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Sterneder CM, Tüngler TL, Haralambiev L, Boettner CS, Boettner F. Pelvic Roll Back Can Trigger Functional Psoas Impingement in Total Hip Arthroplasty. Arthroplast Today 2024; 27:101375. [PMID: 38680848 PMCID: PMC11047294 DOI: 10.1016/j.artd.2024.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 05/01/2024] Open
Abstract
In most cases, impingement of the iliopsoas tendon after total hip arthroplasty is caused by acetabular component retroversion. The present case report describes a patient with functional iliopsoas impingement following total hip arthroplasty. With increasing flexibility of the hip joint after surgery, the functional adjustment to the stiff thoracolumbar spine in this patient with diffuse idiopathic skeletal hyperostosis resulted in progressive pelvic roll back. This roll back resulted in a functional iliopsoas impingement as the psoas tendon travels over the front of the pecten ossis pubis. Since excessive roll back is usually also addressed in primary total hip arthroplasty by decreasing anteversion of the acetabular component, surgeons should be aware to avoid the combination of roll back and decreased anteversion and their potential impact on iliopsoas impingement.
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Affiliation(s)
| | - Tim Ludwig Tüngler
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Lyubomir Haralambiev
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Cosima S. Boettner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Baumann CA, Pazooki P, McNamara KP, Jeffs AD, Perlewitz MA, Visco ZR, Scott SM, Lim MR, Weinberg DS. Characterization of Lumbar Lordosis: Influence of Age, Sex, Vertebral Body Wedging, and L4-S1. Clin Spine Surg 2024:01933606-990000000-00319. [PMID: 38820121 DOI: 10.1097/bsd.0000000000001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/29/2024] [Indexed: 06/02/2024]
Abstract
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.
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Affiliation(s)
- Charles A Baumann
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC
| | - Parsa Pazooki
- School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Kyle P McNamara
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC
| | - Alexander D Jeffs
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC
| | - Madeline A Perlewitz
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC
| | - Zachary R Visco
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC
| | - Stephen M Scott
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC
| | - Moe R Lim
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC
| | - Douglas S Weinberg
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC
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Rasouligandomani M, Del Arco A, Chemorion FK, Bisotti MA, Galbusera F, Noailly J, González Ballester MA. Dataset of Finite Element Models of Normal and Deformed Thoracolumbar Spine. Sci Data 2024; 11:549. [PMID: 38811573 PMCID: PMC11137096 DOI: 10.1038/s41597-024-03351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 05/08/2024] [Indexed: 05/31/2024] Open
Abstract
Adult spine deformity (ASD) is prevalent and leads to a sagittal misalignment in the vertebral column. Computational methods, including Finite Element (FE) Models, have emerged as valuable tools for investigating the causes and treatment of ASD through biomechanical simulations. However, the process of generating personalised FE models is often complex and time-consuming. To address this challenge, we present a dataset of FE models with diverse spine morphologies that statistically represent real geometries from a cohort of patients. These models are generated using EOS images, which are utilized to reconstruct 3D surface spine models. Subsequently, a Statistical Shape Model (SSM) is constructed, enabling the adaptation of a FE hexahedral mesh template for both the bone and soft tissues of the spine through mesh morphing. The SSM deformation fields facilitate the personalization of the mean hexahedral FE model based on sagittal balance measurements. Ultimately, this new hexahedral SSM tool offers a means to generate a virtual cohort of 16807 thoracolumbar FE spine models, which are openly shared in a public repository.
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Affiliation(s)
| | | | - Francis Kiptengwer Chemorion
- BCN MedTech, Department of Engineering, Universitat Pompeu Fabra, Barcelona, 08018, Spain
- InSilicoTrials Technologies Company, Trieste, 34123, Italy
- Barcelona Supercomputing Center, Barcelona, 08034, Spain
| | | | - Fabio Galbusera
- IRCCS Istituto Ortopedico Galeazzi, Milan, 20161, Italy
- Schulthess Klinik, Zürich, 8008, Switzerland
| | - Jérôme Noailly
- BCN MedTech, Department of Engineering, Universitat Pompeu Fabra, Barcelona, 08018, Spain.
| | - Miguel A González Ballester
- BCN MedTech, Department of Engineering, Universitat Pompeu Fabra, Barcelona, 08018, Spain
- ICREA, Barcelona, 08010, Spain
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Balint NT, Antohe BA, Uysal HS, Cristuță AM, Rață M. Relationship between Spinal Range of Motion and Functional Tests in University Students: The Role of Demographic Factors. Healthcare (Basel) 2024; 12:1029. [PMID: 38786439 PMCID: PMC11121651 DOI: 10.3390/healthcare12101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/10/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Spinal disorders are some of the most prevalent health concerns, especially among students. Based on student demographics, this cross-sectional study evaluated the correlation between functional tests (FTs) and spinal range of motion (ROM). This study included 206 students (age = 19.85 ± 1.80 years) from the Vasile Alecsandri University of Bacău. Participants' assessments were conducted using the following tests: (i) Ott, (ii) Schober, (iii) Stibor, (iv) finger-to-floor distance, (v) lateral flexion of the cervical and lumbar spine, and (vi) flexion of the cervical spine. Correlation analyses were evaluated using the Spearman correlation coefficient analysis. The results indicated a very strong relationship between lateral flexion of the lumbar spine on the left (LFLSL) and right (LFLSR) for all departments (r = 0.85 to 0.97, p < 0.05). There was a stronger relationship between FT results and spinal ROM for physical-education-department students compared to students from other departments (n = 17, r = -0.38 to 0.93, p < 0.05). There was no statistically significant correlation between FTs and spinal ROM based on age (p > 0.05). The study results provide evidence of the primary risk factors that predispose students to postural deviations. Practitioners and physiotherapists can utilize these values as a reference for potential therapeutic interventions.
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Affiliation(s)
- Nela Tatiana Balint
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (N.T.B.); (M.R.)
| | - Bogdan Alexandru Antohe
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (N.T.B.); (M.R.)
| | - Huseyin Sahin Uysal
- Faculty of Sport Science, Burdur Mehmet Akif Ersoy University, 15500 Burdur, Turkey;
| | - Alina Mihaela Cristuță
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (N.T.B.); (M.R.)
| | - Marinela Rață
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (N.T.B.); (M.R.)
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Chevillotte T, Chan SK, Grobost P, Laouissat F, Darnis A, Silvestre C, Roussouly P. Quantifying the Spinal Lordosis Ratio Unique to the Type of Spinal Sagittal Alignment in a Normal Population. Global Spine J 2024; 14:1110-1115. [PMID: 36207768 DOI: 10.1177/21925682221133748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Data collection of radiological parameters in non-pathological adult spines. OBJECTIVES Establishing a baseline database for measurements of the spinal lordosis ratio between upper and lower arcs of the lumbar spine unique to each type of spine described by Roussouly's classification. Illustrating the importance of correct rationing of the upper and lower arcs. METHODS Standardised standing true lateral plain radiographs of the spine (including base of skull and proximal femurs) from 373 adult volunteers were obtained. Exclusion criteria : any history of disease involving the spine, pelvis, hips or lower limbs. Incidental detection of any spinal deformity on radiography also excluded further participation in this study. Sacro-pelvic parameters data collected : Pelvic Incidence (PI), Pelvic Tilt (PT), Sacral Slope (SS), location of Inflection Point, number of vertebras in the spinal lordosis and type of Roussouly's spine. Values of upper arc, lower arc and spinal lordosis ratio (SLR) was determined. RESULTS Bivariate analysis revealed statistically significant (P < .0001) correlation between the types of sagittal spinal alignments based on Roussouly's classification and the SLR. Type 1: SLR .76 ± .17, Type 2: SLR .60 ± .18, Type 3 with anteverted pelvis: SLR .53 ± .11, Type 3: SLR .49 ± .12, Type4: SLR .41 ± .11. CONCLUSION With this data we are able to quantify the ratio of lumbar lordosis unique to each type of Roussouly's spine. It functions as a guide when planning lumbar spine surgeries in order to restore the SLR correctly and thus prevent post-op complications such as proximal junction kyphosis.
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Affiliation(s)
- Thomas Chevillotte
- Institut de la Colonne Vertébrale (ICV) Lyon Charcot, Sainte-Foy-les-Lyon, France
| | - Sook-Kwan Chan
- Department of Orthopaedics, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | - Pierre Grobost
- Institut de la Colonne Vertébrale (ICV) Lyon Charcot, Sainte-Foy-les-Lyon, France
| | - Fethi Laouissat
- Hôpital privé de l'est Lyonnaise (HPEL), Saint-Priest, France
| | - Alice Darnis
- Institut de la Colonne Vertébrale (ICV) Lyon Charcot, Sainte-Foy-les-Lyon, France
| | - Clément Silvestre
- Institut de la Colonne Vertébrale (ICV) Lyon Charcot, Sainte-Foy-les-Lyon, France
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Dharnipragada R, Bostrom N, Bertogliat M, Denduluri LS, Dhawan S, Ladd B, Woodrow S, Parr AM. Sagittal balance in sitting and standing positions: A systematic review of radiographic measures. Heliyon 2024; 10:e28545. [PMID: 38590852 PMCID: PMC10999916 DOI: 10.1016/j.heliyon.2024.e28545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024] Open
Abstract
Background Sagittal imbalance can be caused by various etiologies and is among the most important indicators of spinal deformity. Sagittal balance can be restored through surgical intervention based on several radiographic measures. The purpose of this study is to review the normal parameters in the sitting position, which are not well understood and could have significant implications for non-ambulatory patients. Methods A systematic review was performed adhering to PRISMA Guidelines. Using R-software, the weighted means and 95% confidence intervals of the radiographic findings were calculated using a random effect model and significance testing using unpaired t-tests. Results 10 articles with a total of 1066 subjects reported radiographic measures of subjects with no spinal deformity in the sitting and standing position. In the healthy individual, standing sagittal vertical axis -16.8°was significantly less than sitting 28.4° (p < 0.0001), while standing lumbar lordosis 43.3°is significantly greater than sitting 21.3° (p < 0.0001). Thoracic kyphosis was not significantly different between the two groups (p = 0.368). Standing sacral slope 34.3° was significantly greater than sitting 19.5° (p < 0.0001) and standing pelvic tilt 14.0° was significantly less than sitting 33.9° (p < 0.0001). Conclusions There are key differences between standing and sitting postures, which could lead to undue stress on surgical implants and poor outcomes, especially for non-ambulatory populations. There is a need for more studies reporting sitting and standing radiographic measures in different postures and spinal conditions.
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Affiliation(s)
- Rajiv Dharnipragada
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Nick Bostrom
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Mario Bertogliat
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Lalitha S. Denduluri
- College of Liberal Arts, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Bryan Ladd
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Sarah Woodrow
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Ann M. Parr
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
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Cho M, Lee S, Kim HJ. Assessing the predictive power of the GAP score on mechanical complications: a comprehensive systematic review and meta-analysis. 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 2024; 33:1311-1319. [PMID: 38367025 DOI: 10.1007/s00586-024-08135-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 12/08/2023] [Accepted: 01/04/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE The prevention of mechanical complications (MC) is a major concern in adult spinal deformity (ASD) correction surgery; thus, the global alignment and proportion (GAP) score was developed to assess MC risk. Numerous studies have clarified the validity of the GAP score, but their contradictory results have prevented researchers from reaching compelling conclusions. This study aimed to analyze the predictive power of the GAP score on MC via a meta-analysis. METHODS A total of 1,617 patients were included in the meta-analysis. Studies relevant to the GAP score and MC were identified in PubMed, EMBASE, and Cochrane CENTRAL and screened according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The GAP score categories of the patients and their MC/revision surgery status were collected. The data collected for the meta-analysis of odds ratios (OR) included the number of patients in the GAP score subgroups and their MC/revision surgery status. To calculate the OR, three GAP score subgroups were combined into two groups; hence, the analysis was conducted twice (gap proportioned [GAP-P] and higher groups, and gap severely disproportioned [GAP-SD] and lower groups). RESULTS Eleven studies were collected; of them, revision surgery data were available for seven. The proportion of MC in the studies was 27.7-60.6%, while that of revision surgery was 11.7-34.9%. In the meta-analysis of the GAP-P and higher score groups, the difference in MC ratio was significant (OR = 2.83; 95% confidence interval [CI] = 1.20-6.67; P = 0.02), whereas that for revision surgery was not. For the GAP-SD and lower score groups, the GAP-SD group had significantly higher proportions of both MC (OR = 2.65; 95% CI = 1.57-4.45; P < 0.001) and revision surgery (OR = 2.27; 95% CI = 1.33-3.88; P = 0.003). Publication bias was significant only in the latter MC analysis. CONCLUSION The GAP score offers predictive value for the risk of mechanical complications.
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Affiliation(s)
- Minseong Cho
- Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sanghoon Lee
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea.
