Global sagittal angle and spinopelvic sagittal alignment: a step toward investigation of sagittal plane deformity in upper lumbar disc herniation

Br J Neurosurg. 2021 May 13;1-5. doi: 10.1080/02688697.2021.1923651. Online ahead of print.


Background and objectives: Understanding the biomechanical relationship between the spine and the pelvis is important for the management of symptomatic lumbar disease. There are several different metrics that may be used to evaluate the spine in the sagittal plane. The aim of this study is to compare spinopelvic parameters and global sagittal angle (GSA) in a cohort of patients with upper lumbar disc herniations (ULDH) to identify a correlation between the pelvic incidence (PI) and GSA with ULDH.

Material and methods: Eighty-six patients with ULDH and 86 asymptomatic control group underwent whole body biplanar stereographs- and magnetic resonance imaging . The spinopelvic parameters and GSA were measured.

Results: PI, sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis (TK) were all significantly lower than in the control group (p < 0.01) but there was no difference in the pelvic tilt (PT). The two groups were divided into subgroups. PI in the T12-L1 and L1-L2 level groups were significantly smaller than in the control group (p < 0.05). Also, there was a significant difference in TK and LL between the L3-L4 level and control group (p < 0.05), but there was no statistically significant difference in PT between all levels and the control group.

Conclusion: This study demonstrated a unique correlation between several spinopelvic parameters and GSA and the occurrence of ULDH. Lower PI, SS, and LL in T12-L1 and L1-L2 levels indicates a flat lumbar spine which may increase mechanical stress at these levels, thereby leading to disc herniation.

Keywords: Upper lumbar disc herniation; global sagittal angle; pelvic incidence; pelvic tilt.