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Bimali I, Pudasaini S. Hyperkyphosis among the Elderly in a Community: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:710-713. [PMID: 36705225 PMCID: PMC9446495 DOI: 10.31729/jnma.7351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/27/2022] [Indexed: 01/31/2023] Open
Abstract
Introduction Aging brings progressive changes in the physiology of the musculoskeletal system that leads to postural changes and degenerative diseases in elderly. The most common postural change is hyperkyphosis which decreases physical performance, ability to perform daily activities, overall quality of life, and increases the risk of falls in elderly. The aim of the study was to find out the prevalence of hyperkyphosis among the elderly in a community. Methods A descriptive cross-sectional study was done in a local community from 26 May 2019 to 8 June 2019 after obtaining ethical approval from the Institutional Review Committee (Protocol approval number: 138/19). Participants above 60 years of age were included in the study. Convenience sampling was done. A bubble inclinometer was used to measure the degree of kyphosis. Point estimate and 95% Confidence Interval were calculated. Results Among 144 elderly participants, hyperkyphosis was present in 90 (62.50%) (54.59-70.41, 95% Confidence Interval) with the mean hyperkyphosis being 47.07±4.83˚. The elderly in the age group of 70-75 years had a higher degree of hyperkyphosis with a mean value of 47.77±4.92˚. The mean hyperkyphosis was 48.18±5.30˚ and 45.31±3.36˚ in female and male participants respectively. Conclusions The prevalence of hyperkyphosis was found to be higher in our study compared to other studies conducted in similar settings. Early identification and interventions of hyperkyphosis are thus warranted to prevent the detrimental consequences in the later stages of life. Keywords aging; hyperkyphosis; posture.
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Affiliation(s)
- Inosha Bimali
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Sikha Pudasaini
- Department of Physiotherapy, Norvic International Hospital, Thapathali, Kathmandu, Nepal,Correspondence: Ms Sikha Pudasaini, Department of Physiotherapy, Norvic International Hospital, Thapathali, Kathmandu, Nepal. , Phone: +977-9845034903
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Ponzano M, Tibert N, Bansal S, Katzman W, Giangregorio L. Exercise for improving age-related hyperkyphosis: a systematic review and meta-analysis with GRADE assessment. Arch Osteoporos 2021; 16:140. [PMID: 34546447 DOI: 10.1007/s11657-021-00998-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/22/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We reviewed exercise trials in men and women ≥ 45 years with hyperkyphosis at the baseline and performed meta-analyses for kyphosis and health-related outcomes. PURPOSE To determine the effects of exercise interventions on kyphosis angle, back extensor muscle strength or endurance, physical functioning, quality of life, pain, falls, and adverse events in adults 45 years or older with hyperkyphosis. METHODS Multiple databases were searched to May 2020. Randomized controlled trials (RCTs), non-RCT, and pre-post intervention studies that had at least one group with a mean kyphosis angle of at least 40° at the baseline were included. RESULTS Twenty-four studies were included. Exercise or physical therapy improved kyphosis outcomes (SMD - 0.31; 95% confidence intervals [CI] - 0.46, - 0.16; moderate certainty evidence), back extensor muscle strength (MD 10.51 N; 95% CI 6.65, 14.38; very low certainty evidence), and endurance (MD 9.76 s; 95% CI 6.40, 13.13; low certainty evidence). Meta-analyses showed improvements in health-related quality of life (HRQoL) (SMD 0.21; 95% CI 0.06, 0.37; moderate certainty of evidence), general pain (MD - 0.26; 95% CI - 0.39, - 0.13; low certainty of evidence), and performance on the timed up and go (TUG) test (MD - 0.28 s; 95% CI - 0.48, - 0.08; very low certainty of evidence). The effects on the rate of falls (incidence rate ratio [IRR] 1.15; 95% CI 0.64, 2.05; low certainty evidence) or minor adverse events (IRR 1.29; 95% CI 0.95, 1.74; low certainty evidence) are uncertain. No serious adverse events were reported in the included studies. CONCLUSIONS Interventions targeting hyperkyphosis may improve kyphosis outcomes in adults with hyperkyphosis.
