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Eur Spine J (2010) 19:435438 DOI 10.1007/s00586-009-1240-1
ORIGINAL ARTICLE
Sagittal spinal alignment in patients with lumbar disc herniation
Kenji Endo Hidekazu Suzuki Hidetoshi Tanaka
Yupeng Kang Kengo Yamamoto
Received: 7 May 2009 / Revised: 19 November 2009 / Accepted: 28 November 2009 / Published online: 20 December 2009 Springer-Verlag 2009
Abstract A retrospective cross-sectional study was designed to evaluate total sagittal spinal alignment in patients with lumbar disc herniation (LDH) and healthy subjects. Abnormal sagittal spinal alignment could cause persistent low back pain in lumbar disease. Previous studies analyzed sciatic scoliotic list in patients with lumbar disc herniation; but there is little or no information on the relationship between sagittal alignment and subjective ndings. The study subjects were 61 LDH patients and 60 age-matched healthy subjects. Preoperative and 6-month postoperatively lateral whole-spine standing radiographs were assessed for the distance between C7 plumb line and posterior superior corner on the top margin of S1 sagittal vertical axis (SVA), lumbar lordotic angle between the top margin of the rst lumbar vertebra and rst sacral vertebra (L1S1), pelvic tilting angle (PA), and pelvic morphologic angle (PRS1). Subjective symptoms were evaluated by the Japanese Orthopedic Association (JOA) score for lower back pain (nine points). The mean SVA value of the LDH group (32.7 46.5 mm, SD) was signicantly larger than that of the control (2.5 17.1 mm), while L1S1 was smaller (36.7 14.5) and PA was larger (25.1 9.0) in
LDH than control group (49.0 10.0 and 18.2 6.0, respectively). At 6 months after surgery, the malalignment recovered to almost the same level as the control group. SVA correlated with the subjective symptoms measured by the JOA score. Sagittal spinal alignment in LDH exhibits more anterior translation of the C7 plumb line, less lumbar lordosis, and a more vertical sacrum. Measurements of
these spinal parameters allowed assessment of the patho-physiology of LDH.
Keywords Sagittal spinal alignment
Lumbar disc herniation Radicular pain
Introduction
Abnormal sagittal spinal alignment may cause persistent low back pain in patients with lumbar disease. Patients with lumbar disc herniation (LDH) accompanied by radicular pain sometimes present a forward-bending posture while walking. Previous studies analyzed sciatic scoliotic list in LDH [1, 2], although they did not quantify the relationship between sagittal alignment and the subjective ndings. The...