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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(01): 041-046
DOI: 10.1055/s-0041-1729579
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Correlation between the Severity of the Lumbar Degenerative Disease and Sagittal Spinopelvic Alignment

Article in several languages: português | English
Raphael de Rezende Pratali 
1   Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil
,
Raphael Battisti 
1   Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil
,
Carlos Eduardo Algaves Soares de Oliveira 
1   Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil
,
Daniel Augusto Carvalho Maranho 
2   Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, SP, Brasil
,
Carlos Fernando P. S. Herrero 
2   Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, SP, Brasil
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Abstract

Objective To evaluate the impact of the severity of lumbar degenerative disease (LDD) on sagittal spinopelvic alignment.

Methods In total, 130 patients (mean age: 57 years; 75% female) with LDD-associated low-back pain were prospectively included. The severity of the LDD was defined by the following findings on anteroposterior and lateral lumbar spine radiographs: osteophytosis; loss of of height of the intervertebral disc; terminal vertebral plate sclerosis; number of affected segments; deformities; and objective instability. The disease was classified as follows: grade 0–absence of signs of LDD in the lumbar spine; grade I – signs of LDD in up to two segments; grade II – three or more segments involved; grade III – association with scoliosis, spondylolisthesis, or laterolisthesis. Spinopelvic radiographic parameters, including pelvic incidence (PI), lumbar lordosis (LL), discrepancy between the PI and LL (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA), were analyzed according to the LDD grades.

Results The radiographic parameters differed according to the LDD grades; grade-III patients presented higher SVA (p = 0.001) and PT (p = 0.0005) values, denoting greater anterior inclination of the trunk and pelvic retroversion when compared to grade-0 andgrade-I subjects. In addition, grade-III patients had higher PI-LL values, which indicates loss of PI-related lordosis, than grade-I subjects (p = 0.04).

Conclusion Patients with more severe LDD tend to present greater spinopelvic sagittal misalignment compared to patients with a milder disease.

Keywords

spondylosis - spine - lumbar pain - classification - radiography

Financial Support

The present study did not receive any type of funding.




Publication History

Received: 22 July 2020

Accepted: 03 November 2020

Article published online:
18 February 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Pratali RR, Hennemann SA, Amaral R. et al. Standardized terminology of adult spine deformity for brazilian portuguese. Coluna/Columna 2015; 14 (04) 281-285
    CrossrefGoogle Scholar
  • 2 Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 2005; 30 (18) 2024-2029
    CrossrefPubMedGoogle Scholar
  • 3 Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 2009; 34 (17) E599-E606
    CrossrefPubMedGoogle Scholar
  • 4 Schwab FJ, Blondel B, Bess S. et al; International Spine Study Group (ISSG). Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 2013; 38 (13) E803-E812
    CrossrefPubMedGoogle Scholar
  • 5 Schwab F, Ungar B, Blondel B. et al. SRS-Schwab Adult Spinal Deformity Classification: A Validation Study. Spine (Phila Pa 1976) 2012; 37 (12) 1077-1082
    CrossrefPubMedGoogle Scholar
  • 6 Terran J, Schwab F, Shaffrey CI. et al; International Spine Study Group. The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 2013; 73 (04) 559-568
    CrossrefPubMedGoogle Scholar
  • 7 Schwab F, Dubey A, Gamez L. et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976) 2005; 30 (09) 1082-1085
    CrossrefPubMedGoogle Scholar
  • 8 Barreto MVA, Pratali RR, Barsotti CEG, Santos FPE, Oliveira CEAS, Nogueira MP. Incidence of spinal deformity in adults and its distribution according SRS-Schwab classification. Coluna/Columna 2015; (14) 93-96
    CrossrefGoogle Scholar
  • 9 Natarajan RN, Andersson GBJ. Lumbar disc degeneration is an equally important risk factor as lumbar fusion for causing adjacent segment disc disease. J Orthop Res 2017; 35 (01) 123-130
    CrossrefPubMedGoogle Scholar
  • 10 Fu KMG, Rhagavan P, Shaffrey CI, Chernavvsky DR, Smith JS. Prevalence, severity, and impact of foraminal and canal stenosis among adults with degenerative scoliosis. Neurosurgery 2011; 69 (06) 1181-1187
    CrossrefPubMedGoogle Scholar
  • 11 Horton WC, Brown CW, Bridwell KH, Glassman SD, Suk SI, Cha CW. Is there an optimal patient stance for obtaining a lateral 36" radiograph? A critical comparison of three techniques. Spine (Phila Pa 1976) 2005; 30 (04) 427-433
    CrossrefPubMedGoogle Scholar
  • 12 Vasconcelos IT, Sant'Anna DA, Oliveira CEAS, Herrero CFPS, Pratali RR. Escala de graduação da doença degenerativa lombar em exames de radiografia panorâmica da coluna vertebral. Coluna/Columna 2019; 18 (01) 32-36
    CrossrefGoogle Scholar
  • 13 Lafage R, Ferrero E, Henry JK. et al. Validation of a new computer-assisted tool to measure spino-pelvic parameters. Spine J 2015; 15 (12) 2493-2502
    CrossrefPubMedGoogle Scholar
  • 14 Smith JS, Fu KMG, Urban P, Shaffrey CI. Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management. J Neurosurg Spine 2008; 9 (04) 326-331
    CrossrefPubMedGoogle Scholar
  • 15 Pratali RR, Nasreddine MA, Diebo B, Oliveira CEAS, Lafage V. Normal values for sagittal spinal alignment: a study of Brazilian subjects. Clinics (São Paulo) 2018; 73: e647
    CrossrefPubMedGoogle Scholar
  • 16 Lafage R, Schwab F, Challier V. et al; International Spine Study Group. Defining Spino-Pelvic Alignment Thresholds: Should Operative Goals in Adult Spinal Deformity Surgery Account for Age?. Spine (Phila Pa 1976) 2016; 41 (01) 62-68
    CrossrefPubMedGoogle Scholar