Analysis and study on the factors of degenerative lumbar spondylolisthesis by multi-slice spiral CT / 中国医师进修杂志

Objective To explore the influencing factors of degenerative lumbar spondylolisthesis (DLS).Methods Sixty-one DLS patients (DLS group) were enrolled in this study.The control group was formed by 61 patients with same gender and age matched.The lesion position was L4 in two groups.The correlation of intervertebral joint angle,degeneration degree,lumbosacral angle and lumbar spondylolisthesis were analyzed.Results The intervertebral joint and sagittal angle in DLS group was less than that in control group[(37.11 ± 7.52)° vs.(42.44 ± 7.61)°] (P ＜ 0.01).The lumbosacral angle between two groups had no significant difference (P ＞ 0.05).The degeneration degree between two groups had significant difference (P ＜ 0.01).Conclusion Intervertebral joint and sagittal angle and intervertebral joint degeneration degree have important roles in DLS.

Lumbosacral Sagittal Alignment in Association to Intervertebral Disc Diseases

STUDY DESIGN: A cross-sectional case-control study was designed to compare the sagittal alignment of lumbosacral regions in two groups of patients suffering from low back pain, one with intervertebral disc pathologies and one without. PURPOSE: To evaluate the correlation between lumbosacral sagittal alignment and disc degeneration. OVERVIEW OF LITERATURE: Changes in lumbar lordosis and pelvic parameters in degenerative disc lesions have been assessed in few studies. Overall, patients with discopathy were shown to have lower lumbar lordosis and more vertical sacral profiles. METHODS: From patients with intractable low back pain undergoing lumbosacral magnetic resonance imaging, 50 subjects with disc degeneration and 50 controls with normal scans were consecutively enrolled. A method was defined with anterior tangent-lines going through anterior bodies of L1 and S1 to measure global lumbosacral angle, incorporating both lumbar lordosis and sacral slope. Global lumbosacral angle using the proposed method and lumbar lordosis using Cobb's method were measured in both groups. RESULTS: Lumbar lordosis based on Cobb's method was lower in group with discopathy (20degrees-67degrees; mean, 40.48degrees+/-9.89degrees) than control group (30degrees-62degrees; mean, 44.96degrees+/-7.68degrees), although it was not statistically significant. The proposed global lumbosacral angle in subject group (53degrees-103degrees; mean, 76.5degrees+/-11.018degrees) was less than control group (52degrees-101degrees; mean, 80.18degrees+/-9.95degrees), with the difference being statistically significant (p=0.002). CONCLUSIONS: Patients with intervertebral disc lesions seem to have more straightened lumbosacral profiles, but it has not been proven which comes first: disc degeneration or changes in sagittal alignment. Finding an answer to this dilemma demands more comprehensive long-term prospective studies.

Analysis of sagittal parameters in L_5～S_1 insthmic spondylolisthesis / 中国矫形外科杂志

[Objective]To investigate the correlation of sagittal parameters in L5~S1 isthmic spondylolisthesis and its clinical manifestation.[Method]Seventy-six patients with L5~S1 isthmic spondylolisthesis were treated between January 2000 and December 2005,there were 32 males and 44 females with the age between 12 and 68 years.The lateral standing radiographs of the spine and pelvis were analyzed retrospectively.Radiographic parameters measured including pelvic incidence(PI),sacral slope(SS),lumbar lordosis(LL),lumbosacral angle(LSA)and grade of spondylolisthesis.All measurements were done by the same individual and compared to those of a cohort of 30 normal subjects.Students test was used to compare the parameters between the curve types and Pearsons correlation coefficients were used to investigate the association between all parameters(P

The Relationship between Radiologic Parameters of Lumbar Spine and Occurrence of Low Back Pain in High Risk Workers

OBJECTIVE: To investigate the relationship between commonly used radiologic parameters and occurrence of low back pain (LBP) through prospective study using pre-employment radiologic examination in high risk workplace. METHOD: One hundred and fifty four male workers in high risk workplace were evaluated. Lumbar lordosis, lumbosacral angle, lumbar gravity line and lumbar disc height-related parameters were measured using simple radiologic films of lateral lumbosacral view taken during pre-employment medical check. Relationship between occurrence of LBP during post-employment period with a mean 1.7+/-1.0 years and radiologic parameter was investigated. RESULTS: Lumbar lordosis, lumbosacral angle and lumbar disc height were not significantly correlated to the occurrence of LBP. Amount of anterior shift of lumbar gravity line did not showed correlation to occurrence of LBP, but subjects with posterior displacement of lumbar gravity line showed significantly low rate of occurrence of LBP. CONCLUSION: These results suggest that commonly used radiologic parameters are not so useful to predict occurrence of LBP in high risk workers. The possibile preventive effect of posterior shift of lumbar gravity line seems to be worth further researching.

