Deformity

Variation in Lumbar Shape and Lordosis in a Large Asymptomatic Population

A MEANS Study

Shen, Yong BA^a; Sardar, Zeeshan M. MD, MSc^a; Le Huec, Jean-Charles MD^b; Bourret, Stéphane PhD^b; Hasegawa, Kazuhiro MD, PhD^c; Wong, Hee Kit MBBS^d; Liu, Gabriel MBBCh^d; Hey, Hwee Weng Dennis MBBS^d; Riahi, Hend MD^e; Kelly, Michael MD^f; Lombardi, Joseph M. MD^a; Lenke, Lawrence G. MD^a

Author Information

^aDepartment of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, NY

^bBordeaux North Aquitaine Polyclinic, University of Bordeaux, Bordeaux, France

^cNiigata Spine Surgery Center, Niigata City, Japan

^dDepartment of Orthopedic Surgery, National University Hospital, Singapore

^eKassab Orthopedic Institute

^fRady Children’s Hospital, University of California, San Diego, CA

The research conducted in this study received Institutional Review/Ethics Board approval at all sites.

The authors report no conflicts of interest.

Address correspondence and reprint requests to Zeeshan M. Sardar, MD, MSc, Department of Orthopedic Surgery, Columbia University Irving Medical Center, The Daniel and Jane Och Spine Hospital, New York-Presbyterian/Allen, Hospital 5141 Broadway, 3 Field West Broadway and W 220th Street New York 10034, NY; E-mail: [email protected]

Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal’s website, www.spinejournal.com.

Spine 48(11):p 758-765, June 1, 2023. | DOI: 10.1097/BRS.0000000000004624

Abstract

Study Design.

Prospective, cross-sectional cohort study.

Objective.

To determine the relationship between lumbar shape and sagittal parameters.

Summary of Background Data.

Understanding the lumbar shape is vital for deformity surgery. Normative sagittal parameters and spine shape remain unstudied in large, multiethnic, asymptomatic cohorts.

Materials and Methods.

A prospective, cross-sectional cohort of 468 asymptomatic volunteers between 18 and 80 years was enrolled across 5 countries. Demographic data and radiographic parameters such as pelvic incidence (PI) were collected. Pearson correlation test and linear regression were used to find the relationship between lumbar lordosis (LL) and other parameters. One-way analysis of variance and Welch 2-sample t test were performed to compare lumbar shape across such categories as PI and lumbar apex followed by post hoc Bonferroni correction if needed.

Results.

PI was moderately correlated with proximal lumbar lordosis (pLL) (r = −0.54) and weakly correlated with distal lumbar lordosis (dLL) (r = −0.16). Thoracic kyphosis (T1–T12) was moderately correlated with pLL (r = −0.35) and dLL (r = −0.29). dLL was moderately correlated with LL (r = 0.64). 2.6% (12/468) of subjects had lumbar apex at L2, 40.2% (188/468) at L3, 56.6% at L4 (265/468), and 0.6% (3/468) at other levels. Mean PI was different between volunteers with the apex at L3 and L4. A lower mean PI was associated with the apex at L4 (49.0°), whereas a higher mean PI was associated with the apex at L3 (55.8°). The mean PI−LL mismatch for volunteers was −5.4° with a range from −35° to 39.7°. PI−LL mismatch increased from a mean of −10.1° in volunteers with low PI to a mean of 2.2° in volunteers with high PI. Age was not correlated with LL (P = 0.84).

Conclusions.

In asymptomatic adult volunteers, pLL showed a moderate correlation with PI and increased with PI, whereas dLL showed a weak correlation. The lumbar apex migrated proximally with increasing PI. Segmental lordosis and apex position instead of solely global lordosis should be emphasized.

Level of Evidence.

Level III.

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Variation in Lumbar Shape and Lordosis in a Large Asymptomatic Population

A MEANS Study