Does the sagittal spinal profile differ between the elderly Chinese populations with and without lumbar disc herniation?

Background The influence of spinopelvic morphology on the Chinese elderly LDH population was not clear. The purpose of this study is to explore its influence on the characteristics of lumbar disc herniation or degeneration. Methods 212 elderly patients with LDH and 213 asymptomatic volunteers were involved. Spinal parameters were measured on full-length X-ray and compared between two populations. In herniated group, sagittal profiles were determined according to the Roussouly classification, the degenerative grades, the herniated location and the number of intervertebral lumbar disc degeneration were evaluated from the L1 to S1 on MRI scans. The differences on them among Roussouly types were analyzed. Results There were no significant differences in BMI, the mean value of age and sex distribution between two populations. Patients were found to have significantly smaller TK, LL, and SS than those volunteers (p < 0.05), while contradicting observations on PT and TPA were obtained (p < 0.05). Roussouly type 1 and type 2 ( 50.4% and 28.7% respectively) are predominant in the LDH population and the proportion of type 1 in elderly LDH is further increased. Subjects with LDH in type 1 and 2 had lower mean herniated locations and fewer mean herniated numbers than those with type 3 and 4. Conclusions Sagittal spinopelvic parameters were found to be significantly different in elderly LDH patients and asymptomatic volunteers. There were significant differences in the Roussouly distribution among different age groups of LDH. Different Roussouly subtypes have different effects on lumbar disc degeneration and herniation.

Lumbar spine abnormalities in patients with obstructive sleep apnoea

Previous studies suggested cervical spondylosis as a risk factor for development of obstructive sleep apnoea (OSA). We aimed to assess lumbar disc degeneration in patients with OSA and correlate the findings with symptoms and disease severity. Twenty-seven patients with OSA and 29 non-OSA controls underwent sleep studies and lumbar magnetic resonance imaging (MRI), and completed the Epworth Sleepiness Scale and the 24-item Roland‐Morris Disability Questionnaire (RMDQ) questionnaires. Plasma klotho was determined with enzyme-linked immunosorbent assay. Patients with OSA had higher number of disc bulges (4.6 ± 3.7 vs. 1.7 ± 2.5, p < 0.01) and anterior spondylophytes (2.7 ± 4.2 vs. 0.8 ± 2.1, p < 0.01), increased disc degeneration (total Pfirrmann score 16.7 ± 4.7 vs. 13.2 ± 4.1, p < 0.01) and vertebral fatty degeneration (7.8 ± 4.7 vs. 3.8 ± 3.7, p < 0.01). There was no difference in the RMDQ score (0/0–3.5/ vs. 0/0–1/, p > 0.05). Markers of OSA severity, including the oxygen desaturation index and percentage of total sleep time spent with saturation < 90% as well as plasma levels of klotho were correlated with the number of disc bulges and anterior spondylophytes (all p < 0.05). OSA is associated with lumbar spondylosis. Our study highlights the importance of lumbar imaging in patients with OSA reporting lower back pain.

Radiological Analysis of Sagittal and Cross-sectional Morphology of Congenital Lumbar Spinal Stenosis

Background Purpose This retrospective study was applied to investigate the morphology characteristics of the spine and pelvis in patients with congenital spinal stenosis, to explore the effect of morphological parameters in the pathogenesis and development of the disease.Methods The analysis is based on data of a case-control study, including 40 patients (19 females/21 males) with congenital lumbar spinal stenosis, 40 patients (17females/23males) with age-、Sex- and the waist and leg pain score-matched acquired lumbar spinal stenosis and 40 age-、Sex-matched normal volunteers(controls). Lumbar MRI, lumbar computerized tomography（CT）and full-length radiographs were used to obtain sagittal and cross-sectional parameters. Parameters including pelvic incidence（PI）, sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis（SVA）, and thoracic kyphosis（TK）on the sagittal plane were measured on full-length radiographs and analyzed. The anteroposterior (AP) bone canal diameter and spinal canal area of L4 were collected and analyzed on Lumbar CT. Lumbar MRI was taken to evaluate the angle of the ligamentum flavum at the level of L4/5 intervertebral space，and the Lumbar disc degeneration degree was calculated.Results Total scores for lumbar disc degeneration and the angle of the ligamentum flavum were significantly lower in the congenital group than in the acquired group（P= 0.02 and P= 0.012，respectively ； P＜0.05）. The differences of LL, PT, SVA and TK values were statistically significant ， while the differences of SS and PI were not significant among the acquired, congenital, and control groups. TK values were significantly lower in the congenital group than in the acquired and control groups（P=0.024 and P=0.006，respectively； P＜0.05）. Patients in the congenital and acquired groups had significantly lower LL values than patients in the control group (p = 0.000 and 0.041, respectively； P＜0.05). The mean value of LL was 30.31°±13.42° in the congenital group, while 41.10°±12.51° in the acquired group. And the difference of LL between these two groups was statistically significant（p=0.000＜0.05）. The SVA values of the congenital group, acquired group, and control group increased respectively(all P＜0.05). The PT in the congenital group showed significantly lower values than the acquired group (p = 0.041＜0.05). There is no statistically significant difference in other parameters.The correlations between LL and PI are well in the congenital group（r=0.336；P=0.034）, acquired group（r=0.464；P=0.003） and control group（r=0.584；P=0.000）. However, the trend line of LL/PI in the acquired group was drawn below the control population. Also, the trend line of LL/PI in the congenital group was below the waist and leg pain score-matched acquired group with lower lumbar degeneration.Conclusion In addition to bony structural stenosis, the smaller angle of the ligamentum flavum may be an anatomical factor that causes the smaller effective area of the spinal canal in patients with congenital lumbar spinal stenosis. Patients with congenital lumbar spinal stenosis show a significant reduction in the physiological curvature of the thoracic and lumbar spine, and the trunk leans forward. In addition to intervertebral disc degeneration and pain factors, bony spinal stenosis is also a possible factor leading to smaller LL in patients with congenital lumbar spinal stenosis. LL less than 41° can be used as the initial screening standard for congenital lumbar spinal stenosis among patients with lumbar spinal stenosis.