Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

LUMBOPELVIC ALIGNMENT IN PATIENTS WITH LUMBAR SPINAL STENOSIS AND MODIC TYPE 1 VERTEBRAL ENDPLATE CHANGE (#212)

Naoka Tomiya 1 , Yasuchika Aoki 2 , Shiro Sugiura 1 , Takeshi Toyooka 1 , Tetsuya Otsuki 1 , Yuzuru Okamoto 1 , Kohei Okuyama 3 , Seiji Ohtori 3 , Satoru Nishikawa 1
  1. Nishikawa Orthopedics Clinic, Sakura , Chiba, Japan
  2. Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Chiba, Japan
  3. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

INTRODUCTION:
There has been a growing emphasis on the close relationship between lumbopelvic alignment and low back pain (LBP) in patients recently. Modic type 1 vertebral endplate change (MC1) is also recognized as being associated with LBP. Previous studies have shown that patients with MC1 tend to have reduced lumbar lordosis compared to healthy individuals.1) However, there are a limited number of reports that delve into a detailed comparison of lumbopelvic alignment between patients with and without MC1. This study aimed to determine whether the presence of MC1 significantly impacts lumbopelvic alignment in patients with degenerative lumbar spine disease.
METHODS:
The study included 27 patients diagnosed with lumbar spinal stenosis (LSS) who had been experiencing chronic LBP for over 3 months. Their average age was 70.7 ± 10.1 years. Patients with conditions such as lumbar fracture, infection, severe scoliosis, ankylosing spondylitis, or a history of spinal surgery were excluded from the study. Patients were categorized into two groups: LSS (mean age: 69.8 ± 10.8 years; 10 males/10 females) and MC1 groups (mean age: 73.4 ± 8.1 years; 6 males/1 female) according to the presence of MC1 in at least one level from L1-L2 to L5-S1. Lumbopelvic alignment was evaluated by measuring the lumbar lordosis angle (LLA, the angle between the superior endplate of L1 and the superior endplate of S1) and the lumbosacral angle (LSA, the angle between the horizontal plane and the superior endplate of S1). The LLA and LSA between the LSS and MC1 groups were compared using student t-tests.
RESULTS:
The LLA was 44.1 ± 11.8° and 33.7 ± 8.7° in the LSS and MC1 groups, respectively, showing a statistically significant difference between the two groups. In contrast, the LSA was 36.2 ± 7.6° and 35.6 ± 4.3° in the LSS and MC1 groups, respectively, demonstrating no significant difference.
DISCUSSION:
The results showed that LSS patients with MC1 had reduced lumbar lordosis compared to LSS patients without MC1, suggesting that the presence of MC1 is associated with reduced lumbar lordosis. This finding aligns with a previous study2) that demonstrated the significant impact of MC1 on lumbopelvic alignment, while Modic type 2 and Modic type 3 did not show such an effect. However, there was no observed association between MC1 and pelvic tilt. Owing to the retrospective nature of this study, we could not conclusively determine whether MC1 is a cause or a consequence of reduced lumbar lordosis. Nevertheless, our study revealed that MC1 is more closely related to lumbar kyphosis than pelvic tilt.

 

 

 

  1. Zhi Ming Wu, et al, Analysis of the relationship between Modic Change and spinopelvic parameters in the sagittal plane, Med Sci Monit, 2020; 26: e919667
  2. Xiaoping Mu, et al, Correlation of Modic Changes with Sagittal Lumbopelvic Parameters. Journal of Pain Research 2021:14 3877–3885