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Belli G, Russo L, Mauro M, Toselli S, Maietta Latessa P. Relation between Photogrammetry and Spinal Mouse for Lumbopelvic Assessment in Adolescents with Thoracic Kyphosis. Healthcare (Basel) 2024; 12:738. [PMID: 38610160 PMCID: PMC11012063 DOI: 10.3390/healthcare12070738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
The evaluation of the lumbopelvic region is a crucial point during postural assessment in childhood and adolescence. Photogrammetry (PG) and Spinal Mouse (SM) are two of the most debated tools to properly analyze postural alignment and avoid misleading data. This study aims to find out the best linear regression model that could relate the analytic measurements of the SM with one or more PG parameters in adolescents with kyphotic postures. Thirty-nine adolescents (female = 35.9%) with structural and non-structural kyphosis were analyzed (13.2 ± 1.8 years; 1.59 ± 0.12 m; 47.6 ± 11.8 kg) using the SM and PG on the sagittal plane in a standing and forward-bending position, allowing for the measurement of body vertical inclination, lumbar and pelvic alignment, trunk flexion, sacral inclination during bending, and hip position during bending. Lordosis lumbar angles (SM) were significantly (r = -0.379, r = -0.328) correlated with the SIPS-SIAS angle (PG) during upright standing, while in the bending position, the highest correlation appeared among the sacral-hip (SM) and the sacral tangent (ST_PG; r = -0.72) angles. The stepwise backward procedure was assessed to estimate the SM variability in the bending and standing positions. Only in the bending position did the linear regression model reach high goodness-of-fit values with two regressors (ST_PG η2=0.504, BMI η2=0.252; adjusted- R2 =0.558, p < 0.001, CCC = 0.972, r = 0.763). Despite gold-standard methods reducing error evaluation, physicians and kinesiologists may consider photogrammetry as a good method for spinal curve prediction.
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Affiliation(s)
- Guido Belli
- Department of Sciences for Life Quality Studies, University of Bologna, 47921 Rimini, Italy; (G.B.); (S.T.); (P.M.L.)
| | - Luca Russo
- Department of Human Sciences, IUL Telematic University, 50122 Florence, Italy;
| | - Mario Mauro
- Department of Sciences for Life Quality Studies, University of Bologna, 47921 Rimini, Italy; (G.B.); (S.T.); (P.M.L.)
| | - Stefania Toselli
- Department of Sciences for Life Quality Studies, University of Bologna, 47921 Rimini, Italy; (G.B.); (S.T.); (P.M.L.)
| | - Pasqualino Maietta Latessa
- Department of Sciences for Life Quality Studies, University of Bologna, 47921 Rimini, Italy; (G.B.); (S.T.); (P.M.L.)
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Alahmari A, Thornley P, Glennie A, Urquhart JC, Al-Jahdali F, Rampersaud R, Fisher C, Siddiqi F, Rasoulinejad P, Bailey CS. Preoperative Disc Angle is an Important Predictor of Segmental Lordosis After Degenerative Spondylolisthesis Fusion. Global Spine J 2024; 14:610-619. [PMID: 35949020 PMCID: PMC10802516 DOI: 10.1177/21925682221118845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES To determine the effect of interbody cages inserted via posterior approach on segmental lordosis in the setting of preoperative lordotic vs kyphotic discs in patients with lumbar degenerative spondylolisthesis (LDS). METHODS Retrospective analysis of prospectively collected data on assessment and management of LDS patients from 2 contributing centres. Patients were analyzed preoperatively and at 12-month follow-up with standing lumbar radiographs. Index level segmental lumbar lordosis (SLL), disc angle and global lumbar lordosis was measured. Patients were stratified into 4 groups based on index level disc angle and procedure: preoperative lordotic posterolateral fusion (group L-PLF); preoperative kyphotic PLF (group K-PLF); preoperative lordotic interbody fusion (IF) (group L-IF); preoperative kyphotic IF (group K-IF). RESULTS A total of 100/111 (90%) patients completed follow-up with 40 in group L-IF and 48 in group K-IF. There were 18 patients in group L-PLF and 5 in group K-PLF. Among patients with preoperatively lordotic disc angles who had a worsening of SLL, group L-IF had worse SLL than group L-PLF patients, with differences persisting at one-year (mean difference 2.30, 95% CI, .3, 4.3, P = .029). Patients in group K-IF achieved improvement in SLL at one-year more frequently than group L-IF (67% vs 44%, P = .046), with similar mean improvement magnitude between groups L-IF and K-IF (-1.1, 95% CI, -3.7, 1.6, P = .415). CONCLUSION Segmental lordosis worsening was greater with preoperative index lordotic disc angles when an interbody cage was used. Patients who have a kyphotic disc preoperatively gain more lordosis with interbody cage use.
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Affiliation(s)
- Abdulmajeed Alahmari
- Division of Orthopaedics, Department of Surgery, Western University, London, ON, Canada
| | - Patrick Thornley
- Division of Orthopaedics, Department of Surgery, Western University, London, ON, Canada
| | - Andrew Glennie
- Department of Orthopedics and Neurosurgery, Dalhousie University, Halifax, NS, Canada
| | | | - Fares Al-Jahdali
- Department of Orthopedics and Neurosurgery, Dalhousie University, Halifax, NS, Canada
| | - Raja Rampersaud
- University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada; Arthritis Program, Krembil Research Institute, Toronto, Ontario, Canada
| | - Charles Fisher
- University of British Columbia, Vancouver, British Columbia, Canada; Vancouver General Hospital, Vancouver, BC, Canada
| | - Fawaz Siddiqi
- Division of Orthopaedics, Department of Surgery, Western University, London, ON, Canada
| | - Parham Rasoulinejad
- Division of Orthopaedics, Department of Surgery, Western University, London, ON, Canada
| | - Christopher S. Bailey
- Division of Orthopaedics, Department of Surgery, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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Huysmans SM, Senden R, Jacobs E, Willems PJ, Marcellis RG, Boogaart MVD, Meijer K, Willems PC. Gait alterations in patients with adult spinal deformity. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 17:100306. [PMID: 38293567 PMCID: PMC10825775 DOI: 10.1016/j.xnsj.2023.100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024]
Abstract
Background Adult spinal deformity patients (ASD) experience altered spinal alignment affecting spatiotemporal parameters and joint kinematics. Differences in spinal deformity between patients with symptomatic idiopathic scoliosis (ID-ASD) and patients with "de novo" scoliosis (DN-ASD) may affect gait characteristics differently. This study aims to compare gait characteristics between ID-ASD, DN-ASD, and asymptomatic healthy matched controls. Methods In this observational case-control study, ID-ASD (n = 24) and DN-ASD (n = 26) patients visiting the out-patient spine clinic and scheduled for long-segment spinal fusion were included. Patients were matched, based on age, gender, leg length and BMI, with asymptomatic healthy controls. Gait was measured at comfortable walking speed on an instrumented treadmill with 3D motion capture system. Trunk, pelvic and lower extremities range of motion (ROM) and spatiotemporal parameters (SPT) are presented as median (first and thirds quartile). Independent t-test or Mann-Whitney U test was used to compare ID-ASD, DN-ASD and controls. Statistical Parametric Mapping (independent t-test) was used to compare 3D joint kinematics. Results DN-ASD patients walk with increased anterior trunk tilt during the whole gait cycle compared with ID-ASD patients and controls. ID-ASD walk with decreased trunk lateroflexion compared with DN-ASD and controls. DN-ASD showed decreased pelvic obliquity and -rotation, increased knee flexion, and decreased ankle plantar flexion. ID-ASD and DN-ASD displayed decreased trunk, pelvic and lower extremity ROM compared with controls, but increased pelvic tilt ROM. ID-ASD patients walked with comparable SPT to controls, whereas DN-ASD patients walked significantly slower with corresponding changes in SPT and wider steps. Conclusions DN-ASD patients exhibit distinct alterations in SPT and kinematic gait characteristics compared with ID-ASD and controls. These alterations seem to be predominantly influenced by sagittal spinal malalignment and kinematic findings in ASD patients should not be generalized as such, but always be interpreted with consideration for the nature of the ASD.
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Affiliation(s)
- Stephanie M.D. Huysmans
- Department of Orthopedic Surgery and Research School CAPHRI (Care and Public Health Research Institute), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Rachel Senden
- Department of Physiotherapy, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Eva Jacobs
- Department of Orthopedic Surgery and Research School CAPHRI (Care and Public Health Research Institute), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Paul J.B. Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism (MUMC+), the Netherlands
| | - Rik G.J. Marcellis
- Department of Physiotherapy, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Mark van den Boogaart
- Department of Orthopedic Surgery and Research School CAPHRI (Care and Public Health Research Institute), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism (MUMC+), the Netherlands
| | - Paul C. Willems
- Department of Orthopedic Surgery and Research School CAPHRI (Care and Public Health Research Institute), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
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11
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Kim YC, Lee KH, Park GT, Cui JH, Kim KT. How does long thoracolumbar realignment surgery of adult spinal kyphotic deformity affect lower extremity compensation? Using full body radiograph. Br J Neurosurg 2024; 38:39-44. [PMID: 33459072 DOI: 10.1080/02688697.2021.1872771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE By using full body radiograph, the aim of the current study was to elucidate the expected degree of lower extremity compensatory change after long thoracolumbar realignment surgery with adult spinal deformity patient who had normal or only mild osteoarthritis on lower extremities. METHODS Two novel parameters were used for assessment of regional compensation of the lower extremity. The Pearson correlation test was used to assess the correlation of postoperative changes of lower extremity compensation with the other spinopelvic parameters. RESULTS Overall, 113 spinal deformity patients (mean age was 54.5 years) were recruited and the average number of fused vertebrae was 13.3 ± 3.5. Except pelvic tilt (PT), postoperative sacrum-femur angle (SF) changes showed only moderate correlation with all angular spinopelvic parameters (r = 0.323-0.374; p < .001 to p = .001). Also C7 sagittal vertical axis showed no significant correlation with SF (p = .584-.621). However, postoperative changes of sagittal femur-tibia angle (SFT) reported strong correlation with all parameters evaluated (r = 0.455-0.586; p < .001 to p = .046). CONCLUSION For adult spinal deformity patients who had normal or only mild osteoarthritis on the lower extremities underwent long thoracolumbar realignment surgery, the surgeon could expect improvement of compensatory change of the knee with correction of spinopelvic parameters. However, the degree of hip compensation improvement was relatively difficult to predict than that of the knee, except PT.
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Affiliation(s)
- Yong-Chan Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Spine Centre, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Keun-Ho Lee
- Department of Orthopaedic Surgery, College of Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Gyu-Taek Park
- Department of Orthopedic Surgery, Eutteum Orthopedic Hospital, Gyeonggi-do, Korea
| | - Ji Hao Cui
- Department of Orthopaedic Surgery, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan City, China
| | - Ki-Tack Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Spine Centre, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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12
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Balci A, Kocahan T, Akinoglu B, Yilmaz AE, Hasanoglu A. The immediate effect of simulating leg-length discrepancy on spinal posture and pelvic position: a cross-over designed study. Res Sports Med 2024; 32:1-11. [PMID: 35603671 DOI: 10.1080/15438627.2022.2079980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
Leg-length discrepancy (LLD) is a common condition that may cause posture changes and clinical consequences. Rasterstereography is a valid and reliable method that analyzes posture without radiation exposure and invasive procedures. This study aimed to assess the immediate effect of artificial LLD on pelvic position and spinal posture in athletes. Twenty-four elite karate athletes (14 men, 10 women) were included in the study. Sagittal imbalance, coronal imbalance, pelvic obliquity, pelvic torsion angle, thoracic kyphosis angle and lumbar lordosis angle were measured at different artificial LLD heights (5 -10 -15 -20 mm). Statistical analysis was performed with One-Way ANOVA with repeated measures or Friedman test. In cases where there were significant differences, pairwise comparisons were performed with least significant differences (LSD) test or Wilcoxon signed rank test. There were statistically significant differences in pelvic obliquity (p = 0.001), pelvic torsion (p = 0.001) and lumbar lordosis (p = 0.001) with varying LLD. However, there was no significant difference in sagittal imbalance, coronal imbalance and thoracic kyphosis angle. It has been observed that even a 5-mm LLD causes pelvic position and spinal posture changes. Future studies detecting these changes in populations with LLD via rastersterography may prevent possible musculoskeletal disorders.
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Affiliation(s)
- Aydin Balci
- Sports Medicine, Ankara Yildirim Beyazit University, Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Tugba Kocahan
- Department of Health Services, Center of Athlete Training and Health Research, the Ministry of Youth and Sports, Sports General Directorship, Ankara, Turkey
| | - Bihter Akinoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
| | | | - Adnan Hasanoglu
- Department of Health Services, Center of Athlete Training and Health Research, the Ministry of Youth and Sports, Sports General Directorship, Ankara, Turkey
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13
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Arhewoh RE, Marigi I, McCarthy R, Skaggs D, Sponseller P, Luhmann S. Changes in sagittal balance and pre-existing junctional angle influence development of proximal junctional kyphosis in growth guidance systems for early-onset scoliosis. Spine Deform 2024; 12:239-246. [PMID: 37612433 DOI: 10.1007/s43390-023-00754-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/05/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE Proximal junctional kyphosis (PJK) has been reported to occur at a rate of about 30% in traditional growing rods (GR) and magnetically controlled growing rods (MCGR). Growth guidance systems (GGS) have non-rigid, gliding fixation along rods, which may mitigate PJK. There have been no studies done in shilla around PJK, hence this study aimed to assess the occurrence, risk factors, and timeline of PJK. METHODS A prospective, multicenter database was queried for EOS patients who underwent surgery utilizing GGS. INCLUSION CRITERIA < 10 years at index surgery and > 2 year follow-up. RESULTS Sixty-five patients (thirty-six female) met inclusion criteria. Mean age at index surgery was 6.2 y/o (2-9); mean follow-up was 66 m. Most common etiologies were syndromic (n = 23). Mean thoracic kyphosis at pre-op was 41.8°, post-op was 35.5°, and final was 42.2°. Mean PJA at pre-op was 6.15°, post-op 1 was 4.2°, and final was 15.6°. Incidence of PJK at post-op was 35% and final was 43%. Pre-op sagittal balance and change in sagittal balance from pre-op to post-op were associated with post-op PJK (p = 0.05, 0.02). Change in spinal height from pre-op to post-op was associated with PJK at final (p = 0.04). Interestingly, increased PJA at pre-op was significantly associated with decreased PJK at post-op and final (p = 0.01, 0.03). CONCLUSION PJK was identified in 43% of patients post-operatively after GGS for EOS. Pre-op PJA was negatively correlated with an increased incidence of PJK. Changes in sagittal balance, in either direction, was the strongest predictor for development of PJK post-operatively.
