요천추의 시상면상 정렬과 요추 퇴행성 추간판 양상의 연관성 = The Association of Lumbosacral Sagittal Alignments and the Patterns of Lumbar Disc Degeneration

다국어 초록 (Multilingual Abstract)

Study Design: Retrospective review and radiological analysis.
Objectives: We investigated whether the lumbosacral sagittal curvature have any relation to the patterns of lumbar disc degeneration.
Summary of Literature Review: Recently, there have been many studies on the correlations between the changes of lumbar disc degeneration and associated factors, such as age, gender, weight, occupation, cigarette smoking, and genetics; but, it is hard to find research into lumbosacral sagittal alignments.
Materials and Methods: This study enrolled 117 young adult patients limited by age (18-35 years), BMD (<30kg/m2), no smoking,occupation except heavy worker, no prior lumbar surgery and no combined spinal deformity. By measuring the pelvic incidence, sacral slope, lumbar tilt angle, lumbar lordosis and lumbar axis indicating the parameters of sagittal alignments, we investigated the correlation between the number and severity of lumbar disc degeneration and the number of herniated intervertebral discs.
Results: This study found a moderate correlation between pelvic incidence, sacral slope, lumbar lordosis, and the number of lumbar degenerative disc (r =-0.451, p <0.001; r =-0.433, p <0.001; r =-0.425, p <0.001). We calculated the most proper cut-off value of pelvic incidence associated with more than three segments of multiple lumbar disc degeneration, using a minimum p-value approach.
Conclusions: As pelvic incidence, sacral slope, and lumbar lordosis indicating the parameters of lumbosacral sagittal alignments get smaller, the numbers of lumbar disc degenerations and herniated intervertebral discs increase. When pelvic incidence is below 45.6degrees, it is more likely for degenerative changes of lumbar disc to affect more than three segments.

국문 초록 (Abstract)

연구 계획: 후향적 방사선학적 측정을 통한 분석 연구.
목적: 본 연구에서는 요추에서 퇴행성 추간판의 양상과 시상면상 정렬이 어떠한 연관성을 가지고 있는지 알아보고자 하였다.
선행문헌의 요약: 최근 요추 추간판의 퇴행성 변화와 연관된 원인으로 연령, 성별, 체중, 직업, 흡연력 및 유전적인 요인 등에 대해서 많은 연구가 있었으나 요천추의 시상면상 정렬과 연관된 연구는 거의 없었다.
대상 및 방법: 1996년 3월에서 2010년 5월까지 요추 수술을 받은 18-35세 사이 모든 환자를 조사하여 척추 골절 등의 수술을 받은 과거력, 시상면과 연관된 질환 (측만증, 요추 분리증, sheumermon씨 병 등), 직업력 (운동선수, 운전사 및 육체적 노동자), 체질량지수(BMI>30 kg/m2), 흡연력이 있는 환자114명을 제외한 117명을 대상으로 하였다. 시상면상 정렬의 지표인 골반 입사각(PI), 천추 경사(SS), 요추 경사각(LT), 요추 전만각(LL), 첨 요추(LA)를 측정하여 요추 퇴행성 추간판 수 및 중증도, 탈출된 추간판의 수와 상관 관계를 조사하였다.
결과: 골반 입사각, 천추 경사 및 요추 전만각은 요추 퇴행성 추간판 수와 중간 정도의 상관 관계를 보였다(r=-0.451, p <0.001; r=-0.433, p <0.001; r=-0.425, p <0.001). 최소유의확률방법으로 3개 이상의 다발성 요추 퇴행성 추간판이 있는 골반 입사각에 대한 최적의 절사값(cut-off value), PI= 45.6을 산출하였다.
결론: 요천추의 시상면상 정렬을 나타내는 지표인 골반 입사각, 천추 경사 및 요추 전만각이 작을수록 퇴행성 추간판의 수 및 탈출된 추간판의 수는 증가 하였고 골반 입사각이 45.6도 이하일 때 요추 추간판의 퇴행성 변화가 3개 이상의 분절을 가질 가능성이 높았다.

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