Method of quantitative assessment of the shape of the lumbar-thoracic spine

Abstract

Introduction. The presence of deformation of the lumbar-thoracic spine in the sagittal plane is the main factor determining the health status of adult patients. The studies of the features of human posture with or without spinal deformities in statics and movement have been in the focus of clinician attention for a long time. Recent studies offer a unifi ed approach to assessing the position of the vertebrae. However, no such studies have been conducted to analyze the lumbar-thoracic junction. The purpose of the work — to develop a method of qualitative and quantitative assessment of the vertebra positions in lumbar-thoracic junction. Issues: to develop a schematic model of the lumbar-thoracic spine; to develop a typology of the lumbar-thoracic transition; to develop an objective indicator refl ecting the features of the lumbar-thoracic transition in the patient; to characterize the age characteristics of this area of the spine.Materials and methods. A study of digital radiographs for all spine parts in sagittal projection for 141 patients with dorsopathies, 57 men and 84 women aged from 21 to 88 years, was conducted. The study was performed on a personal computer screen, without patient participation. A single digital X-ray image of the spine in the sagittal projection was obtained for each patient. The occipital vertical and anteroposterior axes of TIX–LV (LVI) vertebrae (r axes) were applied to the combined radiograph. At the intersection points of the axes with the occipital vertical, the perpendiculars to the r axes were restored, and the angles between the perpendiculars and the occipital vertical (angles r) were measured. Statistical analysis was carried out using the Microsoft Offi ce Excel 2007 software package.Results. Schematic models of the lumbar-thoracic junction for all cases were constructed on the basis of the data obtained. The models were used to compare the vertebra positions and describe three form types of lumbar-thoracic junction: normal, straightened and reinforced. An aggregated ArTL indicator is proposed and the boundaries of this indicator were determined for the quantitative assessment of each case. It is demonstrated that the age features for this part of the spine are expressed not in a monotonous change in the average value of ArTL with age, but in an increase in the proportion of patients with straightened and enhanced kyphosis, and it is especially noticeable in the group of people over 75 years old.Conclusion. The proposed technology for assessing the position of the vertebrae of the lumbar-thoracic spine was developed to satisfy the needs of osteopaths and specialists in restorative medicine, and this technology is presented for the fi rst time. In the course of the study, schematic models of the spine of each patient were developed; an ArTL indicator was proposed to quantify the type of the lumbar-thoracic region shape. The boundaries for the diagnosis of each type were determined and a study was conducted to identify the age trend. The study revealed the absence of a linear age trend of changes in this part of the spine. Among people over 75 years of age, patients with straightened or enhanced kyphosis of this zone were more common.