoL are similar between patients with low- and high-grade slips, multiple global and local radiographic sagittal parameters negatively impact HRQoLs for both groups. Improvement of global sagittal balance and lumbopelvic parameters in adults with lumbosacral spondylolisthesis may be useful in improving health status in adults. [Table: see text]

Lumbosacral Parameters and Intervertebral Disc Changes in Adult Patients with Pars Defects

Introduction Pars defect refers to fracture in the pars inter articularis and is believed to be one of the leading cause of back pain. Pars defects usually acquired and caused by microtrauma. Spondylolysis is seen in 4–6% of population. 82% occur at L5/S1 and 11% occurs L4/5 (11%). Materials and Methods Between March 2013 and April 2014, we collected particulars of all patients presenting with low back pain with pars defects on standing erect lumbosacral spine X-rays. Patients were excluded if they had (1) Deformity, (2) Non availability of MRI. 57 patients were included. Their X-rays and MRI were studied by two orthopedic surgeons measuring: Lumbar lordosis and Sacral slope on Plain Xrays; Lumbar slip according to meyereding grading; Intervertebral disc status on MRI: (1) Disc degeneration according to Pfirmann's grading, (2) Degree of disc prolapsed. Results 57 subjects had their data reviewed: 30 males, 27 females; ages ranged between 15 and 65 years (mean age = 40 years). Data was collected and cleaned using Microsoft Excel. Then analysis done using SPSS ver.17.characteristics of the sample population were displayed in frequency tables while testing for correlations as wellas student t-testwere taken as significant for P values &lt; 0.05. There's a significant difference between males and female ages (p-value 0.01); males were younger with a mean age of 37 years versus 45 years. Sacral Slope: Ranged between 17 – 64 degrees (Mean = 38 degrees). Lumbar Lordosis: ranged between 15 – 77 degrees (Mean = 52 degrees). Slip degree according to myerdings grading: Grade 0 = 38%, Grade 1 = 58%, and Grade 3 = 4%. On MRI disc changes according to Pfirmann's grading was grade 1 26%, grade 2 5%, grade 3 24%, grade 4 32%, grade 5 11%. And finally the disc prolapse severity wasas under: (1) No bulge 32%, (2) Bulge 29%, (3) Extrusion 34%, (4) Sequestration 4%. Statistically significant correlation found between: (1) Age and degenerative disc changes; cor. coefficient 0.43 and p value 0.001; (2) Age and prolapsed disc; cor. coefficent 0.39 and p value 0.003; (3) Degenerative disc changes and prolapse; cor. coefficient 0.83 and p value &lt; 0.001; (4) Between sacral slope and lumbar lordosis; cor. coefficient 0.72 and p value &lt; 0.001. Conclusions There is increased prevalence of disc degeneration in patients with pars defect. There is direct correlation between age and disc degeneration plus degree of disc prolapse. Severity of degeneration is directly related to degree of disc prolapse. The lumbar lordosis and sacral slope were not found be statistically related to degree of spondylolisthesis. The disc is not protected in patients with defect.

CHANGES IN RADIOGRAPHIC PARAMETERS AFTER MINIMALLY INVASIVE LUMBAR INTERBODY FUSION

Objective : This study aims to evaluate changes in lumbosacral parameters after minimally invasive lumbar interbody fusion. The secondary aim was to evaluate whether interbody cage shape (crescent shaped or rectangular) would influence the results. Method : Retrospective analysis of 70 patients who underwent one or two level lumbar interbody fusion through a minimally invasive posterolateral approach. This included midline preservation and unilateral facetectomy. Pre- and postoperative (three to six months postoperative) radiographs were used for measuring lumbar lordosis (LL), segmental lordosis (SL) at the level of interbody fusion, and sacral slope (SS). Further analyses divided the patients into Roussouly lumbar subgroups. Results : LL was significantly reduced after surgery (59o:39o, p=0.001) as well as the SS (33.8o:31.2o, p=0.05). SL did not change significantly (11.4:11.06, p=0.85). There were no significant differences when comparing patients who received crescent shaped cage (n=27) and rectangular cage (n=43). Hypolordotic patients (Roussouly types 1 and 2) had radiographic improvement in comparison to normolordotic and hyperlordotic groups (types 3 and 4). Conclusion : Minimally invasive lumbar interbody fusion caused reduction in lumbosacral parameters. Cage shape had no influence on the results.

