Impact of disease duration on lumbar curvature correction in patients with rigid post-traumatic thoracolumbar kyphosis

doi:10.12307/2026.097

Abstract

Abstract: BACKGROUND: Currently, most studies on rigid post-traumatic thoracolumbar kyphosis focus on overall sagittal balance and surgical intervention, while the effect of the disease duration on the change of lumbar compensatory curvature and degeneration is still unclear.
OBJECTIVE: To explore the effect of the disease duration on lumbar degeneration and the potential mechanism of rigid post-traumatic thoracolumbar kyphosis in patients with rigid post-traumatic thoracolumbar kyphosis, and provide a basis for optimizing treatment strategies.
METHODS: Clinical and imaging data from 79 rigid post-traumatic thoracolumbar kyphosis patients were retrospectively analyzed. The patients were divided into two groups according to the disease duration: Patients with a disease duration of ≤ 5 years were categorized as group A (n=40), and those with > 5 years as group B (n=39). X-ray images were used to measure the local kyphosis angle of the injured vertebra, the height of the posterior walls of the injured vertebra and adjacent vertebrae, lumbar lordosis, the intervertebral space angle for each lumbar segment, and sacral slope. The Weishaupt-CT classification system was employed to assess lumbar facet joint degeneration. Pfirrmann-MRI grading system was applied to evaluate disc degeneration. The visual analog scale for back pain, Oswestry Disability Index, SRS-22 and American Spinal Injury Association spinal injury grading were compared between the groups. The impact of disease duration on clinical symptoms and imaging characteristics of patients with rigid post-traumatic thoracolumbar kyphosis was analyzed.
RESULTS AND CONCLUSION: (1) There were no significant differences in age, gender, visual analog scale scores, fracture location, fracture type, or American Spinal Injury Association grading between the two groups (P > 0.05). Group A had a significantly higher SRS-22 score than group B (P < 0.05); Group B had a significantly higher Oswestry Disability Index score than group A (P < 0.05). (2) Group B had a substantially greater kyphosis angle of the injured vertebra, lumbar lordosis, and L4/5 intervertebral space angle than group A (P < 0.05). (3) There were no significant differences between groups A and B in the L1/2, L2/3, L3/4, or L5/S1 intervertebral space angles or sacral slope (P > 0.05). (4) Group B showed significantly greater facet joint degeneration at the L3/4, L4/5, and L5/S1 segments and significantly greater disc degeneration at the L2/3, L3/4, L4/5, and L5/S1 segments compared with group A (both P < 0.05). (5) Pearson correlation analysis indicated a positive correlation between disease duration and both the local kyphosis angle of the injured vertebra and lumbar lordosis in group B (r=0.335, 0.418, P < 0.05). (6) Over time, rigid post-traumatic thoracolumbar kyphosis patients experience increased lumbar lordosis and accelerated lumbar degeneration, with the L4/5 segment playing a primary role in compensatory lumbar curvature. Surgical correction should focus on adjusting the lower lumbar curvature.

Key words: rigid post-traumatic thoracolumbar kyphosis, lumbar lordosis, facet joint degeneration, lumbar intervertebral disc degeneration, disease duration, lumbar curvature

CLC Number:

Yang Junjie, Zhang Hao, Chen Zhike, Chen Yao, Jia Bingxu, Wang Qing, Li Guangzhou, Wang Gaoju. Impact of disease duration on lumbar curvature correction in patients with rigid post-traumatic thoracolumbar kyphosis[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(21): 5534-5540.

