SIB# 382 -Lumbar Disc Herniation and Spinal Alignment
The Study: Coronal and sagittal spinal alignment in lumbar disc herniation with scoliosis and trunk shift
The Facts:
a. The authors indicate that lumbar disc herniations are becoming more common.
b. The authors sought to: “To investigate the incidence of scoliosis and trunk shift in patients with LDH (lumbar disc herniation) and analyze the differences in spinopelvic alignment among patients with or without trunk shift and non-symptom controls.” Note: Anyone with a history of adolescent or adult scoliosis was excluded from the study.
c. Patients were divided into two groups. Group 1 included 68 patients with LDH and Group 2 included 61 patients as a control. All subjects in Group 1 had LDH verified by either CT or MRI as one of the inclusion criteria.
d. All subjects had full spine A-P and lateral radiographs.
e. Parameters measured on the radiographs included “trunk shift and Cobb angle, TK (thoracic kyphosis), TLK (thoraco-lumbar junction kyphosis), LL (lumbar lordosis), PI (pelvic incidence), SS (sacral slope), PT (pelvic tilt) and SVA (sagittal vertical axis).”
f. In the frontal view, the authors found no significant association of the side of the disc herniation and the direction of the patient’s trunk shift in the coronal plane. “Fifty percent of patients showed a trunk shift towards the opposite side of disc herniation.”
g. However, in the sagittal view, subjects with LDH and trunk shift exhibited “a more anterior shift of the C7 plumb line”, reduced lumbar lordosis, and a flatter “more horizontal” sacral base.
Take Home:
Patients with LDH and trunk shift are more likely to also have significant alterations in the sagittal spinal alignment.
Reviewer's Comments:
I was not surprised that those patients with both LDH and trunk sift also tended to have a loss of lumbar lordosis and a forward shift of the C7 plumb bob line. Nor was I particularly surprised that only 42 of the 68 LDH patients demonstrated any trunk shift at all.
Reviewer: Roger Coleman DC
Editor’s Comments: This study highlights the fact that changes in the frontal plane alignment are likely to also be associated with changes in the sagittal plane. In the course of a busy day, it’s all too easy to see a scoliotic curve or trunk shift in the AP view and then fail to understand and address the impact of the sagittal imbalances as well. It’s a three dimensional spine folks!
Editor: Mark R. Payne DC
Reference: Wu W, Chen Y, Yu L, Li F, Guo W. Coronal and sagittal spinal alignment in lumbar disc herniation with scoliosis and trunk shift. J Orthop Surg Res. 2019 Aug 20;14(1):264. doi: 10.1186/s13018-019-1300-0.
Link to Abstract:https://www.ncbi.nlm.nih.gov/pubmed/31451116