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Z Orthop Unfall 2016; 154(02): 128-133
DOI: 10.1055/s-0041-109327
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Die sagittale Wirbelsäulenbalance – klinische Bedeutung und radiologische Bemessung

Sagittal Balance of the Spine – Clinical Importance and Radiographic Assessment
S. Decker
1   Unfallchirurgische Klinik, Medizinische Hochschule Hannover
,
C. W. Müller
1   Unfallchirurgische Klinik, Medizinische Hochschule Hannover
,
M. Omar
1   Unfallchirurgische Klinik, Medizinische Hochschule Hannover
,
C. Krettek
1   Unfallchirurgische Klinik, Medizinische Hochschule Hannover
,
F. Schwab
2   Langone Medical Center, New York University, United States
,
P. D. Trobisch
3   Wirbelsäulenchirurgie, Eifelklinik St. Brigida, Simmerath
› Author Affiliations
Further Information

Publication History

Publication Date:
15 December 2015 (online)

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Zusammenfassung

Sagittale Wirbelsäulendeformitäten gehen mit energiereichen Kompensationsmechanismen einher und resultieren regelmäßig in lumbal lokalisierten Rückenschmerzen. Das sagittale Wirbelsäulenprofil wird insbesondere durch das Verhältnis der spinalen Lordosen und Kyphosen in Relation zur Stellung des Beckens beschrieben und ist in einer Wirbelsäulenganzaufnahme radiologisch zu beurteilen. Verschiedene radiologische Schlüsselparameter beschreiben das sagittale Profil. Insbesondere die lumbale Lordose (LL) sowie die pelvine Inzidenz (PI), der pelvine Tilt (PT) und die thorakale Kyphose (TK) sind hier von besonderer Bedeutung. Die Differenz und PI−LL zeigt die höchste Korrelation zur eingeschränkten Lebensqualität. Für eine erste grobe Abschätzung der sagittalen Balance kann jedoch auch die SVA (Sagittal Vertical Axis) verwendet werden. Den Grad der Balance bzw. Imbalance kann man unter Verwendung der SVA sowie des PT ermitteln, die chirurgische Therapie bedarf jedoch einer genaueren Analyse, wozu insbesondere die SRS-Schwab-Klassifikation (SRS: Scoliosis Research Society) verwendet werden kann.

Abstract

Sagittal deformities of the spine frequently result in back pain, as patients have to expend much energy in compensation. The sagittal alignment of the spine is defined by its curvatures (lordosis and kyphosis) relative to the position of the pelvis. Diagnostic assessment is based on full spine a. p. and lateral X-rays. The sagittal balance is primarily described by different angles that can be measured, e.g. lumbar lordosis, pelvic incidence, pelvic tilt and thoracic kyphosis. The quality of life can best be estimated by subtracting lumbar lordosis from the pelvic incidence. However, initial evaluation of the sagittal balance can also be based on the sagittal vertical axis. The severity of imbalance can be described by the sagittal vertical axis and the pelvic tilt, but surgical therapy necessitates a more profound analysis, which can be based on the SRS-Schwab classification.

Schlüsselwörter

sagittale Balance - lumbale Lordose - pelvine Inzidenz - pelviner Tilt - Imbalance

