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Evaluation of sagittal balance and spinopelvic parameters in patients with lumbar disc herniation

Year 2018, , 446 - 453, 29.12.2018
https://doi.org/10.7197/223.vi.502383

Abstract

Aim: The objective of this study was to analyze sagittal balance throughout with spinopelvic
parameters, in patients with a lumbar disc herniation and evaluate these
patients with
functional quality
assessment questionnaires.



Material Method: A
total of 88 adult patients were evaluated in this study. All these patients
were examined clinically  in a 
physical
medicine and rehabilitation policlinic, from one physician in Sivas Numune
State Hospital
 for
a lumbar disc herniation  between 01 March-01
November 2018. The physical examination
findings and records in the patient's
files  were evaluated. The Oswestry
disability (ODI) questionnaire, Roland Morris (RDI) questionnaire and Health Assessment Questionnaire (HAQ) were
evaluated for all voluntary patients. All patients were confirmed with full
spinal anteroposterior and lateral radiographs and  lumbar MRI. Three group pathologies were evaluated
in this study: Group1; disc herniation with bulging ,Group 2; one level disc
herniation and Group 3 multilevel disc herniation, including lumber disc protrusion, extrusion, and sequestration. Spino-pelvic parameters;
lumbar lordosis (LL), pelvic incidence
(PI), pelvic tilt (PT) and sacral slope (SS) were measured on full spine
radiographs in a standing position.



Results: 
LL was significantly less  by
multilevel disc herniation group as compared with bulging group and one level
disc herniation group  (p<0.05). It
was a poor correlation between LL and
waist circumference
by multilevel disc
herniation group.
When compared
groups with functional assessment questionnaires, all  groups were not statistically different each
from other. We demonstrated not significantly different by all three groups
between ODI, HAQ and RDI scores.



Conclusion: Spinal sagittal imbalance caused by LDH is one type of
compensatory
response to prevent low back pain. This mechanism mainly
includes a loss of LL and PT.
Two important
factors that need to be considered are the paravertebral muscles strengthening
to prevent sagittal imbalance and keeping the body weight and waist circumference
in the normal range.

References

  • 1. Wang T, Wang H, Zhang D, Zhang Y, Ding W. Radiological analysis for thoracolumbar disc herniation in spinopelvic sagittal alignment. :2–7. 2. Lamartina C, Berjano P, Petruzzi M, Sinigaglia A, Casero G, Cecchinato R, et al. Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. European Spine Journal. 2012;21(SUPPL. 1):27–31. 3. Liang C, Sun J, Cui X, Jiang Z, Zhang W, Li T. Spinal sagittal imbalance in patients with lumbar disc herniation: Its spinopelvic characteristics, strength changes of the spinal musculature and natural history after lumbar discectomy. BMC Musculoskeletal Disorders [Internet]. 2016;17(1):1–8. Available from: http://dx.doi.org/10.1186/s12891-016-1164-y4. Wei X, Gengwu L, Chao C, Yifan L, Shang S, Ruixi H, et al. Correlations between the sagittal plane parameters of the spine and pelvis and lumbar disc degeneration. Journal of Orthopaedic Surgery and Research. 2018;13(1):1–9. 5. Stevens ML, Lin CCW, Maher CG. The Roland Morris Disability Questionnaire. Journal of Physiotherapy. 2016;62(2):116. 6. Mehra A, Baker D, Disney S, Pynsent PB. Oswestry disability index scoring made easy. Annals of the Royal College of Surgeons of England. 2008;90(6):497–9. 7. Bruce B, Fries JF. Bruce(haq).pdf. 2003;6:1–6. 8. Illes T. The importance of spinopelvic parameters in patients with lumbar disc lesions. 2002;104–8. 9. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the Normal Variation in the Sagittal Alignment of the Human Lumbar Spine and Pelvis in the Standing Position Pierre Roussouly , MD ,* Sohrab Gollogly , MD ,* Eric Berthonnaud , Ph.D.,† and. 2005;30(3):2005. 10. Evcik D, Yücel A. Lumbar lordosis in acute and chronic low back pain patients. Rheumatology International. 2003;23(4):163–5. 11. Endo K, Suzuki H, Tanaka H, Kang Y, Yamamoto K. Sagittal spinal alignment in patients with lumbar disc herniation. European Spine Journal. 2010;19(3):435–8. 12. Wang T, Wang H, Liu FY, Yang DL, Ma L, Ding WY. The characteristics of spino-pelvic sagittal parameters and obesity factors for adolescents with lumbar disc herniation. International Journal of Clinical and Experimental Medicine. 2016;9(7):14321–8. 13. Oh B-H, Kim H-H, Kim C-Y, Nam C-W. Comparison of physical function according to the lumbar movement method of stabilizing a patient with chronic low back pain. Journal of Physical Therapy Science [Internet]. 2015;27(12):3655–8. Available from: https://www.jstage.jst.go.jp/article/jpts/27/12/27_jpts-2015-603/_article
Year 2018, , 446 - 453, 29.12.2018
https://doi.org/10.7197/223.vi.502383

