The study of sagittal spino-pelvic parameters in thoracolumbar osteoporotic vertebral compression fractures

English Keywords:Vertebral compression fracture  Osteoporosis  Sagittal parameters  Therapeutic strategy

English Abstract:

  【Abstract】 Objectives: To investigate the radiographic features of sagittal spino-pelvic parameters in thoracolumbar osteoporotic vertebral compression fractures(OVCFs), and to provide references for clinical treatment of the OVCFs. Methods: This was an analysis of 116 patients(the OVCFs group) with thoracolumbar OVCFs, 102 cases without osteoporotic vertebral fracture were selected as the simple osteoporosis(OP) group, 46 cases of healthy participants with normal bone mineral density(BMD) were selected as the normal BMD group. The distribution of fracture vertebrae was analyzed in the OVCFs group. Sagittal parameters of thoracic kyphosis(TK), thoraco-lumbar kyphosis(TLK), lumbar lordosis(LL), sagittal vertical axis(SVA), T1 pelvic angle(TPA),pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), the Oswestry disability index(ODI) were measured and compared among the three groups, the correlations of the parameters in each group were also analyzed. Each group was divided into balance subgroup and imbalance subgroup according to the spinal sagittal balance. The numbers of cases in three imbalance subgroups were compared. The sagittal parameters of two subgroups were analyzed. Results: (1)No difference in TK, PI was found among the three groups(P＞0.05); TLK, SVA, TPA, PT, ODI in the OVCFs group were higher than those in the simple OP group, and the parameters in the simple OP group were higher than those in the normal BMD group(P＜0.05); LL, SS in the OVCFs group were lower than those in the simple OP group, and LL, SS in the simple OP group was lower than those in the normal BMD group(P＜0.05). Correlation analysis showed that in the normal BMD group, TPA was correlated with SVA, PI, PT, SS; LL was correlated with TK, PI, SS; PI was correlated with PT, SS(P＜0.05). In the simple OP group, TPA was correlated with SVA, LL, PI, PT, SS; TK was correlated with SVA, TPA, TLK; LL was correlated with TK, TLK, PI, SS; PI was correlated with PT, SS(P＜0.05). In the OVCFs group, TPA was correlated with SVA, LL, PI, PT, SS; TK was correlated with SVA, TLK; PT was correlated with PI, SS(P＜0.05). (2)The imbalance subgroup was found in 29.41％ of the simple OP group and 44.83％ of the OVCFs group. (3)Differences in the imbalance subgroup and the balance subgroup of the OVCFs group showed that: the multiple-level vertebral fractures were found in 37.5％ of the balance subgroup and 67.31％of the imbalance subgroup, no difference in the distribution of fracture vertebrae and PI existed between the two subgroups(P＞0.05); TLK, SVA, TPA, PT, ODI in the imbalance subgroup were higher than those in the balance subgroup, however, LL, SS were lower(P＜0.05). In the balance subgroup, SVA was correlated with TPA, TK,TLK, LL, PI, PT; TPA was correlated with TK, TLK, LL, PI, PT, SS; TK was correlated with TLK, LL, PT, SS; TLK was correlated with LL, PI, PT; LL was correlated with PT, SS; PT was correlated with PI, SS(P＜0.05). In the imbalance subgroup, TPA was correlated with SVA, LL, PI, PT, SS; PT was correlated with PI, SS(P＜0.05). Conclusions: When the correlations of parameters of thoracic kyphosis, lumbar lordosis and pelvic are lost in the thoracolumbar OVCFs, sagittal spinal imbalance is more likely to occur in the thoracolumbar OVCFs, the different surgeries should be adopted according to the sagittal spinal balance.