title: Total sagittal spinal alignment in patients with lumbar canal stenosis accompanied by intermittent claudication.
abstract: METHODS
  Cross-sectional study of total sagittal spinal alignment in lumbar spinal canal stenosis (LCS) patients with and without intermittent claudication.
  
  
  OBJECTIVE
  To evaluate total sagittal spinal alignment in LCS.
  
  
  BACKGROUND
  The sagittal spinal alignment is an important factor in the management of lumbar degenerative diseases and lower back pain. Patients with LCS accompanied by intermittent claudication adopt a forward-bending posture during walking. However, few studies have quantitatively assessed the abnormal posture in LCS in relation to clinical symptoms.
  
  
  METHODS
  This study analyzed 93 patients with LCS. They were divided into two groups according to the presence of neurogenic intermittent claudication; patients of the Claudicant group had intermittent claudication of the cauda equina (n = 53; mean age, 66.7) and those of the Nerve root group had no claudication (n = 40; mean age, 67.0). The following parameters were measured on the lateral whole-spine standing radiographs: the distance between the C7 plumb line and the posterior superior corner on the superior margin of S1 (sagittal vertical axis), the angle between the superior margin of the first lumbar vertebra and the first sacral vertebra (L1S1), lumbar lordotic angle, pelvic tilting angle (PA), and pelvic morphologic angle (PRS1).
  
  
  RESULTS
  The sagittal vertical axis of the Claudicant group (57.6 +/- 37.5 mm) was significantly larger than that of the Nerve root group (40.3 +/- 42.3 mm) and was larger in both groups compared with the standard values. Lumbar lordotic angle was smaller (18.8 degrees +/- 13.2 degrees ) and pelvic tilting angle was larger (27.2 degrees +/- 8.3 degrees ) in patients with the Claudicant group than those with the Nerve root group (22.4 degrees +/- 14.0 degrees and 22.7 degrees +/- 7.2 degrees , respectively).
  
  
  CONCLUSIONS
  Patients of the Claudicant group exhibited forward bending of the trunk and pelvis backtilt, compared with those of the Nerve root group.
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, Japan. hidekadu@hotmail.com
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.forename: Kenji
authors.initials: K
authors.lastname: Endo
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Tanaka
authors.forename: Kengo
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D017116:Low Back Pain / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011187:Posture; D011859:Radiography; D013130:Spinal Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D018709:Statistics, Nonparametric