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Affiliation(s)
- Matteo Ponzano
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Nicholas Tibert
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Symron Bansal
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Wendy Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, Canada. .,Schlegel-UW Research Institute for Aging, Waterloo, Canada.
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Kato K, Hatanaka Y. The influence of trunk muscle strength on walking velocity in elderly people with sarcopenia. J Phys Ther Sci 2020; 32:166-172. [PMID: 32158081 PMCID: PMC7032983 DOI: 10.1589/jpts.32.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/28/2019] [Indexed: 12/25/2022] Open
Abstract
[Purpose] Sarcopenia increases the risk of falls and fractures. However, its
relationship with walking, which is the generation mechanism of falls, has not been
clarified. The purpose of this study was to clarify the trunk muscle strength and the
characteristics of walking, in elderly people with sarcopenia. [Participants and Methods]
The participants were 40 elderly people aged 65 years and over. The participants were able
to walk without assistance and were attending outpatient rehabilitation or community
day-care centers. The assessment and measurement items included: the presence or absence
of sarcopenia (using the diagnostic criteria of the Asian Working Group for Sarcopenia),
lower limb and trunk muscle strength, and characteristics of walking. The participants
were divided into two groups depending on the presence or absence of sarcopenia, and a
comparison was made between the two groups. [Results] The participants in the sarcopenia
group had significantly lower trunk extension muscle strength as compared to the
participants in the non-sarcopenia group. In addition, the hip joint maximum flexion
moment, ankle joint maximum plantar flexion moment, and walking velocity of participants
in the sarcopenia group were significantly lower than those in the non-sarcopenia group.
[Conclusion] This study revealed that weakness of the trunk muscle strength causes a
decrease in walking velocity in elderly people with sarcopenia.
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Affiliation(s)
- Kota Kato
- Shutaikai Hospital: 8-1 Shirokita-cho, Yokkaichi-city, Mie 510-0823, Japan.,Suzuka University of Medical Science, Japan
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Kuo YL, Chung CH, Huang TW, Tsao CH, Chang SY, Peng CK, Cheng WE, Chien WC, Shen CH. Association between spinal curvature disorders and injury: a nationwide population-based retrospective cohort study. BMJ Open 2019; 9:e023604. [PMID: 30782710 PMCID: PMC6340633 DOI: 10.1136/bmjopen-2018-023604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Injury is an important issue in public health. Spinal curvature disorders are deformities characterised by excessive curves of the spine. The prevalence of spinal curvature disorders is not low, but its relationship with injury has not been studied. The aim of this study is to investigate whether spinal curvature disorders increase the risk of injury. DESIGN Population-based retrospective cohort study. SETTING Using data from the Taiwan National Health Insurance Research Database from 2000 to 2010. PARTICIPANTS AND EXPOSURE Patients with spinal curvature disorders were selected using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. A cohort without spinal curvature was randomly frequency-matched to the spinal curvature disorders cohort at a ratio of 2:1 according to age, sex and index year. PRIMARY OUTCOME MEASURES The risk of injury was analysed using Cox's proportional hazards regression models adjusting for age, sex, comorbidities, urbanisation level and socioeconomic status. RESULTS A total of 20 566 patients with spinal curvature disorders and 41 132 controls were enrolled in this study. The risk of injury was 2.209 times higher (95% CI 2.118 to 2.303) in patients with spinal curvature disorders than in the control group. The spinal curvature disorders cohort exhibited higher risk of developing injury compared with the control group, regardless of age, sex, comorbidities, urbanisation level and subgroup of spinal curvature disorders. Based on the subgroup analysis, the spinal curvature disorders cohort had higher risks of unintentional injury and injury diagnoses such as fracture, dislocation, open wound, superficial injury/contusion, crushing and injury to nerves and spinal cord compared with the control cohort. CONCLUSIONS Patients with spinal curvature disorders have a significantly higher risk of developing injury than patients without spinal curvature disorders. Aggressive detection and management of spinal curvature disorders may be beneficial for injury prevention.
