title: Spinal sagittal imbalance in patients with lumbar disc herniation: its spinopelvic characteristics, strength changes of the spinal musculature and natural history after lumbar discectomy.
abstract: Spinal sagittal imbalance is a widely acknowledged problem, but there is insufficient knowledge regarding its occurrence. In some patients with lumbar disc herniation (LDH), their symptom is similar to spinal sagittal imbalance. The aim of this study is to illustrate the spinopelvic sagittal characteristics and identity the role of spinal musculature in the mechanism of sagittal imbalance in patients with LDH.
  
  
  
  Twenty-five adults with spinal sagittal imbalance who initially came to our clinic for treatment of LDH, followed by posterior discectomy were reviewed. The horizontal distance between C7 plumb line-sagittal vertical axis (C7PL-SVA) greater than 5 cm anteriorly with forward bending posture is considered as spinal sagittal imbalance. Radiographic parameters including thoracic kyphotic angle (TK), lumbar lordotic angle (LL), pelvic tilting angle (PT), sacral slope angle (SS) and an electromyography(EMG) index 'the largest recruitment order' were recorded and compared.
  
  
  
  All patients restored coronal and sagittal balance immediately after lumbar discectomy. The mean C7PL-SVA and trunk shift value decreased from (11.6 ± 6.6 cm, and 2.9 ± 6.1 cm) preoperatively to (-0.5 ± 2.6 cm and 0.2 ± 0.5 cm) postoperatively, while preoperative LL and SS increased from (25.3° ± 14.0° and 25.6° ± 9.5°) to (42.4° ± 10.2° and 30.4° ± 8.7°) after surgery (P < 0.05). The preoperative mean TK and PT (24.7° ± 11.3° and 20.7° ± 7.8°) decreased to (22.0° ± 9.8° and 15.8 ± 5.5°) postoperatively (P < 0.05). The largest recruitment order on the level of T7-T8, T12-L1 and the herniated level all improved compared with before and after surgery (P < 0.05). All patients have been followed up for more than 2 years. The mean ODI was 77.8 % before surgery to 4.2 % at the final follow-up.
  
  
  
  Spinal sagittal imbalance caused by LDH is one type of compensatory sagittal imbalance. Compensatory mechanism of spinal sagittal imbalance mainly includes a loss of lumbar lordosis, an increase of thoracic kyphosis and pelvis tilt. Spinal musculature plays an important role in spinal sagittal imbalance in patients with LDH.
authors.affiliation: Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No.324 Jing Wu Road, Jinan, 250021, People's Republic of China.
authors.forename: Chen
authors.initials: C
authors.lastname: Liang
authors.affiliation: Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No.324 Jing Wu Road, Jinan, 250021, People's Republic of China. spine163@126.com.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No.324 Jing Wu Road, Jinan, 250021, People's Republic of China.
authors.forename: Xingang
authors.initials: X
authors.lastname: Cui
authors.affiliation: Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No.324 Jing Wu Road, Jinan, 250021, People's Republic of China.
authors.forename: Zhensong
authors.initials: Z
authors.lastname: Jiang
authors.affiliation: Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No.324 Jing Wu Road, Jinan, 250021, People's Republic of China.
authors.forename: Wen
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No.324 Jing Wu Road, Jinan, 250021, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Li
mesh_terms: D000328:Adult; D017586:Diskectomy; D004576:Electromyography; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000033:anatomy & histology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018908:Muscle Weakness / Q000175:diagnosis* / Q000209:etiology; D064170:Paraspinal Muscles / Q000503:physiopathology*; D010384:Pelvic Bones / Q000033:anatomy & histology; D011184:Postoperative Period; D004856:Postural Balance; D011187:Posture; D011859:Radiography; D012189:Retrospective Studies; D012447:Sacrum / Q000033:anatomy & histology; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000033:anatomy & histology; D014057:Tomography, X-Ray Computed
keywords: Electromyography; Lumbar disc herniation; Spinal musculature; Spinal sagittal imbalance