The effect of age, BMI, and bone mineral density on the various lumbar vertebral measurements in females

Characterization of Lumbar Lordosis: Influence of Age, Sex, Vertebral Body Wedging, and L4-S1

STUDY DESIGN

Retrospective radiographic review.

OBJECTIVE

The objectives of the study were to determine the contributions to lumbar lordosis (LL) through both the vertebrae and the intervertebral disc (IVD), and to investigate the relationships between lumbar sagittal spine measurements and age and gender.

SUMMARY OF BACKGROUND DATA

A small body of literature exists on the relative contributions of vertebral body and IVD morphology to LL, the effects of L4-S1 on overall LL, and the relationships/correlations between lumbar sagittal spine measurements.

METHODS

Patients who met the inclusion criteria were retrospectively evaluated. Measurements included LL, pelvic incidence (PI), and % contributions of vertebral body wedging/IVD wedging/L4-S1 to LL. Patients were separated into groups by age and sex, demographic data were collected, and statistical analysis was completed.

RESULTS

LL decreased with age, although PI remained similar. Females demonstrated increased LL and vertebral body wedging % than males. Males demonstrated increased L4-S1% than females. Despite a decrease in LL with age, patients maintained L4-S1% and IVD wedging %. There was a significant negative relationship between PI and IVD wedging, PI and L4-S1%, and LL and L4-S1%.

CONCLUSIONS

During aging, the lumbar spine loses LL linearly. This occurs in the IVD and vertebral bodies. Females have increased LL compared with males, because of an increase in vertebral body wedging and IVD/vertebral wedging cranial to L4. In patients with high PI or LL, increased LL occurs from cranial to L4 and from vertebral body wedging.

Differences in spinal postures and mobility among adults with Prader-Willi syndrome, essential obesity, and normal-weight individuals

Introduction

Spinal kinematics/motion are reported to be altered in adolescents and adults with essential obesity, while no information is available in patients with Prader-Willi syndrome so far. The aim of this study was to examine cross-sectionally the characteristics of spinal postures and mobility in 34 patients with PWS, in 35 age- and sex-matched adults with essential obesity, and in 37 normal-weight individuals.

Methods

Spinal posture and mobility were assessed using a radiation-free back scan, the Idiag M360 (Idiag, Fehraltorf, Switzerland). Differences in spinal posture and mobility between the three groups were determined using a two-way analysis of variance.

Results

Adults with Prader-Willi syndrome had greater thoracic kyphosis [difference between groups (Δ) = 9.60, 95% CI 3.30 to 15.60, p = 0.001], less lumbar lordosis (Δ = -6.50, 95% CI -12.70 to -0.30, p = 0.03) as well as smaller lumbar and hip mobility than those with normal weight.

Discussion

Although the characteristics of the spine in patients with Prader-Will syndrome appear to be similar to that found in subjects with essential obesity, Prader-Willi syndrome was found to influence lumbar movements more than thoracic mobility. These results provide relevant information about the characteristics of the spine in adults with Prader-Willi syndrome to be taken into careful consideration in the management of spinal conditions. These findings also highlight the importance of considering the musculoskeletal assessment of spinal postures and approaches targeting spinal and hip flexibility in adults with Prader-Willi syndrome.

Differences in spinal posture and mobility between adults with obesity and normal weight individuals

The aim of this study was to cross-sectionally investigate the relationships between obesity and spinal posture as well as mobility by comparing the spinal parameters between adults with obesity and normal-weight individuals. The spinal parameters were measured in 71 adults with obesity and 142 normal-weight individuals using a radiation-free back scan, the Idiag M360. Differences in spinal posture and movements between the two groups were determined using a two-way analysis of variance. Adults with obesity had greater thoracic kyphosis [difference between groups (Δ) = 6.1°, 95% CI 3.3°-8.9°, p < 0.0001] and thoracic lateral flexion (Δ = 14.5°, 95% CI 5.1°-23.8°, p = 0.002), as well as smaller thoracic flexion (Δ = 3.5°, 95% CI 0.2°-6.9°, p = 0.03), thoracic extension (Δ = 4.1°, 95% CI 1.1°-7.1°, p = 0.008), lumbar flexion (Δ = 10.4°, 95% CI 7.7°-13.5°, p < 0.0001), lumbar extension (Δ = 4.8°, 95% CI 2.2°-7.4°, p = 0.0003) and lumbar lateral flexion (Δ = 12.8°, 95% CI 9.8°-15.7°, p = < 0.0001) compared to those with normal weight. These findings provide relevant information about the characteristics of the spine in adults with obesity to be taken into careful consideration in the prescription of adapted physical activities within integrated multidisciplinary pathways of metabolic rehabilitation.

The influence of osteoporotic vertebral fractures on global sagittal alignment in elderly patients: a systematic review and meta-analysis

BACKGROUND

Thoracic kyphosis, or loss of lumbar lordosis, is often equated with osteoporosis because vertebral fractures are assumed to be a major causative factor, in addition to degeneration related to age. Despite the few studies aiming to measure the natural change in global sagittal alignment (GSA) that occurs with advancing age, the overall effect of conservatively managed osteoporotic vertebral compression fractures (OVCF) on the GSA in the elderly remains poorly understood.

