Evaluation of sagittal balance and spinopelvic parameters in patients with lumbar disc herniation

Aim : The objective of this study was to analyze sagittal balance throughout with spinopelvic parameters, in patients with a lumbar disc herniation and evaluate these patients with functional quality assessment questionnaires. Material Method: A total of 88 adult patients were evaluated in this study. All these patients were examined clinically  in a  physical medicine and rehabilitation policlinic, from one physician in Sivas Numune State Hospital for a lumbar disc herniation  between 01 March-01 November 2018. The physical examination findings and records in the patient's files  were evaluated. The Oswestry disability (ODI) questionnaire, Roland Morris (RDI) questionnaire and Health Assessment Questionnaire (HAQ) were evaluated for all voluntary patients. All patients were confirmed with full spinal anteroposterior and lateral radiographs and  lumbar MRI. Three group pathologies were evaluated in this study: Group1; disc herniation with bulging ,Group 2; one level disc herniation and Group 3 multilevel disc herniation, including lumber disc protrusion, extrusion, and sequestration. Spino-pelvic parameters; lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) were measured on full spine radiographs in a standing position. Results: LL was significantly less  by multilevel disc herniation group as compared with bulging group and one level disc herniation group  (p<0.05). It was a poor correlation between LL and waist circumference by multilevel disc herniation group. When compared groups with functional assessment questionnaires, all  groups were not statistically different each from other. We demonstrated not significantly different by all three groups between ODI, HAQ and RDI scores. Conclusion: Spinal sagittal imbalance caused by LDH is one type of compensatory response to prevent low back pain. This mechanism mainly includes a loss of LL and PT. Two important factors that need to be considered are the paravertebral muscles strengthening to prevent sagittal imbalance and keeping the body weight and waist circumference in the normal range.