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VOLUME 17 , ISSUE 3 ( September-December, 2022 ) > List of Articles

Original Article

Correlation Analysis between Leg-length Discrepancy and Lumbar Scoliosis Using Full-length Standing Radiographs

Tomo Hamada, Hidenori Matsubara, Satoshi Kato, Toshifumi Hikichi, Kanu Shimokawa, Satoru Demura, Hiroyuki Tsuchiya

Keywords : Deformity correction, Leg-length discrepancy, Limb deformity, Radiography

Citation Information : Hamada T, Matsubara H, Kato S, Hikichi T, Shimokawa K, Demura S, Tsuchiya H. Correlation Analysis between Leg-length Discrepancy and Lumbar Scoliosis Using Full-length Standing Radiographs. 2022; 17 (3):144-147.

DOI: 10.5005/jp-journals-10080-1566

License: CC BY-NC-SA 4.0

Published Online: 30-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: When a leg-length discrepancy (LLD) is severe enough, it can result in lumbar scoliosis and other postural defects. To our knowledge, no study has demonstrated associations between LLD and lumbar curvature using full-length standing radiographs of the lower limbs and lumbar spine. This study aimed to examine the correlations between LLD and lateral curvature of the lumbar spine using standing radiographs. Materials and methods: Full-length standing radiographs of the lower limbs and spinal column of 113 participants (age range: 10–65 years) obtained between November 2006 and September 2019 were reviewed. Leg length was measured as the linear distance from the centre of the femoral head to the centre of the tibial plafond and converted to millimetres using a radiographic ruler captured in the images. Leg-length discrepancy was analysed as the absolute difference (mm) between the left and right leg lengths. Inequality was also evaluated as leg-length discrepancy ratio (LLDR), calculated as leg-length discrepancy/length of the unaffected (longer) leg × 100 (%). Lateral lumbar curvature was evaluated with the Cobb angle (°). The association between LLD or LLDR and lumbar Cobb angle was analysed by correlation analysis. Statistical analysis was performed by simple regression in SPSS. Results: Both LLD and LLDR exhibited a robust and positive correlation with lumbar Cobb angle (γ = 0.53, γ = 0.62), as illustrated by the following regression equations: lumbar Cobb angle (°) = 0.316 × leg-length discrepancy (mm) + 2.83 and lumbar Cobb angle (°) = 2.19 × leg-length discrepancy ratio (%) + 3.0. Conclusion: Using objective imaging data, we found that the lumbar Cobb angle tends to be >10° if the difference in leg lengths is >20 mm.