Abstract

References

  • 1. Wang T, Wang H, Zhang D, Zhang Y, Ding W. Radiological analysis for thoracolumbar disc herniation in spinopelvic sagittal alignment. :2–7. 2. Lamartina C, Berjano P, Petruzzi M, Sinigaglia A, Casero G, Cecchinato R, et al. Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. European Spine Journal. 2012;21(SUPPL. 1):27–31. 3. Liang C, Sun J, Cui X, Jiang Z, Zhang W, Li T. Spinal sagittal imbalance in patients with lumbar disc herniation: Its spinopelvic characteristics, strength changes of the spinal musculature and natural history after lumbar discectomy. BMC Musculoskeletal Disorders [Internet]. 2016;17(1):1–8. Available from: http://dx.doi.org/10.1186/s12891-016-1164-y4. Wei X, Gengwu L, Chao C, Yifan L, Shang S, Ruixi H, et al. Correlations between the sagittal plane parameters of the spine and pelvis and lumbar disc degeneration. Journal of Orthopaedic Surgery and Research. 2018;13(1):1–9. 5. Stevens ML, Lin CCW, Maher CG. The Roland Morris Disability Questionnaire. Journal of Physiotherapy. 2016;62(2):116. 6. Mehra A, Baker D, Disney S, Pynsent PB. Oswestry disability index scoring made easy. Annals of the Royal College of Surgeons of England. 2008;90(6):497–9. 7. Bruce B, Fries JF. Bruce(haq).pdf. 2003;6:1–6. 8. Illes T. The importance of spinopelvic parameters in patients with lumbar disc lesions. 2002;104–8. 9. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the Normal Variation in the Sagittal Alignment of the Human Lumbar Spine and Pelvis in the Standing Position Pierre Roussouly , MD ,* Sohrab Gollogly , MD ,* Eric Berthonnaud , Ph.D.,† and. 2005;30(3):2005. 10. Evcik D, Yücel A. Lumbar lordosis in acute and chronic low back pain patients. Rheumatology International. 2003;23(4):163–5. 11. Endo K, Suzuki H, Tanaka H, Kang Y, Yamamoto K. Sagittal spinal alignment in patients with lumbar disc herniation. European Spine Journal. 2010;19(3):435–8. 12. Wang T, Wang H, Liu FY, Yang DL, Ma L, Ding WY. The characteristics of spino-pelvic sagittal parameters and obesity factors for adolescents with lumbar disc herniation. International Journal of Clinical and Experimental Medicine. 2016;9(7):14321–8. 13. Oh B-H, Kim H-H, Kim C-Y, Nam C-W. Comparison of physical function according to the lumbar movement method of stabilizing a patient with chronic low back pain. Journal of Physical Therapy Science [Internet]. 2015;27(12):3655–8. Available from: https://www.jstage.jst.go.jp/article/jpts/27/12/27_jpts-2015-603/_article
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Details

Primary Language English
Subjects Health Care Administration
Journal Section Surgical Science Research Articles
Authors

Esin Baran

Mustafa Karademir

Publication Date December 29, 2018
Acceptance Date December 27, 2018
Published in Issue Year 2018

Cite

AMA Baran E, Karademir M. Evaluation of sagittal balance and spinopelvic parameters in patients with lumbar disc herniation. CMJ. December 2018;40(4):446-453. doi:10.7197/223.vi.502383