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Cochrane D, Leyten C. Investigating scapula positioning in individuals with non-specific lower back pain: A preliminary study. J Bodyw Mov Ther 2024; 38:47-53. [PMID: 38763595 DOI: 10.1016/j.jbmt.2023.12.007] [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: 04/08/2022] [Revised: 08/31/2023] [Accepted: 12/21/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Low back pain (LBP) is an economic and physically disabling burden on individuals and society. With 70% of cases classed as non-specific, there is a need for further research into the causes and consequences associated. The involvement of postural balance in musculoskeletal conditions is gaining increasing interest in research and health practice. However, there is a lack of literature surrounding LBP and posture in distal segments of the body. OBJECTIVE The current study investigated scapula positioning in those with non-specific LBP. METHODS Scapula angle of rotation, scapula protraction, and scapula elevation were assessed in nine participants with chronic non-specific LBP and compared with that of nine asymptomatic controls (aged 18-60 years). The degree of pelvic tilt was assessed across both groups as a secondary outcome measure. RESULTS No difference was identified between the two sample groups for scapula angle of rotation (p = 0.707), protraction (p = 0.755), or elevation (p = 0.691). Anterior pelvic tilt was greater in those with LBP (p = 0.046), supporting previous literature. CONCLUSION The findings for the scapula position are novel, given that research in this field is limited. It is concluded that there is no change in scapula positioning in those with non-specific LBP, but there is an increased anterior pelvic tilt.
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Affiliation(s)
- Darryl Cochrane
- School of Sport, Exercise & Nutrition, Massey University, New Zealand.
| | - Cara Leyten
- School of Sport, Exercise & Nutrition, Massey University, New Zealand
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Sima S, Lapkin S, Diwan AD. In subjects with chronic low back pain, does neuropathia exclusively correlated to neuronal compression? A correlation study of PainDETECT questionnaire and corresponding MRI and X-ray findings. 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; 33:1465-1473. [PMID: 38300298 DOI: 10.1007/s00586-024-08156-2] [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: 10/12/2023] [Revised: 11/28/2023] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Understanding the complex nature of low back pain (LBP) is crucial for effective management. The PainDETECT questionnaire is a tool that distinguishes between neuropathic (NeP), nociceptive (NoP), and ambiguous pain. This study aimed to investigate the relationship between pain classification and lumbar intervertebral degenerative parameters obtained from imaging. METHODS A cohort study was conducted involving 279 patients, aged 18 years and above, who completed PainDETECT questionnaires and underwent lumbar MRI and/or X-ray scans. RESULTS The study included 102 patients with NoP, 78 with ambiguous pain, and 99 with NeP. The NeP group had lower mean age (58.21 vs. 53.63, p < 0.05) and higher mean numerical rating scale score (7.9 vs. 5.9, p < 0.001) compared to the NoP group. A negative correlation was found between PainDETECT scores and pelvic incidence (τ = - 0.177, p = 0.043). The NeP group exhibited significantly higher severity of foraminal stenosis (U = 18.962, p = 0.002), spinal stenosis (U = 14.481, p = 0.005), and Pfirrmann grade (U = 14.221, p = 0.028) compared to the NoP group. A higher proportion of NeP patients had intervertebral disk bulge (96% vs. 78% vs. 78%, p = 0.002) and high-intensity zones (51% vs. 41% vs. 19%, p < 0.001) compared to those with NoP and ambiguous pain. CONCLUSION NeP, as determined by the PainDETECT questionnaire, is associated with more severe neural compression, increased presence of discogenic disease and inflammatory disk severity, and decreased pelvic incidence. This pioneering study establishes a connection between pathological findings and pain categorization, providing clinicians with valuable guidance for formulating tailored management plans and reducing the need for unnecessary pharmacotherapy, imaging, and non-targeted surgical interventions.
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Affiliation(s)
- Stone Sima
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW, 2217, Australia
| | - Samuel Lapkin
- Faculty of Health, Southern Cross University, Bilinga, QLD, 4225, Australia.
| | - Ashish D Diwan
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW, 2217, Australia
- Spine Service, Department of Orthopaedic Surgery, St George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW, 2217, Australia
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Huang C, Hsieh YL, Chou LW, Wang JL, Chien A. Effects of pilates exercises on radiographic lumbo-pelvic alignment and range of motion in non-specific low back pain patients. J Bodyw Mov Ther 2024; 38:339-345. [PMID: 38763578 DOI: 10.1016/j.jbmt.2023.10.004] [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: 12/21/2022] [Revised: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 05/21/2024]
Abstract
OBJECTIVES To determine the effects of Pilates exercises on lumbo-pelvic alignment in non-specific low back pain (NSLBP) patients. METHODS Twenty-two patients (Male:7; Female:15) with NSLBP aged 20-65 years were recruited and classified based on a modified O'Sullivan's classification system into flexion pattern (FP) or active extension pattern (EP) groups. Oswestry Disability index (ODI), Roland-Morris Disability Questionnaire (RMDQ) as well as radiographic lumbar global range of motion (ROM) and lumbo-pelvic alignment were measured Pre- and immediately post-intervention and at 6- and 12-month. The intervention included supervised six-weeks Pilates program with 60 min per session and up to two sessions per week. RESULTS Lumbar lordosis, sacral slope and sacral inclination were found to be significantly different between the FP and EP groups based on the O'Sullivan's classification system. However, despite the significant changes in RMDQ (p = 0.001), no significant changes were found for any of the alignment parameters (p > 0.05) post intervention for both groups. For lumbar global ROM, a statistically significant change was observed for the EP group (p = 0.028) but not for the FP group (p = 0.249). No significant correlations were identified between any of the self-reported outcomes, radiographic alignment and ROM parameters. CONCLUSIONS Patients self-perceived long-term functional improvements based on responding to questionnaires after Pilates exercises were not reflected in significant changes in lumbo-pelvic alignment or lumbar ROM. This may be due to the current cohort demonstrating within normal ranges due to the lesser severity of their condition, but further research is needed for clarification.
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Affiliation(s)
- Ching Huang
- Department of Physical Therapy, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Yueh-Ling Hsieh
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Li-Wei Chou
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan; Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Jaw-Lin Wang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Andy Chien
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan; Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
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Alam MF, Ansari S, Zaki S, Sharma S, Nuhmani S, Alnagmoosh A, Alsubaiei ME. Effects of physical interventions on pain and disability in chronic low back pain with pronated feet: a systematic review and meta-analysis. Physiother Theory Pract 2024:1-15. [PMID: 38433468 DOI: 10.1080/09593985.2024.2325581] [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: 10/04/2023] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND A link between pronated feet (PF) and chronic low back pain (CLBP) has been reported in the literature. However, physical interventions (PI) like physiotherapy and orthotics mainly target the lower back, neglecting the broader biomechanical impacts of PF that affect the feet, ankles, and overall posture. Currently, there is a lack of comprehensive meta-analyses or systematic reviews on this subject. OBJECTIVES This systematic review with a meta-analysis aimed to evaluate the effects of PI on pain and disability in patients having CLBP with PF. METHODS From inception until October 15, 2023, Medline/PubMed, Web of Science, and Scopus databases were searched using the desired keywords for randomized control trials (RCTs). The quality of the RCTs was evaluated using the PEDro scale and risk of bias tool. RESULTS Four studies involving 268 patients were identified, two compared custom-made foot orthoses to non-biomechanical foot insoles, while the other two used exercises. The meta-analysis included four studies for pain and three for disability. The results showed a significant change in pain [-2.43 (95% CI -2.73 to -2.13, p < .001)] and disability of -6.69 (95% CI -8.04 to -5.33, p < .001)]. CONCLUSIONS This systematic review and meta-analysis of four RCTs elucidates that PI, specifically targeting PF, significantly alleviate pain and reduce disability in patients having CLBP with PF. These findings advocate for integrating foot-based PI within the treatment protocols for patients suffering from CLBP accompanied by PF.
