The Evaluation of Geometric Parameters of Lumbosacral Vertebrae (a Radiographic Study)

The Evaluation of Geometric Parameters of Lumbosacral Vertebrae (a Radiographic Study)

CHAPTER ONE

AIM OF THE STUDY

The aim of this study was to evaluate the radiographic measurements of geometric parameters of the lumbosacral vertebrae of adults in Edo state.

OBJECTIVES OF THE STUDY

The specific objectives included:

To measure the geometric parameters of the lumbar spine: LSA, LLA, SIA, LSDA.
To evaluate the relationship of various geometric parameters of the lumbosacral vertebrae with age, gender and occupation.
To determine any relationship between the geometric measurements and some anthropometric indices.
To determine the relationship between the geometric parameters of the lumbosacral spine, and adiposity and other anthropometric indices.

CHAPTER TWO

LITERATURE REVIEW

Wilhelm Conrad Roentgen accidentally discovered x-rays in 1895 while conducting some experiments in his laboratory (Yochum and Rowe 2005). The “X” in x-rays represented the unknown ray as Roentgen did not know what to name the invisible rays. One of the significant aspects of this discovery was the development of the clinical radiography which allows us to “see” the internal structures of the body especially bony tissue. Although the x-ray was considered an excellent diagnostic imaging tool, the harmful aspect of radiation could not be ignored (Yochum and Rowe 2005). Since its discovery, it has been of immense value in the evaluation of skeletal disorders (Yochum and Rowe 2005; Kendrik et al., 2001). Most patients requiring medical attention for low back pain have routine x-rays taken of the lumbosacral spine as part of the initial evaluation. The radiographs may be evaluated utilizing the ABCS approach (A = Alignment; B = Bone; C = Cartilage; S = Soft tissue). Routinely two views are taken anteroposterior (AP) and lateral (L) views. Igbinedion and Akhigbe (2011) recorded that transition vertebrae cause low back pain. Transition vertebrae involved the downward migration of L₅ (sacralisation) or upward migration of S₁ (lumbarisation) (Igbinedion and Akhigbe, 2011).Igbinedion and Akhigbe (2011); Osunwoke et al., (2009), however, recorded that 32.3% of their patients had transitional vertebrae, of which 5.9% had lumbarisation and 26.4% sacralisation. In that same study, 2.4% males and 3.6% females had lumbarisation and 15.7% males and 10.7% females had sacralisation. In the study recorded by Uduma et al., (2013), lumbarisation was seen in four cases (7.02%) with equal male to female ratio. The earliest age of discovery was 4^th decade. This late presentation of an anatomical variant is probably due to its asymptomatic nature. Symptomatology, therefore, arose on receipt of secondary spondylosis. However, Igbinedion and Akhigbe (2011), did not observed any statistical correlation between transitional vertebrae with sex, age group, body mass index, osteophyte formation, vacuum phenomenon, disk degeneration, and spondylolisthesis. Measurement of the lumbar spine radiographic parameters may be useful in the investigation of low back pain (Amonoo-Kuofi 1992) and in the design and development of spinal implants and instrumentation (Zhou et al., 2000).

The radiographic parameters evaluated during an assessment of the lumbosacral vertebrae are:

CHAPTER THREE

MATERIALS AND METHODS

STUDY DESIGN

This research study was a prospective, non-interventional, cross-sectional study. The data were obtained from the lumbosacral radiographs, and selected anthropometric and demographic data of subjects that were presented at the radiology departments and orthopaedic clinics of the University of Benin teaching hospital Benin-city, Greenhill Radiological centre Ebhoakhuala, Ekpoma and Igbinedion University teaching hospital and medical research centre, Okada. Permission to conduct this study was obtained from the clinical research and Ethics Committees of these hospitals (see Appendices B, C and D).

INCLUSION CRITERIA

All subjects were between the ages of 18 to 64 years.
Those younger than 18 years would have needed parental consent.
The risk of Osteoporotic vertebral fractures is higher in those 65 years or older and this will affect the outcome of the study.

CHAPTER FOUR

RESULTS

DEMOGRAPHICS CHARACTERISTICS

The data of three hundred (300) subjects who met the inclusion criteria were analysed. The age distribution of participants is shown in table 1. The minimum age was 18 years and the maximum age was 64 years. The mean (± SD) age was 48 (± 12) years. Tables 4. – 7. show the age distribution for various radiographic parameters. The fewest number of participants 16 (5.30%) was in the 15 – 24 years age group, while the age group 55 – 64 years had the largest number of participants 111 (37.00%). The distribution of participants by sex is shown in table 2. The male participants were 141 (47.00%) and the females were 159 (53.00%) with a male to female ration of 1: 1. 1. The distribution of participants by occupation is shown in table 3. The majority of the participants were traders (30.70%), followed by civil servants (21.70%). Students were the least in number 21 (7.00%).

