Journal of Orthopedic Research & Physiotherapy Category: Medical Type: Research Article
Measurement of Spinal Canal and Sagittal Balance of the Pelvis-Spine Complex in Normal Congolese Population
- Mukaya J1*, Kabeya JM1, Mbongo A1, Mbuyi-Muamba JM1
- 1 Department Of Radiology, University Hospital Of Kinshasa, Congo, The Democratic Republic Of The
*Corresponding Author:Mukaya J
Department Of Radiology, University Hospital Of Kinshasa, Congo, The Democratic Republic Of The
Received Date: Jun 21, 2016 Accepted Date: Aug 02, 2016 Published Date: Aug 16, 2016
This study aimed to determine the measurement of spinal canal and spinopelvic parameters in Congolese population of Kinshasa.
Materials and methods
212 clinically asymptomatic were enrolled during 2014-2015; 138 subjects (65.1%) were male and 74 (34.9%) were female of matching age between 18 and 30 years.
Radiological study consisted of simple anteroposterior and lateral radiographs as well as computed tomography of the lumbar spine.
The following spinopelvic parameters were measured PI (Pelvic Incidence), Lumbar Lordosis (LL), Sacral Slope (SS) and Pelvic Tilt (PT).
Measurements in axial scan included midline Anteroposterior Vertebral Body diameter (APVB), midline Anteroposterior Canal Diameter (APCD), midline Dural Sac Diameter (DSD), Dural sac Cross-sectional Area (DCA), Canal Cross-Sectional Area (CCA), Interarticular Distance (IAD), Interpedicular Distance (IPD), Foraminal Height (FH) and Lateral Recess (LR). The Lumbar Ratio (LR) was calculated by dividing APCD by APVB.
The mean ± SD of the measurements at the narrowest level except L5-S1 was:
APCD = 15.12 ± 2.30 mm, IPD = 20.31 ± 3.50mm, LR = 5.35 ± 1.40 mm, IAD = 16.32 ± 2.22mm, DSD = 12.12 ± 2.11mm, FH = 18.50 ± 1.7mm, DCA = 169.27 ± 48.54mm2, CCA = 251.80 ± 36.10mm2 and R = 0.54 ± 0.02.
The mean ± SD spinal and pelvic parameters were: LL = 61.1 ± 9.7°, PI = 54.4 ± 7.8°, SS = 41.0 ± 8.4° PV = 13.2 ± 6.5°.
The report is the first to present the normal radiological anatomy of different diameters of the lumbar spinal canal among adult Congolese population. These diameters are smaller than the measurement in Caucasian population.
Few years ago, sagittal parameters of the spine have become inescapable and have constituted a revolution in the diagnostic and therapeutic of spinal disorders . However, in Democratic Republic of Congo (DRC), the profile of the spinal canal and sagittal parameters has never been documented.
The purpose of this study is to determine the normal range of different diameters of canal and sagittal spinal in normal Congolese population.
MATERIALS AND METHODS
Exclusion criteria were: past or present back pain, presence of spinal diseases, spinal configuration anomalies, history of spinal traumatism, metabolic diseases, pregnancy.
Collection of demographic and medical data
Spinopelvic parameters (Figure 1), the morphological type of the canal spinal, the spinal canal configuration and the different measures by a single observer.
Figure 1: Spinopelvic parameters in lateral radiography of lumbar spine.
The following spinopelvic parameters were measured using the worldwide principal protocol :
- PI (Pelvic Incidence) is measured as the angle between a line drawn perpendicular to the sacral end plate at its midpoint of the femoral head axis;
- Lumbar Lordosis (LL) is the sagittal Cobb angle measured between the superior end plate of L1 and the inferior end plate of L5;
- Sacral Slope (SS), angle between the horizontal and sacral plate;
- Pelvic Tilt (PT), angle between the vertical and the line through the midpoint of the sacral plate to femoral heads axis.
Figure 2: Measurements in axial scan of lumbar spinal.
The lumbar Ratio (R) was calculated by dividing APCD by APVB. Likewise, measurements that were less than the mean - 2 SD were considered to be “below normal”.