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Affiliation(s)
- Yen-Liang Kuo
- Division of Chest Medicine, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Division of Pulmonary and Critical Care, Department of Internal Medicine, National Defense Medical Center Tri-Service General Hospital, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Shan-Yueh Chang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, National Defense Medical Center Tri-Service General Hospital, Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care, Department of Internal Medicine, National Defense Medical Center Tri-Service General Hospital, Taipei, Taiwan
| | - Wei-Erh Cheng
- Division of Chest Medicine, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hao Shen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, National Defense Medical Center Tri-Service General Hospital, Taipei, Taiwan
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Roghani T, Zavieh MK, Manshadi FD, King N, Katzman W. Age-related hyperkyphosis: update of its potential causes and clinical impacts-narrative review. Aging Clin Exp Res 2017; 29:567-577. [PMID: 27538834 PMCID: PMC5316378 DOI: 10.1007/s40520-016-0617-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/28/2016] [Indexed: 01/11/2023]
Abstract
The present study aims to qualitatively review the contributing factors and health implications of age-related hyperkyphosis. We conducted a narrative review of observational and cohort studies describing the risk factors and epidemiology of hyperkyphosis from 1955 to 2016 using the following key words: kyphosis, hyperkyphosis, posture, age-related hyperkyphosis, kyphotic posture, aetiology and causes. This review included 77 studies. Approximately 60-70 % of the most severe hyperkyphosis cases have no evidence of underlying vertebral compression fractures. Other proposed factors contributing to hyperkyphosis are degenerative disc disease, weakness of back extensor muscles and genetic predisposition. Strength and endurance of back extensor muscles are very important for maintaining normal postural alignment. Recent evidence suggests that age-related hyperkyphosis is not equivalent to spinal osteoporosis. Due to the negative impact of hyperkyphosis on physical function, quality of life and mortality rates, physicians should focus not only on osteoporosis, but also on age-related postural changes. More research about the relationship between spinal morphology and modifiable factors, especially the structural and functional parameters of trunk muscles, could further illuminate our understanding and treatment options for hyperkyphosis.
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Affiliation(s)
- Tayebeh Roghani
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Minoo Khalkhali Zavieh
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farideh Dehghan Manshadi
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nicole King
- Department of Physical Therapy and Rehabilitation Sciences, University of California, San Francisco, CA, USA
| | - Wendy Katzman
- Department of Physical Therapy and Rehabilitation Sciences, University of California, San Francisco, CA, USA
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Okura M, Ogita M, Yamamoto M, Nakai T, Numata T, Arai H. Self-Assessed Kyphosis and Chewing Disorders Predict Disability and Mortality in Community-Dwelling Older Adults. J Am Med Dir Assoc 2017; 18:550.e1-550.e6. [DOI: 10.1016/j.jamda.2017.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 10/19/2022]
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Katzman WB, Huang MH, Kritz-Silverstein D, Barrett-Connor E, Kado DM. Diffuse Idiopathic Skeletal Hyperostosis (DISH) and Impaired Physical Function: The Rancho Bernardo Study. J Am Geriatr Soc 2017; 65:1476-1481. [PMID: 28369706 DOI: 10.1111/jgs.14810] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Investigate associations of diffuse idiopathic skeletal hyperostosis (DISH) with self-reported and measured physical function in older adults. DESIGN Cross-sectional analyses of data collected in 1992-96 from a longitudinal cohort. SETTING Research clinic within a community. PARTICIPANTS Community-dwelling men (n = 630) and women (n = 961), mean age 71.5 years (SD = 10.8), from the Rancho Bernardo Study. MEASUREMENTS DISH assessed from lateral thoracic and lumbar spine radiographs; self-reported difficulty bending over to the floor, walking 2-3 level blocks, or climbing 1 flight of stairs; performance-based measures of grip strength and chair-stand testing (ability to stand up and sit down in a chair 5 times without using chair arms). RESULTS DISH was present in 25.6% of men and 5.5% of women. In age and sex-adjusted models, those with DISH had 1.72-fold increased odds (95% CI: 1.13, 2.62) of self-reported difficulty bending; this remained significant after further adjustment for Cobb angle, weight, stroke, arthritis, and exercise, OR = 1.69, (95% CI: 1.07, 2.66). In fully adjusted multivariate models, those with DISH had worse grip strength, -1.08 kg, P = .01, but did not differ from those without DISH on walking or climbing stairs. In sex-stratified, fully adjusted models, among men only, those with DISH were 2.17-times (95% CI: 1.04, 4.52) more likely to be unable to complete 5 chair stands without using their arms. CONCLUSIONS DISH was less prevalent in women but affected almost one-quarter of older white men. People with DISH are more likely to experience physical functional impairment, suggesting that DISH has clinical correlations and is not an incidental radiographic finding.
