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Thoracolumbar junction orientation: its impact on thoracic kyphosis and sagittal alignment in both asymptomatic volunteers and symptomatic patients

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Abstract

Purpose

The thoracolumbar junction (TLJ) has not been explored in regard to its contribution to global sagittal alignment. This study aims to define novel sagittal parameters of the TLJ and to assess their roles within global sagittal alignment.

Methods

Included for cross-sectional, retrospective analysis were asymptomatic volunteers and symptomatic patients who had undergone operation for adult spinal deformity. Unique sagittal parameters of the TLJ were measured using the midline of the T12–L1 disk space: The TLJ orientation [TLJO; thoracolumbar tilt (TLT) and slope (TLS)]. Thoracic kyphosis (TK; T5–12), C7–S1 sagittal vertical axis (SVA), lumbar lordosis (LL; L1–S1), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured. Continuous variables were compared using the independent t test. Pearson correlations examined relationships between the parameters in each group. The asymptomatic TK was calculated using the measurement of the asymptomatic volunteer’s TLJO by linear regression.

Results

One hundred fifteen asymptomatic volunteers and 127 symptomatic patients were included. Only LL among the lumbopelvic parameters correlated with TK (asymptomatic volunteers: r = − 0.42; symptomatic patients: r = − 0.40). All the pelvic parameters have no direct correlation with TK in both groups. TLJO had stronger correlation with TK [asymptomatic volunteers: r = − 0.68 (TLS), r = 0.41 (TLT); symptomatic patients: r = − 0.56 (TLS), r = 0.44 (TLT)] than the lumbopelvic parameters. TLS correlated with LL (asymptomatic volunteers: r = 0.78; symptomatic patients: r = 0.73). Most pelvic parameters correlated with TLJO except for PI. The asymptomatic TK was estimated by the derived formula: 20.847 + TLS × (− 1.198).

Conclusion

The TLJO integrates the status of the lumbopelvic sagittal parameters and simultaneously correlates with thoracic and global sagittal alignment.

Graphic abstract

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Authors and Affiliations

  1. Department of Neurosurgery, Korea University College of Medicine, Seoul, South Korea

    Hong Joo Moon

  2. Department of Orthopaedic Surgery, School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8233, St. Louis, MO, 63110, USA

    Hong Joo Moon, Keith H. Bridwell, Alekos A. Theologis, Micheal P. Kelly & Munish C. Gupta

  3. Department of Orthopaedic Surgery, University of California – San Francisco (UCSF), San Francisco, CA, USA

    Alekos A. Theologis

  4. Department of Orthopaedic Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Thamrong Lertudomphonwanit

  5. Spine Service, Hospital for Special Surgery, New York, NY, USA

    Han Jo Kim

  6. Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY, USA

    Lawrence G. Lenke

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  1. Hong Joo Moon
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Correspondence to Munish C. Gupta.

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Moon, H.J., Bridwell, K.H., Theologis, A.A. et al. Thoracolumbar junction orientation: its impact on thoracic kyphosis and sagittal alignment in both asymptomatic volunteers and symptomatic patients. Eur Spine J 28, 1937–1947 (2019). https://doi.org/10.1007/s00586-019-06078-y

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  • DOI: https://doi.org/10.1007/s00586-019-06078-y

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