RESUMO
OBJECTIVE: To explore the effect of Kümmell's disease with kyphosis on the sagittal morphology of the spine-pelvis. METHODS: A retrospective analysis of 34 patients of Kümmell's disease with kyphosis ï¼Kümmell groupï¼ admitted from August 2015 to September 2022, including 10 males and 24 females with an average age of ï¼71.1±8.5ï¼ years old. A control group of 37 asymptomatic population aged ï¼69.3±6.7ï¼ years old was matched. Spinal-pelvic sagittal parameters were measured on the anterior-posterior and lateral X-rays of the whole spine in the standing position, including segmental kyphosisï¼SKï¼ or thoracolumbar kyphosisï¼TLKï¼, thoracic kyphosisï¼TKï¼, lumbar lordosisï¼LLï¼, pelvic incidenceï¼PIï¼, pelvic tiltï¼PTï¼, sacral slopeï¼SSï¼, sagittal vertical axisï¼SVAï¼, T1 pelvic angleï¼TPAï¼ and PI-LL. Vertebral wedge angleï¼WAï¼ in Kümmell was measured and differences in parameters among groups were analyzed and the relationship between spino-pelvic parameters and WA, SK were also investigated. RESULTS: TK, SK, PT, SVA, TPA and PI-LL in Kümmell group were significantly larger than those in control group ï¼P<0.05ï¼, LL and SS in Kümmell group were significantly decreased than those in control group ï¼P<0.05ï¼, and there was no significant difference in PI between two groups ï¼P>0.05ï¼. In Kümmell group, WAï¼30.8±5.9ï¼° showed a positive correlation with SK and TKï¼r=0.366, 0.597, P<0.05ï¼, and SK was significantly correlated with LL and SSï¼r=0.539, -0.591, P<0.05ï¼. Strong positive correlation between LL and PI, SS, SVA, TPA, PI-LL were also confirmed in patients with Kümmell with kyphosisï¼r=0.559, 0.741, -0.273, -0.356, -0.882, P<0.05ï¼. CONCLUSION: Patients with Kümmell with kyphosis not only have segmental kyphosis, but also changes the overall spinal-pelvic sagittal parameters, including loss of lumbar lordosis, pelvic retrorotation, trunk forward tilt. The surgical treatment of Kümmell disease should not only pay attention to the recovery of the height of the collapsed vertebra, but also focus on the overall balance of the spine-pelvic sagittal plane for patients with kyphosis.
Assuntos
Cifose , Lordose , Espondilose , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Lordose/diagnóstico por imagem , Estudos Retrospectivos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Cifose/diagnóstico por imagem , Cifose/cirurgia , Pelve/diagnóstico por imagemRESUMO
OBJECTIVE: To explore the effects of morphological changes such as vertebral wedge deformation and disc degeneration (collapse) on adult thoracolumbar/lumbar degenerative kyphosis(TL/LDK) deformity. METHODS: A retrospective analysis of 32 patients with spinal TL/LDK deformity admitted from August 2015 to December 2020, including 8 males and 24 females, aged 48 to 75(60.3±12.4) years old. On the long-cassette standing upright lateral radiographs, the coronal Cobb angle, sagittal thoracic lumbar/lumbar kyphosis angle(KA) of spine were measured, and the height and wedge parameters of apex vertebral(AV) and two vertebrae(AV-1, AV-2, AV+1, AV+2) above and below AV and the intervertebrae and the intervertebral disc(AV-1D, AV-2D, AV+1D, AV+2D) were evaluated, involving anterior vertebral body height(AVH), posterior vertebral body height(PVH), vertebral wedge angle(VWA), ratio of vertebral wedging(RVW), anterior disc height(ADH), posterior disc height(PDH), disc wedge angle(DWA), ratio of disc wedging(RDW), and DWA/KA. RESULTS: The average angle of kyphosis was (44.2±19.1)°. A significant decrease in anterior height of vertebral was observed compared to the posterior height of vertebral(P<0.005). There was no significant difference in anterior and posterior height of discs. The vertebral wedging ratio/contribution ratio:AV-2(14.98±10.95)%/(14.21±8.08)%, AV-1(21.08±12.39)%/(18.09±7.38)%, AV(26.94±11.94)%/(25.52±8.64)%, AV+1(24.19±8.42)%/(20.82±8.69)%, AV+2(20.56±7.80)%/(15.60±9.71)%, total contribution(94.23±22.25)%, the disc wedging ratio/contribution ratio:AV-2D(2.88±2.57)%/(5.27±4.11)%, AV-1D(1.98±1.41)%/(2.29±2.16)%, AV+1D(-5.54±3.75)%/(-0.57±0.46)%, AV+2D(-8.27±4.62)%/(-1.22±1.11)%, total contribution (5.77±4.79)%. And the contribution rate of AV was significantly higher than that of adjacent vertebral(P<0.05). CONCLUSION: The vertebral body and intervertebral disc shape both have influence on thoracolumbar kyphosis. However, the contribution of vertebral morphometry to the angle of TL/LDK deformity is relatively more important than the disc. The contribution of the wedge change of the AV to the TL/LDK deformity is particularly significant.