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Katzman WB, Parimi N, Mansoori Z, Nardo L, Kado DM, Cawthon PM, Marshall LM, Schousboe JT, Lane NE. Cross-Sectional and Longitudinal Associations of Diffuse Idiopathic Skeletal Hyperostosis and Thoracic Kyphosis in Older Men and Women. Arthritis Care Res (Hoboken) 2016; 69:1245-1252. [PMID: 27723250 DOI: 10.1002/acr.23115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/05/2016] [Accepted: 10/04/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate cross-sectional and longitudinal associations of diffuse idiopathic skeletal hyperostosis (DISH) and thoracic kyphosis in older persons. METHODS DISH and kyphosis were assessed in 1,500 men from the Osteoporotic Fractures in Men (MrOS) study and in 1,267 women from the Study of Osteoporotic Fractures (SOF). DISH was assessed using baseline lateral spine radiographs, and Cobb angle of kyphosis was measured from baseline and followup radiographs, a mean 4.6 years later in men, and 3.7 and 15 years later in women. Linear regression was used to analyze associations of DISH with baseline Cobb angle and with percent annualized change in Cobb angle. We tested for heterogeneity among studies. RESULTS DISH was identified in 222 participants in MrOS (15%) and in 156 participants in SOF (12%). Participants with DISH in both cohorts had higher baseline Cobb angles (P < 0.05), after adjustment for covariates. After approximately 4 years of followup, there was no significant difference in annualized percent change in Cobb angle in those with DISH compared to those without DISH (P > 0.05) for men or women. Women with DISH had less kyphosis progression over 15 years (0.25% less annualized change in Cobb) than those without DISH. CONCLUSION Prevalent DISH is associated with greater kyphosis in older men and women, and is not significantly associated with a change in kyphosis over 4-5 years. However, in women followed over 15 years, DISH was associated with less progression of kyphosis. These results suggest that DISH influences kyphosis and may slow progression over the long term. Additional studies of DISH/kyphosis associations are warranted to understand the functional implications of this finding.