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Affiliation(s)
- Md Farhan Alam
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Sumbul Ansari
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Saima Zaki
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Saurabh Sharma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Abdullah Alnagmoosh
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Mohammed Essa Alsubaiei
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
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Holzgreve F, Nazzal C, Nazzal R, Golbach R, Groneberg DA, Maurer-Grubinger C, Wanke EM, Ohlendorf D. Differences in upper body posture between patients with lumbar spine syndrome and healthy individuals under the consideration of sex, age and BMI. J Occup Med Toxicol 2024; 19:6. [PMID: 38355494 PMCID: PMC10868076 DOI: 10.1186/s12995-024-00405-w] [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: 12/22/2023] [Accepted: 02/12/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Work-related forced postures, such as prolonged standing work, can lead to complaints in the lower back. Current research suggests that there is increased evidence of associations between patients with low back pain (LBP) and reduced lordosis in the lumbar spine and generally less spinal tilt in the sagittal plane. The aim of this study is to extend the influence of LBP to other parameters of upper body posture in standing, taking into account the rotational and frontal planes. METHODS The study included a no-LBP group (418 males, 412 females, aged 21-65 years) and an LBP group (138 subjects: 80 females, 58 males, aged 18-86 years) with medically diagnosed lumbar spine syndrome (LSS). The "ABW BodyMapper" back scanner from ABW GmbH in Germany was used for posture assessment using video raster stereography. Statistical analyses employed two-sample t-tests or Wilcoxon-Mann-Whitney-U tests to assess the relationship between the LBP/no-LBP groups and back posture parameters. Linear and logarithmic regressions were used with independent variables including group, sex, height, weight and body mass index (BMI). Significance level: α = 0.05 (95% confidence). RESULTS The regression analysis showed that sagittal parameters of the spine (sagittal trunk decline, thoracic and lumbar bending angle, kyphosis and lordosis angles) depend primarily on sex, age, BMI, height and/or weight but not on group membership (LBP/no-LBP). In the shoulder region, a significant dependency between group membership and scapular rotation was found. In the pelvic region, there were only significant dependencies in the transverse plane, particularly between pelvic torsion and BMI, weight, height and between pelvic rotation and group membership, age and sex. CONCLUSION No difference between the patients and healthy controls were found. In addition, sex appears to be the main influencing factor for upper body posture. Other influencing factors such as BMI, height or weight also seem to have a significant influence on upper body posture more frequently than group affiliation.
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Affiliation(s)
- Fabian Holzgreve
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt am Main, Germany.
| | - Celine Nazzal
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt am Main, Germany
| | - Rasem Nazzal
- , Physiotherapy practice, Dr. Rasem Nazzal, Frankfurt, Germany
| | - Rejane Golbach
- Institute for Biostatistics and Mathematical Modeling, Center of Health Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt am Main, Germany
| | - Christian Maurer-Grubinger
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt am Main, Germany
| | - Eileen M Wanke
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt am Main, Germany
| | - Daniela Ohlendorf
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt am Main, Germany
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Shakeri M, Mahdavi SM, Rikhtehgar M, Soleimani M, Ghandhari H, Jafari B, Daneshmand S. EOS® is reliable to evaluate spinopelvic parameters: a validation study. BMC Med Imaging 2024; 24:35. [PMID: 38321400 PMCID: PMC10845382 DOI: 10.1186/s12880-023-01178-0] [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: 09/01/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Sagittal and coronal standing radiographs have been the standard imaging for assessing spinal alignment. However, their disadvantages include distortion at the image edges and low interobserver reliability in some parameters. EOS® is a low-dose biplanar digital radiographic imaging system that can avoid distortion by obtaining high-definition images. METHODS This study aimed to evaluate spinopelvic parameters in conventional lateral C1S1 upright radiographs and EOS® images and compare them. Patients with non-deformity changes were subjected to routine clinical examinations. Plain AP and lateral X-ray radiographs were obtained along the entire spine length. Patients were also referred for full-length EOS® of the spine. Thoracic Kyphosis (TK), Lumbar Lordosis (LL), Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), and Sagittal Vertical Axis (SVA) were measured in the two studies by an orthopedic surgeon and a radiologist using PACS software. Also, the orthopedic surgeon evaluated the studies again after two weeks. Intra- and inter-observer reliability was then assessed using the interclass correlation coefficient (ICC). Also, the coefficient of variation was used to assess intra- and inter-observer reliability. Bland-Altman plots were drawn for each parameter. RESULTS The mean age was 48.2 ± 6.6 years. Among the 50 patients, 30 (60%) were female. The mean ICC for TK, LL, PT, SS, PI, and SVA in EOS® images are 0.95, 0.95, 0.92, 0.90, 0.94, and 0.98, respectively, and in C1S1 radiography images, it was 0.92, 0.87, 0.94, 0.88, 0.93, and 0.98, respectively which shows good to excellent results. The coefficient of variation for intraobserver reliability was relatively low (< 18.6%), while it showed higher percentages in evaluating interobserver reliability (< 54.5%). Also, the Bland-Altman plot showed good agreement for each parameter. CONCLUSION Spinopelvic parameters, e.g., TK, LL, SS, PI, and SS, in EOS® are reliable and comparable to those in conventional lateral upright C1S1 radiographs.
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Affiliation(s)
- Mohammadreza Shakeri
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mani Mahdavi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masih Rikhtehgar
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Ghandhari
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Jafari
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedehsan Daneshmand
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Li T, Li Y, Wang W. Association between cup orientation and low back pain after total hip arthroplasty in patients with osteonecrosis of the femoral head. BMC Musculoskelet Disord 2024; 25:10. [PMID: 38167127 PMCID: PMC10759751 DOI: 10.1186/s12891-023-07139-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Postoperative low back pain (LBP) following total hip arthroplasty (THA) is classified as secondary hip-spine syndrome. The purpose of this study was to explore the correlations between cup orientation of THA and postoperative LBP in patients with osteonecrosis of the femoral head (ONFH). METHODS A retrospective cohort study included 364 ONFH patients who underwent bilateral THA between January 2011 and December 2020. Among them, 53 patients (14.6%) experienced postoperative LBP at the end of follow-up and were designated as pain group (PG). A control group (CG) consisting of 106 patients with similar age, sex, and body mass index (BMI) to those in the PG was selected. Postoperative LBP in the PG was assessed using the visual analogue scale (VAS). Demographic data, clinical information, and radiographic criteria were evaluated as potential predictors of LBP. RESULTS Patients in PG (mean age, 47.3 years [range, 27 to 75 years]; 42 [79%] male) had a mean VAS score of 4.6 (range, 1 to 9) compared with 0 for the patients in CG (mean age, 47.6 years [range, 19 to 77 years]; 84 [79%] male). There were no significant differences in clinical data between the two groups (p > 0.05). Preoperative radiographic variables also showed no significant differences between the PG and CG (p > 0.05). However, the postoperative inclination, anteversion, and standing ante-inclination (AI) were significantly lower in the PG compared to the CG, whereas the sitting and standing sacral slope (SS) were significantly higher (p < 0.05). Moreover, the variations in standing AI, standing and sitting pelvic tilt (PT) were significantly lower in the PG compared to the CG, while the variations in standing and sitting SS and lumbar lordosis (LL) were significantly higher (p < 0.05). The variation in standing AI in the PG showed a significantly correlation with the variation of standing SS, standing PT, and LL (p < 0.05). CONCLUSION Postoperative LBP in ONFH patients after bilateral THA is significantly associated with the intraoperative cup orientation. The variation in standing AI is correlated with the variations in standing SS, standing PT, and LL, potentially contributing to the development of postoperative LBP.
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Affiliation(s)
- Tong Li
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, China
| | - Yifei Li
- 15th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiguo Wang
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, China.
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Okuzu Y, Goto K, Kuroda Y, Kawai T, Matsuda S. How Do Spinal Parameters Change in Patients Who Have Improvement of Low Back Pain After Total Hip Arthroplasty? A Propensity Score-Matched Cohort Study. J Arthroplasty 2024; 39:132-137. [PMID: 37331437 DOI: 10.1016/j.arth.2023.06.021] [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: 01/10/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Many studies have demonstrated that low back pain (LBP) improves after total hip arthroplasty (THA). However, the mechanism underlying this improvement remains unclear. We aimed to investigate changes in the spinal parameters of patients who had LBP improvement after THA to elucidate the mechanism of LBP improvement. METHODS We included 261 patients who underwent primary THA between December 2015 and June 2021 and had a preoperative visual analog scale score of ≥ 2 for LBP. The patients were classified into the LBP-improved or LBP-continued groups based on the visual analog scale for LBP at 1 year after THA. Preoperative and postoperative changes in the coronal and sagittal spinal parameters were compared between the 2 groups after propensity score matching for age, sex, body mass index, and preoperative spinal parameters. RESULTS A total of 161 patients (61.7%) were classified into the LBP-improved group. After 85 patients in both groups were matched, the LBP-improved group showed significant differences in spinal parameter changes, which were a higher lumbar lordosis (LL) (P = .04) and lower sagittal vertical axis (SVA) (P = .02) and pelvic incidence (PI) minus LL (PI-LL) (P = .01) postoperatively, whereas the LBP-continued group showed worsened changes in LL and SVA and PI-LL mismatch. CONCLUSION Patients who had LBP improvement after THA had significant differences in spinal parameter changes in LL, SVA, and PI-LL. These spinal parameters may be the key factors in the mechanism of LBP improvement after THA.
