Imaging changes in spinal-pelvic sagittal alignment in
sitting and standing positions in degenerative lumbar spondylolisthesis patients

doi:10.3969/j.issn.2095-4344.2706

Abstract

Abstract:

BACKGROUND: Spinal-pelvic sagittal alignment is important for the diagnosis and treatment of degenerative lumbar spondylolisthesis. However, the current study of the spine-pelvic sagittal alignment in patients with degenerative lumbar spondylolisthesis is limited to the standing position. There is no relevant report on the spine-pelvic sagittal alignment under the sitting position.

OBJECTIVE: To analyze imaging data of sitting-standing spine-pelvic sagittal alignment in patients with degenerative lumbar spondylolisthesis, and to determine the sagittal alignment of spine change in degenerative lumbar spondylolisthesis patients from standing position to sitting position.

METHODS: Totally 44 patients with degenerative lumbar spondylolisthesis (12 males, 32 females; age, 50-84 years) were enrolled from Tianjin Hospital from March to September 2019. All patients took X-rays of the spine in standing and sitting positions. Through the hospital image archiving and communication system, spinal and pelvic parameters were measured, including pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis. The parameters were compared between standing posture and sitting posture. By using Pearson’s correlation test, differences of relationship between spinal and pelvic parameters in standing versus sitting position were discussed. This study was approved by the Ethics Committee of Tianjin Hospital.

RESULTS AND CONCLUSION: (1) When moving from standing to sitting position, in 44 degenerative lumbar spondylolisthesis patients, pelvic tilt increased [(21.3±10.1)°, (34.0±10.4)°, P < 0.001]; sacral slope decreased [(31.5±8.6)°, (20.8±12.7)°, P < 0.001]; lumbar lordosis reduced [(40.9±14.6)°, (25.8±15.0)°, P < 0.001]; sagittal vertical axis increased [(43.0±43.4), (75.0±34.8) mm, P < 0.001]; pelvic incidence and thoracic kyphosis did not significantly changed (P > 0.05). (2) Whether standing or sitting position, lumbar lordosis was correlated with other parameters (P < 0.05). When changing from standing to sitting position, the correlation between sacral slope and sagittal vertical axis disappeared (P > 0.05), but lumbar lordosis was also correlated with sagittal vertical axis (P < 0.05). (3) When the degenerative lumbar spondylolisthesis patients change from standing position to sitting position, the sagittal configuration of spine pelvis shows that the pelvis rotates back around the bilateral femoral heads; the pelvis shows a backward leaning state; the physiological curvature of lumbar spine becomes shallow; and the sagittal balance axis of spine moves forward.

Key words: spine, pelvis, sagittal alignment, position change, degenerative lumbar spondylolisthesis, standing position, sitting position, lumbar surgery

CLC Number:

Liu Yang, Xu Baoshan, Xu Haiwei, Li Ning, Jiang Hongfeng, Wang Tao, Liu Yue. Imaging changes in spinal-pelvic sagittal alignment in sitting and standing positions in degenerative lumbar spondylolisthesis patients[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(24): 3857-3861.

Figures/Tables 4

References

[1] LAZENNEC JY, FOLINAIS D, BENDAYA S, et al. The global alignment in patients with lumbar spinal stenosis: our experience using the EOS full-body images.Eur J Orthop Surg Traumatol.2016;26(7):713-724.
[2] MATSUMOTO T, OKUDA S, MAENO T, et al. Spinopelvic sagittal imbalance as a risk factor for adjacent-segment disease after single-segment posterior lumbar interbody fusion.J Neurosurg Spine.2017;26(4):435-440.
[3] SUN Y, WANG H, YANG D, et al. Characterizatjon of radiographic features of consecutive lumbar spondylolislhesis. Medicine.2016;95(46):e5323．
[4] WANG T, WANG H, IIU H, et al. Sagittal spinopelvic parameters in 2-level lumbar degenerative spondylolisthesis: a retrospective study.Medicine.2016;95(50):e5417．
[5] BARRETT E, LENEHAN B, KIERAN O’SULLIVAN, et al. Validation of the manual inclinometer and flexicurve for the measurement of thoracic kyphosis. Physiother Theory Pract, 2018;34(4):301-308.
[6] SULTAN AA, KHLOPAS A, PIUZZI NS, et al. The Impact of Spino-Pelvic Alignment on Total Hip Arthroplasty Outcomes: A Critical Analysis of Current Evidence.J Arthroplasty.2018; 33(5):1606-1616.
[7] MAC-THIONG JM, PARENT S, JONCAS J, et al. The importance of proximal femoral angle on sagittal balance and quality of life in children and adolescents with high-grade lumbosacral spondylolisthesis.Eur Spine J. 2018;27(8): 2038-2043.
[8] HIDEKAZU S, KENJI E, YASUNOBU S, et al. Radiographic Assessment of Spinopelvic Sagittal Alignment from Sitting to Standing Position.Spine Surg Relat Res.2018;2(4):290-293.
[9] MERCHANT G, BUELNA C, CASTANEDA SF, et al. Accelerometer measured sedentary time among Hispanic adults: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).Prev Med Rep. 2015;2: 845-853.
[10] RINGHEIM I, INDAHL A, ROELEVELD K. Reduced muscle activity variability in lumbar extensor muscles during sustained sitting in individuals with chronic low back pain. PLoS One. 2019;14(3):e0213778.
[11] CHEVILLOTTE T, COUDERT P, CAWLEY D, et al. Influence of posture on relationships between pelvic parameters and lumbar lordosis: Comparison of the standing, seated, and supine positions. A preliminary study.Orthop Traumatol Surg Res.2018;104(5):565-568.
[12] 孙卓然,姜帅,邹达,等.国人青年人群坐-立位脊柱-骨盆矢状位序列变化研究[J].中国脊柱脊髓杂志,2018,28(4):44-48.
[13] 王伟,周思宇,孙卓然,等.中老年人从站立位到坐位的脊柱矢状位序列变化[J].中国脊柱脊髓杂志,2019,29(7):621-626.
[14] 袁倚文,刘臻,胡宗杉,等.选择性融合对Lenke 1型青少年特发性脊柱侧凸患者站立和坐位腰椎与骨盆矢状面平衡的影响[J].中国脊柱脊髓杂志,2019,29(1):1-8.
[15] OBA H, EBATA S, TAKAHASHI J, et al. Loss of Pelvic Incidence Correction After Long Fusion Using Iliac Screws for Adult Spinal Deformity: Cause and Effect on Clinical Outcome. Spine (Phila Pa 1976).2019;44(3):195-202.
[16] RADOVANOVIC I, URQUHART JC, GANAPATHY V, et al. Influence of postoperative sagittal balance and spinopelvic parameters on the outcome of patients surgically treated for degenerative lumbar spondylolisthesis.J Neurosurg Spine. 2017;26(4):448-453.