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Affiliation(s)
| | - Neeta Parimi
- California Pacific Medical Center, San Francisco
| | | | - Lorenzo Nardo
- University of California, San Francisco, and Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deborah M Kado
- University of California San Diego School of Medicine, San Diego
| | - Peggy M Cawthon
- University of California and California Pacific Medical Center, San Francisco
| | | | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners, and University of Minnesota, Minneapolis
| | - Nancy E Lane
- University of California Davis Medical School, Davis
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Fechtenbaum J, Etcheto A, Kolta S, Feydy A, Roux C, Briot K. Sagittal balance of the spine in patients with osteoporotic vertebral fractures. Osteoporos Int 2016; 27:559-67. [PMID: 26272312 DOI: 10.1007/s00198-015-3283-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/05/2015] [Indexed: 01/03/2023]
Abstract
UNLABELLED This study aims to compare the sagittal global spinal balance of patients consulting for osteoporosis, aged above 50 years with and without osteoporotic vertebral fractures (VFs). Global spinal balance is abnormal even in subjects without VFs. VFs and age are determinants of sagittal global balance; however, pelvic parameters play a role in compensatory mechanisms. INTRODUCTION This study aims to compare the spine curvatures, pelvic parameters, and the sagittal global spinal balance of patients aged above 50 years with and without osteoporotic vertebral fractures. METHODS Two hundred patients (95 % women) aged 68.3 ± 9.5 years underwent full skeleton radiographs in the standing position, by EOS®, a low dose biplane X-ray imaging system. VFs were evaluated according to Genant's classification. Spinal (thoracic and lumbar Cobb's indices, thoracic and lumbar tilts) and pelvic (pelvic tilt, sacral slope, and pelvic incidence) parameters were measured. Sagittal spinal balance was measured using the C7 plumb line and the spinosacral angle (SSA). We compared these parameters in patients with and without vertebral fracture and assessed the determinants of abnormal sagittal spinal balance. RESULTS Sixty-nine patients had at least one VF. The sagittal spinal balance was significantly altered in patients with at least one VF, and there was an effect of the number and severity of VFs on parameters. Discriminative value for identification of patients with at least one VF, assessed by Area Under the Curves (AUCs) was 0.652 and 0.706 for C7 plumbline and SSA, respectively. Using multivariate analysis, parameters significantly associated with abnormal spinal balance (SSA) were the presence of at least one VF (OR = 4.96, P < 0.0001), age (OR = 1.07, P = 0.0006), and high pelvic incidence as a protective factor (OR = 0.93, P < 0.0001). CONCLUSIONS Global spinal balance is abnormal in subjects consulting for osteoporosis, even in subjects without VFs. VFs and age are determinants of abnormal sagittal global balance; however, pelvic parameters play a role in compensatory mechanisms.
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Affiliation(s)
- J Fechtenbaum
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | | | - S Kolta
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
- INSERM U1153, Paris, France
| | - A Feydy
- INSERM U1153, Paris, France
- Paris-Descartes University, Paris, France
- Department of Radiology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - C Roux
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
- INSERM U1153, Paris, France
- Paris-Descartes University, Paris, France
| | - K Briot
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France.
- INSERM U1153, Paris, France.
- Hôpital Cochin, Service de Rhumatologie, 27 rue du Faubourg St Jacques, 75014, Paris, France.
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Etemadifar M, Ebrahimzadeh A, Hadi A, Feizi M. Comparison of Scheuermann's kyphosis correction by combined anterior-posterior fusion versus posterior-only procedure. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:2580-6. [PMID: 26365711 DOI: 10.1007/s00586-015-4234-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 09/07/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Conventional treatment of rigid deformity in Scheuermann's kyphosis (SK) in young patients includes a preliminary anterior spinal release and fusion (ASF) followed by posterior spinal fusion and instrumentation (PSF). However, recently there are more trends to do posterior-only surgery for correction of this deformity. The aim of our study was to compare clinical and radiological outcomes of ASF/PSF and PSF-only procedures in treatment of SK. MATERIALS AND METHODS In a prospective clinical and radiological review, thirty operated SK patients in two groups were evaluated. Group A: ASF/PSF technique (n: 16) and group B: PSF-only procedure (n: 14) were followed for at least 2 years (average 57.6 months). Two groups were well matched for the following four criteria: average age, flexibility status, posterior fusion levels, and preoperative Cobb's kyphosis angle. Oswestry disability index (ODI) and scoliosis research society questionnaire-30 (SRS-30) and radiological (kyphosis correction, correction loss, sagittal balance) parameters were evaluated before and after surgery and at the final follow-up. RESULTS In group A, primary thoracic Cobb's kyphosis, immediate post-operative kyphosis, and final follow-up kyphosis angle were 83.6°, 41.4° and 43°, respectively (P < 0.05). Correction rate and correction loss were 50.5 % and 1.6° ± 2.4, respectively. In group B, the corresponding values were 81.9°, 40.1° and 43.2°, respectively (P < 0.05). Correction rate and correction loss were 51 % and 3.1° ± 2.5, respectively. SRS-30 and ODI scores in group A were averaged 68.5 and 21.3 preoperatively and 128.7 and 6.25 at the final follow-up, respectively. In group B, the corresponding values were 64 and 23.2 preoperatively and 133.5 and 5.8 at the final follow-up, respectively. CONCLUSIONS Clinical and radiological parameters were similar in both groups after surgical correction while, complication rates, operation time and blood loss were significantly higher in ASF/PSF procedure.