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Affiliation(s)
- Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
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Kook M, Kim I, Seo J, Kim H, Nam H, Han N. The Relationship Between Low Back Pain and Sagittal Spinal Alignment and Back Muscle Mass in Korean Fishery Workers. Ann Rehabil Med 2023; 47:459-467. [PMID: 37990502 PMCID: PMC10767211 DOI: 10.5535/arm.23075] [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: 06/19/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To investigate the relationship between low back pain (LBP) and sagittal spino-pelvic parameters along with the relationship between LBP and back muscle mass in Korean male and female fishery workers. METHODS This retrospective study included a total of 146 subjects who underwent Fishermen's health survey conducted between June 2018 and August 2020. LBP was evaluated through visual analogue scale (VAS) and Oswestry Disability Index (ODI). Sagittal spino-pelvic parameters were measured from whole spine standing X-rays. Back muscle cross-sectional areas were identified through lumbar spine magnetic resonance imaging and body composition was analyzed through bioelectrical impedance analysis. RESULTS The study included 75 males and 71 females, with an average age of 58.33 years for males and 56.45 years for females. Female subjects exhibited higher VAS and ODI scores, larger pelvic tilt (PT) and trunk fat mass and smaller trunk muscle mass compared to males. In female, ODI positively correlated with sagittal vertical axis (SVA) and PT. No significant correlations were found between ODI scores and body composition in either sex. The high ODI group showed greater SVA, PT, and pelvic incidence-lumbar lordosis and higher trunk fat/muscle ratio. Psoas muscle mass, total and skeletal muscle mass and trunk muscle mass of that group were smaller than those of low ODI group. CONCLUSION Spino-pelvic parameters and back muscle mass were associated with ODI and there were differences between Korean male and female fishery workers.
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Affiliation(s)
- Minjung Kook
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Insuh Kim
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jeongyeon Seo
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyundong Kim
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- Center for Fishermen’s Safety and Health, Inje University Busan Paik Hospital, Busan, Korea
| | - Heesung Nam
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nami Han
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- Center for Fishermen’s Safety and Health, Inje University Busan Paik Hospital, Busan, Korea
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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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Mirzashahi B, Hajializade M, Abdolahi Kordkandi S, Farahini H, Moghtadaei M, Yeganeh A, Amiri S, Mahdavi SM. Spinopelvic Parameters as Risk Factors of Nonspecific Low Back Pain: A Case-Control Study. Med J Islam Repub Iran 2023; 37:61. [PMID: 37457419 PMCID: PMC10349355 DOI: 10.47176/mjiri.37.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Indexed: 07/18/2023] Open
Abstract
Background The effect of spinopelvic alignment on low back pain (LBP) incidence has been studied in many investigations. However, the interrelation between spinopelvic parameters and LBP is poorly understood. In particular, it is unknown whether particular patterns of spinopelvic parameters render nonspecific LBP. In this study, we aimed to evaluate the role of spinopelvic parameters as risk factors of nonspecific LBP. Methods In this case-control study, spinopelvic parameters, including lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI), were compared between 148 patients with nonspecific LBP and 148 healthy controls. Demographic characteristics of the patients, such as age, gender, occupation, smoking, diabetes mellitus, and body mass index (BMI), were recorded as confounders. Spinopelvic parameters were assessed using radiographic findings in 2 groups. The analysis was done once as univariate (Kolmogorov-Smirnov test) and once as multivariate (multivariate logistic regression) analysis. Results Univariate analysis showed that female gender, higher BMI, smoking, and blue-collar jobs were associated with a higher risk of nonspecific LBP. LL, SS, and PI, but not PT, were all greater in LPB patients in the univariate analysis regarding the spinopelvic parameters. Multivariate analysis showed female gender (odds ratio adjusted (ORAdj) = 4.26 [95% CI, 2.11-9.58]; P = 0.001) and LL (ORAdj = 1.58; [95% CI, 1.18-3.22]; P = 0.026) were predictable risk factors for Nonspecific LBP. Conclusion Spinopelvic parameters, particularly LL, could be considered as risk factors of nonspecific LBP so that a more significant LL might indicate a greater risk of LBP. However, the role of other parameters in this association could not be neglected.
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Affiliation(s)
- Babak Mirzashahi
- Department of Orthopedic Surgery, Joint Reconstruction Research Center,
Tehran University of Medical Sciences, Tehran, Iran
| | - Mikaiel Hajializade
- Department of Orthopedics, Rasul-e Akram Hospital, Iran University of
Medical Sciences, Tehran, Iran
| | - Shadi Abdolahi Kordkandi
- Department of Orthopedics, Rasul-e Akram Hospital, Iran University of
Medical Sciences, Tehran, Iran
| | - Hossein Farahini
- Department of Orthopedics, Rasul-e Akram Hospital, Iran University of
Medical Sciences, Tehran, Iran
| | - Mehdi Moghtadaei
- Department of Orthopedics, Rasul-e Akram Hospital, Iran University of
Medical Sciences, Tehran, Iran
| | - Ali Yeganeh
- Department of Orthopedic Surgery, Iran University of Medical Sciences,
Tehran, Iran
| | - Shayan Amiri
- Shohadaye Haftom-e-tir Hospital, Department of Orthopedics, School of
Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mani Mahdavi
- Department of Orthopedics, Rasul-e Akram Hospital, Iran University of
Medical Sciences, Tehran, Iran
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12
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Zhang Z, Wang L, Li JC, Liu LM, Song YM, Yang X. Characteristics of Sagittal Alignment in Patients with Severe and Rigid Scoliosis. Orthop Surg 2023. [PMID: 37154161 DOI: 10.1111/os.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE There has been increasing concern about the importance of sagittal alignment in the evaluation and treatment of spinal scoliosis. However, recent studies have only focused on patients with mild to moderate scoliosis. To date, little is known about the sagittal alignment in patients with severe and rigid scoliosis (SRS). This study was performed to evaluate the sagittal alignment in patients with SRS, and to analyze how it was altered after corrective surgery. METHODS In this retrospective cohort study, we included 58 patients with SRS who underwent surgery from January 2015 to April 2020. Preoperative and postoperative radiographs were reviewed, and the sagittal parameters mainly included thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacrum slope (SS), and sagittal vertical axis (SVA). The sagittal balance state was evaluated according to whether the PI minus the LL (PI-LL) was less than 9°, and the patients were divided into thoracic hyperkyphosis and normal groups based on whether the TK exceeded 40°. The Student's t test, Pearson's test, and Receiver operating characteristic (ROC) curve analysis were used to compare related parameters between the different groups. RESULTS The mean follow-up duration was 2.8 years. Preoperatively, the mean PI was 43.6 ± 9.4°, and the mean LL was 65.2 ± 13.9°. Sixty-nine percent of patients showed sagittal imbalance, and they showed larger TK and LL values and smaller PI and SVA values than those with sagittal balance. Additionally, most patients (44/58) presented with thoracic hyperkyphosis; this group had smaller PI and SVA values than the normal patients. Patients with syringomyelia-associated scoliosis were more likely to present with thoracic hyperkyphosis. The TK and LL values were significantly decreased, and 45% of patients with preoperative sagittal imbalance recovered after surgery. These patients had a larger PI (46.4 ± 9.0° vs 38.3 ± 8.8°, P = 0.003) and a smaller TK (25.5 ± 5.2° vs 36.3 ± 8.0°, P = 0.000) at the final follow-up. CONCLUSION Preoperative sagittal imbalance appears in the majority of SRS patients, accounting for approximately 69% of our cohort. Patients with small PI values or syringomyelia-associated scoliosis were more likely to present with thoracic hyperkyphosis. Sagittal imbalance can generally be corrected by surgery, except in patients with a PI less than 39°. To achieve good postoperative sagittal alignment, we recommend controlling the TK to within 31°.