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Affiliation(s)
- Reme Emmanuel Arhewoh
- Department of Orthopaedic Surgery, St Louis Children's Hospital, Washington University School of Medicine, Saint Louis, MO, 63110, USA
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ian Marigi
- Department of Orthopaedic Surgery, St Louis Children's Hospital, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Richard McCarthy
- Department of Orthopaedics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, 72205, USA
| | - David Skaggs
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Paul Sponseller
- Division of Pediatric Orthopaedics, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Scott Luhmann
- Department of Orthopaedic Surgery, St Louis Children's Hospital, Washington University School of Medicine, Saint Louis, MO, 63110, USA.
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14
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Shin SS, Yoo WG. The difference in the relationship of spinal sagittal alignment between individuals with flat lumbar and normal lordosis posture based on global and regional angles. Technol Health Care 2024; 32:19-30. [PMID: 37248922 DOI: 10.3233/thc-220098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND According to previous studies, the relationship between lumbar lordosis and thoracic kyphosis or that between pelvic parameters and thoracic kyphosis have been inconsistent. OBJECTIVE The purpose of this study was to investigate spinal sagittal alignment and its relationship to global and regional lumbar and thoracic angles, pelvic and sway angles, and C7-S1 distance measurements, followed by a detailed subgroup analysis using an inertial measurement unit system. METHODS A total of 51 asymptomatic volunteers stood in a comfortable posture with inertial measurement units attached to the T1, T7, T12, L3, and S2 vertebrae. T1, T7, T12, L3, and S2 sagittal angles were acquired during standing posture using the Eulerian angle coordinate system. All angles are reported as the mean of three 5-s measurements. Following the measurement of lumbar lordosis angles (T12 relative S2), participants were divided into the flat lumbar and normal lordosis groups. RESULTS There were different correlation patterns between groups because of spinal sagittal imbalance, which was greater in the flat lumbar group than in the normal lordosis group. In addition, sacral inclination proved the ideal parameter to evaluate reciprocal balance in lumbar lordosis, showing a stronger correlation with lower than with upper lumbar lordosis. T1 was the key element in assessing thoracic kyphosis, which showed a stronger correlation with upper than with lower thoracic kyphosis. CONCLUSION We suggest that when assessing posture, it is necessary to identify the global and regional angles and it is useful to classify spinal sagittal alignment into subgroups according to lumbar lordosis and evaluate the groups separately.
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15
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Park S, Yoo HJ, Jang JS, Lee SH. Automated non-contact measurement of the spine curvature at the sagittal plane using a deep neural network. Clin Biomech (Bristol, Avon) 2024; 111:106146. [PMID: 37976690 DOI: 10.1016/j.clinbiomech.2023.106146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Non-radiographical techniques have been suggested to measure the spine curvature at the sagittal plane. However, a neural network has not been used to measure the curvature. METHODS A single video camera captured images of a standing posture at the sagittal plane from twenty healthy males. Six marker positions along the spine's contour in each image were identified for measuring inclination, thoracic kyphosis, and lumbar lordosis angles. We estimated three inflection points around the neck, hip, and between the neck and hip, followed by identifying two adjacent marker positions per inflection point to compute its tangent. The angular deviation of each tangent line from the horizontal was computed to measure inclination angles. Thoracic kyphosis and lumbar lordosis angles were computed by the angular difference between the two adjacent tangents. A deep neural network was trained with 500,000 iterations using the labeled images from 18 participants (388 and 44 images for training and test set) and then evaluated using the unseen images (2 participants, 48 images; evaluation set). FINDINGS The mean total training and test errors were <2 pixels (∼ 0.6 cm). The total error in the evaluation set was qualitatively comparable (∼ 3 pixels = ∼ 0.9 cm), suggesting the model performance was maintained in the unseen data. The angle values between labeled and network-predicted marker positions were similar in the evaluation set. INTERPRETATION The network training with a relatively small number of images was successful based on the small error values observed in the evaluation set. The model may be an affordable, automated, and non-contact measurement tool for the human spine curvature.
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Affiliation(s)
- Sangsoo Park
- School of Global Sport Studies, Korea University Sejong Campus, Sejong City 30019, South Korea.
| | - Hyun-Joon Yoo
- Korea University Research Institute for Medical Bigdata Science, Korea University, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, South Korea
| | - Jin Su Jang
- Human Behavior & Genetic Institute, Associate Research Center, Korea University, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, South Korea
| | - Sang-Heon Lee
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, South Korea
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16
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Tanida S, Masamoto K, Tsukanaka M, Futami T. No short-term clinical improvement and mean 6° of thoracic kyphosis correction using limited-level Ponte osteotomy near T7 for Lenke type 1 and 2 adolescent idiopathic scoliosis: a preliminary study. J Pediatr Orthop B 2023; 32:537-546. [PMID: 36943678 DOI: 10.1097/bpb.0000000000001074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
This study was a retrospective single surgeon case series approved by institutional review board and showed the efficacy of limited Ponte osteotomy at T6/7, 7/8 and 8/9 (limited-PO) in the sagittal plane for patients with Lenke type 1 and 2 adolescent idiopathic scoliosis (AIS). A total of 37 consecutive patients [7 males and 30 females; average age 16.0 ± 2.5 (range: 12-21)] over a 4-year period with posterior corrective fusion surgery were included. Initially, 18 patients were operated on without limited-PO [P(-)-group]. Midway in the series, the senior author switched to the limited-PO [P(+)-group]. The limited-PO has been performed to form the apex of thoracic kyphosis at the T7 level, together with the restoration of thoracic kyphosis. The mean amount of the correction angle of thoracic kyphosis was more in the P(+)-than in P(-)-group (13.8 ± 9.6° vs. 7.8 ± 8.0°, P = 0.046) at 1-year after surgery. Cervical lordosis was spontaneously corrected more in P(+)-than in P(-)-group. The apex of thoracic kyphosis was controlled around the T7 level postoperatively in most cases (18/19 cases). There was no significant difference between the two groups in terms of blood loss and operative time per level, or Scoliosis Research Society-22 domain scores. Limited-PO contributed to the restoration of the whole spinal sagittal alignment for Lenke type 1 and 2 AIS; however, in this preliminary study, the clinical improvement was unclear at least in the short term, because the kyphosis angle obtained by limited-PO was only approximately 6°.
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Affiliation(s)
- Shimei Tanida
- Department of Orthopaedic Surgery, Shiga General Hospital
| | | | - Masako Tsukanaka
- Department of Orthopaedic Surgery, Shiga Medical Center for Children, Shiga, Japan
| | - Toru Futami
- Department of Orthopaedic Surgery, Shiga Medical Center for Children, Shiga, Japan
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17
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Park C, Agarwal N, Mummaneni PV, Berven SH. Spinopelvic Alignment: Importance in Spinal Pathologies and Realignment Strategies. Neurosurg Clin N Am 2023; 34:519-526. [PMID: 37718098 DOI: 10.1016/j.nec.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Sagittal spinal malalignment can lead to pain, decreased function, dynamic imbalance, and compromise of patient-reported health status. The goal of reconstructive spine surgery is to restore spinal alignment parameters, and an understanding of appropriate patient-specific alignment is important for surgical planning and approaches. Radiographic spinopelvic parameters are strongly correlated with pain and function. The relationship between spinopelvic parameters and disability in adult spinal deformity patients is well-established, and optimal correction of sagittal alignment results in improved outcomes regarding patient health status and mechanical complications of surgery.
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Affiliation(s)
- Christine Park
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
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18
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Cha E, Park JH. Spinopelvic Alignment as a Risk Factor for Poor Balance Function in Low Back Pain Patients. Global Spine J 2023; 13:2193-2200. [PMID: 35220778 PMCID: PMC10538310 DOI: 10.1177/21925682221076417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective, observational study. OBJECTIVES This study aimed to examine the association between spinopelvic parameters and balance function in low back pain (LBP). METHODS Among patients in the rehabilitation medicine department, the data of 182 patients (mean age, 47.8 years; M/F = 64/118) was obtained retrospectively. Spinopelvic parameters were measured through a whole-body low-dose biplanar radiography using the EOS imaging system, and balance function was evaluated by the center of pressure (COP) movement using the Zebris treadmill system. Pearson correlations were used to determine the relationship between radiographic and balance function. Stepwise multiple linear regression analyses were conducted with the balance function as a dependent variable and age and spinopelvic parameters as independent variables. RESULTS Increased age, knee flexion (KF), pelvic tilt (PT), C7-central sacral line (C7-CSL) and C7 sagittal vertical axis (SVA), and decreased spino-sacral angle (SSA) were associated with both poor static and dynamic balance. Moreover, increased Cobb's angle and decreased thoracic kyphosis (TK) and lumbar lordosis (LL) was associated with poor static balance. Increased pelvic incidence (PI) was related to poor dynamic balance. Increased age, Cobb's angle, SVA, and decreased TK were risk factors for poor static balance. For dynamic balance, increased age, C7-CSL, and PT were risk factors for poor sagittal balance, whereas increased CAM-plumb line and PT were risk factors for poor coronal balance. CONCLUSIONS Balance function was associated with spinopelvic parameters in patients with LBP. Increased SVA, followed by increased PT, was the strongest independent factor associated with poor static and dynamic balance.
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Affiliation(s)
- Eunsil Cha
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
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19
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Barber LA, Lafage R, Muzammil H, Shinn DJ, Kim JH, Lafage V, Iyer S. Supine and Dynamic Extension Radiographs as the Strongest Predictors of Post-operative Alignment in Minimally Invasive Lumbar Spine Surgery. Global Spine J 2023; 13:2278-2284. [PMID: 35192407 PMCID: PMC10538306 DOI: 10.1177/21925682221079601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Institutional review board-approved retrospective cohort study. OBJECTIVES Failure to achieve alignment goals may result in accelerated adjacent segment degeneration and poorer outcomes. In "open" spine surgery, intraoperative tools can fine tune alignment; minimally invasive spine surgery techniques may not allow for this type of intraoperative adjustment. The aim of this study was to identify pre-operative radiographic parameters that accurately predict post-operative alignment after minimally invasive lumbar spine surgery. We hypothesized that pre-operative supine and extension sagittal alignment would predict post-operative standing alignment. METHODS 50 consecutive patients underwent lateral or anterior lumbar interbody fusion with or without percutaneous posterior instrumentation by a single-surgeon. Sagittal alignment parameters were evaluated on pre-operative standing scoliosis radiographs, dynamic radiographs, supine CT scout, and 6-week post-operative standing radiographs. Demographic and perioperative data were analyzed. RESULTS The mean age was 67.8 years. The mean BMI was 29.7. On average, 3 levels were instrumented (range, 2-6). Surgical time was 4.5 ± 1.8 hours. Following surgery, global lordosis increased from 44.7 ± 17° to 48.6 ± 16° (P = .001). However, there was no significant difference between the pre-operative supine (48.5 ± 15°), pre-operative extension (49.2 ± 18°), or 6-week post-operative standing radiographs (48.6 ± 16°). There were strong correlations between post-operative alignment and pre-operative supine (r = .825) and extension (r = .851) alignment. CONCLUSIONS Our results suggest that pre-operative supine and extension radiographs could be a gold standard for minimally invasive lumbar spine surgery alignment correction as they predict post-operative alignment. The extension alignment was the strongest predictor of post-operative alignment.
