The Study Of The Relationship Between Spino-Pelvic Parameters And Lumbar Spinal Degeneration

1.1.Purpose: To study the relationship between spinal-pelvis parameters and lumbar disc degeneration,so as to provide a basis for predicting and intervening the process of lumbar disc degeneration,and to provide help for spine surgeons to make surgical plans.1.2 Materials and Methods: A total of 136 hospitalized patients from spine department of The Second Affiliated Hospital of Dalian Medical University between September 2017 and January 2019 were retrospectively analyzed.All plain radiographs were left lateral and anterior-posterior radiographs of the standing with global spine.These patients had low back pain or neurologic symptoms different extent,mainly for lumbar degenerative spondylolisthesis,lumbar disc herniation,lumbar spinal stenosis,lumbar spinal instability,or diagnosed as degenerative disc disease.Pfirrmann Scale was used to evaluate the degenerative degree of the lumbar disc collected from the information of Magnetic Resonance Imaging(MRI)according to T2 WI.The assessment included disc between L1 and L2,L2 and L3,L3 and L4,L4 and L5,L5 and S1.Each standing global spine radiograph was performed with natural stand,the hip and knee natural extension,double arms resting 90 ° on the scaffold,and include the base of skull,the full length of spine,pelvis,proximal femur.All patients had 30 cm distance away from the radiation source.Exclusion criteria: 1,There was spinal surgery,trauma,fracture,and infection,tumor,isthmus spondylolithesis,degenerative and congenital scoliosis deformity,cervical vertebra protrusion deformity,severe protrusion deformity;2,Vertebral body deformation with height loss more than a third;3,Exist compensatory flexion in hip and knee,severe hip disease such as congenital marrow hip dysplasia;3,Any patient with Ⅳ scale and above in all lumbar disc degeneration from the Magnetic Resonance Imaging(MRI).Statistical data including: gender,age,weight and height(BMI),the degree of the lumbar disc degeneration,the location of the lumbar spondylolisthesis,pelvis incidence angle(PI),pelvic tilt angle(PT),sacral slope angle(SS),lumbar lordosis Angle(LL),thoracic kyphosis angle(TK),sagittal vertical axis(SVA),spino-sacral angle(SSA),the vertex location of lumbar lordosis,the slippage location of lumbar.Pearson correlation analysis was carried out among the data;Independent sample T-test was conducted according to gender,age and PI value.1.3 Result: A total of 136 patients were included,including 62 male patients and 74 female patients,age from 20 to 80 years old,with an average age of 59.53 years old;BMI changes between 18.93 and 35.16(kg/cm2),with an average BMI of 26.34(kg/cm)(n=128).Among the 136 patients,95 patients had MRI information,and all these 95 patients had BMI data.1.3.1 Pearson correlation analysis among all sagittal parameter: There was a negative correlation between age and PI and SS(P=0.021;P=0.001),positive correlation with TK(P=0.004);There was significant positive correlation between PI and SS,PT,LL(P=0.000;P = 0.000;P=0.0000);PI also determined the position of vertex of the lumbar lordosis(P=0.000).The degenerative degree of L5/S1 intervertebral disc was significantly correlated with PI,SS,LL(PI<0.005);The degenerative degree of L4/L5 intervertebral disc was correlated with PT(P=0.006);The degenerative degree of upper lumbar intervertebral discs(L1/L2 intervertebral disc,2/3 intervertebral disc,L3/L4 intervertebral disc)was correlated with age(P=0.011;P=0.000;P=0.000).1.3.2 Students T test between male group and female group: There was no significant discrepancy in PI value between the male group and the female group(P=0.131),but the value of PT has significant difference between this two group.1.3.3 Students T test in age group: patients tended to lead to the degenerative of upper lumbar intervertebral discs(L1/L2 disc,2/3 disc,L3/L4 disc)in those aged over 55(P=0.03;P=0.001;P=0.002).1.3.4 Students T test in groups divided by the value of PI: the group with less PI values tend to happen high degree degeneration in L5/S1 disc.1.3.5 Students T test between groups with and without slippage in each intervertebral space: SVA values had statistically significant difference in SVA and L1/L2(P=0.006)and L4/L5(P=0.044).1.4 Conclusions: PI is the main factor affecting the disc degeneration of L5/S1.The larger PI(PI>44)tend to cause lighter disc degeneration in L5/S1,otherwise it is more serious.PT has significant effect in the degenerative degree of L4/5 intervertebral disc.with age(age >55)increasing,the range of lumbar disc degeneration developed upward to the upper lumbar spine(L1/L2,L2/L3,L3/L4).PI plays an insignificant role in lumbar degenerative spondylolisthesis,however,SVA is the main factor affecting lumbar spondylolisthesis,which is a result of lumbar degeneration and a compensation of slippage.