Association between Sagittal Plane Parameters of Spine and Pelvis and Lumbar Spinal Degeneration

TITLE: Association between Sagittal plane parameters of Spine and Pelvis and Lumbar Spinal Degeneration.

INTRODUCTION, RATIONALE: The lumbar spine is the hub of human torso activity. Healthcare providers and patients alike remain frustrated about the causes of postural imbalance, and effective long-term treatment is rendered to recurring estimations. Increasing age, excessive activity, and overloading may cause accelerated aging of the lumbar vertebrae, and external forces may cause secondary pathological changes leading to the rupture of the intervertebral disc annulus fibrous, prolapsed intervertebral disc nucleus pulposus, and lower back pain and neurological dysfunction. Lumbar degenerative diseases include the degeneration of the intervertebral disc, cartilage end plate, vertebral body, and ligaments, of which the degeneration of intervertebral discs is the focus of our attention. Studies have shown that lumbar disc herniation, degenerative lumbar instability, and other degenerative lumbar spinal diseases, such as hyperplasia of articular processes, wedging of vertebral bodies, and hyperosteogeny, are often secondary to disc degeneration. Intervertebral disc degeneration is related to many factors, including spine biomechanics, biology, injury, inflammation, and nutrition. By studying the intervertebral disc, researchers have clarified the pathological changes involved in intervertebral disc degeneration but have ignored the roles of biomechanical factors during its development. A more thorough understanding of the correlations between skeletal alignment parameters should enable clinicians to better understand and treat biomechanical dysfunction in the body. Strong correlations between certain pelvic and spinal positional parameters for a specific patient in an upright posture have been described. Unfortunately, there is still a paucity of information on how common spinal and pelvic parameters correlate and shift through the effect of treatment, yielding little information as to the best-practice method of malalignment treatment. When a person is maintaining a standing position, various parts of the body must be in coordination, forming different spine sagittal patterns and resulting in different biomechanical characteristics. Previous studies have indicated that there are changes in the spinal-pelvic sagittal force lines in patients with spinal deformities and lumbar degenerative diseases to varying degrees. To date, research on whether lumbar intervertebral disc degeneration is related to differences in spinal-pelvic sagittal morphology has been sparse. In this study, correlations of the location, scope, and extent of lumbar intervertebral disc degeneration with sagittal spinal and pelvic parameters will be investigated.

RESEARCH QUESTION: To ascertain whether there is any correlation between sagittal plane parameters of Spine & Pelvis and Lumbar Spinal Degeneration?

AIM: To study the association between sagittal plane parameters of Spine and Pelvis and Lumbar Spinal Degeneration.

OBJECTIVES:

A. To Study Sagittal plane parameters of Spine on Radiograph

B. To Study Sagittal plane parameters of Pelvis on Radiograph

C. To Study Lumbar Spinal Degeneration on Magnetic Resonance Imaging scan (MRI)

D. To correlate the Sagittal Plane parameters of Spine and Pelvis and Lumbar Spine Degeneration.

Study Design -Retrospective Cross-sectional Study

Sample size - 80

Inclusion Criteria 1) Age > 18 years. 2) Diagnosed case of Lumbar Disc Degenerative Disease. 3) Patients with Lateral Spinal Radiographs and pre-operative Lumbar MRI.

Exclusion Criteria: 1) Patients with Spinal Traumatic Injuries, Spinal Tumors, Spinal Inflammatory Lesions, Spinal deformities 2) Patients with Lower Limb Neuromuscular disorders affecting their ability to stand 3) Patients with previous surgical intervention at Lumbar Spine .

Spinal-pelvic parameters

(1) Thoracic kyphosis (TK) is the vertebral body with the largest upper thoracic tilt to the junction of the thoracic kyphosis and lumbar lordosis.

(2) Lumbar lordosis (LL) is the junction of the thoracic kyphosis and lumbar lordosis to the S1 end plate.

(3) Pelvic incidence (PI) is the angle between the line perpendicular to the S1 end plate from the midpoint of the end plate and the connecting line from the midpoint of the S1 end plate to the center of the femoral head.

(4) Pelvic tilt (PT) is the angle between the connecting line from the midpoint of the S1 end plate to the centre of the femoral head and the vertical line. (5) Sacral slope (SS) is the angle between the tangent and the horizontal line of the S1 end plate.

(6) T1 tilt angle (TA) is the angle between the T1 vertebral end plate and the horizontal line.

Material Methods

● Selection of patient

● Radiograph of patient (X-Ray)

● Magnetic Resonance Imaging (MRI)

● Measurements of Parameters on Radiograph (X- Ray)

● Correlation of measured Parameters on Radiograph (X-Ray) with Diagnosis and Grading on Magnetic Resonance Imaging (MRI)

● Statistical Analysis of gathered data