Introduction: The purpose of this study was to investigate sagittal spinopelvic parameters and the degree of disc degeneration in young adults.

Methods: From 2009 to 2012, a total of 278 young adult male patients who ranged in age from 18 to 24 years (20.87 ± 1.68) were included in this study. Pelvic incidence (PI), sacral slope (SS) and pelvic tilt (PT), Lumbar lordosis (LL), sacral inclination (SI), lumbosacral angle (LSA), and sacral table angle (STA) were measured. Patients were divided into two groups according to their Pfirrmann grade. The no disc degeneration group (n=100) included those who had no disc degeneration (Pfirrmann grade I), and the disc degeneration group (n=178) comprised the patients who showed disc degeneration (Pfirrmann grade II to V).

Results: LSA and STA were lower in the disc degeneration group than in the no disc degeneration group. The mean LSA values were 116.80° ± 6.52 in the no disc degeneration group and 113.96° ± 7.05 in the disc degeneration group (p < 0.001). The mean STA values were 97.41° ± 6.06 in the no disc degeneration group and 95.38° ± 6.12 in the control group (p = 0.008).

Conclusions: In the present study, we found that patients with disc degeneration showed lower LSA and lower STA than patients without disc degeneration. This means that the patients with disc degeneration had more severe lumbosacral and sacral kyphosis, and vertical sacrum. We suggest that lumbosacral kyphosis and sacral kyphosis are risk factors for disc degeneration in young adults, and STA and LSA should be considered to prevent further disc degeneration. Also, our study demonstrated that lumbosacral structure with a more vertical orientation causes a tendency to develop disc degeneration and herniation. Therefore, exercises to improve a vertical sacrum, such as extension traction treatment, would be helpful in preventing further disc degenerations.

Patient Care: In the present study, we found that patients with disc degeneration showed lower LSA and lower STA than patients without disc degeneration. This means that the patients with disc degeneration had more severe lumbosacral and sacral kyphosis, and vertical sacrum. We suggest that lumbosacral kyphosis and sacral kyphosis are risk factors for disc degeneration in young adults, and STA and LSA should be considered to prevent further disc degeneration. Also, our study demonstrated that lumbosacral structure with a more vertical orientation causes a tendency to develop disc degeneration and herniation. Therefore, exercises to improve a vertical sacrum, such as extension traction treatment, would be helpful in preventing further disc degenerations (Fig. 2).

Learning Objectives: The purpose of this study was to investigate sagittal spinopelvic parameters and the degree of disc degeneration in young adults.

