Die sagittale Wirbelsäulenbalance – klinische Bedeutung und radiologische Bemessung

Zusammenfassung

Sagittale Wirbelsäulendeformitäten gehen mit energiereichen Kompensationsmechanismen einher und resultieren regelmäßig in lumbal lokalisierten Rückenschmerzen. Das sagittale Wirbelsäulenprofil wird insbesondere durch das Verhältnis der spinalen Lordosen und Kyphosen in Relation zur Stellung des Beckens beschrieben und ist in einer Wirbelsäulenganzaufnahme radiologisch zu beurteilen. Verschiedene radiologische Schlüsselparameter beschreiben das sagittale Profil. Insbesondere die lumbale Lordose (LL) sowie die pelvine Inzidenz (PI), der pelvine Tilt (PT) und die thorakale Kyphose (TK) sind hier von besonderer Bedeutung. Die Differenz und PI−LL zeigt die höchste Korrelation zur eingeschränkten Lebensqualität. Für eine erste grobe Abschätzung der sagittalen Balance kann jedoch auch die SVA (Sagittal Vertical Axis) verwendet werden. Den Grad der Balance bzw. Imbalance kann man unter Verwendung der SVA sowie des PT ermitteln, die chirurgische Therapie bedarf jedoch einer genaueren Analyse, wozu insbesondere die SRS-Schwab-Klassifikation (SRS: Scoliosis Research Society) verwendet werden kann.

Abstract

Sagittal deformities of the spine frequently result in back pain, as patients have to expend much energy in compensation. The sagittal alignment of the spine is defined by its curvatures (lordosis and kyphosis) relative to the position of the pelvis. Diagnostic assessment is based on full spine a. p. and lateral X-rays. The sagittal balance is primarily described by different angles that can be measured, e.g. lumbar lordosis, pelvic incidence, pelvic tilt and thoracic kyphosis. The quality of life can best be estimated by subtracting lumbar lordosis from the pelvic incidence. However, initial evaluation of the sagittal balance can also be based on the sagittal vertical axis. The severity of imbalance can be described by the sagittal vertical axis and the pelvic tilt, but surgical therapy necessitates a more profound analysis, which can be based on the SRS-Schwab classification.

Schlüsselwörter

sagittale Balance - lumbale Lordose - pelvine Inzidenz - pelviner Tilt - Imbalance

Key words

sagittal balance - lumbar lordosis - pelvic incidence - pelvic tilt - imbalance

• Literatur

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