Relation between Lumbar Spinal Degeneration and Anatomic Pelvic Parameters in Nepalese Population

Background Degenerative disease of the lumbar spine is an important cause of disability in the world. It includes conditions such as spondylolisthesis, lumbar disc herniations, disc degeneration, and lumbar spinal stenosis. Patient with degenerative spinal disease most commonly present with symptoms of low back ache of varying degrees, lower limb pain and weakness. There are various spino-pelvic parameters which are used to measure and describe the spino pelvic alignment in an individual. The anatomic variation in these parameters have been found to be a predisposing factor for development of lumbar spinal disease and further the diseases are responsible in changes in the spino pelvic parameters itself. To far, very less is known about how the sagittal spino-pelvic alignment of the Nepalese population with persistent low back pain (LBP) differs from that of the general population. This study contributes to our understanding of the relation between low back pain resulting from degenerations of the lumbar spine and sagittal alignment.  Aims and Objectives To evaluate the association between anatomic pelvic parameters and specific types of lumbar spinal degeneration. To find the Association of lumbar spinal degeneration with pelvic radius (PR), sacral table angle (STA) and pelvic incidence (PI)  Methodology Patients with symptomatic lumbar spinal degeneration who were presented to KMCTH OPD from Jan 2019 to July 2020 were included in this cross sectional observational study. Degenerative pathologies were classified as lumbar disc herniation (LDH), lumbar spinal stenosis (LSS), and degenerative spondylolisthesis (DSPL). The constant anatomic pelvic parameters pelvic incidence (PI), pelvic radius (PR), and sacral table angle (STA) were assessed in lateral radiographs of the lumbar spine and compared between the pathologies.  Results Among the screened patients, 206 fulfilled all the inclusion criteria and were analyzed in this study. The mean age of the patients was 51.61 years (range, 23–87 y).The age distribution varied significantly between groups. The mean PI for women was (59.75+/-2.20 mm) was significantly larger (P =0.0002) than that for men (56.05+/-2.23).No sex differences were found with regard to PR men (136.55 ± 7.33 degrees); women-134.88 ± 8.07 degrees) (P =0.112) and STA for men (97.83+/-4.74 degrees) and women (97.300+/-4.71degrees) (P =0.41). For all 3 pelvic parameters, group comparisons revealed significant inter group differences (PR, STA, ANOVA P<0.05 and PI ANOVA P=0.04.  Conclusions We found all the constant anatomic parameters to be specific for distinct types of degeneration, suggesting pelvis shape is a predisposing factor for their development.