Tuba Tülay KOCA, Ejder BERK, Burhan Fatih KOÇYİĞİT, Vedat NANCİTARHAN

Lumbosacral alignment in lumbar disc herniation

Aim: Lumbosacral alignment has a potential role in providing proper spinal function, balanced and appropriate posture. The aimof our study was to compare lumbosacral angles between lumbar disc herniation and lumbar disc herniation-free patients. It wasaimed to identify specific changes in lumbar disc herniation.Material and Methods: A total of 118 (69 female, 49 male) patients with the complaint of chronic low back pain were enrolled.Lumbar magnetic resonance images and standing lateral lumbar radiographs were obtained from the electronic hospital database.The presence or absence of disc herniation was diagnosed with lumbar magnetic resonance images. Measurement of lumbosacralangles were performed on the standing lateral lumbar radiographs.Results: Lumber lordosis angle and lumbosacral disc angle were significantly smaller in the lumbar disc herniation group (p = 0.033and p = 0.038). No significant difference was detected in sacral tilt and lumbosacral angle (p = 0.705 and p = 0.413).Conclusion: The variations in lumbosacral angles cause changes in the spinal kinematics that may affect the occurrence of discherniation. Loss of lumbar lordosis increases the compressive forces on the spine and may associate with the presence of discherniation. Lumbosacral alignment must be taken into account when evaluate the pathophysiology of lumbar disc herniation.

PDF

___

1. Amonoo-Kuofi HS. Changes in the lumbosacral angle, sacral inclination and the curvature of the lumbar spine during aging.Acta Anat (Basel) 1992;145:373-7.
2. Pope MH, Novotny JE. Spinal biomechanics. J Biomech Eng 1993;115:569–74.
3. Roussouly P, Gollogly S, Berthonnaud et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 2005;30:346–53.
4. Chaléat-Valayer E, Mac-Thiong JM, Paquet J et al. Sagittal spino-pelvic alignment in chronic low back pain. Eur Spine J 2011;20:634–40.
5. Evcik D, Yücel A. Lumbar lordosis in acute and chronic low back pain patients. Rheumatol Int 2003;23:163–5.
6. Jackson RP, McManus AC. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine (Phila Pa 1976) 1994;19:1611–8.
7. Barrey C, Jund J, Noseda O, et al. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 2007;16:1459-67.
8. Harrison DD, Cailliet R, Janik TJ, et al. Elliptical modeling of the sagittal lumbar lordosis and segmental rotation angles as a method to discriminate between normal and low back pain subjects. J Spinal Disord 1998;11:430–9.
9. Chun SW, Lim CY, Kim K et al. The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. Spine J 2017;17:1180-91.
10. Keller TS, Colloca CJ, Harrison DE, et al. Influence of spine morphology on intervertebral disc loads and stresses in asymptomatic adults: implications for the ideal spine. Spine J 2005;5:297-309.
11. Coşkun Benlidayı İ, Başaran S, Seydaoğlu G. Lumbosacral morphology in lumbar disc herniation: a “chicken and egg” issue. Acta Orthop Traumatol Turc 2016;50:346–50.
12. Onyemaechi NO, Anyanwu GE, Obikili EN, et al. Impact of overweight and obesity on the musculoskeletal system using lumbosacral angles. Patient Prefer Adherence 2016;10:291-6.
13. De Carvalho DE, Callaghan JP. Influence of automobile seat lumbar support prominence on spine and pelvic postures: a radiological investigation. Appl Ergon 2012;43:876-82.
14. Shirazi-Adl A, Parnianpour M. Role of posture in mechanics of the lumbar spine in compression. J Spinal Disord 1996;9:277–86.
15. Cholewicki J, Crisco JJ 3rd, Oxland TR, et al. Effects of posture and structure on three-dimensional coupled rotations in the lumbar spine: a biomechanical analysis. Spine 1996;21:2421–8.
16. Vialle R, Levassor N, Rillardon L, et al. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 2005;87:260-7.
17. Jabłońska-Sudoł K, Maciejczak A. Relationship between the spino-pelvic parameters and the slip grade in isthmic spondylolisthesis. Neurol Neurochir Pol 2015;49:381-8.
18. Endo K, Suzuki H, Tanaka H et al. Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J 2010;19:435-8.
19. Rajnics P, Templier A, Skalli W, et al. The importance of spinopelvic parameters in patients with lumbar disc lesions. Int Orthop 2002;26:104-8.
20. Roaf R. Vertebral growth and its mechanical control. J Bone Joint Surg Br 1960;42:40–59.
21. Legaye J, Duval-Beaupere G, Hecquet J, et al. Pelvic incidence: a fundamental pelvic parameter for threedimensional regulation of spinal sagittal curves. Eur Spine J 1998;7:99–103.
22. 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.
23. Coskun Benlidayi I, Basaran S. Comparative study of lumbosacral alignment in elderly versus young adults: data on patients with low back pain. Aging Clin Exp Res 2015;27:297-302.
24. Janssen MM, Drevelle X, Humbert L et al. Differences in male and female spino-pelvic alignment in asymptomatic young adults: a three-dimensional analysis using upright low-dose digital biplanar X-rays. Spine (Phila Pa 1976) 2009;34:826-32.
25. Whitcome KK, Shapiro LJ, Lieberman DE. Fetal load and the evolution of lumbar lordosis in bipedal hominins. Nature 2007;450:1075-8.
26. Ghasemi A, Haddadi K, Khoshakhlagh M, et al. The relation between sacral angle and vertical angle of sacral curvature and lumbar disc degeneration: a casecontrol study. Medicine (Baltimore) 2016;95:2746.