Changes in Lumbosacral Radiographic Parameters after Minimally Invasive Lumbar Interbody Fusion

Introduction Modern techniques have allowed for less aggressive surgeries and faster postoperative recovery. This study aims to evaluate changes in lumbosacral parameters after minimally invasive lumbar interbody fusion. The secondary aim was to evaluate whether interbody cage shape (crescent or rectangular shape) would influence the results. Method This is a retrospective analysis of 70 patients who underwent one or two-level lumbar interbody fusion through a minimally invasive posterolateral approach. This included midline preservation and unilateral facetectomy. Pre- and postoperative (3–6 months postoperatively) radiographs were used for measuring lumbar lordosis (LL), segmental lordosis at the level of interbody fusion (SL), and sacral slope (SS). Further analyses divided the patients into Roussouly lumbar subgroups. Results LL was significantly reduced after surgery (59:39 degrees, p = 0.001) as well as the SS (33.8:31.2 degrees, p = 0.05). SL did not change significantly (11.4:11.06, p = 0.85). There were no significant differences when comparing patients who received crescent-shaped cage ( n = 27) and rectangular-shaped cage ( n = 43). Hypolordotic patients (Roussouly types 1 and 2) had radiographic improvement in comparison to normo and hyperlordotic groups (types 3 and 4). Conclusion Minimally invasive lumbar interbody fusion caused reduction in lumbosacral parameters. Hypolordotic patients showed improvement in radiographic measurements, in comparison to normo and hyperlordotic ones.

Quantitative evaluation of the lumbosacral sagittal alignment in degenerative lumbar spinal stenosis.

This study intends to develop a method of quantitative sagittal balance parameters assessment, based on a geometrical model of lumbar spine and sacrum. One hundred eight patients were divided into 2 groups. In the experimental group have been included 59 patients with lumbar spinal stenosis on L1-5 level. Forty-nine healthy volunteers without history of any lumbar spine pathlogy were included in the control group. All patients have been examined with supine MRI. Lumbar lordosis has been adopted as circular arc and described either anatomical (lumbar lordosis angle), or geometrical (chord length, circle segment height, the central angle, circle radius) parameters. Moreover, 2 sacral parameters have been assessed for all patients: sacral slope and sacral deviation angle. Both parameters characterize sacrum disposition in horizontal and vertical axis respectively. Significant correlation was observed between anatomical and geometrical lumbo-sacral parameters. Significant differences between stenosis group and control group were observed in the value of the "central angle" and "sacral deviation" parameters. We propose additional parameters: lumbar coefficient, as ratio of the lordosis angle to the segmental angle (Kl); sacral coefficient, as ratio of the sacral tilt (ST) to the sacral deviation (SD) angle (Ks); and assessment modulus of the mathematical difference between sacral and lumbar coefficients has been used for determining lumbosacral balance (LSB). Statistically significant differences between main and control group have been obtained for all described coefficients (p = 0.006, p = 0.0001, p = 0.0001, accordingly). Median of LSB value of was 0.18 and 0.34 for stenosis and control groups, accordingly. Based on these results we believe that that spinal stenosis is associated with an acquired deformity that is measureable by the described parameters. It's possible that spinal stenosis occurs in patients with an LSB of 0.2 or less, so this value can be predictable for its development. It may suggest that spinal stenosis is more likely to occur in patients with the spinal curvature of this type because of abnormal distribution of the spine loads. This fact may have prognostic significance for develop vertebral column disease and evaluation of treatment results.

Spinopelvic Alignment After Interspinous Soft Stabilization With a Tension Band System in Grade 1 Degenerative Lumbar Spondylolisthesis

Retrospective clinical study. The purpose of this study was to examine the changes in spinopelvic alignment after interspinous soft stabilization (ISS) with a tension band system and to identify the lumbosacral parameters related to those changes and to determine their impact on the clinical outcomes compared with posterior lumbar interbody fusion (PLIF) in patients with low-grade degenerative spondylolisthesis (DS). The sacropelvic morphometric changes after fusion surgery have received much research attention. However, few reports have addressed the issue after use of dynamic or soft stabilization systems. From April 2001 to November 2003, 45 patients presenting with grade 1 DS with stenosis underwent either ISS with a tension band system (ISS group) or PLIF with pedicle screw fixation (PLIF group). The mean follow-up period was 76.8 months. Three pelvic parameters, the sacral slope (SS), pelvic tilt (PT), and pelvic incidence, were investigated to address the sacropelvic morphometric change. Clinical outcomes were assessed using the visual analog scale score, the Oswestry Disability Index, and the patient's satisfaction index. Both groups showed significant improvements in all of the clinical outcomes, with no significant differences between groups. In the ISS group, the SS increased and PT decreased, whereas in the PLIF group, the SS decreased and PT increased, resulting in pelvic anteversion and retroversion, respectively, with significant intergroup differences in SS and PT (SS: P = 0.047; PT: P = 0.01). The positive association of lumbar lordosis with SS (r = 0.448) and its negative association with PT (r = -0.674) in the respective groups indicate the influence of changes in lumbar lordosis on pelvic positional changes. Significant correlations between follow-up segmental lumbar lordosis and the visual analog scale score for leg pain (r = -0.685) and Oswestry Disability Index score (r = -0.425) were found in the ISS group alone. Segmental lordotic change after ISS with a tension band system was the possible decisive factor in the development of pelvic anteversion while maintaining sagittal lumbar balance; lack of lumbar lordosis led to compensatory pelvic retroversion in the PLIF group. Considering the comparable clinical results with PLIF surgery and the achievement of physiologic sagittal spinopelvic balance, the ISS procedure can be a feasible alternative to fusion surgery in patients with grade 1 DS with stenosis.