Description of the study population
|Age||Mean SD 24.2 ± 2.2years|
|Weight (Kg)||Mean SD 56.8 ± 7.4|
|Height (Centimeter)||Mean SD 167.3 ± 9.7|
|BMI (kg/m2)||Mean SD 20.5 ± 3.7|
|≥ 30||3 (1.4%)|
|Parameter||Mean ± SD||Minimum measurement|
|APCD (mm)||15.12 ± 2.30||10.5|
|IPD (mm)||20.31 ± 3.50||16|
|LR (mm)||5.35 ± 1.40||2.5|
|IAD (mm)||16.32 ± 2.22||11.5|
|DSD (mm)||12.12 ± 2.11||7.5|
|FH (mm)||18.50 ± 1.7||15|
|DCA (mm2)||169.27 ± 48.54||70|
|CCA (mm2)||251.80 ± 36.10||179|
|R||0.54 ± 0.02||0.5|
Spinal and pelvic parameters of the sagittal balance of the pelvis-spine complex
|Lumbar lordosis (°)||61.1 ± 9.7||40.8||84.1|
|Pelvic incidence (°)||54.4 ± 7.8||31.2||79.5|
|Sacral slope (°)||41.0 ± 8.4||0.2||56.6|
|Pelvic tilt (°)||13.2 ± 6.5||6.4||34.1|
There was a close correlation between sacral slope and pelvic incidence (r = 0.61), lumbar lordosis and sacral slope (r = 0.64), lumbar lordosis and pelvic incidence (r = 0.68) (Table 4).
The youth of our sample was justified by the fact that bone growth is usually completed at the age of 17 years and maximum of 30 years in that before this age the risk of bone degeneration is low.
The main result of this research was to determine reference values of lumbar spinal canals. The threshold values defining the anatomical lumbar stenosis were: DAP < 10.5 mm DIP < 16 mm, LP < 2.5 mm, DIA < 11.5 mm, DFD < 7.5 mm, DF < 15 mm, C / V < 0.50, SC < 179 mm2 and SD < 70 mm2
These values are well below the values proposed by the classical treatises. Indeed, for classical treatises of French literature, DAP has values:
- Normal value ≥ 15 mm
- Closeness on: 13 and 14 mm
- Closeness absolute ≤ 12 mm [10-15].
For the DFD, cited the normal dimensions of at least 11 mm [10-15].
In English literature, the “Atlas of radiology measurement” by Keats TE and Silstrom C. Mosby 2001  cites as normal value ± 16 mm 3 in L4 of DAP.
These reference values are no less indicative as severe strictures are not incompatible with the absence of symptoms and, conversely, even normal dimensions on supine exams can be significantly reduced by the static conditions or dynamics of standing. In addition, the statistical standard does not necessarily correspond to the boundary between normality and pathology: an individual whose actions deviate more than two standard leads do not mean a sick individual.
Analysis of the sagittal balance of the spine is a fundamental step in the understanding and treatment of many spinal pathologies. One objective of this work was to determine the physiological values of pelvic and spinal parameters of sagittal balance of the spine and to study their interrelations. Hyperlordosis of African described by Courson in 1963  before a clinical aspect of high-lumbar curve corresponds to different values of the pelvic and spinal sagittal balance parameters of the lumbar spine?
The average values of the main angular parameters considered were: lumbar lordosis 61.1 degrees (± 9.7), sacral slope 41.0 degrees (± 8.4), pelvic Version 13.2 degrees (± 6.5) and 54.4 degrees pelvic incidence (± 7.8). There was a close correlation between sacral slope and pelvic incidence (r = 0.61), lumbar lordosis and sacral slope (r = 0.64), lumbar lordosis and pelvic incidence (r = 0.68).
Morphotype pelvic spinal black Africans present values comparable to the literature  and meets the same provisions of anatomical and functional interdependence of sagittal balance of the lumbar spine.
ETHICS AND DISCLOSURES
There was no funding received for this study and there was no conflict of interests.
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Citation:Mukaya J, Kabeya JM, Mbongo A, Mbuyi-Muamba JM (2016) Measurement of Spinal Canal and Sagittal Balance of the Pelvis-Spine Complex in Normal Congolese Population. J Orthop Res Physiother 2: 025.
Copyright: © 2016 Mukaya J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.