Variation in Lumbar Shape and Lordosis in a Large Asymptomatic Population: A MEANS Study.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Jun 2023
01 Jun 2023
Historique:
received:
22
06
2022
accepted:
07
11
2022
medline:
10
5
2023
pubmed:
22
3
2023
entrez:
21
3
2023
Statut:
ppublish
Résumé
Prospective, cross-sectional cohort study. To determine the relationship between lumbar shape and sagittal parameters. Understanding the lumbar shape is vital for deformity surgery. Normative sagittal parameters and spine shape remain unstudied in large, multiethnic, asymptomatic cohorts. A prospective, cross-sectional cohort of 468 asymptomatic volunteers between 18 and 80 years was enrolled across 5 countries. Demographic data and radiographic parameters such as pelvic incidence (PI) were collected. Pearson correlation test and linear regression were used to find the relationship between lumbar lordosis (LL) and other parameters. One-way analysis of variance and Welch 2-sample t test were performed to compare lumbar shape across such categories as PI and lumbar apex followed by post hoc Bonferroni correction if needed. PI was moderately correlated with proximal lumbar lordosis (pLL) ( r = -0.54) and weakly correlated with distal lumbar lordosis (dLL) ( r = -0.16). Thoracic kyphosis (T1-T12) was moderately correlated with pLL ( r = -0.35) and dLL ( r = -0.29). dLL was moderately correlated with LL ( r = 0.64). 2.6% (12/468) of subjects had lumbar apex at L2, 40.2% (188/468) at L3, 56.6% at L4 (265/468), and 0.6% (3/468) at other levels. Mean PI was different between volunteers with the apex at L3 and L4. A lower mean PI was associated with the apex at L4 (49.0°), whereas a higher mean PI was associated with the apex at L3 (55.8°). The mean PI-LL mismatch for volunteers was -5.4° with a range from -35° to 39.7°. PI-LL mismatch increased from a mean of -10.1° in volunteers with low PI to a mean of 2.2° in volunteers with high PI. Age was not correlated with LL ( P = 0.84). In asymptomatic adult volunteers, pLL showed a moderate correlation with PI and increased with PI, whereas dLL showed a weak correlation. The lumbar apex migrated proximally with increasing PI. Segmental lordosis and apex position instead of solely global lordosis should be emphasized. Level III.
Sections du résumé
STUDY DESIGN
METHODS
Prospective, cross-sectional cohort study.
OBJECTIVE
OBJECTIVE
To determine the relationship between lumbar shape and sagittal parameters.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Understanding the lumbar shape is vital for deformity surgery. Normative sagittal parameters and spine shape remain unstudied in large, multiethnic, asymptomatic cohorts.
MATERIALS AND METHODS
METHODS
A prospective, cross-sectional cohort of 468 asymptomatic volunteers between 18 and 80 years was enrolled across 5 countries. Demographic data and radiographic parameters such as pelvic incidence (PI) were collected. Pearson correlation test and linear regression were used to find the relationship between lumbar lordosis (LL) and other parameters. One-way analysis of variance and Welch 2-sample t test were performed to compare lumbar shape across such categories as PI and lumbar apex followed by post hoc Bonferroni correction if needed.
RESULTS
RESULTS
PI was moderately correlated with proximal lumbar lordosis (pLL) ( r = -0.54) and weakly correlated with distal lumbar lordosis (dLL) ( r = -0.16). Thoracic kyphosis (T1-T12) was moderately correlated with pLL ( r = -0.35) and dLL ( r = -0.29). dLL was moderately correlated with LL ( r = 0.64). 2.6% (12/468) of subjects had lumbar apex at L2, 40.2% (188/468) at L3, 56.6% at L4 (265/468), and 0.6% (3/468) at other levels. Mean PI was different between volunteers with the apex at L3 and L4. A lower mean PI was associated with the apex at L4 (49.0°), whereas a higher mean PI was associated with the apex at L3 (55.8°). The mean PI-LL mismatch for volunteers was -5.4° with a range from -35° to 39.7°. PI-LL mismatch increased from a mean of -10.1° in volunteers with low PI to a mean of 2.2° in volunteers with high PI. Age was not correlated with LL ( P = 0.84).
CONCLUSIONS
CONCLUSIONS
In asymptomatic adult volunteers, pLL showed a moderate correlation with PI and increased with PI, whereas dLL showed a weak correlation. The lumbar apex migrated proximally with increasing PI. Segmental lordosis and apex position instead of solely global lordosis should be emphasized.
LEVEL OF EVIDENCE
METHODS
Level III.
Identifiants
pubmed: 36944088
doi: 10.1097/BRS.0000000000004624
pii: 00007632-202306010-00004
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
758-765Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Lee CS, Park JS, Nam Y, Choi YT, Park SJ. Long-term benefits of appropriately corrected sagittal alignment in reconstructive surgery for adult spinal deformity: Evaluation of clinical outcomes and mechanical failures. J Neurosurg Spine. 2021;34:390–8.
