골반대의 시상면과 관상면상의 부정렬 지표의 상관관계

안영태(Young-Tae Ahn),김신웅(Shin-Woong Kim),이현엽(Hyeon-Yeop Lee) 대한스포츠한의학회 2014 대한스포츠한의학회지 Vol.14 No.2

Objectives The purpose of this study is to find out the relationship between the coronal lumbosacral-pelvic parameters and the sagittal lumbosacral-pelvic parameters. Methods This study was carried out on 190 patients who visited Bu-Chun Jaseng Hospital of Korean Medicine with low back pain. Researchers measured their lumbosacral-pelvic parameters and analyzed the relationship between the coronal parameters and the sagittal parameters. Result 1. There is a significant correlation in the Ferguson angle and iliac height difference. 2. There was a no significant correlation between the lumbar lordotic angle and lumbosacral-pelvic parameters. 3. In case of anterior displacement of lumbar gravity line, it showed low occurrence rate of iliac width imbalance. However, there was no statistically significant. 4. There was more im-balance of left and right iliac width in female. Conclusion 1. Imbalance of left and right iliac height was more appeared in patients with the Ferguson angle that out of normal range. 2. There was more imbalance of left and right iliac width in female than male. 3. There was no significant correlation between the coronal lumbosacral-pelvic parameters and the sagittal lumbosacral-pelvic parameters except Ferguson angle.

요추부 척추전방전위증 환자에서 후방경유 추체간 골유합술 후 시상면 균형과 하부요통 간의 관계 분석

김 희열,주 창일,이 승명 조선대학교 의학연구원 2017 The Medical Journal of Chosun University Vol.42 No.2

Measures of radiographic pelvic and spinal parameters of sagittal balance analysis have become of considerable importance for reconstructive surgery of the spine, particularly in cases of degenerative spondylolisthesis. The authors conducted a retrospective study of clinical outcomes and a radiological review on 231 patients with one or two level degenerative spondylolisthesis. First, patients were classified using preoperative pelvic parameters and evaluations were conducted using mean values of pre- and postoperative spinopelvic parameters. Second, patients were divided into two study groups, that is, Group A (n=105; exhibited no improvement (increase or no change) in pelvic tilt postoperatively) and Group B (n=126; exhibited pelvic tilt improvement (decrease) postoperatively). Clinical outcomes in the two groups were compared using Visual Analogue Pain Scores (VAS) and Oswestry disability index (ODI). All preoperative pelvic parameters show restoration tendency after PLIF surgery for spondylolisthesis, and greater deviations of preoperative pelvic parameters from normality showed greater recovery postoperatively. VAS and ODI improvements at follow-up were poorer in group A than in group B.

A Retrospective Study of the Effect of Spinopelvic Parameters on Fatty Infiltration in Paraspinal Muscles in Patients With Lumbar Spondylolisthesis

Jia-Chen Yang,Jia-Yu Chen,Yin Ding,Yong-Jie Yin,Zhi-Ping Huang,Xiu-Hua Wu,Zu-Cheng Huang,Yi-Kai Li,Qing-An Zhu 대한척추신경외과학회 2024 Neurospine Vol.21 No.1

Objective: The effect on fat infiltration (FI) of paraspinal muscles in degenerative lumbar spinal diseases has been demonstrated except for spinopelvic parameters. The present study is to identify the effect of spinopelvic parameters on FI of paraspinal muscle (PSM) and psoas major muscle (PMM) in patients with degenerative lumbar spondylolisthesis. Methods: A single-center, retrospective cross-sectional study of 160 patients with degenerative lumbar spondylolisthesis (DLS) and lumbar stenosis (LSS) who had lateral full-spine x-ray and lumbar spine magnetic resonance imaging was conducted. PSM and PMM FIs were defined as the ratio of fat to its muscle cross-sectional area. The FIs were compared among patients with different pelvic tilt (PT) and pelvic incidence (PI), respectively. Results: The PSM FI correlated significantly with pelvic parameters in DLS patients, but not in LSS patients. The PSM FI in pelvic retroversion (PT > 25°) was 0.54 ± 0.13, which was significantly higher in DLS patients than in normal pelvis (0.41 ± 0.14) and pelvic anteversion (PT < 5°) (0.34 ± 0.12). The PSM FI of DLS patients with large PI ( > 60°) was 0.50 ± 0.13, which was higher than those with small ( < 45°) and normal PI (0.37 ± 0.11 and 0.36 ± 0.13). However, the PSM FI of LSS patients didn’t change significantly with PT or PI. Moreover, the PMM FI was about 0.10–0.15, which was significantly lower than the PSM FI, and changed with PT and PI in a similar way of PSM FI with much less in magnitude. Conclusion: FI of the PSMs increased with greater pelvic retroversion or larger pelvic incidence in DLS patients, but not in LSS patients.