OBJECTIVE

To systematically evaluate the relevant literature regarding the influence of OVCF on the GSA compared to patients of similar age without fractures using the following radiological parameters: Pelvic Incidence (PI), Pelvic Tilt (PT), Lumbar Lordosis (LL), Thoracic Kyphosis (TK), Sagittal Vertical Axis (SVA) and Spino-sacral Angle (SSA).

METHODS

A systematic review of the English language literature dating up until October 2022, was undertaken utilizing the PRISMA guidelines.

RESULTS

Of a total of 947 articles, 10 studies met the inclusion criteria (4 Level II, 4 level III and 2 level IV evidence) and were subsequently analyzed. Overall, 584 patients (8 studies) of mean age 73.7 years (69.3-77.1) had acute OVCF of one or more vertebra that were managed conservatively. The male to female ratio was 82:412. Five studies mentioned the number of fractured vertebrae, with a total of 393 in 269 patients (average of 1.4 fractured vertebrae per patient). Their pre-operative radiological parameters on standing X-rays showed a mean PI of 54.8°, PT 24°, LL 40.8°, TK 36.5°, PI-LL 14°, SVA 4.8 cm, and SSA 115°. In addition, 437 patients were used as a control group with osteoporosis without fractured vertebrae, (6 studies) with an average age of 72.4 years (67-77.8) and male to female ratio of 96:210 (5 studies). They all had upright X-rays to assess their global sagittal alignments. Radiological parameters showed an average PI of 54.3°, PT 17.3°, LL 43.4°, TK 31.25°, PI-LL 10.95°, SVA 1.27 cm and SSA 125°. A statistical analysis comparing the OVCF group with the control group (4 studies), showed a significant increase in PT of 5.97° (95%CI 2.63, 9.32; P < 0.0005), a significant increase in TK by 8.28° (95%CI 2.15, 14.4; P < 0.008), an increase in PI-LL by 6.72° (95%CI 3.39, 10.04; P < 0.0001), an increase in SVA by 1.35 cm (95%CI 0.88, 1.83; P < 0.00001), and a decrease in SSA by 10.2° (95%CI 10.3, 23.4; P < 0.00001).

CONCLUSION

Osteoporotic vertebral compression fractures managed conservatively appear to be a significant causate factor of global sagittal imbalance.

The effect of lifting load on the kinematic characteristics of lumbar spinous process in vivo

BACKGROUND

There are limited data on the in vivo natural kinematics of the lumbar spinous process. This paper intends to explore the effect of lifting load on the in vivo movement mode of the lumbar spinous process and its biomechanical changes.

METHODS

Ten asymptomatic subjects between the ages of 25 and 39 underwent CT scans of the lumbar spine in the supine position, and 3D models of L3-L5 were constructed. Using a Dual Fluoroscopy Imaging System (DFIS), instantaneous orthogonal fluoroscopic images of each subject's flexion-extension, left-right bending, and left-right rotational movements were taken under different loads (0 kg, 5 kg, 10 kg). The supine CT model was matched, using computer software, to the bony contours of the images from the two orthogonal views, so that the instantaneous 3D vertebral position at each location could be quantified. A Cartesian coordinate system was ultimately constructed at the tip of the spinous process to obtain the 6DOF kinematic data of the spinous process.

RESULTS

In different postural movements of the trunk, there was no significant difference in the rotation angle and translation range of the lumbar spinous process under different loads (P > 0.05). In flexion to extension motion, spinous processes mainly rotate < 4° along the medial and lateral axes and translate < 4 mm along the craniocaudal direction. In the left-right bending motion, spinous processes mainly rotate < 5° along the anterior and posterior axes, and the translation is mainly coupling < 2 mm. In the rotational motion, the spinous process is mainly coupled motion, the rotation range is less than 3°, and the translation range is less than 2 mm. The distance between spinous processes measured in the supine position was 6.66 ± 2.29 mm at L3/4 and 5.08 ± 1.57 mm at L4/5.

CONCLUSION

The in vivo kinematics of the lumbar spinous process will not change significantly with increasing low load. In complex motion, the spinous process is dominated by coupling motion.

Childhood Obesity and Incorrect Body Posture: Impact on Physical Activity and the Therapeutic Role of Exercise

Obesity is associated with various dysfunctions of the organism, including musculoskeletal problems. In this narrative review, we aim to consider postural problems in children and adolescents with obesity, focusing on the relationship with its negative impact on physical activity, and to discuss the role of exercise as a therapeutic approach. The body reacts to excess weight by changing its normal balance, and the somatosensory system of children with obesity is forced to make major adjustments to compensate for postural problems. These adaptations become more difficult and tiring if activities that require continuous postural changes and multi-tasking are engaged in. Children with obesity have less body control and functional ability due to the excess fat mass, which reduces their ability to perform motor skills and take part in physical activity. Appropriate early interventions for the management of musculoskeletal problems are needed to ensure healthy growth and to prevent comorbidities in childhood and adulthood. Prevention programs must be based not only on the reduction of body weight but also on the definition of correct postural habits from an early age. It is equally important to provide correct information on the types and doses of physical activity that can help prevent these problems.