CHAPTER FIVE

DISCUSSION

ANTHROPOMETRIC AND DEMOGRAPHIC CHARACTERISTICS

The majority of the subjects in this study were middle aged persons. The age range of the subjects was dissimilar to those of Tibrewal and Pearcy (1985); Chernukha et al., (1998); Shao et al., (2002), but similar to that of Nourbakhish et al., (2009). This finding may be explained by the fact that the subject in this study were symptomatic.

There is a slight female preponderance in this study which is similar to the reports of Kim et al., (2006) and Eyichukwu and Ogugua (2012). However this finding differs from the results of Kamali et al., (2004) which showed a male preponderance.

Amongst the participants, traders were the most common occupational group 92 (30.7%), followed by civil servants 65 (21.7%). These are essentially sedentary workers who are at risk of developing low back pain as reported by Eyichukwu and Ogugua (2012).

In terms of the key anthropometric measurements, the mean (±SD) of the height, hip circumference, BMI and WHR were similar to the reports of Andrew et al., (2001). These values were higher than the values in the studies by Naidoo (2008) and Miyamoto et al., (2008) and may be explained by the fact that Africans and Arabs as represented in this study and the studies by Andrew et al., (2001) and Nourbakhish et al., (2001) are bigger in stature than Asians as represented in this studies by Naidoo (2008) and Miyamoto et al., (2008).

The majority of the subjects in this study (58.00%) were either overweight or obese, a finding similar to the study by Andrew et al., (2001) and Nourbakhish et al., (2001). Since our subjects were symptomatic, this finding suggests that obesity may be a risk factor for low back pain. Naidoo (2008) and Miyamoto et al., (2008) had majority of the subjects within the normal range for BMI possibly because they were asymptomatic subjects.

CHAPTER SIX

CONCLUSION AND RECOMMENDATIONS

CONCLUSION

The primary aim of this study was:

To evaluate the radiographic measurements of the lumbosacral vertebrae of adults in Edo state.

RECOMMENDATIONS

Recommendations for future studies include the following:

A similar study on asymptomatic subjects which will produce the normal values for individuals in Edo state.
A comparative study between symptomatic subjects (with LBP) and asymptomatic subjects in order to determine possible difference between these two groups and also to further establish the clinical significance of our findings.
A similar study with x-rays taken in erect and sitting position to determine the effect of position on the value of radiographic parameters.
A similar study conducted on other ethnic groups in Nigeria to determine possible ethnic differences in the values of the radiographic parameters.

REFERENCES

Ahey, M., Akbari, M., Salsabili, N. (1977). “The survey of Lumbar Curve in low back pain and healthy subjects”. Nabz: (7): 8 – 35.
Ambrose, M., DaGraca, A., Wishner, C. (2003). “Study of the occurrence of Spondylotic Spondylolisthesis in relation to the Sacral Base angle and Lumbosacral Disc angle”. Dissertation at Logan College of Chiropractic; 1 – 10.
Amonoo-Kuofi, H. S. (1992). “Changes in the Lumbosacral Angle, Sacral Inclination and the Curvature of the Lumbar Spine during aging”. Acta Anatomica 145(4): 373 -377.
Andrews, R., Brafield, B., Mayes, L., Russell, T., Teel, J. (2001). “The effect of obesity on sacral base angle”. Senior Research Project, Logan College of Chiropractic; 1 – 14.
Anson, B. J., McVay, C. B. (19710. “Vertebral column (chapter 24)” Surgical anatomy 5^th ed. Philadephia N. B. Saunder’s Company; 903 – 904.
Ayodele, T. O. (2009). “Comparative efficacy of low metal glucosamine sulphate iontophoresis in the management of lumbar spondylosis.” Indian J Physiother Occup Ther 3: 12 – 25.
Azar, M. S., Talebpour, F., Alaee, A., Hadinejad, A., Nozari, A., Sajadi, M. (2010). “Association of low back pain with lumbar lordosis and lumbosacral angle.” Mazand University Medical Science 20(75): 9 – 15.
Banks, S. D. (1983). “The use of Spinographic parameters in the differential diagnosis of lumber facet and disc syndromes.” Journal of manipulation and physiological Therapy. 6(3): 113.

Related Topics:

Other Topics