Necessity of Whole Spine Standing Lateral Radiograph in Adults over 50 Years Old Who Have Degenerative Lumbar Disease: Comparison with Supine Lumbar Lateral Radiograph

ABSTRACT

STUDY DESIGN: Cross-sectional study. OBJECTIVES: Sagittal imbalance cannot be predicted depending on the degree of lumbar lordosis. Thus, we tried to evaluate the necessity of whole spine standing lateral radiograph through comparison of the spinal and pelvic parameter between supine lumbar lateral radiograph and whole spine standing lateral radiograph. SUMMARY OF LITERATURE REVIEW No studies in the literature compare supine lumbar lateral radiograph and whole spine standing lateral radiograph. MATERIALS AND METHODS: We randomly selected 50 males and 50 females among the patients over the age of 50 who visited our hospital for outpatient due to degenerative lumbar disease. Lumbar lordosis (sLL/wLL), sacral slope (sSS/wSS), and pelvic tilt (sPT/wPT) were measured and compared respectively by supine lumbar lateral radiograph and whole spine standing lateral radiograph. We categorized as group AI (sLL or =30degrees) by supine lumbar lateral radiograph and analyzed them. We also categorized as group BI (SVA5 cm) by whole spine standing lateral radiograph and analyzed them. RESULTS: There were no statistical difference in lumbar lordosis (sLL/wLL 35.1degrees/37.7degrees) and pelvic parameter (sSS/wSS 32degrees/31.7degrees, sPT/wPT 24.3degrees/24.2degrees. sPI/wPI 56.3degrees/58.2degrees) between supine lumbar lateral radiograph and whole spine standing lateral radiograph, and there were also no statistical difference between two groups (group AI & AII) in SVA, lumbar lordosis and pelvic parameter. Pelvic parameter compared by supine lumbar lateral radiograph and whole spine standing lateral radiograph based on sagittal balance was no significant difference, but lumbar lordosis appeared statistical difference. CONCLUSION: Sagittal imbalance appears quite a lot in patients with degenerative lumbar disease and supine lateral radiograph can't reflect the whole sagittal imbalance. So, whole spine standing lateral radiograph should be performed routinely to analyze the sagittal alignment.