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Affiliation(s)
- Lauren A. Barber
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Renaud Lafage
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Hamna Muzammil
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Daniel J. Shinn
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jeong H. Kim
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sravisht Iyer
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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20
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Bergin SM, Dibble CF, Lee HJ, Abd-El-Barr MM, Shaffrey CI, Than KD. Surgical technique of combined minimally invasive anterior column realignment at L1-L2 with open extension of prior fusion. JOURNAL OF SPINE SURGERY (HONG KONG) 2023; 9:288-293. [PMID: 37841785 PMCID: PMC10570644 DOI: 10.21037/jss-23-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/12/2023] [Indexed: 10/17/2023]
Abstract
Surgical correction of fixed kyphotic deformity or severe sagittal imbalance traditionally involves three column osteotomies, which are associated with high morbidity rates. Anterior column realignment (ACR) has emerged as a minimally invasive alternative for restoring segmental lordosis. This technique involves a lateral approach and release of the anterior longitudinal ligament (ALL), followed by placement of a hyperlordotic interbody cage. In this study, we present a successful case of minimally invasive ACR for the treatment of flatback deformity and adjacent segment disease in a patient with prior L2-S1 fusion. Imaging revealed a flatback deformity, sagittal vertical axis elevation, and spinopelvic disharmony. The patient underwent a multistage procedure involving a lateral retropleural approach for ACR and interbody fusion, followed by open posterior instrumented fusion and vertebroplasties. Postoperatively, the patient experienced significant pain relief and improvement in lumbar lordosis, pelvic tilt, and pelvic incidence-lumbar lordosis mismatch. ACR combined with posterior release allows for manipulation of all three spinal columns, leading to spine reconstruction and improved spinopelvic harmony. We discuss the advantages of ACR, including its minimally invasive nature and potential benefits for patients with sagittal deformities. The presented surgical technique demonstrates the feasibility and efficacy of minimally invasive ACR in addressing flatback deformity and adjacent segment disease.
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Affiliation(s)
- Stephen M Bergin
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC, USA
| | | | - Ho Jin Lee
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC, USA
| | | | | | - Khoi D Than
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC, USA
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21
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Lee BJ, Bae SS, Choi HY, Park JH, Hyun SJ, Jo DJ, Cho Y. Proximal Junctional Kyphosis or Failure After Adult Spinal Deformity Surgery - Review of Risk Factors and Its Prevention. Neurospine 2023; 20:863-875. [PMID: 37798982 PMCID: PMC10562224 DOI: 10.14245/ns.2346476.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 10/07/2023] Open
Abstract
Proximal junction kyphosis (PJK) is a common imaging finding after long-level fusion, and proximal junctional failure (PJF) is an aggravated form of the progressive disease spectrum of PJK. This includes vertebral fracture of upper instrumented vertebra (UIV) or UIV+1, instability between UIV and UIV+1, neurological deterioration requiring surgery. Many studies have reported on PJK and PJF after long segment instrumentation for adult spinal deformity (ASD). In particular, for spine deformity surgeons, risk factors and prevention strategies of PJK and PJF are very important to minimize reoperation. Therefore, this review aims to help reduce the occurrence of PJK and PJF by updating the latest contents of PJK and PJF by 2023, focusing on the risk factors and prevention strategies of PJK and PJF. We conducted a search on multiple database for articles published until February 2023 using the search keywords "proximal junctional kyphosis," "proximal junctional failure," "proximal junctional disease," and "adult spinal deformity." Finally, 103 papers were included in this study. Numerous factors have been suggested as potential risks for the development of PJK and PJF, including a high body mass index, inadequate postoperative sagittal balance and overcorrection, advanced age, pelvic instrumentation, and osteoporosis. Recently, with the increasing elderly population, sarcopenia has been emphasized. The quality and quantity of muscle in the surgical site have been suggested as new risk factor. Therefore, spine surgeon should understand the pathophysiology of PJK and PJF, as well as individual risk factors, in order to develop appropriate prevention strategies for each patient.
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Affiliation(s)
- Byung-Jou Lee
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Soo Bae
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Ho Young Choi
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dae Jean Jo
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Yongjae Cho
- Department of Neurosurgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Korean Spinal Deformity Society (KSDS)
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Neurosurgery, Ewha Womans University School of Medicine, Seoul, Korea
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22
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Eddine HK, Saleh S, Hajjar J, Harati H, Nasser Z, Desoutter A, Al Ahmar E, Estephan E. Evaluation of the accuracy of new modalities in the assessment and classification of lumbar lordosis: A comparison to Cobb's angle measurement. Heliyon 2023; 9:e18952. [PMID: 37600414 PMCID: PMC10432978 DOI: 10.1016/j.heliyon.2023.e18952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background Because of the association of lumbar lordosis with some clinical conditions such as low back pain, the chiropractic field has emphasized the significance of evaluating the lumbar lordotic status, by measuring Cobb's angle, regarded as the radiological gold standard, for the assessment of lumbar lordosis, on lateral radiographs. However, research has shown that this technique has some considerable drawbacks, mostly in terms of low accuracy and high variability between clinicians when compared with other radiological modalities. The main objective was to compare the diagnostic accuracy of newly established radiological measurements with one of Cobb's angle methods, for the characterization of lumbar lordosis status in a sample of Lebanese patients aged 15 and above. Material and methods This retrospective single-center study consisted of measuring Cobb's L1-S1 and Cobb's L1-L5 angles, along with the novel established measurements which are the derivative and the normalized surface area, on 134 lateral radiographs of the lumbar spine of Lebanese patients aged fifteen years old and above, gotten from the Radiology department at Zahra'a's Hospital in Beirut, performed by two observers using MATLAB. Inter-rater agreement was assessed by calculating the Intra-class correlation coefficients. Spearman correlation was analyzed between both Cobb's angle methods and with the derivative and normalized area respectively. 54 patients of the sample were diagnosed by two radiologists, according to their LL status. ROC curve analysis was performed to compare the diagnostic accuracy of the four techniques used. Data were analyzed with IBM SPSS Statistics 23.0 (NY, USA); P < 0.05 was considered statistically significant. Results According to the ROC curve analysis the new methods, which are the derivative and the normalized surface area, displayed lower diagnostic accuracy (AUCderivative = 0.818 and 0.677, AUCsurface area = 0.796 and 0.828) than Cobb's L1-L5 (AUCL1-L5 = 0.924 and 0.929 values) and L1-S1 (AUCL1-S1 = 0.971 and 0.955) angles, in the characterization of hypo and hyperlordotic patients, respectively, in our Lebanese sample consisting of patients aged 15 and above, because of their lower area under the curve's values compared to the traditional Cobb's techniques. The Cobb's L1-S1 has shown to have the highest diagnostic accuracy among the four methods to characterize normal patients from hypo and hyperlordotic ones, by referring to its highest area under the curve's values. However, the sensitivity of Cobb's L1-L5 angle in characterizing hyperlordotic patients was similar to the one of the normalized surface area with a value of 100%.Conclusion: among the four modalities, the new methods didn't show a better diagnostic accuracy compared to the traditional modalities. Cobb's L1-S1 displayed the highest diagnostic accuracy despite its drawbacks. Further prospective studies are needed to validate the cut-offs obtained for Cobb's L1-S1 angle in our sample.
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Affiliation(s)
- Hassane Kheir Eddine
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Sahera Saleh
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Joseph Hajjar
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Hayat Harati
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Zeina Nasser
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | | | - Elie Al Ahmar
- School of Engineering, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Elias Estephan
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- LBN, University Montpellier, Montpellier, France
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
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Wang Z, Hu X, Cui P, Liu X, Zhu W, Kong C, Wang W, Lu S. Description of age-related changes in cervical sagittal alignment based on pelvic incidence classification in asymptomatic Chinese population. 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 2023; 32:2402-2414. [PMID: 37193902 DOI: 10.1007/s00586-023-07769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/06/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To investigate the pelvic incidence (PI)- and age-related cervical alignment changes of Chinese healthy population. METHODS Six hundred and twenty-five asymptomatic adult subjects, who underwent the standing whole spinal radiograph, were recruited in this work. The sagittal parameters were measured, including Occipito-C2 angle (O-C2), C2-7 angle (C2-7), cranial arch, caudal arch, T1-slope (T1S), C2-7 sagittal vertical axis (C2-7 SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), PI, and sagittal vertical axis (SVA). All subjects were stratified into 5 age groups, namely 40-59 years, 60-64 years, 65-69 years, 70-74 years, and 75 years and above, with each age group further divided into 2 subgroups based on PI (deeming PI < 50° as low PI, and PI ≥ 50° as high PI). The correlations between PI or age, and other sagittal parameters were assessed. The age-related changes of sagittal parameters in each PI subgroup were also assessed, followed by one-way analysis of variance analysis for change comparison between age groups. RESULTS The average cervical sagittal parameters were as below: 18.2 ± 6.8° for O-C2, 10.4 ± 10.2° for C2-7, 3.9 ± 7.5° for cranial arch, 6.5 ± 7.1° for caudal arch, 23.6 ± 7.3° for T1S, and 21.0 ± 9.7 mm for C2-7 SVA. There was no obvious difference observed between PI and cervical sagittal parameters, excepting for caudal arch. While, C2-7, cranial arch, caudal arch, T1S, and C2-7 SVA increased remarkably with the age. Thereof, C2-7 exhibited great increases at the age of 60-64 years and 70-74 years, respectively, cranial arch increased notably at 60-64 years of age, and caudal arch developed obviously at 70-74 years of age, regardless of PI. CONCLUSION This study showed the PI- and age-related cervical alignment changes of Chinese healthy population. Based on the classification in our study, high or low PI apparently did not correlate with the occurrence of cervical degenerative disease.
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Affiliation(s)
- Zheng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Xinli Hu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Peng Cui
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Xu Liu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Weiguo Zhu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China.
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China.
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China.
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China.
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Najjar E, Pasku D, Mardashti A, Meshneb M, Komaitis S, Salem KM, Quraishi NA. The influence of osteoporotic vertebral fractures on global sagittal alignment in elderly patients: a systematic review and meta-analysis. 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 2023; 32:2580-2587. [PMID: 37222801 DOI: 10.1007/s00586-023-07780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
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.
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Affiliation(s)
- Elie Najjar
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Dritan Pasku
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Ali Mardashti
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Mustafa Meshneb
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Spyridon Komaitis
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Khalid M Salem
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Nasir A Quraishi
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
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Pouleau HB, De Witte O, Dhaene B, Jodaïtis A. Restore cervical sagittal alignment by cervical disc arthroplasty and systematic total bilateral uncuscectomy in severe spondylosis: A prospective study. BRAIN & SPINE 2023; 3:101765. [PMID: 38020991 PMCID: PMC10668056 DOI: 10.1016/j.bas.2023.101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/27/2023] [Accepted: 06/11/2023] [Indexed: 12/01/2023]
Abstract
Introduction Severe spondylosis is common and represents contraindication to achieve cervical disc arthroplasty (CDA). Research question Is it possible to restore cervical sagittal alignment using an adequate prosthetic model and performing systematic bilateral total uncuscectomy (or uncinectomy), even in cases of severe spondylosis ? Material and methods We propose a prospective clinical and radiological study comparing the evolution of preoperative and postoperative cervical sagittal balance 1 year after the interposition of a prosthesis with mobile bearing and systematic total uncuscectomy. VAS for brachialgia and cervicalgia, NDI, Odom's criteria, C2-C7 Cobb angle, C2-C7 SVA, T1 slope, C2 slope, C1-C2 Cobb angle, and segmental Cobb angle were analyzed preoperatively and 1 year postoperatively. Results 73 patients for a total of 129 levels treated were analyzed. Patients showed significant improvements in VASb, VASc, NDI, and Odom's criteria one year after surgery without clinical differences in the severe spondylosis subgroup (41 patients for 77 levels treated). Our results showed an increase in the C2-C7 Cobb angle postoperatively and a better correlation between T1 slope and C2-C7 Cobb angle postoperatively than preoperatively. Postoperative radiological results were similar between the spondylosis and non-spondylosis subgroups. However preoperative C2-C7 Cobb angle and preoperative ROM were lower in the severe spondylosis subgroup. Discussion and conclusion This study showed the possibility of restoring cervical sagittal balance by performing cervical disc arthroplasty with systematic uncuscectomy, even in cases of severe spondylosis. Moreover, we propose a simplified mathematical formula to preoperatively evaluate the lack of angulation to restore sagittal cervical alignment.
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Affiliation(s)
- Henri-Benjamin Pouleau
- University Hospital Center Tivoli, La Louvière, Department of Neurosurgery, Belgium
- Academic Hospital Center Erasme, Bruxelles, Department of Neurosurgery, Belgium
| | - Olivier De Witte
- Academic Hospital Center Erasme, Bruxelles, Chief of Department of Neurosurgery, Belgium
| | - Benjamin Dhaene
- University Hospital Center Tivoli, La Louvière, Chief of Department of Radiology, Belgium
| | - Alexandre Jodaïtis
- University Hospital Center Tivoli, La Louvière, Chief of Department of Neurosurgery, Belgium
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Tharu NS, Lee TTY, Lai KKL, Lau TE, Chan CY, Zheng YP. Sagittal Spinal Alignment in People with Chronic Spinal Cord Injury and Normal Individual: A Comparison Study Using 3D Ultrasound Imaging. J Clin Med 2023; 12:jcm12113854. [PMID: 37298049 DOI: 10.3390/jcm12113854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of this study was to compare the sagittal spinal alignment of people with chronic spinal cord injury (SCI) with normal individuals and to determine whether transcutaneous electrical spinal cord stimulation (TSCS) could cause a change in the thoracic kyphosis (TK) and lumbar lordosis (LL) to re-establish normal sagittal spinal alignment. A case series study was conducted, wherein twelve individuals with SCI and ten neurologically intact subjects were scanned using 3D ultrasonography. In addition, three people with SCI having complete tetraplegia participated further to receive a 12-week treatment (TSCS with task-specific rehabilitation) after evaluation of sagittal spinal profile. Pre- and post-assessments were conducted to evaluate the differences in sagittal spinal alignment. The results showed that the TK and LL values for a person with SCI in a dependent seated posture were greater than those of normal subjects for: standing (by TK: 6.8° ± 1.6°; LL: 21.2° ± 1.9°), sitting straight (by TK: 10.0° ± 4.0°; LL: 1.7° ± 2.6°), and relaxed sitting (by TK: 3.9° ± 0.3°; LL: 7.7° ± 1.4°), respectively, indicating an increased risk for spinal deformity. In addition, TK decreased by 10.3° ± 2.3° after the TSCS treatment, showing a reversible change. These results suggest that the TSCS treatment could be used to restore normal sagittal spinal alignment for individuals with chronic SCI.
