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. 2022 Nov;10(6):1407-1414.
doi: 10.1007/s43390-022-00533-5. Epub 2022 Jul 6.

Lordosis loss in degenerative spinal conditions

Will K M Kieffer  1 , Angus Don  2 , Antony Field  3 , Peter A Robertson  2
Affiliations

Lordosis loss in degenerative spinal conditions

Will K M Kieffer et al. Spine Deform. 2022 Nov.

Abstract

Purpose: To establish whether common degenerative lumbar spine conditions have a predictable sagittal profile and associated range of lordosis. The spinopelvic balance of a normal population and normal ranges are well described in the literature. There is also evidence that certain degenerative conditions can lead to a preponderance of loss of lordosis at specific spinal levels. There is limited literature on the range and magnitude of loss of lordosis for known degenerative lumbar spine pathologies.

Methods: A retrospective analysis of prospectively obtained radiographs from a dual surgeon database was performed and imaging analysed for spinopelvic parameters. Degenerative conditions studied were; Lumbar degenerative spondylolisthesis (L3/4 and L4/5 analysed separately), L5/S1 degenerative disc disease, L5/S1 isthmic spondylolisthesis. Pelvic incidence, sacral slope, pelvic tilt, segmental and global lumbar lordosis, vertebral lordosis and lumbar vertical axis were measured.

Results: The range of change in segmental lordosis was normally distributed for all studied degenerative spinal conditions except L5/S1 isthmic spondylolisthesis. L5/S1 degenerative disc disease affected younger adults (mean age 37), whilst degenerative spondylolisthesis at L3/4 and L4/5 affected older adults (mean ages 69.5 and 68.9 respectively). Removing an outlying high-grade L5/S1 isthmic spondylolisthesis made the data distribution approach a normal distribution.

Conclusion: Most degenerative spinal pathologies cause a normally distributed spectrum of deformity which should be addressed and corrected with a tailored, individualised surgical plan for each patient. Universal treatment recommendations should be interpreted with caution.

Keywords: Degeneration; Degenerative spinal conditions; Lordosis; Lumbar spine; Sagittal balance; Spinal alignment; Spinopelvic parameters; Spondylolisthesis.

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