Comparison Of Compensation Of Sagittal Balance Between Adult Developmental Thoracolumbar Kyphosis And Old Fractured Thora Columbar Kyphosis

ObjectivesTo analyze and compare the difference in the compensation of sagittal balance between developmental thoracolumbar junctional kyphosis(DTLJK)and old fracture thoracolumbar junctional kyphosis(FTLJK)in adults.MethodsThe clinical and imaging data of 42 adult patients with developmental thoracolumbar junctional kyphosis and 38 patients with old thoracolumbar fracture kyphosis who visited the Department of Spinal Surgery in Shandong Provincial Hospital from May 2013 to October 2018 were retrospectively collected,and 40 healthy adults were included as controls.The imaging data are mainly lateral X-ray of the whole spine in the standing position,and the following parameters need to be measured:(1)Sagittal plane parameters of the spine:thoracic kyphosis(TK),lumbar lordosis(LL),local kyphosis angle(KA),sagittal vertical axis(SVA),apex vertebra(AV),kyphotic position(distance,D);(2)Sagittal plane parameters of the pelvis:pelvic incidence(PI),sacral slope(SS)and pelvic tilt(PT).One-way ANOVA analysis was used for the comparison of spinal-pelvic parameters among the three groups,and Student-Newman-Keuls(SNK)test was used for pairwise comparisons.Pearson's correlation test was used for correlation analysis of each spinal-pelvic parameter.Differences were considered statistically significant at P<0.05.Results1.General conditions There was no significant difference in age and gender distribution among the three groups(P>0.05).2.Comparison of spinal-pelvic parameters?The LL of FTLJK group was significantly larger than that of DTLJK group and control group(-47.6± 9.5°,-37.3 ± 11.5° and-41.9± 8.3°,respectively,P<0.05),but there was no significant difference between DTLJK group and control group(P>0.05).? PI and SS of DTLJK group(44.5 ± 6.7°,23.3 ± 7.6°,respectively)were significantly smaller than those of FTLJK group(49.4 ± 8.0°,31.2± 8.6°,respectively)and control group(48.2 ± 7.2,31.1 ± 5.0°,respectively)(P<0.05).? PT and SVA in DTLJK group(21.1 ± 6.20°,40.4 ± 47.8mm,respectively)were significantly greater than those in control group(17.1 ± 6.8°?,18.6 ± 36.2 mm,respectively)(P<0.05),and also greater than those in FTLJK group(18.3 ± 7.1°,26.9± 364mm,respectively),but the difference was not statistically significant(P>0.05).?There was no significant difference in KA(29.6 ± 8.6°,27.9±9.4°,respectively)between DTLJK group and FTLJK group(P>0.05);there was no significant difference in D(3.5 ± 1.1,3.8± 1.1,respectively)between DTLJK group and FTLJK group(P>0.05);there was no significant difference in TK(25.4 ± 10.2°,25.7± 7.7°,and 27.7 ± 7.9?,respectively)between DTLJK group,FTLJK group,and control group(P>0.05).3.Correlation analysis between spinal-pelvic parameters? In DTLJK group,LL correlated with PT and SS(r = 0.399 and-0.621,respectively,P<0.05),SS correlated with PI and PT(r = 0.638 and-0.537,respectively,P<0.05),TK correlated with SVA(r = 0.418,P<0.05);?In the FTLJK group,LL was correlated with SS and TK(r =-0.415 and-0.469,respectively,P<0.05),and SS was correlated with PI,PT,and SVA(r = 0.634,-0.503,and 0.453,respectively,P<0.05).4.Correlation analysis between kyphotic parameters and spinopelvic parameter?In DTLJK group,KA was correlated with PT and SS(r = 0.449 and-0.497,respectively,P<0.05),and in FTLJK group,KA was correlated with LL(r ?-0.559,P<0.05);?In the DTLJK group,there was a correlation between D and TK,LL,and SS(r =-0.547,0.566,and-0.479,respectively,P<0.05);in the FTLJK group,there was no correlation between D and TK,LL,PI,PT,SS,and SVA(P>0.05).Conclusion1.The adult patients with developmental thoracolumbar kyphosis were mainly compensated by posterior pelvic rotation,and finally had sagittal imbalance of trunk anteversion;patients with old thoracolumbar fracture kyphosis were mainly compensated by increasing lumbar lordosis without changes in the overall sagittal balance.2.PI-LL,TK-LL correlation was lost in adult patients with developmental thoracolumbar kyphosis,and SVA was mainly associated with TK;PI-LL correlation was lost in patients with old thoracolumbar fracture kyphosis,but TK-LL correlation was still preserved,and SVA was mainly associated with SS.3.The kyphotic apical vertebra position was correlated with TK,LL,and SS in adult patients with developmental thoracolumbar kyphosis,and the lower the level of the apical vertebra,the smaller the TK,LL,and SS;the kyphotic apical vertebra position was not correlated with each spinal-pelvic parameter in patients with old thoracolumbar fracture kyphosis.