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Affiliation(s)
- Mohammadreza Etemadifar
- Department of Orthopedic Spinal Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Ebrahimzadeh
- Department of Orthopedic Spinal Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abdollah Hadi
- Department of Orthopedic Spinal Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mehran Feizi
- Department of Orthopedic, Isfahan University of Medical Sciences, Isfahan, Iran
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Diffuse idiopathic skeletal hyperostosis association with thoracic spine kyphosis: a cross-sectional study for the Health Aging and Body Composition Study. Spine (Phila Pa 1976) 2014; 39:E1418-24. [PMID: 25387143 PMCID: PMC4228693 DOI: 10.1097/brs.0000000000000615] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A descriptive study of the association between diffuse idiopathic skeletal hyperostosis (DISH) and kyphosis. OBJECTIVE To investigate the association of DISH with Cobb angle of kyphosis in a large cohort of older subjects from the Health Aging and Body Composition Study. SUMMARY OF BACKGROUND DATA DISH and thoracic kyphosis are well-defined radiographical findings in spines of older individuals. Characteristics of DISH (ossifications between vertebral segments) reflect changes of spine anatomy and physiology that may be associated with Cobb angle of kyphosis. METHODS Using data from 1172 subjects aged 70 to 79 years, we measured DISH and Cobb angle of kyphosis from computed tomographic lateral scout scans. Characteristics of participants with and without DISH were assessed using the χ² and t tests. Association between DISH and Cobb angle was analyzed using linear regression. Cobb angle and DISH relationship was assessed at different spine levels (thoracic and lumbar). RESULTS DISH was identified on computed tomographic scout scan in 152 subjects with 101 cases in only the thoracic spine and 51 in both thoracic and lumbar spine segments. The mean Cobb angle of kyphosis in the analytic sample was 31.3° (standard deviation = 11.2). The presence of DISH was associated with a greater Cobb angle of 9.1° and 95% confidence interval (95% CI) (5.6-12.6) among African Americans and a Cobb angle of 2.9° and 95% CI (0.5-5.2) among Caucasians compared with those with no DISH. DISH in the thoracic spine alone was associated with a greater Cobb angle of 10.6° and 95% CI (6.5-14.7) in African Americans and a Cobb angle of 3.8° and 95% CI (1.0-6.5) in Caucasians compared with those with no DISH. CONCLUSION DISH is associated with greater Cobb angle of kyphosis, especially when present in the thoracic spine alone. The association of DISH with Cobb angle is stronger within the African American population.
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Bruno AG, Anderson DE, D'Agostino J, Bouxsein ML. The effect of thoracic kyphosis and sagittal plane alignment on vertebral compressive loading. J Bone Miner Res 2012; 27:2144-51. [PMID: 22589006 PMCID: PMC3431452 DOI: 10.1002/jbmr.1658] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To better understand the biomechanical mechanisms underlying the association between hyperkyphosis of the thoracic spine and risk of vertebral fracture and other degenerative spinal pathology, we used a previously validated musculoskeletal model of the spine to determine how thoracic kyphosis angle and spinal posture affect vertebral compressive loading. We simulated an age-related increase in thoracic kyphosis (T(1) -T(12) Cobb angle 50-75 degrees) during two different activities (relaxed standing and standing with 5-kg weights in the hands) and three different posture conditions: (1) an increase in thoracic kyphosis with no postural adjustment (uncompensated posture); (2) an increase in thoracic kyphosis with a concomitant increase in pelvic tilt that maintains a stable center of mass and horizontal eye gaze (compensated posture); and (3) an increase in thoracic kyphosis with a concomitant increase in lumbar lordosis that also maintains a stable center of mass and horizontal eye gaze (congruent posture). For all posture conditions, compressive loading increased with increasing thoracic kyphosis, with loading increasing more in the thoracolumbar and lumbar regions than in the mid-thoracic region. Loading increased the most for the uncompensated posture, followed by the compensated posture, with the congruent posture almost completely mitigating any increases in loading with increased thoracic kyphosis. These findings indicate that both thoracic kyphosis and spinal posture influence vertebral loading during daily activities, implying that thoracic kyphosis measurements alone are not sufficient to characterize the impact of spinal curvature on vertebral loading.