요천추 및 골반 지표와 요통 치료 호전도에 대한 후향적 고찰

조성우 ( Sung Woo Cho ) 한방재활의학과학회 2014 한방재활의학과학회지 Vol.24 No.3

Objectives The aim of this study was to investigate the relationship between the improvement of low back pain and lumbosacral-pelvic parameters. Methods Fifty one patients were classified into the normal group and the abnormal group, based on X-ray. In each group, lumbosacral-pelvic parameters were measured. The data were analysed by independent t-test. Results The significant difference of the parameters of Femur Height was found in the normal group and the abnormal group. Conclusions These results show that we can predict effect of LBP treatment by investigating the parameters of and Femur Height. (J Korean Med Rehab 2014;24(3):139-148)

Global Sagittal Alignment and Clinical Outcomes after 1–3 Short-Segment Lumbar Fusion in Degenerative Spinal Diseases

Youn Yung-Hun,조규정,Na Yeop,Kim Jeong-Seok 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.4

Study Design: Level III retrospective study.Purpose: We investigated the impact of short-segment lumbar fusion on the restoration of global sagittal alignment and the correlations between spino-pelvic parameters and clinical outcomes.Overview of Literature: Sagittal imbalance leads to energy consumption and pain in maintaining a standing position. For adult spinal deformity, it is critical to create optimal lumbar lordosis (LL) in order to achieve restoration of sagittal imbalance. However, surgeons do not pay attention to correcting LL in short-segment lumbar fusion.Methods: A total of 69 patients with transforaminal lumbar interbody fusion (TLIF) for degenerative spinal disease were evaluated with a minimum 2-year follow-up. All patients underwent TLIF with hyper-lordotic angle cages to achieve higher LL. Radiological spino-pelvic parameters including sagittal vertical axis (SVA) and clinical outcomes using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) were evaluated.Results: The average LL was 35.8°±9.9° before surgery, 42.3°±9.3° 1 year after surgery, and 40.3°±10.2° 2 years after surgery (<i>p</i> <0.01). The average SVA was 43.1±6.2 mm before surgery, 21.2±4.9 mm 1 year after surgery, and 34.0±4.7 mm 2 years after surgery (<i>p</i> <0.01). The average LL and SVA improved in two- or three-segment fusion, but not in one-segment fusion. The correlation between ΔLL and ΔSVA was significant in all segment fusions. The correlation between ΔLL and ΔSVA was more significant at the L4–5 and L5–S1 segments than at L3–4. ODI was significantly correlated with SVA (<i>p</i> <0.05). NRS showed no correlation with the radiological parameters.Conclusions: Two- or three-segment lumbar fusion using hyper-lordotic angle cages improved LL and SVA. A significant correlation between the correction of LL and SVA was found. Higher correction of LL using hyper-lordotic angle cages is thus recommended in short-segment lumbar fusion, since postoperative improvements of SVA significantly affect clinical outcomes.

Effect of pelvic adjustment on chronic low back pain and spino-pelvic parameters in middle-aged women

Yun-Gyo Seo(서윤교),Jaehee Kim(김재희) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.9