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Affiliation(s)
- Zhuang Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jing-Chi Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Li-Min Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yue-Ming Song
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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13
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Jang JS, Kim JI, Ku B, Lee JH. Reliability Analysis of Vertebral Landmark Labelling on Lumbar Spine X-ray Images. Diagnostics (Basel) 2023; 13:diagnostics13081411. [PMID: 37189512 DOI: 10.3390/diagnostics13081411] [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: 01/19/2023] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Vertebral landmark labelling on X-ray images is important for objective and quantitative diagnosis. Most studies related to the reliability of labelling focus on the Cobb angle, and it is difficult to find studies describing landmark point locations. Since points are the most fundamental geometric feature that can generate lines and angles, the assessment of landmark point locations is essential. The aim of this study is to provide a reliability analysis of landmark points and vertebral endplate lines with a large number of lumbar spine X-ray images. A total of 1000 pairs of anteroposterior and lateral view lumbar spine images were prepared, and 12 manual medicine experts participated in the labelling process as raters. A standard operating procedure (SOP) was proposed by consensus of the raters based on manual medicine and provided guidelines for reducing sources of error in landmark labelling. High intraclass correlation coefficients ranging from 0.934 to 0.991 verified the reliability of the labelling process using the proposed SOP. We also presented means and standard deviations of measurement errors, which could be a valuable reference for evaluating both automated landmark detection algorithms and manual labelling by experts.
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Affiliation(s)
- Jun-Su Jang
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Republic of Korea
| | - Joong Il Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Republic of Korea
| | - Boncho Ku
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Republic of Korea
| | - Jin-Hyun Lee
- Institute for Integrative Medicine, Catholic Kwandong University International St. Mary's Hospital, 25 Simgok-ro 100 beon-gil, Seo-gu, Incheon 22711, Republic of Korea
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14
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Lukas KJ, Verhaegen JCF, Livock H, Kowalski E, Phan P, Grammatopoulos G. The effect of ethnicity on the age-related changes of spinopelvic characteristics: a systematic review. Bone Joint Res 2023; 12:231-244. [PMID: 37051815 PMCID: PMC10065848 DOI: 10.1302/2046-3758.124.bjr-2022-0335.r1] [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: 04/03/2023] Open
Abstract
Aims Spinopelvic characteristics influence the hip’s biomechanical behaviour. However, to date there is little knowledge defining what ‘normal’ spinopelvic characteristics are. This study aims to determine how static spinopelvic characteristics change with age and ethnicity among asymptomatic, healthy individuals. Methods This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify English studies, including ≥ 18-year-old participants, without evidence of hip or spine pathology or a history of previous surgery or interventional treatment, documenting lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). From a total of 2,543 articles retrieved after the initial database search, 61 articles were eventually selected for data extraction. Results When all ethnicities were combined the mean values for LL, SS, PT, and PI were: 47.4° (SD 11.0°), 35.8° (SD 7.8°), 14.0° (SD 7.2°), and 48.8° (SD 10°), respectively. LL, SS, and PT had statistically significant (p < 0.001) changes per decade at: −1.5° (SD 0.3°), −1.3° (SD 0.3°), and 1.4° (SD 0.1°). Asian populations had the largest age-dependent change in LL, SS, and PT compared to any other ethnicity per decade at: −1.3° (SD 0.3°) to −0.5° (SD 1.3°), –1.2° (SD 0.2°) to −0.3° (SD 0.3°), and 1.7° (SD 0.2°) versus 1.1° (SD 0.1°), respectively. Conclusion Ageing alters the orientation between the spine and pelvis, causing LL, SS, and PT to modify their orientations in a compensatory mechanism to maintain sagittal alignment for balance when standing. Asian populations have the largest degree of age-dependent change to their spinopelvic parameters compared to any other ethnicity, likely due to their lower PI. Cite this article: Bone Joint Res 2023;12(4):231–244.
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Affiliation(s)
- Kenneth J. Lukas
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Jeroen C. F. Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, Antwerp, Belgium
| | - Holly Livock
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Philippe Phan
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Correspondence should be sent to George Grammatopoulos. E-mail:
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15
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Aspalter S, Stefanits H, Maier CJ, Radl C, Wagner H, Hermann P, Aichholzer M, Stroh N, Gruber A, Senker W. Reduction of spondylolisthesis and restoration of lumbar lordosis after anterior lumbar interbody fusion (ALIF). BMC Surg 2023; 23:66. [PMID: 36973719 PMCID: PMC10045589 DOI: 10.1186/s12893-023-01966-z] [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: 01/06/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Anterior lumbar interbody fusion (ALIF) is a well-established surgical treatment option for various diseases of the lumbar spine, including spondylolisthesis. This study aimed to evaluate the postoperative correction of spondylolisthesis and restoration of lumbar and segmental lordosis after ALIF. METHODS Patients with spondylolisthesis who underwent ALIF between 2013 and 2019 were retrospectively assessed. We assessed the following parameters pre-and postoperatively (6-months follow-up): Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), lumbar lordosis (LL), segmental lordosis (SL), L4/S1 lordosis, and degree of spondylolisthesis. RESULTS 96 patients were included. In 84 cases (87.50%), additional dorsal instrumentation was performed. The most frequent diagnosis was isthmic spondylolisthesis (73.96%). VAS was reduced postoperatively, from 70 to 40, as was ODI (50% to 32%). LL increased from 59.15° to 64.45°, as did SL (18.95° to 28.55°) and L4/S1 lordosis (37.90° to 44.00°). Preoperative spondylolisthesis was 8.90 mm and was reduced to 6.05 mm postoperatively. Relative spondylolisthesis was 21.63% preoperatively and 13.71% postoperatively. All clinical and radiological improvements were significant (all p < 0.001). No significant difference considering the lordosis values nor spondylolisthesis was found between patients who underwent ALIF surgery without dorsal instrumentation and patients who received additional dorsal instrumentation. Venous laceration was the most frequent complication (10.42%). CONCLUSIONS With ALIF, good clinical results and safe and effective reduction of spondylolisthesis and restoration of lordosis can be achieved. Additional dorsal instrumentation does not significantly affect postoperative lordosis or spondylolisthesis. Individual vascular anatomy must be reviewed preoperatively before considering ALIF.
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Affiliation(s)
- Stefan Aspalter
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Harald Stefanits
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria.
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Wagner-Jauregg Weg 15, Linz, 4020, Austria.
| | - Christoph Johannes Maier
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Christian Radl
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Helga Wagner
- Center for Clinical Studies (CCS Linz), Johannes Kepler University, Linz, Austria
- Department of Medical Statistics and Biometry, Institute of Applied Statistics, Johannes Kepler University, Linz, Austria
| | - Philipp Hermann
- Center for Clinical Studies (CCS Linz), Johannes Kepler University, Linz, Austria
| | - Martin Aichholzer
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Nico Stroh
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Wolfgang Senker
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
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16
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Prevalence of musculoskeletal complaints and health-related quality of life in a Maroon and Kalinya Indigenous rural village in Suriname. Qual Life Res 2023:10.1007/s11136-023-03363-8. [PMID: 36823327 DOI: 10.1007/s11136-023-03363-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Musculoskeletal complaints (MSCs), a leading contributor to disability worldwide, have a major impact on health-related quality of life (HRQoL). Poor general health related to lifestyle factors such as smoking, alcohol consumption and physical inactivity can lead to a higher risk to suffer MSCs. For minority groups in Suriname such as the Maroons and the Indigenous peoples no research has been conducted regarding prevalence of MSCs, HRQoL and various lifestyle factors. The aims were to determine the prevalence of MSCs and HRQoL in two rural tribal villages in the forested interior of Suriname and to identify various lifestyle factors associated with HRQoL in these communities. METHOD This was a cross-sectional community-based study using the Community Oriented Program for the Control of Rheumatic Diseases stage 1, phase 1 & 2 methodology in Goejaba, a Maroon village and Galibi, an Indigenous rural village. Sociodemographic data, self-reported comorbidities, past MSCs (for longer than seven days), lifestyle factors including smoking, alcohol use, body mass index (BMI) and physical activity (PA), and HRQoL (using the 36-item Short Form Survey (SF-36)) data were gathered among 153 Indigenous individuals in Galibi, and 516 Maroons in Goejaba. Regression models were constructed to explore associations between presence of MSCs, lifestyle factors and HRQoL. RESULTS High prevalence rates for past MSCs were reported in Galibi (72.4%) and Goejaba (58.3%). In both communities, respondents with MSCs reported significantly worse HRQoL than persons without MSCs. MSCs and the presence of comorbidities had a strong negative association with HRQoL, whereas PA positively influenced the physical and mental health domains of the SF-36. Smoking, alcohol use and BMI showed no association with HRQoL. CONCLUSIONS In this first study, a high prevalence for MSCs was reported in an Indigenous and Maroon rural community in Suriname. MSCs and comorbidities had a significant negative impact on HRQoL. PA was associated with higher self-reported HRQoL.