Key words

sagittal balance - lumbar lordosis - pelvic incidence - pelvic tilt - imbalance
 

  • Literatur

  • 1 Park HJ, Kim SS, Lee YJ et al. Clinical correlation of a new practical MRI method for assessing central lumbar spinal stenosis. Br J Radiol 2013; 86: 20120180
    CrossrefPubMedGoogle Scholar
  • 2 Takatalo J, Karppinen J, Niinimaki J et al. Does lumbar disc degeneration on magnetic resonance imaging associate with low back symptom severity in young Finnish adults?. Spine (Phila Pa 1976) 2011; 36: 2180-2189
    CrossrefPubMedGoogle Scholar
  • 3 Waris E, Eskelin M, Hermunen H et al. Disc degeneration in low back pain: a 17-year follow-up study using magnetic resonance imaging. Spine (Phila Pa 1976) 2007; 32: 681-684
    CrossrefPubMedGoogle Scholar
  • 4 Lafage V, Schwab F, Skalli W et al. Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine (Phila Pa 1976) 2008; 33: 1572-1578
    CrossrefPubMedGoogle Scholar
  • 5 Legaye J, Duval-Beaupère G. Sagittal plane alignment of the spine and gravity: a radiological and clinical evaluation. Acta Orthop Belg 2005; 71: 213-220
    PubMedGoogle Scholar
  • 6 Le Huec JC, Roussouly P. Sagittal spino-pelvic balance is a crucial analysis for normal and degenerative spine. Eur Spine J 2011; 20 (Suppl. 05) S556-S557
    CrossrefPubMedGoogle Scholar
  • 7 Schwab F, Lafage V, Patel A et al. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976) 2009; 34: 1828-1833
    CrossrefPubMedGoogle Scholar
  • 8 Schwab F, Lafage V, Boyce R et al. Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine (Phila Pa 1976) 2006; 31: E959-E967
    CrossrefPubMedGoogle Scholar
  • 9 Korovessis PG, Stamatakis MV, Baikousis AG. Reciprocal angulation of vertebral bodies in the sagittal plane in an asymptomatic Greek population. Spine (Phila Pa 1976) 1998; 23: 700-704
    CrossrefPubMedGoogle Scholar
  • 10 Stagnara P, De Mauroy JC, Dran G et al. Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine (Phila Pa 1976) 1982; 7: 335-342
    CrossrefPubMedGoogle Scholar
  • 11 Kobayashi T, Atsuta Y, Matsuno T et al. A longitudinal study of congruent sagittal spinal alignment in an adult cohort. Spine (Phila Pa 1976) 2004; 29: 671-676
    CrossrefPubMedGoogle Scholar
  • 12 Legaye J, Duval-Beaupère G, Hecquet J et al. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 1998; 7: 99-103
    CrossrefPubMedGoogle Scholar
  • 13 Legaye J, Hecquet J, Marty C et al. Equlibre sagittal du rachis. Relations entre bassin et courbures rachidiennes sagittales en position debout. Rachis 1993; 5: 215-226
    PubMedGoogle Scholar
  • 14 Morvan G, Mathieu P, Vuillemin V et al. Standardized way for imaging of the sagittal spinal balance. Eur Spine J 2011; 20 (Suppl. 05) S602-S608
    CrossrefPubMedGoogle Scholar
  • 15 Vaz G, Roussouly P, Berthonnaud E et al. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 2002; 11: 80-87
    CrossrefPubMedGoogle Scholar
  • 16 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: 415-422
    CrossrefPubMedGoogle Scholar
  • 17 Dubousset J, Charpak G, Skalli W et al. Skeletal and spinal imaging with EOS system. Arch Pediatr 2008; 15: 665-666
    CrossrefPubMedGoogle Scholar
  • 18 du Peloux J, Fauchet R, Faucon B et al. [The plan of choice for the radiologic examination of kyphoscolioses]. Rev Chir Orthop Reparatrice Appar Mot 1965; 51: 517-524
    PubMedGoogle Scholar
  • 19 Gelb DE, Lenke LG, Bridwell KH et al. An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976) 1995; 20: 1351-1358
    CrossrefPubMedGoogle Scholar
  • 20 Schwab FJ, Blondel B, Bess S et al. Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 2013; 38: E803-812
    CrossrefPubMedGoogle Scholar
  • 21 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: 1611-1618
    CrossrefPubMedGoogle Scholar
  • 22 Duval-Beaupère G, Schmidt C, Cosson P. A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng 1992; 20: 451-462
    CrossrefPubMedGoogle Scholar
  • 23 Mac-Thiong JM, Berthonnaud E, Dimar 2nd JR et al. Sagittal alignment of the spine and pelvis during growth. Spine (Phila Pa 1976) 2004; 29: 1642-1647
