Abstract
Objective To evaluate the impact of the severity of lumbar degenerative disease (LDD) on sagittal
spinopelvic alignment.
Methods In total, 130 patients (mean age: 57 years; 75% female) with LDD-associated low-back
pain were prospectively included. The severity of the LDD was defined by the following
findings on anteroposterior and lateral lumbar spine radiographs: osteophytosis; loss
of of height of the intervertebral disc; terminal vertebral plate sclerosis; number
of affected segments; deformities; and objective instability. The disease was classified
as follows: grade 0–absence of signs of LDD in the lumbar spine; grade I – signs of
LDD in up to two segments; grade II – three or more segments involved; grade III –
association with scoliosis, spondylolisthesis, or laterolisthesis. Spinopelvic radiographic
parameters, including pelvic incidence (PI), lumbar lordosis (LL), discrepancy between
the PI and LL (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA), were analyzed
according to the LDD grades.
Results The radiographic parameters differed according to the LDD grades; grade-III patients
presented higher SVA (p = 0.001) and PT (p = 0.0005) values, denoting greater anterior inclination of the trunk and pelvic retroversion
when compared to grade-0 andgrade-I subjects. In addition, grade-III patients had
higher PI-LL values, which indicates loss of PI-related lordosis, than grade-I subjects
(p = 0.04).
Conclusion Patients with more severe LDD tend to present greater spinopelvic sagittal misalignment
compared to patients with a milder disease.
Keywords
spondylosis - spine - lumbar pain - classification - radiography