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17
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Liu GP, Liu L, Han M, Zhang JW, Wang ZF, Liu GW, Han CH, Ma C. Radiographic patterns and characteristics of sagittal profiles in normal spinopelvic curvatures: An explicit depiction of the distribution of lumbar vertebral bodies and discs. Clin Anat 2023; 36:624-630. [PMID: 36692147 DOI: 10.1002/ca.24006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/10/2022] [Accepted: 12/24/2022] [Indexed: 01/25/2023]
Abstract
The current study aimed to investigate the sagittal morphology of the spinopelvic complex and the components of the lumbar spine in the normal population. In total, 132 adult volunteers were retrospectively evaluated and divided into four groups according to the Roussouly classification. Statistical analysis of radiological parameters, including lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), PI-LL, LL-TK, lumbar vertebral lordosis from L1 to L5 (L1L-L5L), the intervertebral angle from L1-L2 to L5-S1 (IVA1-2-IVA5-1), segmental lordosis from L1 to L5 (S1L-S5L), the proportion of L1-L5 (L1%-L5%), the proportion of the intervertebral angle from L1-L2 to L5-S1 (IVA1-2%-IVA5-1%), and proportion of segmental lordosis from L1 to L5 (S1L%-S5L%), was performed. Based on the classification, type II (n = 46) was the most common, followed by type I (n = 39), type III (n = 36), and type IV (n = 11). The quantitative values of the sagittal parameters of the four groups were obtained. Results showed a significant difference in terms of LL, PI, SS, and LL-TK. Further, L1%, L2%, L3%, IVA1-2%, IVA2-3%, S1L%, S2L%, and S3L% had an increasing trend. PI was positively correlated with LL, S1L, S2L, S3L, S4L, S1L%, and S2L%, but not with S5L%. In conclusion, pelvic parameters had a significant effect on lumbar curvature and lordosis distribution. Further, the abovementioned results were beneficial for individual surgical decision-making regarding targeted intervertebral angle, screw-insertion dimension, and rod contouring.
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Affiliation(s)
- Guang-Pu Liu
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China.,Department of Spinal Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Lei Liu
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Meng Han
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Jian-Wei Zhang
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Zhen-Fei Wang
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Guang-Wang Liu
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Cong-Hui Han
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China.,Department of Spinal Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Chao Ma
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China.,Department of Spinal Surgery, Xuzhou Central Hospital, Xuzhou, China
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18
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Duan D, Cui Y, Gong L, Fan Y, Liu J, Zhou Y, Li W. Single Posterior Surgery Versus Combined Posterior-Anterior Surgery for Lumbar Tuberculosis Patients. Orthop Surg 2023; 15:868-877. [PMID: 36655386 PMCID: PMC9977579 DOI: 10.1111/os.13628] [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: 03/19/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Posterior approach of debridement, interbody graft, and instrumentation, and combined posterior-anterior approach of posterior instrumentation and anterior debridement and interbody graft are two essential surgeries for the surgical treatment of spinal tuberculosis (TB), and, until now, which one should be chosen is still controversial. This study aimed to compare the therapeutic efficacy between the single posterior surgery and combined posterior-anterior surgery for lumbar tuberculosis (LTB) patients to elucidate the role of debridement and the effects that result from posterior structure resection. METHODS One hundred and nineteen LTB patients managed with single posterior debridement, interbody graft, and instrumentation surgery (Group P, 73 cases), or combined posterior-anterior surgery of posterior instrumentation and anterior debridement and interbody graft (Group P-A, 46 cases) from January 2008 to December 2016 were retrospectively analyzed. Different indexes were compared between the two groups to evaluate the curative effect and explore the role of debridement and the effects that result from posterior structure resection: operation time, blood loss, visual analog scale (VAS), Japanese Orthopaedic Association (JOA), Erythrocyte Sedimentation Rate (ESR), C-reactive Protein (CRP), surgical complication type and rate, spinopelvic sagittal parameters (local kyphosis [LK], pelvic incidence [PI] and pelvic tilt [PT], lumbar lordosis [LL], and sacral slope [SS]), drainage retention duration, hospital stay, time of abscess disappearance, time of activity recovery, and time of bone graft fusion by t-test or χ2 test. RESULTS The follow-up period ranged from 24 to 60 months. No significant variations were detected between the two groups for age, sex ratio, BMI, disease duration, indication, and the preoperative values of VAS, JOA, ESR, CRP, and LK (p > 0.05). The VAS, JOA, ESR, and CRP significantly improved in both groups after the operation (p < 0.05), along with the LK and LL (p < 0.05). Meanwhile, the SS, PI, and PT showed minor improvement after the operation (p > 0.05). Compared to the P-A group, the P group had shorter operation time and less blood loss and hospital stay (p < 0.05). However, both groups presented similar VAS, JOA, ESR, CRP, and LK improvements (p > 0.05). Additionally, the surgical complication type and rate, postoperative spinopelvic sagittal parameters, and bone graft fusion time did not differ between the two groups (p > 0.05). On the other hand, the patients in the P-A group had a shorter time of abscess disappearance and activity recovery (p < 0.05) but a similar time of drainage retention (p > 0.05) compared to the P group. CONCLUSION Both single posterior and combined posterior-anterior surgeries presented a good therapeutic effect for LTB patients with a low surgical complication rate and good quality of LK correction and LL reconstruction and maintenance. Moreover, single posterior surgery was less traumatic than combined posterior-anterior surgery but with slower TB lesion healing and activity recovery. Compared to debridement, stability seems to be more vital for STB healing, posterior structure resection does not affect the effect of spinopelvic realignment.
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Affiliation(s)
- Dapeng Duan
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
| | - Yaqing Cui
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
| | - Liqun Gong
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
| | - Yayi Fan
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
| | - Jun Liu
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
| | - Yongchun Zhou
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
| | - Weiwei Li
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
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19
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Muellner M, Wang Z, Hu Z, Hardt S, Pumberger M, Becker L, Haffer H. Hip replacement improves lumbar flexibility and intervertebral disc height - a prospective observational investigation with standing and sitting assessment of patients undergoing total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2022; 46:2195-2203. [PMID: 35821119 PMCID: PMC9492615 DOI: 10.1007/s00264-022-05497-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/22/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE The pathogenic mechanism of the hip-spine syndrome is still poorly elucidated. Some studies have reported a reduction in low back pain after total hip arthroplasty (THA). However, the biomechanical mechanisms of THA acting on the lumbar spine are not well understood. The aim of the study is to evaluate the influence of THA on (1) the lumbar lordosis and the lumbar flexibility and (2) the lumbar intervertebral disc height. METHODS A total of 197 primary THA patients were prospectively enrolled. Pre- and post-operative biplanar stereoradiography was performed in standing and sitting positions. Spinopelvic parameters (lumbar lordosis (LL), pelvic tilt, sacral slope, pelvic incidence), sagittal spinal alignment (sagittal vertical axis, PI-LL mismatch (PI-LL)) and lumbar disc height index (DHI) for each segment (L1/2 to L5/S1) were evaluated. The difference between standing and sitting LL (∆LL = LLstanding - LLsitting) was determined as lumbar flexibility. Osteochondrosis intervertebralis was graded according to Kellgren and Lawrence (0-4), and patients were assigned to subgroups (mild: 0-2; severe: 3-4). RESULTS Lumbar flexibility increased significantly after THA (pre: 22.04 ± 12.26°; post: 25.87 ± 12.26°; p < 0.001), due to significant alterations in LL in standing (pre: 51.3 ± 14.3°; post: 52.4 ± 13.8°; p < 0.001) and sitting (pre: 29.4 ± 15.4°; post: 26.7 ± 15.4°; p = 0.01). ∆LL increased significantly in both subgroups stratified by osteochondrosis (pre/post: ΔLLmild: 25.4 (± 11.8)/29.4 ± 12.0°; p < 0.001; ΔLLsevere: 17.5 (± 11.4)/21.0 ± 10.9°; p = 0.003). The DHI increased significantly from pre-operatively to post-operatively in each lumbar segment. PI-LL mismatch decreased significantly after THA (pre: 3.5°; post: 1.4°; p < 0.001). CONCLUSION The impact of THA on the spinopelvic complex was demonstrated by significantly improved lumbar flexibility and a gain in post-operative disc height. These results illustrate the close interaction between the pelvis and the vertebral column. The investigation provides new insights into the biomechanical patterns influencing the hip-spine syndrome.
