Lumbar Sagittal Alignment May Be a Good Predictor for the Lumbar Spine Degeneration

Background: Increasing attention has been focused on (modic changes and end plate defect) MC&ED as a potential role in the etiopathogenesis of lumbar degeneration. The precise mechanism leading to progression of MC&ED is lacking. Some scholars thought lumbar sagittal alignment might be a key influence factor, but without enough clinical evidence. Hence, we investigated how lumbar sagittal alignment influences MC&ED.MethodsNinety-six asymptomatic or symptomatic patients with Modic changes or end plate defect were retrospectively recruited in this study from August 2016 to December 2018. MC&ED were observed in 76 patients and not observed in 20 patients, representing two groups for comparison. The lumbar sagittal parameters were measured, including lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). The lumbar lordosis index(LLI) and idea LL were then calculated. Clinical outcomes were assessed using a visual analog scale(VAS) and an Oswestry Disability Index (ODI) before and after an operation.ResultsThere were no significant difference in the distribution of demographic and baseline clinical variables between both groups. Mean age and BMI showed significant difference between both groups ( P  < 0.05). There were significant correlations between LL, LLI, Loss of LL, and Level 1 (r = 0.281, 0.230, and 0.284, P  < 0.05) Also, PI, PT were significantly correlated with Level 4 (r = 0.249, 0.202, P < 0.05). Compared with presurgery scores, an improvement was seen in postoperative VAS and ODI scores ( P  < 0.05). Further, the postoperative scores at 24 months in the without Modic or end plate defect group showed greater improvements compared with the with Modic or endplate defect group ( P  < 0.05).ConclusionThis analysis indicated that maintaining lumbar sagittal alignment was related to a lower risk of Modic changes in patients with the spinal degenerative disease. The lumbar sagittal alignment might be a factor that influenced the posterior inclination of the pelvis in symptomatic lumbar disease.