Lumbar Lordosis in Low Back Pain Patients

The purposes of this study were to identify lumbar lordosis in low back pain patients and to investigate differences in lumbar lordosis in low back pain patients according to etiologies. On the basis of the findings of spinal roentgenogram, MRI, and SPECT imagies, the patients were divided into four groups; 1) facet syndrome with facet joint inflammation or degenerative change, 2) disc herniation including disc bulging or extrusion, 3) combined low back pain accompaning facet joint lesion with disc herniation, 4) simple low back pain with no abnormal imaging findings. There were statistically significant decrease in low back pain patients compared with normal controls in terms of lumbosacral curvature. No sex and age differences were observed within low back pain patients and normal controls in terms of lumbosacral curvature. The review disclosed a significant decrease of the lumbosacral angle in order of simple low back pain, disc herniation, combined low back pain compared with normal controls. But facet syndrome patients showed no change of lumbosacral angle. Patients with disc bulging showed no significant decrease of lumbosacral angle compared with normal controls but patients with disc extrusion showed significant decrease. It is believed that the decrease of lumbosacral angle in low back patients results from a pathokinesiological effort to keep facet joint from pressure stemed from facet overlying and to minimize the shearing force over lumbosacral joint. The facet joint stiffness due to inflammation may play a major role in no change of lumbosacral angle in facet syndrome patients. In conclusion, different causes of low back pain should be taken into consideration for the assessment of lumbosacral angle.

A Study on the Changes in the Lumbar Lordosis, Lumbosacral and Sacral Inclination Angle during Aging / 체질인류학회지

Three parameters (lumbar lordosis, lumbosacral and sacral inclination angle) were measured on 512 normal plain lateral radiographs of lumbosacral spine and the patterns of change during aging were studied. The following results were obtained. 1. The lumbar lordosis angle showed a tendency to increase with age. But a brief decrease was observed after the 6th decade in both sexes, between the 2(nd) and 3(rd) decades in males, and between the 3(rd) and 4(th) decades in females. The lumbar spines of females were generally more lordotic than those of males. 2. The lumbosacral angle appeared to increase with age. The angle in males showed a decline between the 2nd and 4th decades while the angle in females decreased after the 6th decade. Males usually had greater angles than females. 3. The sacral inclination angle continued to increase until the 6th decade, after which a decrease was noted. The angle in females was generally greater than that in males. These results showed that all three angles varied with age, and the pattern of change differed between male and female.

Pseudospondylolisthesis (Review of 22 Cases)

Study of 22 cases with the pseudospondylolisthesis established that it occurred more frequently in the older women, and far more frequently at the L4 level, as same results as reported by others. The slipping occurred as a result of degenerative disease of the articular process and facet joint, but it never exceeded 25% in this series. This study was performed to recognize the stability of the lumbosacral joint by the measurement of the anterior and posterior vertical heights(deformity) of the body of the L5 vertebra and lumbosacral angles in our cases. We also attempted to observe whether the facet angle changes at the involved level was meaningful or not. Result : lumbosacral angles in the our patients with pseudospondylolisthesis were increased greater than normal, so lumbar lordosis was less than normal. The body of the L5 vertebra was not as wedged anteroposteriorly as it normally was. The contour of the body of the L5 vertebra resembled rectangle shape. The pedicle-facet angles were increased at involved level, but this measurement was not correctly demonstrated on the plain roentgenograms. Conclusion : The stability of the lumbosacral joint in the patients with pseudospondylolisthesis was increased due to rectangle shape of the body of the L5 vertebra and less lumbar lordosis. The pedicle-facet angles at the involved level were increased, but not correct diagnostic values.

Statistical Study of the Lumosacral Angles in Lumbago Patients / 대한정형외과학회잡지

The purpose of this study is to assess the differences of the lumbosacral angles between the lying and standing position among Iumbago patients. Among Iumbago patients the following diseases with known causes were exclused in this study; spondylolisthesis, spondylolysis, pure herniated nucleus pulposus, tuberculous spondylitis, congenltal anomalies, trauma and psychosis etc. Only the following with unknown causes were included; idlopatic lumbago, hernlated nucleus pulposus with bone and joint changes, instability and degenerative osteoarthritis. The following lumbosacral angles were measured and evaluated in 460 lumbago patients; 271 patients in the lying position and 189 patients in the standing position. 1. Ferguson angle 2. Sacrovertebral angle (Mitchell angle) 3. LS horlzontal angle 4. Promonotorium angle 5. Line of weight bearing The results were summarized as follows; 1. Ferguson angle Lying position 38.4 Standing positon 35.3 Sacrovertebral angle 140.7 142 L5 horizontal angle 20.4 17.4 Promontorlum angle 134.4 134.9 2. Ferguson and L5 horizontal angles in lumbago patients were increased in the lying position and decreased in the standing position as compared with the angles in normal individuals (control group). 3. Sacrovertebral angle In lumbago patients was decreased in the lying position. 4. Promonotorium angle in lumbago patients was increased in the lying and standing position. 5. Judging by the Iine of weight bearing, Iumbago patients in the:lying position showed more instability as compared with that in the standing position group.