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Affiliation(s)
- Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Zhen Wang
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Zhouyang Hu
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Luis Becker
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Ham CH, Park YK, Kim JH, Kwon WK, Kim DW, Moon HJ. Characteristics of Sagittal Spinopelvic Alignment Changes After Symptom Relief After Simple Lumbar Decompression. Neurosurgery 2022; 91:331-338. [PMID: 35506942 DOI: 10.1227/neu.0000000000002013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sagittal spinopelvic alignment (SSPA) parameters are essential for the diagnosis of adult spinal deformities (ASDs) and their progression. Certain clinical symptoms that occur in patients with lumbar spinal stenosis (LSS) and herniated nucleus pulposus (HNP) may distort the SSPA and mimic ASD. OBJECTIVE To differentiate SSPA in symptomatic patients from asymptomatic patients within 10 minutes in the standing position. METHODS This retrospective cohort study evaluated changes in SSPA after simple lumbar decompression surgery in patients with LSS and HNP. Relative sagittal alignment (RSA), relative pelvic version, relative lumbar lordosis (RLL), Lordosis Distribution Index (LDI), and global alignment and proportion (GAP) values were calculated using the conventional Schwab classification method. First, the preoperative and postoperative SSPA parameters were compared. Second, patients were subgrouped into symptomatic within 10 minutes of standing (SP group) and other symptoms of LSS and HNP as controls. Changes in SSPA parameters after symptom relief after simple lumbar decompression surgery were compared between the two groups. RESULTS Overall, all SSPA parameters improved after surgery. However, after subgrouping, patients in the control group did not show significant SSPA alterations, except for LDI, whereas patients in the SP group significantly improved in terms of their RSA, RLL, LDI, and GAP values after symptom relief after surgery. CONCLUSION Patients with pain on standing within 10 minutes showed significant correction in RSA, RLL, and GAP values after simple lumbar decompression. Therefore, it is important to observe such clinical symptoms to avoid misdiagnosis of ASD.
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Affiliation(s)
- Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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21
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Yuan JJ, Li G, Liu Y, Zhang Q, Ren ZS, Tian R. The Association Between Sagittal Spinopelvic Alignment and Persistent Low Back Pain After Posterior Lumbar Interbody Fusion for Treatment of Mild L5-S1 Spondylolisthesis: A Retrospective Study. Int J Gen Med 2022; 15:4807-4816. [PMID: 35592537 PMCID: PMC9112190 DOI: 10.2147/ijgm.s353797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/13/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction The aim of this study was to explore the association between sagittal spinopelvic alignment and persistent low back pain (PLBP) following posterior decompression and instrumented fusion for mild L5-S1 spondylolisthesis. Methods By retrieving medical records from January 2015 to April 2020, 200 patients following PLIF for mild L5-S1 spondylolisthesis were retrospectively reviewed. Patients were divided into two groups: PLBP group and non-PLBP group. The baseline characteristics and radiographic parameters were analyzed and compared between groups. Results The PLBP group comprised 26 patients, and the non-PLBP group comprised 174 patients. No significant differences in preoperative spinopelvic parameters were found between the two groups (p > 0.05). There were statistically significant differences between the preoperative and postoperative variations of LL, SL, LSA, SD, and HOD spinopelvic parameters, regardless of group (p < 0.05). Postoperative PT and SS differed significantly between the PLBP group and non-PLBP group (p < 0.05). In the PLBP group, there were no significant differences between preoperative and postoperative PT; the same applied to SS. However, significant differences were found for the variations in preoperative and postoperative PT and SS between the two groups. The ΔPT was found as an independent risk factor for postoperative PLBP. Conclusion Patients with mild L5-S1 spondylolisthesis with PLBP after posterior lumbar spinal fusion had decreased SS and increased PT.
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Affiliation(s)
- Jian-Jun Yuan
- Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, 300121, People’s Republic of China
- Correspondence: Jian-Jun Yuan, Department of Spinal Surgery, Tianjin Union Medical Center, No. 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, People’s Republic of China, Tel +86 18602663218, Fax +86 022-27557256, Email
| | - Guang Li
- Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, 300121, People’s Republic of China
| | - Yan Liu
- Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, 300121, People’s Republic of China
| | - Quan Zhang
- Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, 300121, People’s Republic of China
| | - Zhi-Shuai Ren
- Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, 300121, People’s Republic of China
| | - Rong Tian
- Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, 300121, People’s Republic of China
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22
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Analysis of Risk Factors for Adjacent Segment Degeneration after Minimally Invasive Transforaminal Interbody Fusion at Lumbosacral Spine. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:4745534. [PMID: 35498212 PMCID: PMC9050292 DOI: 10.1155/2022/4745534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/15/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022]
Abstract
Background. Adjacent segment degeneration (ASD) has been considered as a serious complication from changes in the biological stress pattern after spinal fusion. The sagittal balance significantly associated with lumbar loading is largely dependent on L5-S1 segment. However, the evidence indicating risk factors for radiological and symptomatic ASD after minimally invasive transforaminal interbody fusion (MIS-TLIF) remains insufficient. Methods. This single-central retrospective study recruited patients with lumbosacral degeneration receiving MIS-TLIF at the L5-S1 level from January 2015 to December 2018. The targeted variables included demographic information, radiological indicators, surgery-related parameters, and patient-reported outcomes (PROs) extracted from the electronic medical system by natural language processing. In these patients, a minimum of 3-year follow-up was done. After reviewing the preoperative and postoperative follow-up digital radiographs, patients were assigned to radiological ASD group (disc height narrowing ≥3 mm, progressive slipping ≥3 mm, angular motion >10°, and osteophyte formation >3 mm), symptomatic ASD group, and control group. We identified potential predictors for radiological and symptomatic ASD with the service of stepwise logistic regression analysis. Results. Among the 157 consecutive patients treated with MIS-TLIF in our department, 16 cases (10.2%) were diagnosed with radiological ASD at 3-year follow-up. The clinical evaluation did not reveal suspicious risk factors, but several significant differences were confirmed in radiological indicators. Multivariate logistic regression analysis showed postoperative PI, postoperative DA, and ∆PI-LL in radiological ASD group were significantly different from those in control group. Nevertheless, for patients diagnosed with simultaneously radiological and symptomatic ASD, postoperative DA and postoperative PT as risk factors significantly affected the clinical outcome following MIS-TLIF. Conclusion. In this study, while approximately 10% of lumbosacral degenerations develop radiographic ASD, prognosis-related symptomatic ASD was shown not to be a frequent postoperative complication. Postoperative PI, postoperative DA, and mismatched PI-LL are risk factors for radiological ASD, and postoperative DA and postoperative PT are responsible for the occurrence of symptomatic ASD following MIS-TLIF. These radiological risk factors demonstrate that restoration of normal sagittal balance is an effective measure to optimize treatment strategies for secondary ASD prevention.