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Affiliation(s)
- Alexander G Bruno
- Harvard-MIT Health Sciences and Technology Program, Cambridge, MA 02215, USA.
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13
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Abstract
STUDY DESIGN Retrospective radiographic analysis. OBJECTIVE To investigate where and to what degree the correction of Scheuermann's kyphosis occurred in two different procedures: posterior instrumentation/fusion with an anterior release and posterior-only instrumentation/fusion with Ponte procedure. SUMMARY OF BACKGROUND DATA Controversy remains regarding the outcome for these two procedures. The postoperative segmental disc shape change that account for deformity correction has not been described for either procedure. METHODS Eleven patients undergoing a thoracoscopic anterior release followed by posterior instrumentation (A + P) and 11 patients having posterior-only (PO) instrumentation/fusion were retrospectively reviewed. In addition to conventional Cobb measurements, segmental measures of intradiscal angulation as well as anterior and posterior disc heights were made before and after surgery. RESULTS The thoracic hyperkyphosis was corrected to similar degrees in both groups (A + P vs. PO, P = 0.87). The PO group averaged 82.7° ± 6.4° before surgery and corrected to 47.9° ± 5.4° after surgery; while the A + P group averaged 84.9° ± 10.2° before surgery and corrected to 48.6° ± 5.7° after surgery. The segmental analysis demonstrated similar degrees of intradiscal angular changes between the two surgical procedures. The majority of the correction occurred at and below the apex and was independent of an anterior release. The changes in both anterior and posterior disc thicknesses were also similar between the two groups. Both groups' anterior disc spaces opened at T8 and below, whereas maximum anterior disc opening occurred at the thoracolumbar junction. To a lesser extent, the posterior disc heights were reduced, but also to similar degrees for both surgical approaches. CONCLUSION For both surgical procedures, the majority of the kyphosis correction occurred in the lower thoracic levels and anterior disc heights increased up to twice as much as posterior disc heights shortened. The addition of the anterior release did not significantly alter the degree of correction or the disc shape changes.
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Imagama S, Matsuyama Y, Hasegawa Y, Sakai Y, Ito Z, Ishiguro N, Hamajima N. Back muscle strength and spinal mobility are predictors of quality of life in middle-aged and elderly males. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:954-61. [PMID: 21072545 PMCID: PMC3099149 DOI: 10.1007/s00586-010-1606-4] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 08/18/2010] [Accepted: 10/17/2010] [Indexed: 01/22/2023]
Abstract
With aging of society, clarification of the relationship between QOL and abnormal posture in the elderly may allow improvement of QOL through any preventive methods and training. However, sagittal balance has not been studied widely and most studies have focused on postmenopausal patients with osteoporosis. In this report, we provide the first evaluation of the simultaneous effects of degenerative changes on radiograph, spinal range of motion (ROM), sagittal balance, and back muscle strength, and examine the influence of these effects on QOL of the middle-aged and elderly male subjects. The subjects were 100 Japanese males who underwent a basic health checkup. Lumbar lateral radiograph, sagittal balance and spinal mobility determined with SpinalMouse(®) and back muscle strength were measured. The thoracic/lumbar angle ratio (T/L ratio) was used as an index of sagittal balance. SF-36 physical component summary (PCS) scores showed a significant negative correlation with age (r = -0.377), osteophyte score (r = -0.246) and T/L ratio (r = -0.214), and a significant positive correlation with lumbar lordosis angle (r = 0.271), thoracic ROM (r = 0.282), and back muscle strength (r = 0.549). Multiple regression analysis indicated that thoracic spinal ROM (r = 0.254, p < 0.01) and back muscle strength (r = 0.488, p < 0.0001) were significantly associated with SF-36 PCS (R (2) = 0.403). In conclusion, QOL of the middle-aged and elderly male subjects was related to sagittal balance, lumbar lordosis angle, spinal ROM, and back muscle strength. Exercise including muscle strength and spinal ROM may be able to influence these primary factors related to QOL. Back muscle strength and thoracic ROM impact on improvement of QOL in the middle-aged and the elderly.