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Affiliation(s)
- Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Timothy Tin-Yan Lee
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kelly Ka-Lee Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ting-Er Lau
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Chui-Yi Chan
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Cho Y, Jo DJ, Hyun SJ, Park JH, Yang NR. From the Spinopelvic Parameters to Global Alignment and Proportion Scores in Adult Spinal Deformity. Neurospine 2023; 20:467-477. [PMID: 37401065 PMCID: PMC10323335 DOI: 10.14245/ns.2346374.187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 07/05/2023] Open
Abstract
In the last 20 years, sagittal alignment and balance of the spine have become one of the most important issues in the field of spine surgery. Recent studies emphasize that sagittal balance and alignment are more important for health-related quality of life. The understanding of normal and abnormal sagittal alignment of the spine is necessary for the diagnosis and appropriate treatment of adult spinal deformity (ASD), and we will discuss the currently used classification of ASD, the parameters of sagittal alignment that are essential for the diagnosis of spinal deformity, compensatory actions to maintain sagittal balance, and the relationship between sagittal alignment and clinical symptoms. Furthermore, we will also discuss the recently introduced Global Alignment and Proportion scores. The Korean Spinal Deformity Society is publishing a series of review articles on spinal deformities to help spine surgeons better understand spinal deformities.
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Affiliation(s)
- Yongjae Cho
- Department of Neurosurgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Dae Jean Jo
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Na Rae Yang
- Department of Neurosurgery, Ewha Womans University College of Medicine, Seoul, Korea
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Baymurat AC, Yapar A, Kilicaslan OF, Tokgoz MA, Selcuk H, Yas S, Senkoylu A. Intermittent pedicle screw application provides better kyphosis restoration in adolescent idiopathic scoliosis for Lenke type 1 and type 2 curves. 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 2023; 32:2213-2220. [PMID: 37010609 DOI: 10.1007/s00586-023-07669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/04/2023] [Accepted: 03/17/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE There is still no consensus on the optimum pedicle screw density required for the desired thoracic kyphosis restoration in adolescent idiopathic surgery (AIS). The aim of this study to evaluate the effect of pedicle screw density on thoracic kyphosis restoration in AIS surgery. METHODS The data of 106 patients from two centers that operated for Lenke type 1 and 2 AIS were retrospectively reviewed. Two groups were constituted according to the pedicle screw density: intermittent pedicle screw constructs (IPSC) (n = 52 patients) and consecutive pedicle screw construct (CPSC) (n = 54 patients) groups. The preoperative and at least 24-month follow-up radiographs and SRS-22 scores were evaluated. The Cobb angle of the main and concomitant curves in the coronal plane and the sagittal plane were measured and compared. RESULTS The mean follow-up period for the IPSC and CPSC groups was 72.3 ± 37.2 and 62.9 ± 28.8 months, respectively. In the SRS-22 questionnaire, there was no significant difference between the two groups in terms of self-image/appearance domain scores (p = 0.466), but better results were obtained in the IPSC group in terms of treatment satisfaction domain scores (p = 0.010) and better thoracic kyphosis restoration was achieved in IPSC group radiologically for Lenke type 1 curves with - 81.4 ± 81.4% in the IPSC group and 6.8 ± 83.8% in the CPSC group (p < 0.001). CONCLUSION It was considered that better thoracic kyphosis restoration could be achieved with the less lordotic effect of IPSC in Lenke type 1 curves. Although the current situation had a significant impact on radiological outcomes, its effect on SRS-22 scores was limited.
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Affiliation(s)
- Alim Can Baymurat
- Department of Orthopaedics and Traumatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Aliekber Yapar
- Department of Orthopaedics and Traumatology, Antalya Education and Research Hospital, Health Sciences University, Antalya, Turkey
| | - Omer Faruk Kilicaslan
- Department of Orthopaedics and Traumatology, Antalya Education and Research Hospital, Health Sciences University, Antalya, Turkey
| | - Mehmet Ali Tokgoz
- Department of Orthopaedics and Traumatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Huseyin Selcuk
- Department of Orthopaedics and Traumatology, Antalya Education and Research Hospital, Health Sciences University, Antalya, Turkey
| | - Semih Yas
- Department of Orthopaedics and Traumatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Alpaslan Senkoylu
- Department of Orthopaedics and Traumatology, Gazi University Medical Faculty, Ankara, Turkey.
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Belli G, Toselli S, Mauro M, Maietta Latessa P, Russo L. Relation between Photogrammetry and Spinal Mouse for Sagittal Imbalance Assessment in Adolescents with Thoracic Kyphosis. J Funct Morphol Kinesiol 2023; 8:jfmk8020068. [PMID: 37218864 DOI: 10.3390/jfmk8020068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
The evaluation of postural alignment in childhood and adolescence is fundamental for sports, health, and daily life activities. Spinal Mouse (SM) and photogrammetry (PG) are two of the most debated tools in postural evaluation because choosing the proper instrument is also important to avoid false or misleading data. This research aims to find out the best linear regression models that could relate the analytic kyphosis measurements of the SM with one or more PG parameters of body posture in adolescents with kyphotic posture. Thirty-four adolescents with structural and non-structural kyphosis were analyzed (13.1 ± 1.8 years; 1.59 ± 0.13 m; 47.0 ± 12.2 kg) using SM and PG on the sagittal plane in a standing and forward-bending position, allowing us to measure body vertical inclination, trunk flexion, and sacral inclination and hip position during bending. The stepwise backward procedure was assessed to estimate the variability of the grade of inclination of the spine and thoracic spine curvature with fixed upper and lower limits, evaluated with SM during flexion. In both models, the PG angle between the horizontal line and a line connecting the sacral endplate-C7 spinous process and the PG hip position were the best regressors (adjusted-R2 SM bend = 0.804, p < 0.001; adjusted-R2 SM fixed bending = 0.488, p < 0.001). Several Spinal Mouse and photogrammetry parameters showed significant correlations, especially when the Spinal Mouse measurements were taken when the adolescents were in the forward-bending position. Physicians and kinesiologists may consider photogrammetry as a good method for spinal curve prediction.
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Affiliation(s)
- Guido Belli
- Department of Sciences for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
| | - Stefania Toselli
- Department of Sciences for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
| | - Mario Mauro
- Department of Sciences for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
| | | | - Luca Russo
- Department of Human Sciences, IUL Telematic University, 50122 Florence, Italy
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Shichman I, Ben-Ari E, Sissman E, Singh V, Hepinstall M, Schwarzkopf R. Total knee arthroplasty in patients with lumbar spinal fusion leads to significant changes in pelvic tilt and sacral slope. Arch Orthop Trauma Surg 2023; 143:2103-2110. [PMID: 35536355 DOI: 10.1007/s00402-022-04462-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The knee-hip-spine syndrome has been well elucidated in the literature in recent years. The aim of this study was to evaluate the effect of total knee arthroplasty (TKA) on spinopelvic sagittal alignment in patients with and without pre-TKA lumber spinal fusion. METHODS This is a retrospective cohort study of 113 patients who underwent TKA for primary osteoarthritis. Patients were stratified into the following three groups: (1) patients who had pre-TKA spinal fusion (SF, n = 19), (2) patients who had no spinal fusion but experienced pre-TKA flexion contracture (FC, n = 20), and (3) patients without flexion contracture or spinal fusion before TKA (no SF/FC, n = 74). Spinopelvic sagittal alignment parameters, including pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and plumb line-sacrum distance (SVA) were measured preoperatively and 3 months postoperatively on lateral standing full-body low-dose images. RESULTS TKA resulted in significant pre- to postoperative changes in pelvic tilt (average ∆ PT = - 8.6°, p = 0.018) and sacral slope (average ∆ SS = 8.6°, p = 0.037) in the spinal fusion (SF) group. Non-significant changes in spinopelvic sagittal alignment parameters (PT, SS, LL, TK, SVA) were noted postoperatively in all patients in the FC and the no SF/FC groups. CONCLUSIONS TKA can lead to meaningful changes in spinopelvic alignment in patients with prior lumbar fusion compared to those without spinal fusion. Patients with spinal fusion who are candidates for both hip and knee replacements should consider undergoing TKA first since changes in spinopelvic sagittal alignment can increase the risk of future complications. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Ittai Shichman
- NYU Langone Health, Division of Adult Reconstruction, Department of Orthopedic Surgery, Hospital of Joint Diseases, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Erel Ben-Ari
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Ramat Gan, Israel
| | - Ethan Sissman
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Ramat Gan, Israel
| | - Vivek Singh
- NYU Langone Health, Division of Adult Reconstruction, Department of Orthopedic Surgery, Hospital of Joint Diseases, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Matthew Hepinstall
- NYU Langone Health, Division of Adult Reconstruction, Department of Orthopedic Surgery, Hospital of Joint Diseases, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- NYU Langone Health, Division of Adult Reconstruction, Department of Orthopedic Surgery, Hospital of Joint Diseases, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA.
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Shen F, Kim HJ, Jeon SW, Chang BS, Lee CK, Yeom JS. Influence of Handgrip Strength and Paraspinal Muscles' Volume on Clinical Outcomes in the Patients With Each Sagittal Imbalance and Lumbar Spinal Stenosis. Global Spine J 2023; 13:609-616. [PMID: 33719649 DOI: 10.1177/21925682211001871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To compare handgrip strength (HGS), paraspinal muscles' (PSM) volume, and their effects on clinical symptom severity between the patients with sagittal imbalance (SI) and symptomatic lumbar spinal stenosis (LSS). METHODS A total of 54 paired consecutive patients with SI and LSS were enrolled after propensity score matching. Preoperative HGS, cross-sectional area (CSA) of psoas (PS) and multifidus (MF) muscles, and patient-reported measures, including visual analog scale (VAS) for back/ leg pain, Oswestry Disability Index (ODI), and EuroQOL (EQ-5D) were compared between both groups. Within each SI and LSS group, patient-reported measures were compared between high and low HGS subgroups. The correlation of HGS and CSA of PSMs to patient-reported measures was evaluated. RESULTS There was no difference in HGS between 2 groups, however, the CSA of PS and MF muscles in SI group was significantly lower than those in LSS group. Patients with low HGS showed inferior results for ODI and EQ-5D, compared to those with high HGS subgroup in both SI and LSS groups. HGS and CSA of MF muscle were correlated with ODI in both groups. CONCLUSIONS There was no significant difference between the SI and LSS groups in HGS, however, PSMs' volume in SI group were significantly lower than those in LSS group. Therefore SI would be associated with loss of localized muscle mass in back area, rather than global skeletal muscle weakness. HGS and PSMs' volume were adversely associated with functional status in SI and LSS patients.
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Affiliation(s)
- Feng Shen
- Department of Orthopedic Surgery, the 235960Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, 37990Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea
| | - Seung Won Jeon
- Spine Center and Department of Orthopedic Surgery, 37990Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine and 58927Seoul National University Hospital, Seoul, Korea
| | - Choon-Ki Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine and 58927Seoul National University Hospital, Seoul, Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopedic Surgery, 37990Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea
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Changes in the lumbar intervertebral foramen between supine and standing posture in patients with adult spinal deformity: a study with upright computed tomography. Skeletal Radiol 2023; 52:215-224. [PMID: 36114881 DOI: 10.1007/s00256-022-04185-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantitatively assess the impact of supine and standing positions on the morphological changes in the lumbar intervertebral foramen (LIF) in patients with adult spinal deformity (ASD) using upright CT and conventional supine CT. MATERIALS AND METHODS Thirty patients with ASD were prospectively enrolled in this study. All subjects underwent standing whole spine posterior/anterior radiographs, lateral radiographs, and whole spine CT, both in the supine and upright standing positions. Two orthopedic surgeons independently measured nine radiographic parameters in the radiograph and the lumbar foraminal area (FA) and height (FH) in supine and upright CT. Statistical analyses were performed to evaluate the risk of LIF decrease when standing upright compared to the supine position. The chi-squared, t test, Pearson's coefficients, intra- and inter-rater reliabilities, and ROC curves were calculated. The level of significance was set at p < 0.05. RESULTS Among the 300 LIFs, both the lumbar FA and FH were either increased or decreased by > 5% in approximately 30% of LIFs each. The FA decreased in the lower lumbar spine. The concave side had a significantly higher rate of decreased FA and FH than the convex side (p < 0.05 and < 0.05, respectively). ROC analysis showed that narrowing of the intervertebral disc (cutoff > 0.05°) is a risk factor for decreased FA and FH. CONCLUSIONS This study describes the details of the changes in the neuroforamen using a novel upright CT. In patients with ASD, approximately 30% of LIFs either increased or decreased in size by > 5% when standing. The risk factors for LIF decrease are the lower lumbar spine, concave side, and narrow side of the disc wedge.
