The Study: Sagittal spinal alignment in patients with lumbar disc herniation.
a. This is a retrospective cross sectional study.
b. The authors attempted to evaluate total sagittal alignment of the spine in a group of patients with lumbar disc herniations (LDH).
c. They used 60 healthy subjects and 61 subjects with lumbar disc herniations (LDH).
d. The subjects with the lumbar disc herniations underwent surgery.
e. Before and 6 months following the surgeries they took lateral full spine standing radiographs of the patients who received surgery. In addition the normal subjects also received lateral full spine standing x-rays.
f. The authors concluded: “Sagittal spinal alignment of LDH [lumbar disc herniation] exhibits a more anterior translation of C7 plumb line, less lordosis, and a more vertical sacrum.”*
* (Editor’s Note- By “vertical sacrum” the authors are referring to flattening of the sacral base, i.e. a reduction of the Ferguson’s angle. All bold emphasis shown here is ours, not that of the original authors.)
g. In addition they concluded that: “Analysis of spinal posture and clinical symptoms showed correlation of SVA [sagittal vertical axis] and L1S1 [lumbar lordotic angle between the top margin of the first lumbar vertebra and first sacral vertebra] with subjective symptoms measured by the JOA [Japanese Orthopedic Association] score.”
h. “Six months after surgery, the LDH [lumbar disc herniation] patients showed significant recovery according to the subjectively based JOA [Japanese Orthopedic Association] score, as well as the reduced SVA [sagittal vertical axis] and PA, [pelvic tilting angle] and larger L1S1 [lumbar lordotic angle between the top margin of the first lumbar vertebra and first sacral vertebra] values compared to the preoperative scores and values.”
Editor’s Note: Normally, we don’t include original illustrations in our reviews however, in this case it seems important to do so in order for the reader to fully understand the above comments regarding the postural changes described in the article. Interested readers should click on the link below to read the full article and more completely understand the implications of this paper.
Lumbar disc herniation patients tended to be bent forward and have less lumbar lordosis and these things showed a correlation with the patient’s symptoms.
The normal subjects were different from the lumbar disc herniation patients in that those with lumbar disc herniations tended to be bent forward and have less lumbar lordosis. So your mother was right. Stand up straight. Mom knew that structure matters.
Reviewer: Roger Coleman DC
Editor: Mark R. Payne DC
Reference: Endo K, Suzuki H, Tanaka H, Kang Y, Yamamoto K. Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J. 2010 Mar;19:435-8.
Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/20091188