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Affiliation(s)
- Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi 466-8550, Japan.
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15
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Abstract
SYNOPSIS Age-related hyperkyphosis is an exaggerated anterior curvature in the thoracic spine that occurs commonly with advanced age. This condition is associated with low bone mass, vertebral compression fractures, and degenerative disc disease, and contributes to difficulty performing activities of daily living and decline in physical performance. While there are effective treatments, currently there are no public health approaches to prevent hyperkyphosis among older adults. Our objective is to review the prevalence and natural history of hyperkyphosis, associated health implications, measurement tools, and treatments to prevent this debilitating condition. LEVEL OF EVIDENCE Diagnosis/prognosis/therapy, level 5.J Orthop Sports Phys Ther 2010;40(6):352-360, Epub 15 April 2010. doi:10.2519/jospt.2010.3099.
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Hosman AJ, Langeloo DD, de Kleuver M, Anderson PG, Veth RP, Slot GH. Analysis of the sagittal plane after surgical management for Scheuermann's disease: a view on overcorrection and the use of an anterior release. Spine (Phila Pa 1976) 2002; 27:167-75. [PMID: 11805663 DOI: 10.1097/00007632-200201150-00009] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A historic cohort study was conducted to investigate surgical correction and sagittal alignment in 33 patients with thoracic Scheuermann's disease. OBJECTIVE To evaluate kyphosis correction, correction loss, sagittal balance, and the effect of an anterior release. SUMMARY OF BACKGROUND DATA Currently, both posterior and anteroposterior techniques seem to produce impressive corrections for Scheuermann's disease. However, few reports have been made on sagittal malalignment after surgery. METHODS A cohort of 33 patients who had undergone surgery for their Scheuermann's kyphosis were reviewed: Group A: posterior technique (n = 16), Group B: anteroposterior technique (n = 17). Pre- and postoperative curve morphometry (Cobb, Ferguson, Voutsinas), balance (C7 plumb line), and Oswestry score were compared. RESULTS The mean follow-up period was 4.5 +/- 2 years (range, 2-8.2 years). The mean preoperative kyphosis (Cobb) was 78.7 degrees +/- 8.9 degrees, and the mean postoperative kyphosis was 51.7 degrees +/- 10.3 degrees. At follow-up evaluation, the correction loss was 1,4 degrees +/- 3.9 degrees. There was no difference in curve morphometry, correction, sagittal balance, average age, and follow-up period between Groups A and B. One junctional kyphosis, in Group B, was noted. After surgery, all the patients were satisfied, and the Oswestry score showed significant improvement. No neurologic complications were observed. CONCLUSIONS Good follow-up results included a 100% follow-up rate, adequate corrections, little correction loss, lower Oswestry scores, and a high satisfaction rate in both groups. The anteroposterior treatment did not influence the curve morphometry more than posterior fusion only. In reducing postoperative sagittal malalignment, the authors believe that surgical management should aim at a correction within the high normal kyphosis range of 40 degrees to 50 degrees, consequently providing good results and, particularly in flexible adolescents and young adults, minimizing the necessity for an anterior release.
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Affiliation(s)
- Allard J Hosman
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands.
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