Morphometric analysis of the spine in patients with single-level lumbar disc herniations: clinical study

Yıl 2025, Cilt: 7 Sayı: 3, 311 - 319, 30.05.2025

Bülent Bakar , Alemiddin Özdemir , Ahmet Melih Erdoğan , Mehmet Emir Çevik , Özge Aydın , Sergen Sivuk , Abdullah Baybars Öktem , Ulaş Yüksel , Mustafa Öğden

https://doi.org/10.38053/acmj.1675007

Öz

Aims: It was reported in the literature that sagittal balance may be impaired in patients with spinal deformities and lumbar degenerative diseases. In this study, we analyzed the relationship between disc herniation and the results of spinal column morphological measurements related to sagittal balance on lumbar direct radiographs and preoperative blood biochemistry results in patients with single-level lumbar disc herniation and healthy subjects.
Methods: Patients who underwent surgery for L4-L5 or L5-S1 intervertebral disc herniation and healthy individuals were included in the study. The participants were then grouped into the control group (n=15) and the LDH group (n=30). Patients were also grouped into the L4-5 HNP group (n=15) and the L5-S1 HNP group (n=15). Age, gender, blood count, and serum C-reactive protein values of all individuals and L1-S1 Cobb angles, T12 and S1 slope angles, L4-S1 Cobb angles, each disc height, and L1-L5 vertebral column height were measured on lumbar direct radiographs.
Results: Age (p=0.035), T12 slope angle (p=0.032), L4-S1 Cobb angle (t=3.649, p=0.001), L1-L2 intervertebral disc height (p=0.032), L5-S1 intervertebral disc height (p=0.033), and eosinophil counts (p=0.039) were different between the control group and LDH group. However, there was no statistical difference between patients with L4-L5 disc herniation and patients with L5S1 disc herniation in terms of study parameters. ROC-curve and regression analysis revealed that if age over 39 years if the T12 slope angle was less than 21.50 degrees if the L4-S1 Cobb angle was less than 32.43 degrees if L1-L2 disc height was above 7.45 mm and if L5-S1 disc height was below 8.15 mm (p=0.041) these parameters could be used predictive markers for the diagnosis of the lumbar disc herniation (p<0.05).
Conclusion: At the end of the study, it was argued that patient age, T12 slope angle, L4-S1 Cobb angle, L1-L2, and L5-S1 intervertebral disc heights measured on lumbar X-ray images could be used as predictive parameters for the diagnosis of lumbar disc herniation in these patients.

Anahtar Kelimeler

Lumbar disc herniation , Cobb angle , T12 slope angle , S1 slope angle

Kaynakça

• Wang T, Ma L, Yang DL, et al. Radiological analysis for thoracolumbar disc herniation in spinopelvic sagittal alignment: a retrospective study. Medicine (Baltimore). 2017;96(14):e6593. doi:10.1097/MD. 0000000000006593
• Lamartina C, Berjano P, Petruzzi M, et al. Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J. 2012;21Suppl 1(Suppl 1): S27-S31. doi:10.1007/s00586-012-2236-9
• Liang C, Sun J, Cui X, Jiang Z, Zhang W, Li T. Spinal sagittal imbalance in patients with lumbar disc herniation: its spinopelvic characteristics, strength changes of the spinal musculature, and natural history after lumbar discectomy. BMC Musculoskelet Disord. 2016;17(1):1-8. doi:10. 1186/s12891-016-1164-y
• Baran E, Karademir M. Evaluation of sagittal balance and spinopelvic parameters in patients with lumbar disc herniation. Cumhuriyet Medical Journal. 2018;40(4):446-453. doi:10.7197/223.vi.502383
• Endo K, Suzuki H, Tanaka H, Kang Y, Yamamoto K. Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J. 2010; 19(3):435-438. doi:10.1007/s00586-009-1240-1
• Rajnics P, Templier A, Skalli W, Lavaste F, Illes T. The importance of spinopelvic parameters in patients with lumbar disc lesions. Int Orthop. 2002;26(2):104-108. doi:10.1007/s00264-001-0317-1
• Wei X, Gengwu L, Chao C, et al. Correlations between the sagittal plane parameters of the spine and pelvis and lumbar disc degeneration. J Orthop Surg Res. 2018;13(1):137. doi:10.1186/s13018-018-0838-6
• Philippi M, Shin C, Quevedo S, et al. Roussouly classification of adult spinal deformity. Proc (Bayl Univ Med Cent). 2024;37(4):688-691. doi:10. 1080/08998280.2024.2334548
• Oh YM, Eun JP. Clinical impact of sagittal spinopelvic parameters on disc degeneration in young adults. Medicine (Baltimore). 2015;94(42):e1833. doi:10.1097/MD.0000000000001833
• Chun SW, Lim CY, Kim K, Hwang J, Chung SG. The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. Spine J. 2017;17(8):1180-1191. doi:10.1016/j.spinee.2017. 04.034
• Menezes-Reis R, Garrido Salmon CE, Bonugli GP, et al. Association between spinal alignment and biochemical composition of lumbar intervertebral discs assessed by quantitative magnetic resonance imaging. Quant Imaging Med Surg. 2021;11(6):2428-2441. doi:10.21037/qims-20-40
• Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J. 2011;20 Suppl 5(Suppl 5):609-618. doi:10.1007/s00586-011-1928-x
• Nikoobakht M, Pourmahmoudian M, Gerszten PC, Pourmahmoudian M. Global sagittal angle and spinopelvic sagittal alignment: a step toward investigation of sagittal plane deformity in upper lumbar disc herniation. Br J Neurosurg. 2024;38(3):551-555. doi:10.1080/02688697.2021.1923651