Radiological and clinical evaluation of spinopelvic alignment in patients with lumbar disc herniation

The aim of this study was to evaluate the relationship between spinopelvic alignment, fatty degeneration of erector spinae muscle, erector spinae muscle atrophy, modic degenerations and clinical parameters in patients with lumbar disc herniation. A total of 128 patients aged 18-65 years with lumbar disc herniation were included in the study. Symptom duration, Trendelenburg test, Ely test, Thomast test, visual analogue scale, Oswestry Low Back Pain Disability Questionnaire, Pain Detect Questionnaire were evaluated. Atrophy in the erector spinae muscle, fatty degeneration in the erector spinae muscle and the presence of modic changes were evaluated on lumbar magnetic resonance imaging. Spinopelvic parameters were evaluated on spine radiographs. Patients were also divided into groups according to symptomatic/asymptomatic low back pain and the presence or absence of modic degeneration. The results of our study showed that an increase in SVA negatively affected pain and activities of daily living. There was no difference in fatty degeneration and disc herniation stages between symptomatic and asymptomatic low back pain groups. Modic degenaration was found in 40% of the patients. The most common type 2 degeneration was observed and most of the modic degenerations were at L5-S1 and L4-5 levels. PT value was increased in patients with modic degeneration. PI-LL value was higher in patients with type 3 modic degeneration. Modic degeneration increased with increasing age and BMI. All patients with LDH had fatty degenerations of the erector spinae muscle and approximately 44% had grade 2 degeneration. Fatty degeneration of the erector spinae muscle and atrophy of the erector spinae muscle cross-sectional area had a negative effect on activities of daily living. Although there was no significant difference between asypmtomatic and sypmtomatic patients in terms of MSU classification, the most common lesion in symptomatic patients was type 2B. The BMI value was higher in the symptomatic patient group and the degree of disc herniation and fatty degeneration of the erector spinae muscle increased as the BMI value increased. The lack of a healthy control group in our study constitues the limitation of our study. In conclusion, there are many causes in the etiology and pathophysiology of lumbar disc herniation such as spinopelvic alignment, modic changes, atrophy and fatty degeneration in the erector spinae muscle and obesity. It is important to consider these causes holistically in the evaluation of patients with lumbar disc herniation.