Figures/Tables 4

References

[1] CAHUEQUE M, COBAR A, ZUÑIGA C, et al. Management of burst fractures in the thoracolumbar spine. J Orthop. 2016;13(4):278-281.
[2] KATSUURA Y, OSBORN JM, CASON GW. The epidemiology of thoracolumbar trauma: A meta-analysis. J Orthop. 2016;13(4): 383-388.
[3] LEE G, WANG Q, ZHONG D, et al. Relation Between Severity of Injury and Neurological Deficit in Thoracolumbar Burst Fracture. Clin Spine Surg. 2016;29(5):208-211.
[4] WOOD KB, LI W, LEBL DR, et al. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145-164.
[5] 杨万梅, 崔西龙, 王康康, 等. 陈旧性创伤性脊柱后凸畸形术前站立位至俯卧位脊柱-骨盆矢状位参数变化研究[J]. 中国修复重建外科杂志,2023,37(5):596-600.
[6] FUSINI F, COLÒ G, RISITANO S, et al. Back to the future in traumatic fracture shapes of lumbar spine: An analysis of risk of kyphosis after conservative treatment. J Craniovertebr Junction Spine. 2021;12(1): 38-43.
[7] MAZEL C, AJAVON L. Malunion of post-traumatic thoracolumbar fractures. Orthop Traumatol Surg Res. 2018;104(1s):S55-S62.
[8] BOHL MA, HLUBEK RJ, XU DS, et al. Posterior open-wedge anterior longitudinal ligament release: Cadaveric technique analysis. Clin Anat. 2019;32(3):348-353.
[9] SCHWAB F, LAFAGE V, BOYCE R, et al. Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine (Phila Pa 1976). 2006;31(25): E959-E967.
[10] GLASSMAN SD, BRIDWELL K, DIMAR JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005; 30(18):2024-2029.
[11] LE HUEC JC, AUNOBLE S, PHILIPPE L, et al. Pelvic parameters: origin and significance. Eur Spine J. 2011;20 Suppl 5(Suppl 5):564-571.
[12] 宋凯, 迟鹏飞, 吴兵, 等. 脊柱畸形患者骨盆-下肢冠状位影像学参数的测量及其平衡代偿机制 [J]. 中国脊柱脊髓杂志,2020,30(6): 500-508.
[13] 李庆辉, 王辉昊, 俞仲翔. 脊柱矢状面平衡的代偿机制和矢状面失衡的运动疗法研究进展[J]. 中医正骨,2024,36(3):59-63.
[14] 陈飞, 康意军, 周彬, 等. 后路改良经椎弓根截骨术治疗创伤后胸腰椎后凸畸形[J]. 中南大学学报(医学版),2016,41(11): 1208-1214.
[15] WANG Q, TANG C, WANG G, et al. Treatment of rigid post-traumatic thoracolumbar kyphosis by a novel technique of spinal joints release. J Orthop Surg Res. 2023;18(1):124.
[16] KUKLO TR, POLLY DW, OWENS BD, et al. Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine (Phila Pa 1976). 2001;26(1):61-65; discussion 66.
[17] CELESTRE PC, DIMAR JR 2ND, GLASSMAN SD. Spinopelvic Parameters: Lumbar Lordosis, Pelvic Incidence, Pelvic Tilt, and Sacral Slope: What Does a Spine Surgeon Need to Know to Plan a Lumbar Deformity Correction? Neurosurg Clin N Am. 2018;29(3):323-329.
[18] RAJASEKARAN S, KANNA RM, SCHNAKE KJ, et al. Osteoporotic Thoracolumbar Fractures-How Are They Different? Classification and Treatment Algorithm. J Orthop Trauma. 2017;31 Suppl 4:S49-S56.
[19] WEISHAUPT D, ZANETTI M, BOOS N, et al. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol. 1999;28(4): 215-219.
[20] PFIRRMANN CW, METZDORF A, ZANETTI M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26(17):1873-1878.
[21] SCHWAB FJ, BLONDEL B, BESS S, et al. 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.
[22] 王清, 王高举, 钟德君, 等. 后前路联合环形松解保留椎体后壁治疗创伤后僵硬性胸腰椎后凸畸形[J]. 中国修复重建外科杂志,2012, 26(3):261-265.
[23] 刘津呈. 创伤后僵硬性胸腰椎后凸畸形影像学特点观察[D]. 泸州:西南医科大学,2023.
[24] LAFAGE V, SCHWAB F, PATEL A, et al. 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.
[25] ROBERSON JR, WHITESIDES TE JR. Surgical reconstruction of late post-traumatic thoracolumbar kyphosis. Spine (Phila Pa 1976). 1985;10(4): 307-312.
[26] 周恒才, 朱锋, 邱勇, 等. 退变性胸腰椎后凸与陈旧性胸腰椎骨折后凸矢状面代偿模式的比较[J]. 中国脊柱脊髓杂志,2015,25(5): 427-432.
[27] 吉立新，陈仲强, 宋祥平, 等. 胸腰段压缩骨折腰椎前凸角度及病变椎体倾斜角度的变化特点[J]. 山东医药,1999,33(22):9-10.
[28] BERVEN SH, DEVIREN V, SMITH JA, et al. Management of fixed sagittal plane deformity: outcome of combined anterior and posterior surgery. Spine (Phila Pa 1976). 2003;28(15):1710-1715; discussion 1716.
[29] 文王强, 徐浩翔, 张泽佩, 等. 腰椎小关节退变的相关因素及生物力学特点[J]. 中国组织工程研究,2020,24(24):3883-3889.
[30] MOHANTY SP, PAI KANHANGAD M, KAMATH S, et al. Morphometric study of the orientation of lumbar zygapophyseal joints in a South Indian population. J Orthop Surg (Hong Kong). 2017;25(3): 2309499017739483.
[31] WU M, WANG S, DRISCOLL SJ, et al. Dynamic motion characteristics of the lower lumbar spine: implication to lumbar pathology and surgical treatment. Eur Spine J. 2014;23(11):2350-2358.
[32] BAE JS, JANG JS, LEE SH, et al. A comparison study on the change in lumbar lordosis when standing, sitting on a chair, and sitting on the floor in normal individuals. J Korean Neurosurg Soc. 2012;51(1):20-23.
[33] BARREY C, ROUSSOULY P, PERRIN G, et al. Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J. 2011;20 Suppl 5(Suppl 5):626-633.
[34] SCHWAB F, PATEL A, UNGAR B, et al. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976). 2010;35(25):2224-2231.
[35] GAO R, WU J, YUAN W, et al. Modified partial pedicle subtraction osteotomy for the correction of post-traumatic thoracolumbar kyphosis. Spine J. 2015;15(9):2009-2015.
[36] HU W, WANG B, RUN H, et al. Pedicle subtraction osteotomy and disc resection with cage placement in post-traumatic thoracolumbar kyphosis, a retrospective study. J Orthop Surg Res. 2016;11(1):112.
[37] SCHWAB F, BLONDEL B, CHAY E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery. 2014;74(1):112-120; discussion 120.
[38] VACCARO AR, SILBER JS. Post-traumatic spinal deformity. Spine (Phila Pa 1976). 2001;26(24 Suppl):S111-118.