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Wang W, Pan F, Wang P, Wang W, Wang Y, Kong C, Lu S. Biomechanical Response of Four Roussouly's Sagittal Alignment Lumbar to Degeneration of Different Parts of Intervertebral Disc: Finite Element Model Analysis. Ing Rech Biomed 2023. [DOI: 10.1016/j.irbm.2023.100772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Amirouche F, Dolan M, Pradhan S, Mikhael M, Monsef JB. Assessment of Cervical and Lumbar Kinematics in Simulated Open and Closed Kinetic Chain. Int J Spine Surg 2023; 17:51-59. [PMID: 36302601 PMCID: PMC10025859 DOI: 10.14444/8382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The pelvic girdle and spine vertebral column work as a long chain influenced by pelvic tilt. This study aims to assess the effect of open and closed chain anterior pelvic tilt (APT) or posterior pelvic tilt (PPT) on cervical and lumbar spine kinematics using an in vitro cadaveric spine model. METHODS Three human cadaveric spines with intact pelvis were suspended with the skull fixed in a metal frame. Optotrak 3-dimensional motion system captured coordinates of pin markers at 24 different points for real-time tracking of cervical and lumbar regions. Additional geometric parameters were measured to calculate pelvic incidence and pelvic tilt. A force-torque digital gauge applied consistent force to standardize the acetabular or sacral axis' APT and PPT during simulated open- and closed-chain movements, respectively. RESULTS In closed-chain PPT, significant differences in relative intervertebral decompression were noted between spinal levels C2/C3 (4.85 mm) and C5/C6 (1.26 mm), while compression was noted between L1/L2 (-2.54 mm) and L5/S1 (-11.84 mm) and between L3/L4 (-2.78 mm) and L5/S1 (-11.84 mm) (P < 0.05). Displacement during closed-chain PPT was significantly greater than during open-chain PPT for cervical and lumbar spines. In closed-chain APT, significant differences in relative intervertebral decompression were noted between spinal levels L1/L2 (2.87 mm) and L5/S1 (24.48 mm) and between L3/L4 (2.94 mm) and L5/S1 (24.48 mm) (P < 0.05). Pelvic incidence remained the same as the pelvis tilted anterior and posterior. CONCLUSIONS In PPT, open-chain pelvic tilts did not produce as much cervical and lumbar intervertebral displacement compared with closed-chain pelvic tilts. In contrast, APT saw fewer differences between open- and closed-chain tilting. There was a reciprocal relationship between pelvic tilt and sacral slope, producing a constant pelvic incidence throughout all pelvic tilt angles. CLINICAL RELEVANCE The results of this study may help determine how a patient's pelvic tilt is causing pain and using that knowledge to guide rehabilitation of stabilizing muscles. The data produced here may also be helpful in determining which rehabilitation exercises may be more difficult or prone to injury for patients with either excessive anterior or posterior pelvic tilt. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Farid Amirouche
- Department of Orthopaedic Surgery, Northshore University HealthSystem an Affiliate of University of Chicago Pritzker School of Medicine, Evanston, IL, USA
- Department of Orthopaedic Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - Martine Dolan
- Department of Orthopaedic Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - Sonia Pradhan
- Department of Orthopaedic Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - Mark Mikhael
- Department of Orthopaedic Surgery, Northshore University HealthSystem an Affiliate of University of Chicago Pritzker School of Medicine, Evanston, IL, USA
- Orthopaedic Spine Surgery, Illinois Bone and Joint Institute, Glenview, IL, USA
| | - Jad Bou Monsef
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Ignasiak D, Behm P, Mannion AF, Galbusera F, Kleinstück F, Fekete TF, Haschtmann D, Jeszenszky D, Zimmermann L, Richner-Wunderlin S, Vila-Casademunt A, Pellisé F, Obeid I, Pizones J, Sánchez Pérez-Grueso FJ, Karaman MI, Alanay A, Yilgor Ç, Ferguson SJ, Loibl M. Association between sagittal alignment and loads at the adjacent segment in the fused spine: a combined clinical and musculoskeletal modeling study of 205 patients with adult spinal deformity. 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 2023; 32:571-583. [PMID: 36526952 DOI: 10.1007/s00586-022-07477-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Sagittal malalignment is a risk factor for mechanical complications after surgery for adult spinal deformity (ASD). Spinal loads, modulated by sagittal alignment, may explain this relationship. The aims of this study were to investigate the relationships between: (1) postoperative changes in loads at the proximal segment and realignment, and (2) absolute postoperative loads and postoperative alignment measures. METHODS A previously validated musculoskeletal model of the whole spine was applied to study a clinical sample of 205 patients with ASD. Based on clinical and radiographic data, pre-and postoperative patient-specific alignments were simulated to predict loads at the proximal segment adjacent to the spinal fusion. RESULTS Weak-to-moderate associations were found between pre-to-postop changes in lumbar lordosis, LL (r = - 0.23, r = - 0.43; p < 0.001), global tilt, GT (r = 0.26, r = 0.38; p < 0.001) and the Global Alignment and Proportion score, GAP (r = 0.26, r = 0.37; p < 0.001), and changes in compressive and shear forces at the proximal segment. GAP score parameters, thoracic kyphosis measurements and the slope of upper instrumented vertebra were associated with changes in shear. In patients with T10-pelvis fusion, moderate-to-strong associations were found between postoperative sagittal alignment measures and compressive and shear loads, with GT showing the strongest correlations (r = 0.75, r = 0.73, p < 0.001). CONCLUSIONS Spinal loads were estimated for patient-specific full spinal alignment profiles in a large cohort of patients with ASD pre-and postoperatively. Loads on the proximal segments were greater in association with sagittal malalignment and malorientation of proximal vertebra. Future work should explore whether they provide a causative mechanism explaining the associated risk of proximal junction complications.
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Affiliation(s)
- Dominika Ignasiak
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland.
| | - Pascal Behm
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Anne F Mannion
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Fabio Galbusera
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Frank Kleinstück
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Tamás F Fekete
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Dezsö Jeszenszky
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Laura Zimmermann
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | | | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Obeid
- Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Çaglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Stephen J Ferguson
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Markus Loibl
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
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Tsekoura M, Katsoulaki M, Kastrinis A, Nomikou E, Fousekis K, Tsepis E, Billis E. The Effects of Exercise in Older Adults with Hyperkyphotic Posture. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:501-506. [PMID: 37581824 DOI: 10.1007/978-3-031-31986-0_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
The objective of this review was to investigate the effects of exercise in older adults with hyperkyphosis. Medline and Google Scholar databases were searched from June to August 2022 for studies related to exercise interventions in older adults above 60 years of age. All types of exercise interventions (such as strengthening, stretching, Yoga, and/or any other exercise with a focus on treatment or prevention of postural malalignment) were included. The keywords used were "hyperkyphosis," "exercise," and "older adults." Ten studies were included involving 625 older adults with hyperkyphotic posture. The exercise interventions included spine strengthening (strengthening of back and abdominal muscles), poses of Yoga and postural alignment, and flexibility and respiratory muscle exercises. Duration of exercise programs varied from 6 weeks (1 study) to 8 weeks (3 studies), 12 weeks (4 studies), and 6 months (3 studies). Exercise adherence was generally good in studies. In summary, low to moderate evidence suggest that exercises in age-related hyperkyphosis have a role in the management of this group of patients. It can be beneficial in order to improve postural control, spinal stability, and kyphosis outcomes. The adherence reported across studies suggests that exercise is an acceptable treatment option for people with age-related hyperkyphosis. Types of exercise and dose-response parameters of exercise eliciting improvement warrant further investigation. Due to heterogeneity in clinical trials, future research is needed with the goal of improving the health of our growing geriatric population.
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Affiliation(s)
- M Tsekoura
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece.
| | - M Katsoulaki
- "Physiodrasis," Physio and Rehab Clinic, Athens, Greece
| | - A Kastrinis
- Department of Physiotherapy, Health Assessment and Quality of Life Research Laboratory, University of Thessaly, Volos, Greece
| | - E Nomikou
- "The House" Physio and Rehab Clinic, Athens, Greece
| | - K Fousekis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece
| | - E Tsepis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece
| | - E Billis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece
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Matsumoto K, Shah A, Kelkar A, Mumtaz M, Kumaran Y, Goel VK. Sagittal Imbalance May Lead to Higher Risks of Vertebral Compression Fractures and Disc Degeneration-A Finite Element Analysis. World Neurosurg 2022; 167:e962-e971. [PMID: 36064117 DOI: 10.1016/j.wneu.2022.08.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Sagittal balance is an important clinical parameter of the spine for its normal function. Maintenance of the sagittal balance is crucial in the clinical management of spinal problems. METHODS Three different finite element models with spinal alignments based on Schwab's classification were developed: (1) Balanced/Normal model (sagittal vertical axis [SVA] = 0 mm, lumbar lordosis [LL] = 50°, thoracic kyphosis [TK] = 25°, pelvic incidence [PI] = 45°, pelvic tilt [PT] = 10°, sacral slope [SS] = 35°); (2) Balanced with compensatory mechanisms/Flatback model (SVA = 50 mm, LL = 20°, TK = 20°, PI = 45°, PT = 30°, SS = 15°); and (3) Imbalanced/Hyperkyphotic model (SVA = 150 mm, LL = -5°, TK = 25°, PI = 45°, PT = 40°, SS = 5°). All 3 models were subjected to the follower loads simulating bodyweight/muscular contractions along with the moments to simulate flexion, extension, lateral bending, and axial rotation. The maximum cortical vertebral stress, annular stress, and intradiscal pressure (IDP) were calculated and compared. RESULTS The results showed that the hyperkyphotic model had higher stresses in the vertebrae (25% higher), the annulus fibrosus (48% higher) and the IDP (8% higher) than the normal models in flexion. The segments near the thoracolumbar junction (T10-L1) showed the highest increase in the vertebral body stress, the annulus fibrosus stress, and the IDP. CONCLUSIONS This study showed that the imbalance in sagittal alignment might be responsible for disc degeneration and atraumatic vertebral fractures at the thoracolumbar regions, supporting clinical findings.
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Affiliation(s)
- Koji Matsumoto
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, Ohio, USA; Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Anoli Shah
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, Ohio, USA
| | - Amey Kelkar
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, Ohio, USA
| | - Muzammil Mumtaz
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, Ohio, USA
| | - Yogesh Kumaran
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, Ohio, USA
| | - Vijay K Goel
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, Ohio, USA.
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Iwasa M, Hamada H, Uemura K, Ando W, Takao M, Sugano N. Errors in the radiographic measurement of pelvic incidence. J Orthop Res 2022; 41:1266-1272. [PMID: 36317843 DOI: 10.1002/jor.25477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/27/2022] [Accepted: 10/28/2022] [Indexed: 11/15/2022]
Abstract
Pelvic incidence (PI) is often quantified in patients undergoing total hip arthroplasty. Errors in radiographic PI measurements can affect clinical outcomes. The purposes of this study were (1) to evaluate the error in radiographic PI measurement in patients with hip osteoarthritis (OA) and (2) to analyze the factors related to the error. Radiographs and computer tomography (CT) images of 100 patients (24 men and 76 women; mean age 63.7 years) with unilateral OA were reviewed. The error in radiographic PI measurement was defined as the difference between the radiographic measurement of the PI (rPI) and the accurate value of PI measured using CT images (cPI). Factors related to the error in the rPI were analyzed, including the coronal and axial rotation of the pelvis on lateral radiographs. The degree of coronal and axial rotation was expressed as the angle of rotation around the anteroposterior and craniocaudal axes. The mean rPI was significantly larger than the cPI (57.8° and 54.1°, p < 0.01). The error in the rPI was 3.6° on average and 15.8° at maximum. The mean coronal and axial rotation of the pelvis was 9.6° and 4.4°, respectively. The error in the rPI positively correlated with coronal pelvic rotation and rPI, and negatively correlated with axial pelvic rotation (p < 0.01, r = 0.35, 0.43, and -0.45, respectively). The rPI was 3.6° larger on average than the cPI in patients with hip OA. Coronal and axial rotation of the pelvis and a large PI were related to the error in the rPI.
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Affiliation(s)
- Makoto Iwasa
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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Zhou S, Zhong W, Sun Z, Guo Y, Zhao Y, Li W, Li W. The Standing and Sitting Spino-Pelvic Sagittal Alignment in Patients with Instrumented Lumbar Fusion Might Correlate with Adjacent Segment Degeneration. Orthop Surg 2022; 14:3313-3321. [PMID: 36303439 PMCID: PMC9732614 DOI: 10.1111/os.13553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 12/14/2022] Open
Abstract
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° ± 7.2° vs 9.7° ± 6.0°, 7.7° ± 8.3° vs 13.6° ± 8.5°, 2.2° ± 6.5° vs 5.4° ± 5.1°, respectively, p < 0.05). Increase of PT in the lumbosacral fixation group was lower than that in the control group (4.4° ± 9.1° vs 8.3° ± 7.1°, p < 0.05). Patients who had adjacent segments degeneration (ASD) showed more kyphosis in unfused lumbar segments than the other patients (16.4° ± 10.7° vs -1.0° ± 4.8°, 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.