본 연구의 목적은 골반 교정이 중년 여성의 만성 요통과 척추 골반 지표들에 미치는 영향을 규명하는데 있다. 이를 위하여 만성 요통이 있는 중년 여성 38명을 실험군(20명)과 무처치 대조군(18명)에 무선 할당하여 실험군에게는 골반 교정을 주 4회, 8주 간 시술하였다. 시술 전과 8주 후에 요통은 시각적 상사 척도와 Oswestry 요통 장애 지수로 측정하였고, 그 외 요부 유연성, 염증인자인 혈중 C-reactive protein (CRP) 및 척추 골반 지표들을 평가하였다. 처치 8주 후 대조군에 비하여 골반 교정군에서 요통 강도, 요통 장애 지수 및 요부 유연성 모두가 유의하게 향상되었으며, 혈중 CRP의 유의한 변화는 없었다. 척추 골반 지표들을 분석한 결과 골반 교정군에서 대조군에 비해 요추전만각, 천골경사 및 골반균형지표는 유의하게 변화된 반면, 골반입사각의 변화가 뚜렷하지 않았다. 따라서 골반 교정은 요통 환자의 통증 경감과 기능 향상에 효과적일 것이며, 척추 골반 정렬의 변화의 결과일 것이다. The purpose of this study was to investigate the effects of pelvic adjustment on low back pain and spino-pelvic parameters in middle-aged women. Thirty-eight middle-aged women with chronic low back pain were randomly assigned to the pelvic adjustment (n = 20) oruntreated control (n = 18) group. Pelvic adjustment interventionswereperformed four times a week for 8 weeksin the former group. At baseline and after 8 weeks, the back pain and back function were evaluated using the visual analogue scale (VAS), Oswestry disability index (ODI), and back flexibility. Additionally, the spino-pelvic radiographic parameters and serum C-reactive protein (CRP) levels were assessed. After 8 weeks, the VAS, ODI, and back flexibility significantly improved in the pelvic adjustment group compared with the control group. It was found that the changes from baseline in the lumbar lordotic angle, sacral slope, pelvic crest unleveling, and femoral head height inequality were significantly greater in the pelvic adjustment group than in the control group. There were no significant changes in the pelvic incidence or serum CRP levels in either group. In conclusion, pelvic adjustment has beneficial effects on chronic low back pain and back function, suggesting that the effects of pelvic adjustment on back pain may at least in part result from changes in the spino-pelvic alignment.

퇴행성 요추 질환의 수술 후 척추-골반 지표의 임상적 의미

박수안,이주헌 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.3

Study Design: A review of the literature. Objectives: To discuss how to evaluate, interpret, and utilize measurements of spino-pelvic alignment before and after spinal surgery in patients with lumbar degenerative disease. Summary of Literature Review: Various spino-pelvic parameters are currently utilized in the evaluation of spinal patients; however, interpretation of these parameters is not easy. Materials and Methods: Each spino-pelvic parameter and factors affecting its value, and how to interpret and utilize the spino-pelvic parameters before and after spinal surgery were discussed for patients with lumbar degenerative disease with and without sagittal spinal deformity. Results: Sagittal modifiers in the SRS-Schwab classification including pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), and pelvic tilt (PT) are widely accepted in the evaluation of lumbar degenerative disease with sagittal deformity. Surgery for sagittal realignment is meant to restore both the SVA and PT by restoring the LL in reference to the PI. However, patients with an extremely high SVA and PT or those with a high SVA and low PT can end up with postoperative residual malalignment. In patients without deformity, PI-LL mismatch (> 10°) should be highlighted and should be actively corrected by restoring the lordosis of the pathologic segment. Conclusions: Sagittal modifiers are beneficial for their simplicity and comprehensibility; however, they are insufficient for evaluating sub-regional spinal deformity. Spino-pelvic parameters can be useful for evaluating spinal patients in a clinical setting, but the measurements are greatly affected by confounding factors such as poor patient posture, unqualified testers, and manual measurement techniques. 연구 계획: 종설. 목적: 시상면 척추 변형이 동반되었거나 동반되지 않은 요추 퇴행성 질환 환자를 대상으로 척추-골반 정열 관점에서 어떻게 환자를 분석하고 그 결과를해석하여 임상에 적용할 지에 대하여 논의하고자 한다. 선행문헌의 요약: 다양한 척추-골반 지표들이 척추 환자의 분석에 사용되고 있지만, 여러 임상 증례에서 각각 다르게 나타나기도 하고, 몇가지 교란 요인들에 의해서 측정값이 영향을 받는 등의 이유로, 척추-골반 지표는 해석하기 어려운 문제가 있다. 대상 및 방법: 각각의 척추-골반 지표와 측정값에 영향을 미치는 요인들에 대하여 설명하였다. 요추 퇴행성 질환 환자중 척추 변형이 있는 경우와 없는 경우에 어떻게 측정된 지표를 해석하고 치료에 활용할지에 대하여 설명하였다. 각각의 주제에 대하여 문헌 고찰과 저자의 경험을 토대로 작성하였다. 결과: SRS-Schwab 분류에서 사용되는 3개의 시상면 수정지표인 골반 입사각-요추 전만각(PI-LL), 시상면 수직축(SVA), 골반 경사각(PT)이 시상면 척추변형을 동반한 요추 퇴행성 질환을 평가하는 대표적 지표로 사용되고 있다. 시상면 재정열 수술은 PI를 참고하여 LL를 교정하므로써 수술 후 SVA와 PT 가 회복되도록 하는 것이지만, SVA와 PT가 과도하게 큰 환자나 SVA는 크지만 PT가 PI에 비해 상대적으로 매우 작은 환자들은 재정열을 목표로 수술 하더라도 수술 후 부정 정열이 남을 수 있기 때문에 주의를 요한다. 척추 변형이 없는 요추 퇴행성 질환의 수술에서도 10도 이상의 PI-LL mismatch가 존재한다면 병소 분절의 전만각이 증가하도록 교정하는 것이 술 후 임상증상을 보다 효율적으로 개선시키는 방법이다. 결론: SRS-Schwab 분류에서 사용하는 3개의 시상면 수정지표는 간단하고 이해하기 쉬운 면은 장점이지만 척추 세부 지역의 변형을 평가할 수 없는 단점이 있다. 더불어 척추-골반 지표는 임상에서 사용함에 있어 유용하지만, 환자의 자세, 관찰자, 측정 방법 등에 따라 오차 범위가 커지는 점을 기억해야한다.

