title: Radiological analysis of upper lumbar disc herniation and spinopelvic sagittal alignment.
abstract: A retrospective cross-sectional study was designed to explore the role of spinopelvic sagittal alignment in upper lumbar disc herniation (ULD) development.
  
  
  
  A total of 207 consecutive patients who underwent surgery for single-level lumbar disc herniation [24 with ULD and 183 with lower lumbar disc herniation (LLD)] and 40 asymptomatic volunteers were enrolled. Full-length radiographs of the spine were taken to evaluate pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertical axis (SVA). The Roussouly classification was utilized to categorize all subjects according to their sagittal alignment. Spinopelvic parameters and Roussouly classification results were compared between groups.
  
  
  
  There were significant differences in PI, SS, PT, LL, and SVA between the ULD, LLD, and control groups. PI in the ULD (40.9°) was significantly lower than in the LLD and control groups (48.8° and 47.6°, respectively). LL was significantly lower in the ULD than in the LLD (-32.4° and -40°, respectively). There were significant differences between the three groups in Roussouly types. The LLD had a significantly higher proportion (62.6 %) of type 2 lordosis (flat back), and the ULD had a higher proportion (33.3 %) of type 1 lordosis than the other groups.
  
  
  
  This study demonstrated the importance of PI and lumbar curvature in the pathogenesis of ULD. The higher prevalence of short LL and long TK with low PI in the ULD group implies that an increased mechanical stress at this level may be one of the risk factors of ULD.
authors.affiliation: Department of Neurosurgery, Spine Health Wooridul Hospital, Seoul, Korea.
authors.forename: Junseok
authors.initials: J
authors.lastname: Bae
authors.affiliation: Department of Neurosurgery, Spine Health Wooridul Hospital, Seoul, Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Spine Health Wooridul Hospital, Seoul, Korea.
authors.forename: Sang-Ha
authors.initials: SH
authors.lastname: Shin
authors.affiliation: Department of Neurosurgery, Spine Health Wooridul Hospital, Seoul, Korea.
authors.forename: Jin Suk
authors.initials: JS
authors.lastname: Seo
authors.affiliation: Department of Orthopedic Surgery, Spine Health Wooridul Hospital, Seoul, Korea.
authors.forename: Kyeong Hwan
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Suwon Nanoori Spine Hospital, 259, Jungbu-daero, Yeongtong-gu, Suwon-si, Gyeonggi-do, Korea. spinejjs@naver.com.
authors.forename: Jee-Soo
authors.initials: JS
authors.lastname: Jang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging*; D008141:Lordosis / Q000000981:diagnostic imaging; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Lumbar lordosis; Pelvic incidence; Sagittal balance; Spinopelvic parameter; Upper lumbar disc herniation
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