Motion of Lumbar Endplate in Degenerative Lumbar Scoliosis Patients with Different Cobb Angle In Vivo: Reflecting the Biomechanics of the Lumbar Disc

Abstract

Study Design. Controlled laboratory study. Objective. To evaluate the influence of degenerative lumbar scoliosis (DLS) with different Cobb angles and degenerative discs on the range of motion (ROM) of the lumbar endplates during functional weight-bearing activities in vivo. Summary of Background. DLS data might influence spinal stability and range of motion of the spine. Altered lumbar segment motion is thought to be related to disc degeneration. However, to date, no data have been reported on the motion patterns of the lumbar endplates in patients with DLS in vivo. Methods. We recorded 42 DLS patients with the apical disc at L2-L3 and L3-L4. Patients were divided into A group with a coronal Cobb angle >20° (number: 13; $62.00\pm 8.57$ years old) and group B with a coronal Cobb angle <20° (number: 28; $65.79\pm 6.66$ years old). Patients’ discs were divided into a degenerated disc group (III-V) and a nondegenerated disc group (I-II) according to the Pfirrmann classification. Computed tomography (CT) was performed on every subject to build 3-dimensional (3D) models of the lumbar vertebrae (L1–S1), and then the vertebras were matched according to the dual fluoroscopic imaging system. The kinematics of the endplate was compared between the different Cobb angle groups and the healthy group reported in a previous study and between the degenerative disc group and nondegenerative disc group by multiway analysis of variance. Results. Coupled translation at L5-S1 was higher than other levels during the three movements. During the flexion-extension of the trunk, around the anteroposterior axis, rotation in group A was higher than that in the control group at L2-L3 and L3-L4 ( $6.62\pm 3.61$  mm vs $4.36\pm 2.55$  mm, $5.01\pm 3.19$  mm; $P<0.05$ , $P<0.05$ ). During the left-right bending of the trunk, around the mediolateral axis, rotations in groups A and B were higher than those in the control group at L5-S1 ( $17.52\pm 11.43$ °, $17.25\pm 9.22$ ° vs $10.08\pm 5.42$ °; $P<0.05$ , $P<0.05$ ). During the left-right torsion, around the anteroposterior axis, rotation in group A was higher than that in group B and the control group at L2-3 ( $9.69\pm 5.94$ ° vs $5.77\pm 4.02$ °, $4.47\pm 2.00$ °; $P<0.05$ , $P<0.05$ ). In patients with Cobb angle <20°, coupled translation was higher in the degenerated disc group than in the nondegenerated disc group, especially along the anteroposterior axis. Conclusion. An increase in the coupled rotation of the endplate at the scoliotic apical level in patients with DLS was related to a larger Cobb angle. Moreover, segments with degenerative discs had higher coupled translations in the anteroposterior direction than segments with nondegenerative discs in DLS patients with Cobb angle <20°. These data might provide clues regarding the etiology of DLS and the basis for operative planning.