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Inose H, Hirai T, Yoshii T, Kimura A, Takeshita K, Inoue H, Maekawa A, Endo K, Miyamoto T, Furuya T, Nakamura A, Mori K, Kanbara S, Imagama S, Seki S, Matsunaga S, Takahashi K, Okawa A. Factors contributing to neck pain in patients with degenerative cervical myelopathy: A prospective multicenter study. J Orthop Surg (Hong Kong) 2022; 30:10225536221091848. [PMID: 35426758 DOI: 10.1177/10225536221091848] [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: 11/15/2022] Open
Abstract
PURPOSE Although the understanding of the mechanisms of low back pain due to spinopelvic sagittal imbalance has strengthened, the understanding of the mechanisms of neck pain remains insufficient. Thus, this study aimed to identify the factors associated with preoperative and postoperative neck pain in patients with degenerative cervical myelopathy who underwent laminoplasty. METHODS In this prospective multicenter study, we prospectively enrolled patients who were scheduled for laminoplasty for degenerative cervical myelopathy. The associations between different variables and the Numerical Pain Rating Scale (NRS) scores for neck pain were investigated using univariate and multiple linear regression models. RESULTS In total, 92 patients were included in the current study. The univariate analysis showed that age, sex, cervical lordosis in neutral and extension, and thoracic kyphosis were significantly associated with the preoperative NRS score for neck pain; moreover, preoperative cervical lordosis in extension and range of motion and postoperative cervical lordosis in neutral, flexion, and extension were significantly associated with the postoperative NRS Scale score for neck pain. Stepwise multiple regression analysis showed that the independent factors contributing to preoperative neck pain were preoperative cervical lordosis in extension, sex, and age. The independent preoperative predictor and contributor to postoperative neck pain were preoperative cervical lordosis in extension and postoperative cervical lordosis in extension, respectively. CONCLUSIONS Cervical lordosis in extension showed significant association with neck pain in patients with degenerative cervical myelopathy. Therefore, when performing laminoplasty for patients with a low cervical lordosis in extension, attention should be paid to residual postoperative neck pain.
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Affiliation(s)
- Hiroyuki Inose
- Department of Orthopaedic and Trauma Research, 13100Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Takashi Hirai
- Department of Orthopaedic Surgery, 13100Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, 13100Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Atsushi Kimura
- Department of Orthopaedics, 12838Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopaedics, 12838Jichi Medical University, Shimotsuke, Japan
| | - Hirokazu Inoue
- Department of Orthopaedics, 12838Jichi Medical University, Shimotsuke, Japan
| | - Asato Maekawa
- Department of Orthopaedic Surgery, 13112Tokyo Medical University, Shinjuku-ku, Japan
| | - Kenji Endo
- Department of Orthopaedic Surgery, 13112Tokyo Medical University, Shinjuku-ku, Japan
| | - Takuya Miyamoto
- Department of Orthopaedic Surgery, 12737Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, 12737Chiba University Graduate School of Medicine, Chiba, Japan
| | - Akira Nakamura
- Department of Orthopaedic Surgery, 13051Shiga University of Medical Science, Otsu, Japan
| | - Kanji Mori
- Department of Orthopaedic Surgery, 13051Shiga University of Medical Science, Otsu, Japan
| | - Shunsuke Kanbara
- Department of Orthopaedic Surgery, 12965Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, 12965Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, 34823University of Toyama, Toyama, Japan
| | - Shunji Matsunaga
- Department of Orthopaedic Surgery, 73599Imakiire General Hospital, Kagoshima, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, 13100Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, 13100Tokyo Medical and Dental University, Bunkyo-ku, Japan
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Liu J, Huang P, Jiang G, Gao L, Zhang M, Dong X, Zhang W, Zhang X. Spinal-pelvic sagittal parameters in patients with gluteal muscle contracture: an imaging study. PeerJ 2022; 10:e13093. [PMID: 35310171 PMCID: PMC8932307 DOI: 10.7717/peerj.13093] [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: 09/14/2020] [Accepted: 02/18/2022] [Indexed: 01/12/2023] Open
Abstract
Background Gluteal muscle contracture (GMC) may cause abnormal spinal alignment as well as hip and pelvic deformities. The spine-pelvis alignment of GMC patients is unclear. This study aimed to describe the spine-pelvis sagittal alignment in patients with GMC and to explore the impact of GMC on the pathogenesis of low back pain (LBP). Methods Radiological analysis was performed in 100 patients with GMC and 100 asymptomatic volunteers who acted as the control group. Sagittal parameters were measured by two independent raters and their averages were presented on lateral radiographs of the whole spine, including pelvic incidence (PI), sagittal vertical axis (SVA), pelvic tilt (PT), lumbar lordosis (LL), sacral slope (SS), thoracic kyphosis (TK), and the relationship between PI and LL (expressed as PI-LL). All cases were categorized into one of three classes based on the apex position of lumbar lordosis and were further divided into three groups by the PI value. The GMC and control parameters were compared and the correlations between the parameters in the GMC group were analysed. Results The PI value of the GMC group was significantly less than that of the control group (42.38 ± 10.90° vs 45.68 ± 7.49°, P < 0.05). There was no difference found between the key parameters (SVA, PT, and PI-LL), which correlated with outcomes in adult deformity. No differences of SS were found between the two groups (P > 0.05). The GMC group showed lower average LL (42.77 ± 10.97° vs 46.41 ± 9.07°) and TK (17.34 ± 9.50° vs 20.45 ± 8.02°) compared with the control group (P < 0.05). LL was correlated with PI, SS, PT, TK (P < 0.01) and SVA (P < 0.05). TK and SVA were not correlated with any parameters except LL and pairwise correlations were found among PI, SS, and PT. There were no differences found between the distributions of the lumbar lordosis apex of GMC and the control but the range of SS in apex groups 3 and 4 did differ. GMC patients had the most small-PI value (44%) while approximately 64% of asymptomatic individuals had a normal PI. Interobserver variability was sufficient for all parameters calculated by the intraclass correlation coefficient (ICC). Conclusions Gluteal muscle contracture causes a low PI which may contribute to low back pain. Patients with GMC present the same global sagittal spinal-pelvic balance as asymptomatic individuals due to a compensatory mechanism through excessive flat lumbar and thoracic curves. Future studies on the relationship between spinal-pelvic sagittal and coronal alignment and low back pain are needed to understand the mechanical forces involved in the onset of GMC.
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Affiliation(s)
- Jiyi Liu
- Shantou University, Shantou, China,Peking University Shenzhen Hospital, Shenzhen, China
| | | | - Guanwei Jiang
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg/saar, Germany,Sino Euro Orthopaedics Network (SEON), Berlin, Germany
| | - Mengdi Zhang
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Xueping Dong
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Wentao Zhang
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Xintao Zhang
- Peking University Shenzhen Hospital, Shenzhen, China
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Factors Contributing to Residual Low Back Pain after Osteoporotic Vertebral Fractures. J Clin Med 2022; 11:jcm11061566. [PMID: 35329892 PMCID: PMC8950593 DOI: 10.3390/jcm11061566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023] Open
Abstract
Although osteoporotic vertebral fractures (OVFs) are the most common type of osteoporotic fracture, few reports have investigated the factors contributing to residual low back pain in the chronic phase after OVFs by using radiographic evaluation. We examined the contribution of nonunion, vertebral deformity, and thoracolumbar alignment to the severity of residual low back pain post-OVF. This post hoc analysis of a prospective randomized study included 195 patients with a 48-week follow-up period. We investigated the associations between radiographic variables with the visual analog scale (VAS) scores for low back pain at 48 weeks post-OVF using a multiple linear regression model. Univariate analysis revealed that analgesic use, the local angle on magnetic resonance imaging, anterior vertebral body compression percentage on X-ray, and nonunion showed a significant association with VAS scores for low back pain. Multiple regression analysis produced the following equation: VAS for low back pain at 48 weeks = 15.49 + 0.29 × VAS for low back pain at 0 weeks + (with analgesics: +8.84, without analgesics: −8.84) + (union: −5.72, nonunion: −5.72). Among local alignment, thoracolumbar alignment, and nonunion, nonunion independently contributed to residual low back pain at 48 weeks post-OVF. A treatment strategy that reduces the occurrence of nonunion is desirable.