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Affiliation(s)
- Siyu Zhou
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineMinistry of EducationBeijingChina
| | - Woquan Zhong
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineMinistry of EducationBeijingChina
| | - Zhuoran Sun
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineMinistry of EducationBeijingChina
| | - Yang Guo
- Department of OrthopaedicTianjin HospitalTianjinChina
| | - Yi Zhao
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineMinistry of EducationBeijingChina
| | - Wei Li
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineMinistry of EducationBeijingChina
| | - Weishi Li
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineMinistry of EducationBeijingChina
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Zhou S, Sun Z, Li W, Zou D, Li W. The Pelvic Incidence Stratified Sagittal Spinopelvic Alignment in Asymptomatic Chinese Population With Different Age Groups. Global Spine J 2022; 12:1821-1826. [PMID: 33472426 PMCID: PMC9609520 DOI: 10.1177/2192568221989647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To provide the age- and pelvic incidence-related variations of sagittal alignment in asymptomatic Chinese population. METHODS This study recruited asymptomatic adult subjects. All subjects undertook the standing whole spinal radiograph and the sagittal parameters were measured: sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI) and pelvic tilt (PT). All subjects were divided into young, middle aged and elderly groups, then each age group was further divided into 5 subgroups (very low, low, average, high and very high) based on PI values. The relations between PI, age and other parameters were evaluated. The differences in sagittal parameters of each PI subgroup were compared. RESULTS 546 subjects were included with an average age of 38.6 years (18 to 81). The number of subjects over 70 years and with very low PI was relatively small. The average of PI, TPA, PT and LL were 45.9° ± 8.4°, 6.4° ± 6.2°, 11.9° ± 6.6° and 49.2° ± 10.1°, respectively. SVA, TPA, TK and PT increased with age (P < 0.05), while SVA, TPA, PT, PI-LL also increased with PI (P < 0.05). LL, PT, TPA, PI-LL and LL-TK were different among the 5 PI subgroups (P < 0.05). However, the values of LL in elderly subjects with high and very high PI were similar. CONCLUSION The age- and PI-related variations in sagittal alignment of Chinese population were provided. The sagittal parameters were significantly influenced by age and PI. The individual pelvic morphology should be carefully considered during the assessment and restoration of sagittal balance.
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Affiliation(s)
- Siyu Zhou
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China
| | - Zhuoran Sun
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China
| | - Wei Li
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China
| | - Da Zou
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China
| | - Weishi Li
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China,Weishi Li, Department of Orthopaedic, Peking
University Third Hospital, Beijing 100191, China.
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Dietz N, Gruter BE, Nevzati E, Cho SK, Farshad M, Williams B, Hollis P, Spiessberger A. Compensatory mechanisms in adult degenerative thoracolumbar spinal deformity - Radiographic patterns, their reversibility after corrective surgery, and the influence of pelvic morphology. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:454-459. [PMID: 36777913 PMCID: PMC9910128 DOI: 10.4103/jcvjs.jcvjs_120_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Loss of lumbar lordosis (LL) in degenerative deformity activates spinal compensatory mechanisms to maintain neutral C7 sagittal vertical axis (C7SVA), such as an increase in pelvic tilt (PT) and decreased thoracic kyphosis (TK). We study the extent to which PT increase and TK reduction contribute to the compensation of pelvic incidence (PI)-LL mismatch. Methods A cohort of 43 adult patients with adult degenerative thoracolumbar deformity were included in this retrospective study. Radiographic spinopelvic measurements were obtained before and after corrective surgery. Pearson correlations were calculated. Results Preoperative PI-LL mismatch significantly correlated with an increase in PT and a decrease in TK in the whole cohort r = +0.66 (95% confidence interval [CI] 0.44-0.8) and r = -0.67 (95% CI - 0.81--0.47), respectively, at a relative rate of 0.37 (standard deviation [SD]: 0.07) and - 0.57 (SD: 0.09), respectively. In patients with low PI, only TK showed a significant correlation with PI-LL mismatch, r = -0.56 (95% CI - 0.8 to - 0.16), at a rate of - 0.57 (SD: 0.19). The high PI subgroup showed a significant correlation with PT, TK, and C7SVA, r = 0.62 (95% CI 0.26-0.82), r = -0.8 (95% CI - 0.9--0.58), and r = 0.71 (95% CI 0.41-0.87) at rates of 0.48 (SD: 0.11), -0.72 (SD: 0.12), and 0.62 (SD: 1.27). Conclusions Decreased TK represented a more consistent compensatory mechanism in patients with high and low PI when compared to an increase in PT. PI-LL mismatch induced more pronounced changes in TK than did PT in both subgroups. Patients with high PI relied more on increases in PT and a relative decrease in TK to compensate for PI-LL mismatch than patients with low PI.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | | | - Edin Nevzati
- Department of Neurosurgery, Luzerner Kantonsspital, Luzern, Switzerland
| | - Samuel K Cho
- Department of Orthopedic Surgery, Icahn School of Medicine, Mount Sinai Hospital, NY, USA
| | - Mazda Farshad
- Department of Orthopedic Surgery, "Balgrist" University Hospital Zurich, Zurich, Switzerland
| | - Brian Williams
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - Peter Hollis
- Department of Neurosurgery, North Shore University Hospital, NY, USA
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The T4-L1-Hip Axis: Defining a Normal Sagittal Spinal Alignment. Spine (Phila Pa 1976) 2022; 47:1399-1406. [PMID: 35867583 DOI: 10.1097/brs.0000000000004414] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a cross-sectional cohort. OBJECTIVE The aim was to describe sagittal plane alignment and balance in a multinational cohort of nondegenerated, asymptomatic adults. SUMMARY OF BACKGROUND DATA Current sagittal alignment targets were developed using correlations between radiographic and quality-of-life measures in spinal deformity patients, rather than disease-free samples leading to relatively poor accounting for variance within a population. MATERIALS AND METHODS Sagittal balance was defined using vertebral body tilt and spinopelvic alignment was defined as the vertebral pelvic angles from C2 to L5 (vertebral pelvic angle=vertebral tilt+pelvic tilt). Associations with pelvic incidence (PI) were assessed using linear regression. Multivariable linear regression was used to estimate a normal L1-S1 lordosis, adjusting for PI and the L1 pelvic angle (L1PA). Correlation between the L1 and T4 pelvic angles was assessed to define a normal thoracic alignment conditioned on lumbar alignment. RESULTS Among 320 volunteers from 4 continents, median age was 37% and 60% were female. C2 tilt was independent of PI with minimal variation. PI was inadequate for estimating a normal lumbar lordosis (L1-S1, r2 =0.3), but was strongly associated with the lumbar pelvic angles (L1PA, r2 =0.58). Defining lumbar lordosis as a function of PI and L1PA resulted in high explained variance ( R2 =0.74) and the T4 pelvic angle had near perfect correlation with the L1PA ( r =0.9). CONCLUSIONS We defined normal sagittal balance and spinopelvic alignment in a disease-free international volunteer cohort. Four parameters are either fixed or directly modifiable in surgery and can define a normal thoracic and lumbar alignment: the L1-S1 lordosis defined as a function of PI and the L1PA; and the T4 pelvic angle is nearly equivalent to the L1PA, aligning the T4-L1-hip axis.
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Comparison of Spinopelvic Configuration and Roussouly Alignment Types Between Pediatric and Adult Populations. Spine (Phila Pa 1976) 2022; 47:1303-1313. [PMID: 35797644 DOI: 10.1097/brs.0000000000004411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/03/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE The aim was to describe spinopelvic alignment types by pelvic incidence (PI) and age to compare the Roussouly classification between pediatric and adult populations. SUMMARY OF BACKGROUND DATA The Roussouly classification was validated for adults. Alignment types may vary during growth. MATERIALS AND METHODS Radiographs of 1706 non pathologic individuals (5-49 yr) were analyzed. Individuals ≤19 years were stratified by chronological age and skeletal maturity (triradiate cartilage, Risser), and compared with adults. Global and spinopelvic alignment parameters were assessed. Roussouly Types 1, 2, 3, 3A (anteverted pelvis), and 4 were determined. The distribution of parameters was analyzed by Bayesian inference. The relationship between PI and age by Roussouly type was modeled by linear regression. RESULTS The Sagittal Vertical Axis C7 decreased during growth and was significantly smaller in adults (20-34 yr) (Pr>0.99). Thoracic kyphosis and lumbar lordosis increased during growth and were larger in adults (Pr<0.025). Lordosis increased mainly in the cranial arch (Pr<0.025). PI and pelvic tilt increased during growth and were larger in adults (Pr<0.025). In children and adolescents, PI<45° represented the largest proportion, significantly larger compared with adults (Pr>0.99). Proportions of Roussouly Types 1 and 2 were similar throughout ages. Types 3 and 4 were rarer during the prepubertal period (Pr<0.025). The proportion of Type 3A was significantly higher in children and adolescents (Pr>0.99). Linear regression showed that Type 4 had the largest PI increase with age, with significantly higher curve slope compared with other types (Pr>0.9999). Types 3, 3A and 2 had similar slopes and lowest PI increase with age. CONCLUSION Global and spinopelvic alignment changed during childhood and adolescence, leading to different kyphosis and lordosis distribution compared with adults. Growth-related PI increase influenced Roussouly types with typical predominance of Type 3A in the pediatric population and larger PI increase in Type 4. LEVEL OF EVIDENCE Level III.
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Karabag H, Iplikcioglu AC, Dusak A, Karayol SS. Pelvic incidence measurement with supine magnetic resonance imaging: A validity and reliability study. Clin Neurol Neurosurg 2022; 222:107424. [PMID: 36030728 DOI: 10.1016/j.clineuro.2022.107424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/13/2022] [Accepted: 08/20/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Classically, pelvic incidence (PI) and other spinopelvic sagittal parameters are measured using plain x-ray obtained with the patient standing. However, it is difficult to obtain a perfect mid-sagittal appearance of the sacral endplate and superimposition of both femoral heads from a plain x-ray. Overlapping of the iliac wings also could obscure the appearance of the sacral endplate. Recent studies showed that MRI was more reliable than x-ray for evaluating some spinal sagittal parameters. To our knowledge, measurements of spinopelvic sagittal parameters using supine MRI have not been reported previously. We assessed the validity and reliability of measurements of spinopelvic sagittal parameters from standing lateral x-rays and supine magnetic resonance imaging (MRI). METHODS We recruited 26 asymptomatic volunteers for this study. Standing lateral lumbosacral radiographs, including femoral heads and spinopelvic MRI images with coronal images of the femoral heads were performed. The anatomic reference point required to measure PI was found on coronal MRI images and transferred to the midline sagittal MRI using the bladder wall as a second reference point. PI, sacral slope (SS), and pelvic tilt (PT) were measured on x-ray and MRI images. Validity and reliability of results also were tested. RESULTS Of 14 males and 12 females (average age, 31.30), PI was obtained from x-ray and MRI in 52. ± 6.89 and 51.42 ± 6.43, respectively. From standing x-ray to supine MRI, PT decreased by 3.16°, while SS increased 2.5°. A paired t-test showed a significant difference between PT values from x-ray and MRI. The correlation was highest between the x-ray and MRI measurements of PI, PT, and SS, respectively. Intraobserver and interobserver reliabilities were between 0.88 and 0.96 on x-ray and MRI. All reliabilities were excellent, although MRI values were higher. CONCLUSION MRI was more reliable in the measurement of spinopelvic parameters than classic standing x-ray examination. Higher reliability and being radiation-free could make MRI a good alternative to standing x-ray.
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Affiliation(s)
- Hamza Karabag
- Department of Neurosurgery, Harran University Faculty of Medicine, Şanlıurfa, Turkey.
| | | | - Abdurrahim Dusak
- Department of Radiology, Harran University Faculty of Medicine, Şanlıurfa, Turkey.
| | - Sunay Sibel Karayol
- Department of Radiology, Harran University Faculty of Medicine, Şanlıurfa, Turkey.
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Wang W, Kong C, Pan F, Wang Y, Wu X, Pei B, Lu S. Biomechanical comparative analysis of effects of dynamic and rigid fusion on lumbar motion with different sagittal parameters: An in vitro study. Front Bioeng Biotechnol 2022; 10:943092. [PMID: 36061438 PMCID: PMC9437262 DOI: 10.3389/fbioe.2022.943092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Although the management of the lumbar disease is highly dependent on the severity of the patient’s condition, optimal surgical techniques to reduce the risk of adjacent degeneration disease (ADS) remain elusive. Based on in vitro biomechanical tests of the cadaver spine, this study aimed to comparatively analyze the kinematic responses of the spine with dynamic and rigid fixations (i.e., Coflex fixation and posterolateral fusion) after single-or double-level lumbar fusion in daily activities. Methods: Six human lumbar specimens (L1-S1) were selected for this experiment, and the sagittal parameters of each lumbar specimen were measured in the 3D model. The specimens were successively reconstructed into five groups of models: intact model, single-level L4-5 Coflex fixation model, single-level L4-5 Fusion (posterior pedicle screw fixation) model, double-level L4-5 Coflex + L5-S1 Fusion model; and double-level L4-5 Fusion + L5-S1 Fusion model. The pure moment was applied to the specimen model to simulate physiological activities in daily life through a custom-built robot testing device with an optical tracking system. Results: For single-level lumbar fusion, compared to the traditional Fusion fixation, the Coflex dynamic fixation mainly restricted the extension of L4-L5, partially retained the range of motion (ROM) of the L4-L5 segment, and reduced the motion compensation of the upper adjacent segment. For the double-level lumbar fixation, the ROM of adjacent segments in the Coflex + Fusion was significantly decreased compared to the Fusion + Fusion fixation, but there was no significant difference. In addition, PT was the only sagittal parameter of the preoperative lumbar associated with the ROM under extension loading. The Coflex fixation had little effect on the original sagittal alignment of the lumbar spine. Conclusion: The Coflex was an effective lumbar surgical technique with a less altering kinematic motion of the lumbar both at the index segment and adjacent segments. However, when the Coflex was combined with the fusion fixation, this ability to protect adjacent segments remained elusive in slowing the accelerated degradation of adjacent segments.
