Correlation between the Severity of the Lumbar Degenerative Disease and Sagittal Spinopelvic Alignment

Objective  To evaluate the impact of the severity of lumbar degenerative disease (LDD) on sagittal spinopelvic alignment. Methods  In total, 130 patients (mean age: 57 years; 75% female) with LDD-associated low-back pain were prospectively included. The severity of the LDD was defined by the following findings on anteroposterior and lateral lumbar spine radiographs: osteophytosis; loss of of height of the intervertebral disc; terminal vertebral plate sclerosis; number of affected segments; deformities; and objective instability. The disease was classified as follows: grade 0-absence of signs of LDD in the lumbar spine; grade I - signs of LDD in up to two segments; grade II - three or more segments involved; grade III - association with scoliosis, spondylolisthesis, or laterolisthesis. Spinopelvic radiographic parameters, including pelvic incidence (PI), lumbar lordosis (LL), discrepancy between the PI and LL (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA), were analyzed according to the LDD grades. Results  The radiographic parameters differed according to the LDD grades; grade-III patients presented higher SVA ( p  = 0.001) and PT ( p  = 0.0005) values, denoting greater anterior inclination of the trunk and pelvic retroversion when compared to grade-0 andgrade-I subjects. In addition, grade-III patients had higher PI-LL values, which indicates loss of PI-related lordosis, than grade-I subjects ( p  = 0.04). Conclusion  Patients with more severe LDD tend to present greater spinopelvic sagittal misalignment compared to patients with a milder disease.