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

Abstract

Goal of the study This study intends to develop a method of quantitative sagittal balance parameters assessment, based on a geometrical model of lumbar spine and sacrum. MethodsOne 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. ResultsSignificant 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. ConclusionBased 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.keywords: sagittal lumbosacral balance, lumbar lordosis, lordosis angle, lumbosacral sagittal alignment volume 9 article 68

Management of recurrent lumbar disc herniation: a comparative analysis of posterior lumbar interbody fusion and repeat discectomy

“…This can be attributed to the wider working space provided by fusion techniques, allowing for a more complete discectomy 12 . Furthermore, stabilizing and fusing the lumbar motion segment can prevent pathological micro movements that accelerate degeneration and recurrence 26 . On the other hand, repeat discectomy had a reported recurrence rate of up to 22.9% 4 , which is similar to the findings of this study (22.5%).…”

Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients

“…Disc herniation is a late feature of degenerative spine disease and a sign of spinal segment instability. This means that, in the absence of stabilization, the pathological micromovements at this segment will predispose to same-level and adjacent-level recurrent herniation, deformity, and pain [ 23 ]. As a result, progression to fusion is reported at up to 83% [ 24 ].…”

Spine system changes in soldiers after load carriage training in a plateau environment: a prediction model research

“…Anatomically, the LLA and LSA can indirectly reflect the stability of the lumbar spine [ 40 , 41 ]. If the LLA or LSA is too large, it will affects the balance of the spinal system, increases the load on structures such as the paraspinal muscles and IVDs, and increases the probability of injury [ 42 ]. The increases in these two angles confirmed the compensatory effect of the lumbar curvature on weight loading.…”