References: 1. Rajnics P, Templier A, Skalli W, Lavaste F, Illes T. The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord Tech 2002;15-1:24-30. 2. Vaz G, Roussouly P, Berthonnaud E, Dimnet J. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 2002;11-1:80-7. 3. Mehta VA, Amin A, Omeis I, Gokaslan ZL, Gottfried ON. Implications of spinopelvic alignment for the spine surgeon. Neurosurgery 2012;70-3:707-21. 4. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 2005;30-18:2024-9. 5. Roaf R. Vertebral growth and its mechanical control. J Bone Joint Surg Br 1960;42-B:40-59. 6. Acaroglu ER, Iatridis JC, Setton LA, Foster RJ, Mow VC, Weidenbaum M. Degeneration and aging affect the tensile behavior of human lumbar anulus fibrosus. Spine (Phila Pa 1976) 1995;20-24:2690-701. 7. Koeller W, Muehlhaus S, Meier W, Hartmann F. Biomechanical properties of human intervertebral discs subjected to axial dynamic compression--influence of age and degeneration. J Biomech 1986;19-10:807-16. 8. Kurowski P, Kubo A. The relationship of degeneration of the intervertebral disc to mechanical loading conditions on lumbar vertebrae. Spine (Phila Pa 1976) 1986;11-7:726-31. 9. Keorochana G, Taghavi CE, Lee KB, Yoo JH, Liao JC, Fei Z, Wang JC. Effect of sagittal alignment on kinematic changes and degree of disc degeneration in the lumbar spine: an analysis using positional MRI. Spine (Phila Pa 1976) 2011;36-11:893-8. 10. Legaye J, Duval-Beaupere G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 1998;7-2:99-103. 11. Wiltse LL, Winter RB. Terminology and measurement of spondylolisthesis. J Bone Joint Surg Am 1983;65-6:768-72. 12. Dubousset J. Treatment of spondylolysis and spondylolisthesis in children and adolescents. Clin Orthop Relat Res 1997-337:77-85. 13. Osterman K, Osterman H. Experimental lumbar spondylolisthesis in growing rabbits. Clin Orthop Relat Res 1996-332:274-80. 14. Barrey C, Jund J, Noseda O, Roussouly P. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. European Spine Journal 2007;16-9:1459-67. 15. Ohmori K, Ishida Y, Takatsu T, Inoue H, Suzuki K. Vertebral Slip in Lumbar Spondylolysis and Spondylolisthesis. Journal of Bone and Joint Surgery-British Volume 1995;77-5:771-3. 16. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 2001;26-17:1873-8. 17. Yang X, Kong Q, Song Y, Liu L, Zeng J, Xing R. The characteristics of spinopelvic sagittal alignment in patients with lumbar disc degenerative diseases. Eur Spine J 2013. 18. Skaf GS, Ayoub CM, Domloj NT, Turbay MJ, El-Zein C, Hourani MH. Effect of age and lordotic angle on the level of lumbar disc herniation. Adv Orthop 2011;2011:950576. 19. Rajnics P, Templier A, Skalli W, Lavaste F, Illes T. The importance of spinopelvic parameters in patients with lumbar disc lesions. Int Orthop 2002;26-2:104-8. 20. Endo K, Suzuki H, Tanaka H, Kang Y, Yamamoto K. Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J 2010;19-3:435-8. 21. Barrey C, Jund J, Noseda O, Roussouly P. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 2007;16-9:1459-67. 22. Ergun T, Lakadamyali H, Sahin MS. The relation between sagittal morphology of the lumbosacral spine and the degree of lumbar intervertebral disc degeneration. Acta Orthop Traumatol Turc 2010;44-4:293-9. 23. Videman T, Battie MC. The influence of occupation on lumbar degeneration. Spine (Phila Pa 1976) 1999;24-11:1164-8. 24. Liuke M, Solovieva S, Lamminen A, Luoma K, Leino-Arjas P, Luukkonen R, Riihimaki H. Disc degeneration of the lumbar spine in relation to overweight. Int J Obes (Lond) 2005;29-8:903-8. 25. Dammers R, Koehler PJ. Lumbar disc herniation: level increases with age. Surg Neurol 2002;58-3-4:209-12; discussion 12-3. 26. Tanguay F, Labelle H, Wang Z, Joncas J, de Guise JA, Mac-Thiong JM. Clinical significance of lumbosacral kyphosis in adolescent spondylolisthesis. Spine (Phila Pa 1976) 2012;37-4:304-8. 27. Oh YM, Eun JP. The relationship between sagittal spinopelvic parameters and the degree of lumbar intervertebral disc degeneration in young adult patients with low-grade spondylolytic spondylolisthesis. Bone Joint J 2013;95-B-9:1239-43. 28. Wang Z, Parent S, Mac-Thiong JM, Petit Y, Labelle H. Influence of sacral morphology in developmental spondylolisthesis. Spine (Phila Pa 1976) 2008;33-20:2185-91. 29. Whitesides TE, Jr., Horton WC, Hutton WC, Hodges L. Spondylolytic spondylolisthesis: a study of pelvic and lumbosacral parameters of possible etiologic effect in two genetically and geographically distinct groups with high occurrence. Spine (Phila Pa 1976) 2005;30-6 Suppl:S12-21.