Differences in spinal posture and mobility between children/adolescents with obesity and age-matched normal-weight individuals

The aim of this study was to cross-sectionally explore the association of obesity with spinal posture and mobility, commonly associated with musculoskeletal problems, by comparing the spinal parameters between 90 obese and 109 normal-weight children and adolescents. A non-invasive electromechanical device, the Idiag M360 (Idiag, Fehraltorf, Switzerland), was used to measure the spinal parameters. An age-and-sex-adjusted two-way analysis of variance (ANOVA) was used to determine postural and mobility differences between the two groups. Children and adolescents with obesity had significantly greater thoracic kyphosis [difference between groups (Δ) = 13.0⁰, 95% CI 10.1⁰–15.8⁰, p < 0.0001] and thoracic extension (Δ = 6.5⁰, 95% CI 2.9⁰–11.6⁰, p = 0.005), as well as smaller mobility in thoracic flexion (Δ = 5.0⁰, 95% CI 1.2⁰–8.8⁰, p = 0.01), thoracic lateral flexion (Δ = 17.7⁰, 95% CI 11.6⁰–23.8⁰, p < 0.0001), lumbar flexion (Δ = 12.1⁰, 95% CI 8.7⁰–15.5⁰, p < 0.0001), lumbar extension (Δ = 7.1⁰, 95% CI 3.1⁰–12.2⁰, p = 0.003) and lumbar lateral flexion (Δ = 9.1⁰, 95% CI 5.5⁰–12.8⁰, p < 0.0001) compared to the normal-weight children and adolescents. These findings provide important information about the characteristics of the spine in children and adolescents with obesity and unique insights into obesity-related mechanical challenges that the spine has to withstand and strategies designed to improve spinal mobility in this young population.

Relationship Between the Foraminal Area and Demographic and Clinical Characteristics of Patients with Low Back Pain

OBJECTIVE

Our study aims to contribute to existing knowledge by evaluating patients with low back pain to provide a more accurate relationship between the diameter of the intervertebral foramen and the clinical, demographic, and lumbar spine anatomical factors such as age, sex, BMI, the Zurich Claudication Questionnaire (ZCQ) , facet joint, intervertebral disc, ligamentum flavum, and spinal canal.

METHODS

We studied 90 consecutive patients who had undergone evaluation for low back pain. We used magnetic resonance imaging to assess the cross-sectional areas of the intervertebral foramina at each level of the lumbar spine together with the ligamentum flavum area and the dural sac cross sectional area measurements. The presence of disc and facet joint degeneration was evaluated and data on symptoms was obtained.

RESULTS

Age (p<0.0001), lumbar disc degeneration (LDD) grade (p=0.016), and dural sac cross sectional area (DSCSA, p<0.0001) were found to statistically significantly influence the foraminal area (FA). The mean FA at all lumbar levels increased with increasing DSCSA. The mean FA decreased with age at all levels except of L5/S1. LDD grade 1-3 increased the mean FA at L5/S1, but not at other levels. No statistically significant effects of the side of the measurement, sex, BMI, ZCQ score, ligamentum flavum area, nor facet joint degeneration were found.

CONCLUSIONS

The results of the present study allow us to quantify the effect of age, dural sac cross-sectional area, and lumbar disc degeneration grade on the foraminal area.

Computed tomography study of the relationship between pelvic incidence and bony contribution to lumbar lordosis in children

There is little data regarding the relationship in children and how it may change with aging. The aim of this radiographic study was to define the relationship between pelvic incidence (PI) and segmental vertebral body lordosis through childhood. In 150 children, CT scans of the lumbar spine and pelvis were analyzed measuring PI, sacral table angle (STA), sacral kyphosis (SK), and segmental lordosis (SL) individually L1-L5. Children were grouped by age: (1) 0-60 months; (2) 61-120 months; (3) 121-185 months. Mean PI for the entire cohort was 40.4, mean SL for L1-0.6, L2 0.0, L3 1.8, L4, 4.7, and L5 11.4. There were 40 children in Group 1, 63 in Group 2 and 37 in Group 3. SL differed between age groups at all levels except at L2. L1 and L2 became more kyphotic with increasing age; L3, L4, and L5 became more lordotic with increasing age. The correlation between PI and SL at each level became stronger with increasing age. Similarly, the correlation between PI and STA and between PI and SK also became stronger with increasing age. As children mature, the relationship between PI and segmental lordosis at each level of the lumbar spine becomes stronger-the relationship between PI and lordosis trends toward that seen in the adult. Future work should aim to define when the adult PI-LL relationship is realized.