J Korean Soc Spine Surg.  2016 Dec;23(4):239-245. 10.4184/jkss.2016.23.4.239.

Basic Pelvic Parameters Associated with Lumbar Degenerative Disease: Review Article

• Joo YS
• Cho JH

• KMID: 2365085
• DOI: http://doi.org/10.4184/jkss.2016.23.4.239

Abstract

STUDY DESIGN: Literature review.
OBJECTIVES
The aim of this study was to present updated information on the basic pelvic parameters associated with lumbar degenerative disease. SUMMARY OF LITERATURE REVIEW: Sagittal imbalance has been known to be related to a poor prognosis in almost all adult spine problems, including lumbar degenerative disease.
MATERIALS AND METHODS
Review of the relevant literature.
RESULTS
Pelvic incidence is a morphologic parameter of the pelvis. It influences lumbar lordosis and thoracic kyphosis, and determines the limitations of pelvic retroversion in sagittal imbalance. Pelvic tilt is a positional parameter of the pelvis, indicating the degree of compensation for sagittal imbalance. A C7-sagittal vertical axis >5 cm, pelvic tilt >20°, and pelvic incidence-lumbar lordosis mismatch are known to be independent factors predictive of poor outcomes.
CONCLUSIONS
The C7-sagittal vertical axis, pelvic tilt, and pelvic incidence-lumbar lordosis mismatch should be considered when surgery is planned for a patient with degenerative lumbar disease.

Keyword

Sagittal imbalance; Sagittal vertical axis; Pelvic incidence; Pelvic tilt

MeSH Terms

Adult
Animals
Compensation and Redress
Humans
Incidence
Kyphosis
Lordosis
Pelvis
Prognosis
Spine

Figure

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  Fig. 1 시상면상 골반 인자. 골반 입사각(Pelvic incidence), 골반 경사(Pelvic tilt), 천골 경사(Sacral slope).

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  Fig. 2 골반 입사각에 따른 골반의 회전(retroversion) 차이. 작은 골반 입사각에 따른 적은 골반 회전 능력(A), 큰 골반 입사각에 따른 많은 골반 회전 능력(B).

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  Fig. 3. 시상면상 균형 상태(A). 시상면상 제 7경추에서 내린 수선이 제 1천추 후상방에서 5 cm 이상 전방을 통과할 경우 시상면상 불균형이 있음을 의미(B).

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  Fig. 4 3년전 타병원에서 L5-S1 유합술 받고 현재 양 하지 방사통이 심해서 내원한 66세 여자 환자. 전신 측면 기립 방사선 사진상 C7-SVA 4.5 cm, 골반 경사 16도로 비교적 균형이 잘 맞는 상태로(A), MRI 시상면 검사상 제 3-4-5요추간 협착증 소견 확인되었음(B). 제 3-4-5요추체간 유합술 이후 C7-SVA는 3 cm, 요추 전만은 46도로 호전되었으며, 시상면상 균형이 잘 유지되고 증상도 호전되었음(C).

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  Fig. 5 12년전 타병원에서 L4-5-S1 유합술 받고, 현재 양쪽 엉치 통증이 심해서 내원한 67세 여자 환자. 전신 측면 기립 방사선 검사상 C7-SVA 13 cm, 골반 경사 28도로 시상면상 불균형 있었던 상태이며(A), 굴곡 측면 방사선 검사상 제 3-4요추간 불안정성 있는 상태이고(B), MRI 시상면 검사상 제 3-4요추간 협착증 소견 있었음(C). 이전 기기를 제거하고, 제 3-4요추체간 유합술을 하였으나, C7-SVA가 12 cm, 골반 경사가 26도로 거의 호전이 없어, 제 3-4요추체간 불안정성은 없지만, 불편한 증상이 계속되었음(D).

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