2012년 10월 3일 수요일

Correlation of Sacropelvic Geometry with Disc Degeneration in Spondylolytic Cadaver Specimens (Spine 2012;37:E10-E15)

Anatomy (Spine 2012;37:E10-E15)

Title
Correlation of Sacropelvic Geometry with Disc Degeneration in Spondylolytic Cadaver Specimens

Authors
Jason O. Toy
Jason C. Tinley
Jason D. Eubanks
Sheeraz A. Qureshi
Nicholas U. Ahn

Study Design.
An anatomic study of sacral inclination, pelvic incidence, pelvic lordosis, and disc degeneration in cadaveric
lumbar spines.


Objective.
To evaluate the relationship between sacropelvic parameters and disc degeneration in subjects with bilateral
spondylolysis at L5.


Summary of Background Data.
1. L5–S1 disc degeneration is greater in patients with spondylolytic defects (L5–S1) than with an intact pars interarticularis secondary to the instability caused by spondylolysis.
2. Sacral inclination, pelvic incidence, and pelvic lordosis affect sagittal balance and axial forces on the L5–S1 disc.
Methods.
1. Observational study with 120 cadaveric specimens, spondylolysis (L5–S1) identified of 3100 total cadaveric specimens.
2. The specimens were evaluated for sacral inclination, pelvic incidence, and pelvic lordosis.
3. Disc degeneration and facet arthrosis at L4–L5 and L5–S1 were measured by the classifi cation of Eubanks et al .
4. Linear regression analyses were then used to determine the relationship between sacropelvic parameters and degeneration at the L5–S1 segment, correcting for confounding factors such as age, sex, and race.

Results.
1. Significant association between sacral inclination and disc degeneration at L5–S1 ( P = 0.018).
2. Two groups, those in the highest quarter of pelvic incidence, and the remainder.
3. Signifi cant association between disc degeneration at L5–S1 and the highest quarter of pelvic incidence ( P = 0.017).
4. Increasing pelvic lordosis was also associated with an increase in facet arthrosis at L4–L5 ( P = 0.006).

Conclusion.
1. The findings of this study show a relationship between the sacropelvic geometry and the degree of L5–S1 disc degeneration as well as L4–L5 facet degeneration in spondylolytic specimens.
2. This relationship may prove useful in predicting the course of disc degeneration in patients with spondylolysis.

Key Points
1. This study evaluated the relationship between sacropelvic parameters and disc degeneration in subjects with bilateral spondylolysis at L5.
2. We found a signifi cant relationship between the sacropelvic geometry and the degree of L5–S1 disc degeneration as well as L4–L5 facet degeneration in spondylolytic specimens.
3. We believe that the most important and relevant variable that the clinician should focus on is sacral inclination.

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