    CrossrefPubMedGoogle Scholar
  • 24 Zarate-Kalfopulos B, Romero-Vargas S, Otero-Camara E et al. Differences in pelvic parameters among Mexican, Caucasian, and Asian populations. J Neurosurg Spine 2012; 16: 516-519
    CrossrefPubMedGoogle Scholar
  • 25 Glassman SD, Bridwell K, Dimar JR et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 2005; 30: 2024-2029
    CrossrefPubMedGoogle Scholar
  • 26 Schwab F, Patel A, Ungar B et al. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 2010; 35: 2224-2231
    CrossrefPubMedGoogle Scholar
  • 27 Turner JD, Akbarnia BA, Eastlack RK et al. Radiographic outcomes of anterior column realignment for adult sagittal plane deformity: a multicenter analysis. Eur Spine J 2015; 24 (Suppl. 03) S427-S432
    CrossrefPubMedGoogle Scholar
  • 28 Bronsard N, Protopsaltis T, Moal B et al. T1 Pelvic Angle (TPA): A new global sagittal imbalance radiographic parameter including pelvic tilt and trunk inclination and its correlation with quality of life scores. Eur Spine J 2013; 22: 1218-1219
    PubMedGoogle Scholar
  • 29 Knott PT, Mardjetko SM, Techy F. The use of the T1 sagittal angle in predicting overall sagittal balance of the spine. Spine J 2010; 10: 994-998
    CrossrefPubMedGoogle Scholar
  • 30 Lafage V, Schwab F, Patel A et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 2009; 34: E599-606
    CrossrefPubMedGoogle Scholar
  • 31 Schwab F, Ungar B, Blondel B et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 2012; 37: 1077-1082
    CrossrefPubMedGoogle Scholar
  • 32 Schwab F, Lafage V, Farcy JP et al. Surgical rates and operative outcome analysis in thoracolumbar and lumbar major adult scoliosis: application of the new adult deformity classification. Spine (Phila Pa 1976) 2007; 32: 2723-2730
    CrossrefPubMedGoogle Scholar
  • 33 Scheer JK, Smith JS, Clark AJ et al. Comprehensive study of back and leg pain improvements after adult spinal deformity surgery: analysis of 421 patients with 2-year follow-up and of the impact of the surgery on treatment satisfaction. J Neurosurg Spine 2015; 22: 540-553
    CrossrefPubMedGoogle Scholar
  • 34 Terran J, Schwab F, Shaffrey CI et al. The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 2013; 73: 559-568
    CrossrefPubMedGoogle Scholar
  • 35 Kueny RA, Kolb JP, Lehmann W et al. Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing. Eur Spine J 2014; 23: 2196-2202
    CrossrefPubMedGoogle Scholar
  • 36 Goldstein CL, Brodke DS, Choma TJ. Surgical Management of Spinal Conditions in the Elderly Osteoporotic Spine. Neurosurgery 2015; 77 (Suppl. 04) S98-S107
    CrossrefPubMedGoogle Scholar
  • 37 Schoenfeld AJ, Carey PA, Cleveland 3rd AW et al. Patient factors, comorbidities, and surgical characteristics that increase mortality and complication risk after spinal arthrodesis: a prognostic study based on 5,887 patients. Spine J 2013; 13: 1171-1179
    CrossrefPubMedGoogle Scholar
  • 38 Bissolotti L, Donzelli S, Gobbo M et al. Association Between Sagittal Balance and Scoliosis in Patients with Parkinson Disease: A Cross-sectional Study. Am J Phys Med Rehabil 2015; [Epub ahead of print]
    PubMedGoogle Scholar
  • 39 Koller H, Acosta F, Zenner J et al. Spinal surgery in patients with Parkinsonʼs disease: experiences with the challenges posed by sagittal imbalance and the Parkinsonʼs spine. Eur Spine J 2010; 19: 1785-1794
    CrossrefPubMedGoogle Scholar
  • 40 Bissolotti L, Gobbo M, Villafane JH et al. Spinopelvic balance: new biomechanical insights with clinical implications for Parkinsonʼs disease. Eur Spine J 2014; 23: 576-583
    CrossrefPubMedGoogle Scholar
  • 41 Yokoyama K, Kawanishi M, Yamada M et al. Postoperative change in sagittal balance after Kyphoplasty for the treatment of osteoporotic vertebral compression fracture. Eur Spine J 2015; 24: 744-749
    CrossrefPubMedGoogle Scholar
  • 42 Cecchinato R, Berjano P, Damilano M et al. Spinal osteotomies to treat post-traumatic thoracolumbar deformity. Eur J Orthop Surg Traumatol 2014; 24 (Suppl. 01) S31-S37
    CrossrefPubMedGoogle Scholar