SIB #460 -Lumbar Disc Herniation and Spinal Alignment

The Study: Coronal and sagittal spinal alignment in lumbar disc herniation with scoliosis and trunk shift 

Overview: This study investigates and compares the incidence of scoliosis and spinopelvic alignment in patients with known lumbar disc herniation to a control group of patients with and without trunk shift.

Key Points:         

·         The study looked at 68 subjects and 61 controls.

 ·         All subjects in the study had disc herniation(s) confirmed with either CT or MRI. 

·         AP and Lateral Full Spine radiographs were obtained. 

·         Measured parameters included trunk shift, Cobb angle, Thoracic Kyphosis, Lumbar Lordosis, Pelvic Incidence, Sacral Slope, Pelvic Tilt and Sagittal Vertical Axis.

·         Curves of 5 degrees up to 38 degrees were found in 42 patients. 

·         51% of the patients demonstrated trunk shift to the side opposite of the disc herniation. 

·         Disc herniations with coronal plane trunk shift were strongly associated with  anterior shifting of the C7 plumb line, loss of lumbar lordosis and a flatter sacral base.

Author’s Conclusions: Lumbar disc herniation is associated with identifiable spinopelvic postural imbalance.  Understanding of “spinal sagittal balance and morphotypes for specific situations may be conducive to earlier treatment possibilities and prevention measures.”  (emphasis ours)

Reviewer's Comments: I hate to reduce this down to one idea, but what really impressed me was the concept that the authors thought understanding these findings “…may be conducive to earlier treatment possibilities and prevention measures.” In other words, these authors felt that understanding malalignment as seen on full spine radiographs may aid in formulating both preventive and treatment methods. Another medical article that shows interest in spinal alignment. What a unique concept [sarcasm].

 Reviewer:  Roger Coleman DC 

Editor’s Comments: Just one more example of the medical profession publishing  research which improves our understanding and delivery of chiropractic spinal care. To add insult to injury, the authors used a hundred year old chiropractic technology (full spine radiography) which our own profession has foolishly abandoned. Our profession should be doing this type of basic but valuable research, but this paper would almost certainly have never gotten IRB approval here, because of the institutional bias against radiography, especially full spine radiographs. And that’s just a sad commentary on where we are as a profession. Here endeth the rant.

 Editor: Mark R, Payne DC 

Reference: Weifei Wu, Ying Chen, Ling Yu, Fel Li, Weichun Guo. Coronal and sagittal spinal alignment in lumbar disc herniation with scoliosis and trunk shift. J Orthop Surg Res 2019 Aug 20;14(1):264.

 Link to Abstract: https://pubmed.ncbi.nlm.nih.gov/31451116/

 Link to Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710870/