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  1. Giles LG, Taylor JR. Low-back pain associated with leg length inequality. Spine (Phila Pa 1976) 1981;6(5):510–521. DOI: 10.1097/00007632-198109000-00014.
  2. Gofton JP, Trueman GE. Studies in osteoarthritis of the hip. II. Osteoarthritis of the hip and leg-length disparity. Can Med Assoc J 1971;104(9):791–799. PMID: 5089638.
  3. Friberg O. Leg length asymmetry in stress fractures. A clinical and radiological study. J Sports Med Phys Fitness 1982;22(4):485–488. PMID: 7169791.
  4. Murrell P, Cornwall MW, Doucet SK. Leg-length discrepancy: Effect on the amplitude of postural sway. Arch Phys Med Rehabil 1991;72(9):646–648. PMID: 1859258.
  5. Delacerda FG, McCrory ML. A case report: Effect of a leg length differential on oxygen consumption. J Orthop Sports Phys Ther 1981;3(1):17–20. DOI: 10.2519/jospt.1981.3.1.17.
  6. Brunet ME, Cook SD, Brinker MR, et al. A survey of running injuries in 1505 competitive and recreational runners. J Sports Med Phys Fitness 1990;30(3):307–315. PMID: 2266763.
  7. Nichols PJ. Short-leg syndrome. Br Med J 1960;1(5189):1863–1865. DOI: 10.1136/bmj.1.5189.1863.
  8. Gibson PH, Papaioannou T, Kenwright J. The influence on the spine of leg-length discrepancy after femoral fracture. J Bone Joint Surg Br 1983;65(5):584–587. DOI: 10.1302/0301-620X.65B5.6643562.
  9. Guichet JM, Spivak JM, Trouilloud P, et al. Lower limb-length discrepancy. An epidemiologic study. Clin Orthop Relat Res 1991;(272):235–241. PMID: 1934739.
  10. Dahl MT. Limb length discrepancy. Pediatr Clin North Am 1996;43(4):849–865. DOI: 10.1016/s0031-3955(05)70438-7.
  11. Subotnick SI. The short leg syndrome. J Am Podiatry Assoc 1976;66(9):720–723. DOI: 10.7547/87507315-66-9-720.
  12. Siffert RS. Lower limb-length discrepancy. J Bone Joint Surg Am 1987;69(7):1100–1106. PMID: 3308894.
  13. Machen MS, Stevens PM. Should full-length standing anteroposterior radiographs replace the scanogram for measurement of limb length discrepancy? J Pediatr Orthop B 2005;14(1):30–37. DOI: 10.1097/01202412-200501000-00005.
  14. Kakushima M, Miyamoto K, Shimizu K. The effect of leg length discrepancy on spinal motion during gait: Three-dimensional analysis in healthy volunteers. Spine (Phila Pa 1976) 2003;28(21):2472–2476. DOI: 10.1097/01.BRS.0000090829.82231.4A.
  15. Betsch M, Rapp W, Przibylla A, et al. Determination of the amount of leg length inequality that alters spinal posture in healthy subjects using rasterstereography. Eur Spine J 2013;22(6):1354–1361. DOI: 10.1007/s00586-013-2720-x.
  16. Ploumis A, Trivedi V, Shin JH, et al. Progression of idiopathic thoracic or thoracolumbar scoliosis and pelvic obliquity in adolescent patients with and without limb length discrepancy. Scoliosis Spinal Disord 2018;13:18. DOI: 10.1186/s13013-018-0166-y.
  17. Giles LG, Taylor JR. The effect of postural scoliosis on lumbar apophyseal joints. Scand J Rheumatol 1984;13(3):209–220. DOI: 10.3109/03009748409100389.
  18. Giles LG, Taylor JR. Lumbar spine structural changes associated with leg length inequality. Spine (Phila Pa 1976) 1982;7(2):159–162. DOI: 10.1097/00007632-198203000-00011.
  19. Sabharwal S, Zhao C, McKeon JJ, et al. Computed radiographic measurement of limb-length discrepancy. Full-length standing anteroposterior radiograph compared with scanogram. J Bone Joint Surg Am 2006;88(10):2243–2251. DOI: 10.2106/JBJS.E.01179.
  20. Cobb JR. Outline for the study of scoliosis. Instr Course Lect 1948;5:261–275. DOI: 10.2519/jospt.1981.3.1.17.
  21. Sabharwal S, Zhao C. Assessment of lower limb alignment: Supine fluoroscopy compared with a standing full-length radiograph. J Bone Joint Surg Am 2008;90(1):43–51. DOI: 10.2106/JBJS.F.01514.
  22. Rubin A. Statistics for Evidence-based Practice and Evaluation. Boston: Wadsworth; 2007;164–166.
  23. Passias PG, Vasquez-Montes D, Poorman GW, et al. Predictive model for distal junctional kyphosis after cervical deformity surgery. Spine J 2018;18(12):2187–2194. DOI: 10.1016/j.spinee.2018.04.017.
  24. Gurney B. Leg length discrepancy. Gait Posture 2002;15(2):195–206. DOI: 10.1016/s0966-6362(01)00148-5.
  25. Papaioannou T, Stokes I, Kenwright J. Scoliosis associated with limb-length inequality. J Bone Joint Surg Am 1982;64(1):59–62. PMID: 7054204.
  26. Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine (Phila Pa 1976) 1983;8(6):643–651. DOI: 10.1097/00007632-198309000-00010.
  27. Gurney B, Mermier C, Robergs R, et al. Effects of limb-length discrepancy on gait economy and lower-extremity muscle activity in older adults. J Bone Joint Surg Am 2001;83(6):907–915. DOI: 10.2106/00004623-200106000-00013.
  28. Knutson GA. Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: Prevalence, magnitude, effects and clinical significance. Chiropr Osteopat 2005;13:11. DOI: 10.1186/1746-1340-13-11.
  29. Wild M, Kühlmann B, Stauffenberg A, et al. Does age affect the response of pelvis and spine to simulated leg length discrepancies? A rasterstereographic pilot study. Eur Spine J 2014;23(7):1449–1456. DOI: 10.1007/s00586-013-3152-3.
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