The Study Of Sagittal Spino-pelvic Parameters In Thoracolumbar Osteoporotic Vertebral Compression Fractures

Background and PurposeWith the aging development,the incidences of the osteoporosis vertebral compression fracture(OVCFs)continuous increase,the OVCFs become the elderly health common diseases.Thoracolumbar vertebral compression fractures could cause spine-pelvis sagittal alignment changes,change the balance of the original.When pine-pelvis sagittal alignment is beyond the compensation levels of the adjacent bends and pelvic,the patients may put up the clinical sagittal imbalance,the sagittal imbalance of the spine affected the quality of life so much.This study was designed to investigate the radiographic characteristics of sagittal spino-pelvic parameters in thoracolumbar OVCFs,to provide references for clinical treatment of the OVCFs.To describe the spine-pelvis balance,the widely recognized image of the SVA was used as the judgment standard of the spinal sagittal balance,and the T1 pelvic angle(TPA)was also taken as the parameter of the spinal sagittal balance.However,TPA as the new standard of the description of sagittal balance,the clinical significance and application need to be further confirmed.Another purpose of this study is that investigate the value of TPA in the evalution of spino-pelvic sagittal balance through studying thoracolumbar OVCFs.Method116 cases of thoracolumbar OVCFs were selected as the OVCFs group,102 cases of osteoporotic vertebral non-fracture were selected as the simple osteoporosis(OP)group,46 cases of healthy participants with normal bone mineral density(BMD)group were selected as the normal BMD group.The distribution of fracture vertebraes was analyzed in 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.Each group was divided into balance subgroup and imbalance subgroup according to the judgment standard of the spinal sagittal balance.Compared the number of each imbalance subgroup.The sagittal parameters of the OVCFs group's 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 OVCFs group were bigger than those in the simple OP group(P<0.05),and the parameters above in the simple OP group were bigger than those in the normal BMD group(P<0.05);LL?SS in OVCFs group was smaller than those in the simple OP group(P<0.05),and LL?SS in the simple OP group was smaller than those in the normal BMD group(P<0.05);The parameters' correlations lost in OVCFs group,however,the correlations existed in the other two groups.(2)The imbalance subgroup was found in 29.41%of the simple OP group and 44.83%of the OVCFs group respectively.(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 respectively,No difference in the distribution of fracture vertebraes and PI existed between the two groups(P>0.05);TLK?SVA?TPA?PT?ODI in the imbalance subgroup were bigger than those in the balance subgroup(P<0.05),however,LL?SS was smaller(P<0.05);In the balance subgroup,SVA was correlated with TPA?TK?TLK?LL?PT?ODI,TPA was correlated with TK?TLK?LL?PI?PT?SS?ODI(P<0.05),the spine tends to present sagittal compensation.In the imbalance subgroup,TPA was correlated with SVA?LL?PI?PT?SS?ODI(P<0.05),the imbalance group demonstrated sagittal decompensation with anterior-shifted SVA.Conclusion1.Sagittal spinal imbalance is more likely to occur in the thoracolumbar OVCFs,the patients should take surgical interventions the first choice,adopt different operation strategies according to the sagittal spinal balance.2.TPA can both represent the sagittal balance of spine and pelvis,can be treated as the judgment standard of the spinal sagittal balance.