The Standing and Sitting Spino-Pelvic Sagittal Alignment in Patients with Instrumented Lumbar Fusion Might Correlate with Adjacent Segment Degeneration

Objectives Sitting is a common weight-bearing posture, like standing, but there still lacks enough understanding of sagittal alignment in sitting position for patients after lumbar fusion. This study aimed to investigate the accommodation of fixed spine from standing to sitting position and its influence on unfused segments. Methods Sixty-two patients after lumbar fusion (test group) and 40 healthy volunteers (control group) were recruited in this research. All subjects underwent lateral radiographs of entire spine in the standing and sitting positions. The spinopelvic parameters including sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), and pelvic tilt (PT) were measured. The changes in parameters of patients between two positions were compared with control group, and patients were divided in different groups based on fusion level and their parameters were compared. Results When changing from standing to sitting positions, a forward-moving SVA and TPA were observed in both patients and control groups, accompanied by the decrease in LL, TK and increase in PT, but the changes of patients were smaller in TPA, LL, and TK (6.5 degrees +/- 7.2 degrees vs 9.7 degrees +/- 6.0 degrees, 7.7 degrees +/- 8.3 degrees vs 13.6 degrees +/- 8.5 degrees, 2.2 degrees +/- 6.5 degrees vs 5.4 degrees +/- 5.1 degrees, respectively, p < 0.05). Increase of PT in the lumbosacral fixation group was lower than that in the control group (4.4 degrees +/- 9.1 degrees vs 8.3 degrees +/- 7.1 degrees, p < 0.05). Patients who had adjacent segments degeneration (ASD) showed more kyphosis in unfused lumbar segments than the other patients (16.4 degrees +/- 10.7 degrees vs -1.0 degrees +/- 4.8 degrees, p < 0.05) from standing to sitting. Conclusions The spine straightens in lumbar and thoracic curve, combined with forward-moving axis and pelvic retroversion when changing to the sitting position. However, these changes are relatively limited in patients after lumbar fusion, so the adjacent unfused lumbar segments compensate to stress during sitting and this may be related to ASD.