Changes in Regional and Global Sagittal Parameters of the Spine during Growth in the Pediatric Population

이춘성,황창주,조재환,이동호,양재준,박세한 대한척추외과학회 2022 대한척추외과학회지 Vol.29 No.3

Study Design: Cross-sectional study. Objectives: To demonstrate normative values for various parameters of spinal sagittal global balance in the pediatric population and elucidate whether these parameters change during growth. Summary of Literature Review: While sagittal parameters for adults have been thoroughly evaluated, relatively few studies have reported normal values and changing trends of sagittal parameters in the pediatric population. Materials and Methods: A total of 200 patients aged 5–20 years were evaluated. Cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), pelvic incidence–lumbar lordosis (PI-LL), C2–C7 sagittal vertical axis (SVA), C7 SVA, T1 pelvic angle (T1PA), and the spinosacral angle (SSA) were assessed. Results: Significant positive correlations were found between age and PI (r=0.297, p<0.001), SS (r=0.184, p=0.009), and PT (r=0.203, p=0.004). Among the global sagittal parameters, T1PA (r=0.345, p<0.001) demonstrated a significant association with age, whereas C7 SVA (r=−0.053, p=0.464) and SSA (r=−0.029, p=0.194) were not significantly associated. Furthermore, PI-LL was significantly smaller in the ≥12-year age group than that in the ≤11-year age group (p=0.037). Conclusions: In conclusion, PI, PT, and SS increase during growth owing to the increasing size of the pelvis. T1PA accordingly increases with an increase in pelvic parameters, whereas no other global sagittal parameters, such as C7 SVA or SSA, change during childhood. The changing trends and normative values of each parameter demonstrated in the present study should be considered when planning long-level fusion operations for pediatric patients.

골반 부전과 요통 발생 위치의 상관 관계에 대한 고찰 -기립위 Pelvis X-ray 분석을 통하여-

배우열 ( U Yeol Bae ),권헌준 ( Hun Joon Kwon ),정종훈 ( Jong Hoon Jung ),이종훈 ( Jong Hoon Lee ),김동섭 ( Dong Sub Kim ),조성우 ( Sung Woo Cho ) 한방재활의학과학회 2013 한방재활의학과학회지 Vol.23 No.3

