J Korean Soc Spine Surg.  2014 Jun;21(2):76-83. 10.4184/jkss.2014.21.2.76.

Necessity of Whole Spine Standing Lateral Radiograph in Adults over 50 Years Old Who Have Degenerative Lumbar Disease: Comparison with Supine Lumbar Lateral Radiograph

• Kim WJ
• Park KY
• Sung HI
• Ku JY
• Kwon WJ
• Park CK
• Choy WS

• KMID: 1800402
• DOI: http://doi.org/10.4184/jkss.2014.21.2.76

Abstract

STUDY DESIGN: Cross-sectional study.
OBJECTIVES
Sagittal imbalance cannot be predicted depending on the degree of lumbar lordosis. Thus, we tried to evaluate the necessity of whole spine standing lateral radiograph through comparison of the spinal and pelvic parameter between supine lumbar lateral radiograph and whole spine standing lateral radiograph. SUMMARY OF LITERATURE REVIEW: No studies in the literature compare supine lumbar lateral radiograph and whole spine standing lateral radiograph.
MATERIALS AND METHODS
We randomly selected 50 males and 50 females among the patients over the age of 50 who visited our hospital for outpatient due to degenerative lumbar disease. Lumbar lordosis (sLL/wLL), sacral slope (sSS/wSS), and pelvic tilt (sPT/wPT) were measured and compared respectively by supine lumbar lateral radiograph and whole spine standing lateral radiograph. We categorized as group AI (sLL<30degrees) and group AII (sLL> or =30degrees) by supine lumbar lateral radiograph and analyzed them. We also categorized as group BI (SVA< or =5 cm) and group BII (SVA>5 cm) by whole spine standing lateral radiograph and analyzed them.
RESULTS
There were no statistical difference in lumbar lordosis (sLL/wLL: 35.1degrees/37.7degrees) and pelvic parameter (sSS/wSS: 32degrees/31.7degrees, sPT/wPT: 24.3degrees/24.2degrees. sPI/wPI: 56.3degrees/58.2degrees) between supine lumbar lateral radiograph and whole spine standing lateral radiograph, and there were also no statistical difference between two groups (group AI & AII) in SVA, lumbar lordosis and pelvic parameter. Pelvic parameter compared by supine lumbar lateral radiograph and whole spine standing lateral radiograph based on sagittal balance was no significant difference, but lumbar lordosis appeared statistical difference.
CONCLUSION
Sagittal imbalance appears quite a lot in patients with degenerative lumbar disease and supine lateral radiograph can't reflect the whole sagittal imbalance. So, whole spine standing lateral radiograph should be performed routinely to analyze the sagittal alignment.

Keyword

Degenerative lumbar disease; Supine lumbar lateral radiograph; Whole spine standing lateral radiograph; Sagittal balance

MeSH Terms

Adult*
Animals
Cross-Sectional Studies
Female
Humans
Lordosis
Male
Outpatients
Spine*

Figure

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  Fig. 1. Fits-on-clavicle position (A, B) or cross-arm position (C, D) is recommended during taking radiographs.

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  Fig. 2. Spinal & Pelvic parameters. LL: lumbar lordosis, SS: Sacral slope, SVA: Sagittal vertical axis, PI: Pelvic incidence, PT: Pelvic tilt.

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  Fig. 3. A 53-year-old man's supine lumbar lateral radiograph (A) and whole spine lateral radiograph with SVA ≤ 5 cm (B).

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  Fig. 4. A 75-year-old woman's supine lumbar lateral radiograph (A) and whole spine lateral radiograph with SVA > 5 cm (B).

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