Thoracolumbar/Lumbar Degenerative Kyphosis—The Importance of Thoracolumbar Junction in Sagittal Alignment and Balance

Author:

Liu Chenjun12,Ge Rile3,Li Haoyuan1,Zhu Zhenqi1,Xia Weiwei1,Liu Haiying2

Affiliation:

1. Department of Spinal Surgery, PeKing University People’s Hospital, 11th. Xizhimen South Ave., Beijing 100044, China

2. Chinese Preventive Medicine Association, Committee on Prevention and Control of Spinal Disease, Gulou West Street No. 154, Beijing 100009, China

3. Trauma Medicine Center, PeKing University People’s Hospital, 11th. Xizhimen South Ave., Beijing 100044, China

Abstract

Purpose: To conduct a more comprehensive study of sagittal alignment in patients with thoracolumbar/lumbar (TL/L) degenerative kyphosis. Methods: A total of 133 consecutive patients from September 2016 to March 2019 with degenerative spinal kyphosis were enrolled. These patients were divided into different types according to sagittal alignment, including thoracolumbar junctional kyphosis (TLJK). Then, we divided the patients with TLJK into two groups: the Sagittal Balance group (C7-SVA < 50 mm) and the Sagittal Imbalance group (C7-SVA ≥ 50 mm). The sagittal parameters of each type or group were compared and correlation analysis was conducted. Results: Thoracolumbar/lumbar degenerative kyphosis consists of four types: Type I, lumbar kyphosis; Type II, degenerative flat back; Type III, thoracolumbar junctional kyphosis; and Type IV, global kyphosis. According to different sagittal alignments, Type III can further be divided into three subtypes: IIIA, with smooth kyphosis of thoracic and upper lumbar; IIIB, like a clasp knife, with a flat thoracic and lumbar angle; and IIIC, with bigger thoracic kyphosis and lumbar lordosis. The thoracolumbar kyphosis angle (°) of the three subtypes were −23.61 ± 5.37, −25.40 ± 7.71, and −40.01 ± 8.40, respectively. Lumbar lordosis was correlated with thoracic kyphosis (IIIA, r = −0.600, p = 0.005; IIIB, r = −0.312, p = 0.046; IIIC, r = −0.657, p = 0.015), and correlated with sacral slope (IIIA, r = 0.537, p = 0.015; IIIB, r = 0.654, p = 0.000; IIIC, r = 0.578, p = 0.039). All spinopelvic parameters were compared between the Sagittal Balance group and the Sagittal Imbalance group, and only the thoracolumbar kyphosis angle showed statistical difference (t = −2.247, p = 0.028). Conclusions: The common characteristics of thoracolumbar junctional kyphosis were found to be a bigger thoracolumbar junctional angle and vertex of kyphosis located in the thoracolumbar junction (T10-L2). Despite TLJK, a change in the thoracic angle was still important to maintain sagittal balance. The thoracolumbar junction plays an important role in sagittal alignment and balance.

Funder

Peking University People’s Hospital Scientific Research and Development Funds

Ministry of Finance of China

Publisher

MDPI AG

Subject

Medicine (miscellaneous)

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