ObjectivesThe aim of this study was to investigate pelvic insufficiency and its correlation with lumbago side. Methods72 cases of patients who received treatment from March 2010 to February 2013 for lumbago were analyzed. Their pelvic insufficiency parameters were estimated by x-ray analysis and lumbago sides were considered. The data were analyzed to find out correlation of pelvic insufficiency parameters and correlation between parameters and lumbago sides. Pearson correlation and two-by-k cross tabulation analysis were used. Results1) Iliac height difference had significant correlation with femur height difference and the result was alike previous studies` results. 2) Femur height difference and iliac height difference had no significant correlation with iliac width difference. 3) Posterior rotation malposition ilium side and inflare side had no significant correlation with lumbago side. ConclusionsIliac height difference had significant correlation with femur height difference and sides of pelvic insufficiency had no significant correlation with lumbago sides. (J Korean Med Rehab 2013;23(3):79-85) ObjectivesThe aim of this study was to investigate pelvic insufficiency and its correlation with lumbago side. Methods72 cases of patients who received treatment from March 2010 to February 2013 for lumbago were analyzed. Their pelvic insufficiency parameters were estimated by x-ray analysis and lumbago sides were considered. The data were analyzed to find out correlation of pelvic insufficiency parameters and correlation between parameters and lumbago sides. Pearson correlation and two-by-k cross tabulation analysis were used. Results1) Iliac height difference had significant correlation with femur height difference and the result was alike previous studies` results. 2) Femur height difference and iliac height difference had no significant correlation with iliac width difference. 3) Posterior rotation malposition ilium side and inflare side had no significant correlation with lumbago side. ConclusionsIliac height difference had significant correlation with femur height difference and sides of pelvic insufficiency had no significant correlation with lumbago sides. (J Korean Med Rehab 2013;23(3):79-85)

시상면 균형과 관련된 골반지표의 방사선학적 특성

김상범,이기수,원유건,전준범,황철목,홍창화 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.3

연구 계획: 척추 변형의 치료 시 골반지표의 방사선학적 특성에 대한 고찰. 목적: 이 문헌은 척추의 시상 정렬, 골반 지표, 정렬을 측정하는 방법을 평가하고, 이 지표들 사이의 관계를 연구하여 척추의 변형을 이해하고자 한다. 선행문헌의 요약: 척추와 골반의 시상면상 주요 지표들을 파악하고 서로의 상관관계를 아는 것은 여러 가지 척추 질환의 진단과 치료에 있어서 매우 중요하다. 대상 및 방법: 문헌 고찰결과: 골반 및 척추의 지표들은 상호간에 밀접한 상관관계의 양상을 보이므로 시상면 균형을 분석하는데 척추 지표뿐만 아니라 골반 지표를 계측하는 것은 필수적이다. 퇴행성 변화는 정상 척추의 만곡을 손상시킬 가능성이 있고, 이는 시상 부정정렬을 일으키게 된다. 시상 균형의 분석은 척추의 질환을 이해 하는데 중요한 요소이다. 또한, 수술적 치료의 결과는 방사선학적 척추-골반 지표와 이들의 변형의 관계를 이해함으로써 잘 판단 할 수 있다. 결론: 시상 정렬과 균형 그리고 보상기전의 관계를 인지하기 위한 척추와 골반 지표의 이해는 척추 변형의 본질과 이를 치료하는데 있어 포괄적인 개념을제공 한다. Study design: A literature review on the radiologic findings of pelvic parameters for treatment of spinal deformity. Objectives: This review examines sagittal spine alignment, pelvic parameters, and methods for assessing alignment, and examines the relationships among all of these parameters to understand spinal deformity. Summary of Literature Review: Understanding the main pelvic and sagittal spinal parameters and recognizing their correlation is imperative in the diagnosis and treatment of various spinal disorders. Materials and Methods: Review of the literature. Results: As spinal and pelvic parameters tend to have a strong correlation, it is essential to measure not only spinal parameters but also pelvic parameters in analyzing sagittal balance. Degenerative changes have the potential to greatly disrupt the normal curvature of the spine, leading to sagittal malalignment. Analysis of sagittal balance is crucial to optimizing the management of spinal diseases. Improvement in surgical outcomes may be achieved through better understanding of radiographic spino-pelvic parameters and their association with deformity. Conclusions: Understanding spinal and pelvic parameters raises awareness of the relationship among alignment and balance, the soft tissue envelope, and compensatory mechanisms, which will, in turn, provide a more comprehensive understanding of the nature of spinal deformity and the modalities with which it is treated.