Lee C-H, Chung CK, Jang J-S, et al. Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance: a meta-analysis. J Neurosurg Spine. 2017;27:540–51.
Ochtman AEA, Kruyt MC, Jacobs WCH, et al. Surgical restoration of sagittal alignment of the spine: correlation with improved patient-reported outcomes: a systematic review and meta-analysis. JBJS Rev. 2020;8:e1900100.
Aoki Y, Nakajima A, Takahashi H, et al. Influence of pelvic incidence-lumbar lordosis mismatch on surgical outcomes of short-segment transforaminal lumbar interbody fusion. BMC Musculoskelet Disord. 2015;16:213.
Matsumoto T, Okuda S, Maeno T, et al. Spinopelvic sagittal imbalance as a risk factor for adjacent-segment disease after single-segment posterior lumbar interbody fusion. J Neurosurg Spine. 2017;26:435–40.
Yilgor C, Sogunmez N, Boissiere L, et al. Global alignment and proportion (GAP) score. J Bone Joint Surg. 2017;99:1661–72.
Boulay C, Tardieu C, Hecquet J, et al. Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J. 2006;15:415–22.
Rose PS, Bridwell KH, Lenke LG, et al. Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine (Phila Pa 1976). 2009;34:785–91.
Jean L. The sagittal pelvic thickness: a determining parameter for the regulation of the sagittal spinopelvic balance. ISRN Anat. 2013;2013:364068.
Bassani T, Galbusera F, Luca A, Lovi A, Gallazzi E, Brayda-Bruno M. Physiological variations in the sagittal spine alignment in an asymptomatic elderly population. Spine J. 2019;19:1840–9.
Pesenti S, Lafage R, Stein D, et al. The amount of proximal lumbar lordosis is related to pelvic incidence. Clin Orthop Relat Res. 2018;476:1603–11.
Li Y, Sun J, Wang G. Lumbar lordosis morphology correlates to pelvic incidence and erector spinae muscularity. Sci Rep. 2021;11:802.
Celestre PC, Dimar JR II, Glassman SD. Spinopelvic parameters: lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope: what does a spine surgeon need to know to plan a lumbar deformity correction? Neurosurg Clin N Am. 2018;29:323–9.
Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998;7:99–103.
Sjoberg DD, Whiting K, Curry M, Lavery JA, Larmarange J. Reproducible summary tables with the gtsummary Package. R J [Internet]. 2021;13:570. https://journal.r-project.org/archive/2021/RJ-2021-053/index.html
Baker JF, Robertson PA. Segmental contributions to lumbar lordosis: a computed tomography study. Int J Spine Surg. 2020;14:949–55.
Pan C, Wang G, Sun J. Correlation between the apex of lumbar lordosis and pelvic incidence in asymptomatic adult. Eur Spine J. 2020;29:420–7.
Sebaaly A, Silvestre C, Rizkallah M, et al. Revisiting thoracic kyphosis: a normative description of the thoracic sagittal curve in an asymptomatic population. Eur spine J. 2021;30:1184–9.
Okamoto M, Hasegawa K, Hatsushikano S, et al. Relative position of sacral base in the pelvis and its correlation with spino-pelvic parameters. Eur Spine J. 2020;29:446–54.
Hasegawa K, Hatsushikano S, Le Huec J-C, et al. Pelvic thickness, sex, ethnicity, and age affect pelvic incidence in healthy volunteers of Multi-Ethnic Alignment Normative Study (MEANS) database. Eur spine J. 2022;31:1421–30.
Sugiura K, Morimoto M, Higashino K, et al. Transitional vertebrae and numerical variants of the spine prevalence and relationship to low back pain or degenerative spondylolisthesis. Bone Jt J. 2021;103-B:1301–8.
Tatara Y, Niimura T, Sekiya T, Mihara H. Changes in lumbosacral anatomy and vertebral numbering in patients with thoracolumbar and/or lumbosacral transitional vertebrae. JB JS Open Access. 2021;6:e20.00167.
Tucker BJ, Weinberg DS, Liu RW. Lumbosacral transitional vertebrae: a cadaveric investigation of prevalence and relation to lumbar degenerative disease. Clin Spine Surg. 2019;32:E330–4.
Staub BN, Lafage R, Kim HJ, et al. Cervical mismatch: the normative value of T1 slope minus cervical lordosis and its ability to predict ideal cervical lordosis. J Neurosurg Spine. 2018;30:31–7.
Mehta VA, Amin A, Omeis I, Gokaslan ZL, Gottfried ON. Implications of spinopelvic alignment for the spine surgeon. Neurosurgery. 2015;76(suppl 1):S42–56; discussion S56.