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Differences in lumbar segment angle among Roussouly types of global sagittal alignment in asymptomatic adult subjects

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Abstract

Study design

A radiological study.

Objectives

To examine lumbar segment angle according to the Roussouly type of global sagittal alignment and to determine the reference disc angles in minimally invasive surgery (MIS) for adult spinal deformity.

Summary of background data

Optimal restoration of lumbar lordosis (LL) in adult spinal deformity surgery includes achieving the ideal shape of LL as well as the amount of LL. However, the distribution of lumbar segment angles by the Roussouly type has yet to be elucidated.

Methods

Forty sets of whole spine lateral radiographs covering the four Roussouly types (N = 160) were obtained from a database of asymptomatic adult subjects. Global and spinopelvic parameters were measured. Disc and vertebral angles at each lumbar level were compared among the Roussouly types.

Results

There were 75 (46.9%) men with a mean age of 32.8 ± 8.9 years among the total of 160 study subjects. A significant difference was found in spino-sacral angle, sacral slope, pelvic incidence, LL, and lower arc of LL (L4S1) among the Roussouly types (all P < 0.001). The ratio of the lower arc of LL (L4S1) to LL was 83.4% in Roussouly type 1, 65.2% in type 2, 64.7% in type 3, and 61.5% in type 4. The disc angles at the L1-2 and L2-3 levels in Roussouly type 1 were significantly smaller than in the other types. The disc angle at the L5-S1 level in Roussouly type 1 was significantly larger than that in type 2. Roussouly type 4 had a larger disc angle at the L2-3 and L4-5 levels than types 1 and 2.

Conclusions

The results of this study showed that the disc angle distribution differs among Roussouly types. The configuration of LL as well as the amount of LL should be considered in adult spinal deformity surgery.

Level of evidence

Level IV.

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Author information

The roles of authors: NSC: conception or design of the work; the acquisition, analysis, interpretation of data for the work, drafting the work or revising it critically for important intellectual content, final approval of the version to be published. HDL: the acquisition, analysis, interpretation of data for the work, drafting the work or revising it critically for important intellectual content, final approval of the version to be published. CHJ: conception or design of the work, drafting the work or revising it critically for important intellectual content, final approval of the version to be published

Correspondence to Chang-Hoon Jeon.

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The authors declare that they have no conflict of interest.

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The ethical committee of the hospital reviewed and approved the design of the present study.

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Chung, N., Lee, H. & Jeon, C. Differences in lumbar segment angle among Roussouly types of global sagittal alignment in asymptomatic adult subjects. Spine Deform (2020) doi:10.1007/s43390-019-00010-6

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Keywords

  • Roussouly classification
  • Lumbar Lordosis
  • Disc angle
  • Minimally invasive surgery
  • Adult spinal deformity