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Affiliation(s)
- Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Fumin Pan
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Yu Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Xueqing Wu
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable and Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Baoqing Pei
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable and Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- *Correspondence: Baoqing Pei, ; Shibao Lu,
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
- *Correspondence: Baoqing Pei, ; Shibao Lu,
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Bahar ME, Hwang JS, Ahmed M, Lai TH, Pham TM, Elashkar O, Akter KM, Kim DH, Yang J, Kim DR. Targeting Autophagy for Developing New Therapeutic Strategy in Intervertebral Disc Degeneration. Antioxidants (Basel) 2022; 11:antiox11081571. [PMID: 36009290 PMCID: PMC9405341 DOI: 10.3390/antiox11081571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 12/25/2022] Open
Abstract
Intervertebral disc degeneration (IVDD) is a prevalent cause of low back pain. IVDD is characterized by abnormal expression of extracellular matrix components such as collagen and aggrecan. In addition, it results in dysfunctional growth, senescence, and death of intervertebral cells. The biological pathways involved in the development and progression of IVDD are not fully understood. Therefore, a better understanding of the molecular mechanisms underlying IVDD could aid in the development of strategies for prevention and treatment. Autophagy is a cellular process that removes damaged proteins and dysfunctional organelles, and its dysfunction is linked to a variety of diseases, including IVDD and osteoarthritis. In this review, we describe recent research findings on the role of autophagy in IVDD pathogenesis and highlight autophagy-targeting molecules which can be exploited to treat IVDD. Many studies exhibit that autophagy protects against and postpones disc degeneration. Further research is needed to determine whether autophagy is required for cell integrity in intervertebral discs and to establish autophagy as a viable therapeutic target for IVDD.
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Affiliation(s)
- Md Entaz Bahar
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Jin Seok Hwang
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Mahmoud Ahmed
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Trang Huyen Lai
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Trang Minh Pham
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Omar Elashkar
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Kazi-Marjahan Akter
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Gyeongsang National University, Jinju 52828, GyeongNam, Korea
| | - Dong-Hee Kim
- Department of Orthopaedic Surgery, Institute of Health Sciences, Gyeongsang National University Hospital and Gyeongsang National University College of Medicine, Jinju 52727, GyeongNam, Korea
| | - Jinsung Yang
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Deok Ryong Kim
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
- Correspondence: ; Tel.: +82-55-772-8054
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Charles YP, Bauduin E, Pesenti S, Ilharreborde B, Prost S, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Blondel B. Variation of Global Sagittal Alignment Parameters According to Gender, Pelvic Incidence, and Age. Clin Spine Surg 2022; 35:E610-E620. [PMID: 35383599 DOI: 10.1097/bsd.0000000000001321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE The aim was to describe existing global sagittal alignment parameters across ages and to analyze differences according to gender and pelvic incidence (PI). SUMMARY OF BACKGROUND DATA Variability with age has been reported. It remains unclear how gender and spinopelvic morphology could additionally influence global alignment parameters. MATERIALS AND METHODS Radiographs of 2599 individuals (5-93 y) were analyzed. Translation parameters were: Sagittal Vertical Axis (SVA)-C7, SVA-C2, SVA-Center Acoustic Meatus (CAM), C7/Sacrofemoral Distance (SFD) ratio. Inclination parameters were: C7-Vertical Tilt (VT), T1-VT and T9-VT, Odontoid-Hip Axis (OD-HA), OD-CAM. Pelvic compensation parameters were: T1-Pelvic Angle (TPA), Global Tilt (GT), Spino-Sacral Angle (SSA). Global sagittal alignment (GSA) was considered among formulae. The distribution of parameters was analyzed using a Bayesian inference. Correlations with spinopelvic parameters were investigated. RESULTS SVA-C7, SVA-C2, SVA-CAM were larger in males and high PI, and increased significantly after 50 years (Pr>0.9999). C7/SFD decreased during growth and was larger in low PI (Pr=0.951). There was no correlation with spinopelvic parameters. Age-related variations of inclination parameters were nonsignificant. T1-VT and T9-VT increased with PI and were significantly larger in high PI (Pr>0.95). C7-VT was significantly larger in low PI (Pr>0.9999). OD-HA and OD-CAM were constant and increased after 80 years. TPA and GT increased with PI (Pr>0.9999) and age after 35 years (Pr>0.9999). SSA decreased nonsignificantly after 50 years. TPA correlated with PI (ρ=0.6130) and pelvic tilt (PT) (ρ=0.8375). GT correlated with PI (ρ=0.5961) and PT (ρ=0.8996). SSA correlated with sacral slope (ρ=0.9026). GSA was larger in high PI (Pr>0.9999) and increased after 35 years (Pr>0.9999). GSA correlated with PT (ρ=0.7732). CONCLUSION Translation parameters increase with age, more prominently in males and high PI. Variations of inclination parameters are smaller. Pelvic compensation parameters and GSA increase with age and are closely related to PT and spinopelvic morphology. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yann P Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims
| | - Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris
| | - Federico Solla
- Service d'Orthopédie Pédiatrique, Fondation Lenval, Nice
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, Bordeaux
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris
| | - Georges N Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris
| | | | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris
| | - Jonathan Lebhar
- Institut Locomoteur de l'Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire
| | | | | | - Erik A Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille
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Wang W, Pei B, Wu S, Lu D, He P, Ma C, Wu X. Biomechanical responses of human lumbar spine and pelvis according to the Roussouly classification. PLoS One 2022; 17:e0266954. [PMID: 35905050 PMCID: PMC9337691 DOI: 10.1371/journal.pone.0266954] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background Few studies have analyzed the different biomechanical properties of the lumbar with various morphological parameters, which play an important role in injury and degeneration. This study aims to preliminarily investigate biomechanical characteristics of the spine with different sagittal alignment morphotypes by using finite element (FE) simulation and in-vitro testing. Methods According to the lumbar-pelvic radiographic parameters of the Chinese population, the parametric FE models (L1-S1-pelvis) of Roussouly’s type (1–4) were validated and developed based on the in-vitro biomechanical testing. A pure moment of 7.5 Nm was applied in the three anatomical planes to simulate the physiological activities of flexion, extension, left-right lateral bending and left-right axial rotation. Results The sagittal configuration of four Roussouly’s type models had a strong effect on the biomechanical responses in flexion and extension. The apex of the lumbar lordosis is a critical position where the segment has the lowest range of motion among all the models. In flexion-extension, type 3 and 4 models with a good lordosis shape had a more uniform rotation distribution at each motor function segment, however, type 1 and 2 models with a straighter spine had a larger proportion of rotation at the L5-S1 level. In addition, type 1 and 2 models had higher intradiscal pressures (IDPs) at the L4-5 segment in flexion, while type 4 model had larger matrix and fiber stresses at the L5-S1 segment in extension. Conclusion The well-marched lordotic type 3 lumbar had greater stability, however, a straighter spine (type 1 and 2) had poor balance and load-bearing capacity. The hypolordotic type 4 model showed larger annulus fiber stress. Therefore, the sagittal alignment of Roussouly’s type models had different kinetic and biomechanical responses under various loading conditions, leading to different clinical manifestations of the lumbar disease.
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Affiliation(s)
- Wei Wang
- Beijing key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Baoqing Pei
- Beijing key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- * E-mail: (BP); (SW)
| | - Shuqin Wu
- School of Big Data and Information, Shanxi Polytechnic Institute, Shanxi, China
- * E-mail: (BP); (SW)
| | - Da Lu
- Beijing key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Peiyan He
- Beijing key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Chenghao Ma
- Beijing key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xueqing Wu
- Beijing key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Prasse T, Hofstetter CP, Heck VJ, Meyer C, Wetsch WA, Scheyerer MJ, Eysel P, Bredow J. Current Evidence on where to End a Fusion within the Thoracolumbar Junction Most Preferably - A Systematic Literature Review. Neurochirurgie 2022; 68:648-653. [PMID: 35817090 DOI: 10.1016/j.neuchi.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022]
Abstract
Proximal junctional kyphosis (PJK) is one main complication in the surgical treatment of adult spinal deformities. Ending within the thoracolumbar junction (TLJ) should but cannot always be avoided to reduce the risk for PJK. With this systematic review we sought to define the most preferable vertebra within the TLJ to minimize the risk for PJK and establish recommendations based on our findings. We conducted a systematic literature review by scanning the MEDLINE database in accordance with the PRISMA criteria. All articles addressing primary long-distance dorsal thoracolumbar fusion of at least three segments to treat adult spinal deformities were included. 1385 articles were identified and three were included to this review. The first study showed significantly higher rates of PJK in patients where the construct was extended to T7 or higher when compared to an ending at T11 to L1. The second article stated that an expansion to the TLJ resulted in significantly less surgical revisions due to PJK reduction. On the other hand, the third article found that a fusion of the whole thoracic spine reduces the PJK incidence postoperatively. Even though the most favorable vertebra within the TLJ to avoid PJK best could not yet be determined, our study identifies several principles that represent the current state of evidence for surgical treatment of adult scoliosis. Proper preoperative decision making based on thorough analysis and interpretation of the patient's sagittal alignment parameters can improve the individual outcome critically.
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Affiliation(s)
- T Prasse
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Street 62, 50937 Cologne, Germany.
| | - C P Hofstetter
- University of Washington, Department of Neurological Surgery, 1959 NE Pacific Street, 98195 Seattle, USA
| | - V J Heck
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Street 62, 50937 Cologne, Germany
| | - C Meyer
- Center for Spinal Surgery, Helios Klinikum Bonn/Rhein-Sieg, Von-Hompesch-Straße 1, 53123 Bonn, Germany
| | - W A Wetsch
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anesthesiology and Intensive Care, Kerpener Street 62, 50937 Cologne, Germany
| | - M J Scheyerer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Street 62, 50937 Cologne, Germany
| | - P Eysel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Street 62, 50937 Cologne, Germany
| | - J Bredow
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Urbacher Weg 19, 51149 Cologne, Germany
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Tsutsui S, Yamamoto E, Kozaki T, Murata A, Yamada H. Biomechanical study of rod stress in lumbopelvic fixation with lateral interbody fusion: an in vitro experimental study using synthetic bone models. J Neurosurg Spine 2022; 37:73-79. [PMID: 35171839 DOI: 10.3171/2021.11.spine21807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite improvements in surgical techniques and instruments, high rates of rod fracture following a long spinal fusion in the treatment of adult spinal deformity (ASD) remain a concern. Thus, an improved understanding of rod fracture may be valuable for better surgical planning. The authors aimed to investigate mechanical stress on posterior rods in lumbopelvic fixation for the treatment of ASD. METHODS Synthetic lumbopelvic bone models were instrumented with intervertebral cages, pedicle screws, S2-alar-iliac screws, and rods. The construct was then placed in a testing device, and compressive loads were applied. Subsequently, the strain on the rods was measured using strain gauges on the dorsal aspect of each rod. RESULTS When the models were instrumented using titanium alloy rods at 30° lumbar lordosis and with lateral interbody fusion cages, posterior rod strain was highest at the lowest segment (L5-S1) and significantly higher than that at the upper segment (L2-3) (p = 0.002). Changing the rod contour from 30° to 50° caused a 36% increase in strain at L5-S1 (p = 0.009). Changing the rod material from titanium alloy to cobalt-chromium caused a 140% increase in strain at L2-3 (p = 0.009) and a 28% decrease in strain at L5-S1 (p = 0.016). The rod strain at L5-S1 using a flat bender for contouring was 23% less than that obtained using a French bender (p = 0.016). CONCLUSIONS In lumbopelvic fixation in which currently available surgical techniques for ASD are used, the posterior rod strain was highest at the lumbosacral junction, and depended on the contour and material of the rods.
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Affiliation(s)
- Shunji Tsutsui
- 1Department of Orthopaedic Surgery, Wakayama Medical University; and
| | - Ei Yamamoto
- 2Department of Biomedical Engineering, Faculty of Biology-Oriented Science and Technology, Kindai University, Wakayama, Japan
| | - Takuhei Kozaki
- 1Department of Orthopaedic Surgery, Wakayama Medical University; and
| | - Akimasa Murata
- 1Department of Orthopaedic Surgery, Wakayama Medical University; and
| | - Hiroshi Yamada
- 1Department of Orthopaedic Surgery, Wakayama Medical University; and
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