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Mutaguchi M, Murayama R, Takeishi Y, Kawajiri M, Yoshida A, Nakamura Y, Yoshizawa T, Yoshida M. Relationship between low back pain and stress urinary incontinence at 3 months postpartum. Drug Discov Ther 2022; 16:23-29. [PMID: 35264471 DOI: 10.5582/ddt.2022.01015] [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: 11/05/2022]
Abstract
Previous studies have proposed that pelvic misalignment may be associated with stress urinary incontinence through a decrease in the contractile function of the pelvic floor muscles; however, this relationship remains unclear. This study aimed to clarify the relationship between low back pain, an indication of pelvic misalignment, and stress urinary incontinence at 3 months postpartum. We conducted a cross-sectional study of women who gave birth to full-term babies between July 2008 and July 2009. Stress urinary incontinence was defined as urinary leakage when coughing, sneezing, or exercising. Low back pain was defined as pain between the ribs and gluteal sulcus in the preceding 2 months. Of the 228 subjects included in the study, the prevalence of stress urinary incontinence was 22.8% (n = 52). The prevalence of low back pain in the stress urinary incontinence group was significantly higher than that in the non-stress urinary incontinence group (78.8% [n = 41] vs. 57.4% [n = 101]; p = 0.005). Stress urinary incontinence was associated with older age, primiparity, vaginal delivery, and low back pain at 3 months. In conclusion, low back pain was associated with stress urinary incontinence after adjusting for pregnancy and delivery factors, suggesting pelvic misalignment contributes to the development of stress urinary incontinence. We propose that including care for pelvic misalignment in pelvic floor muscle training, the treatment of choice for stress urinary incontinence, could be beneficial.
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Affiliation(s)
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoko Takeishi
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Maiko Kawajiri
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Akari Yoshida
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yasuka Nakamura
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Toyoko Yoshizawa
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Mikako Yoshida
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Song J, Pan F, Kong C, Sun X, Wang Y, Wang W, Lu S. Does the sagittal spinal profile differ between the elderly Chinese populations with and without lumbar disc herniation? Asian J Surg 2022; 45:2719-2724. [DOI: 10.1016/j.asjsur.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/13/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022] Open
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Zhou Q, Zhang J, Liu H, He W, Deng L, Zhou X, Yang H, Liu T. Comparison of Percutaneous Kyphoplasty With or Without Posterior Pedicle Screw Fixation on Spinal Sagittal Balance in Elderly Patients With Severe Osteoporotic Vertebral Compression Fracture: A Retrospective Study. Front Surg 2022; 9:800664. [PMID: 35252327 PMCID: PMC8894236 DOI: 10.3389/fsurg.2022.800664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo compare the effects of percutaneous kyphoplasty (PKP) with or without posterior pedicle screw fixation (PPSF) on spinal sagittal balance in elderly patients with severe osteoporotic vertebral compression fracture (sOVCF).MethodsFrom January 2016 to December 2018, 102 elderly patients with single-level thoracolumbar sOVCF were enrolled. Among them, 78 cases underwent PKP (Group A), and 24 cases underwent PPSF+KP (Group B). Clinical evaluation included perioperative parameters, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back pain; Radiographic evaluation included anterior vertebral height (AVH) and rate (AVHr), local kyphotic angle (LKA), and spino-pelvic sagittal balance parameters.ResultsPerioperative parameters including operation time, blood loss, fluoroscopic time and hospital stay in Group A were less than those in Group B (p < 0.05). Compared with the pre-operative results, the ODI and VAS scores of both groups decreased significantly in the three follow-ups after surgery (p < 0.05). The post-operative ODI and VAS scores of Group A were significantly better than those of Group B, but the results were opposite at the final follow-up (p < 0.05). Compared with the pre-operative values, except that there was no significant difference in pelvic incidence (PI) (p > 0.05), other radiographic parameters of both groups were improved significantly in the three follow-ups after surgery (p < 0.05). The AVH, AVHr, LKA and lumbar lordosis (LL) in Group B were better than those in Group A in the three follow-ups after surgery (p < 0.05). At the final follow-up, the sacral slope (SS) and pelvic tilt (PT) differed significantly between the two groups (p < 0.05).ConclusionsBoth PPSF+KP and PKP can achieve favorable clinical outcomes and maintain the spinal sagittal balance. Compared with PPSF+KP, PKP showed more significant advantages in the early post-operative period. However, in the long-term follow-up, PPSF+KP showed better clinical outcomes and may be better than PKP in maintaining spinal sagittal balance.
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Wu Z, Ye X, Ye Z, Hong K, Chen Z, Wang Y, Li C, Li J, Huang J, Zhu Y, Lu Y, Liu W, Xu X. Asymmetric Biomechanical Properties of the Paravertebral Muscle in Elderly Patients With Unilateral Chronic Low Back Pain: A Preliminary Study. Front Bioeng Biotechnol 2022; 10:814099. [PMID: 35223786 PMCID: PMC8866935 DOI: 10.3389/fbioe.2022.814099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Clinical incidences of chronic low back pain among the elderly are increasing. However, studies have not fully elucidated on changes in biomechanical properties of paravertebral muscles in patients with unilateral chronic low back pain. We evaluated the changes in biomechanical properties of painful and non-painful paravertebral muscles in elderly patients with unilateral chronic low back pain.Methods: Biomechanical properties of paravertebral muscles, including muscle tone and stiffness, in elderly patients with unilateral chronic low back pain were measured using MyotonPRO. Lumbar Lordosis and Sacral Slope were measured by magnetic resonance imaging. Cross-sectional areas of paravertebral muscles were evaluated using ImageJ software version 1.53. Chronic low back pain severity was assessed by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores. The correlations between VAS scores, ODI scores, Lumbar Lordosis, Sacral Slope, cross-sectional areas (painful side), disease duration, and biomechanical properties of paravertebral muscles in the painful side were analyzed.Results: A total of 60 elderly patients with unilateral chronic low back pain were enrolled in this study. The muscle tone and stiffness of paravertebral muscles on the painful side were significantly higher than those on the non-painful side (p < .05). Cross-sectional areas of paravertebral muscles on the painful side at the L3 level were smaller than those of the non-painful side (p < .05). The VAS scores and ODI scores were significantly positively correlated with muscle tone and stiffness of paravertebral muscles on the painful side (p < .05 and p < .01, respectively). There were no significant correlations between disease duration, cross-sectional areas (painful side), Lumbar Lordosis, or Sacral Slope and muscle tone and stiffness of paravertebral muscles on the painful side (p > .05).Conclusion: In elderly patients with unilateral chronic low back pain, muscle tone and stiffness of paravertebral muscles on the painful side are higher than for those on the non-painful side. The asymmetry of biomechanical properties of paravertebral muscles is associated with severity of chronic low back pain.
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Affiliation(s)
- Zugui Wu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangling Ye
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zixuan Ye
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kunhao Hong
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Zehua Chen
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Wang
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Congcong Li
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junyi Li
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinyou Huang
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Yue Zhu
- Baishui Health Center, Qujing, China
| | - Yanyan Lu
- Luoyang Orthopedic Hospital Of Henan Province (Orthopedic Hospital of Henan Province), Zhengzhou, China
- *Correspondence: Xuemeng Xu, ; Wengang Liu, ; Yanyan Lu,
| | - Wengang Liu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
- *Correspondence: Xuemeng Xu, ; Wengang Liu, ; Yanyan Lu,
| | - Xuemeng Xu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
- *Correspondence: Xuemeng Xu, ; Wengang Liu, ; Yanyan Lu,
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Clinical characteristics of geriatric patients with non-specific chronic low back pain. Sci Rep 2022; 12:1286. [PMID: 35079089 PMCID: PMC8789852 DOI: 10.1038/s41598-022-05352-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/11/2022] [Indexed: 01/11/2023] Open
Abstract
A comprehensive analysis of clinical information in patients with chronic low back pain (CLBP) was performed to clarify the clinical characteristics of geriatric LBP from the perspective of body composition, spinal alignment, and blood findings related to senescence. We enrolled 203 patients with an average age of 79.0 years (77 men and 126 women), with non-specific CLBP as a single-center prospective cohort study, the patients were compared with age- and sex-matched controls without CLBP using a propensity score-matching. We performed laboratory analysis, radiographic evaluations for global spinal parameter and lumbar degeneration, and body composition analysis using whole-body dual-energy X-ray absorptiometry. We observed a higher red blood cell distribution width (RDW) (p < 0.001), which is an index of aging, as well as a lower vitamin D level (p = 0.002), skeletal muscle mass index (p = 0.045) and a higher fat mass (p = 0.007) in patients with CLBP. Moreover, patients with geriatric CLBP had significantly lower lumbar lordosis (p = 0.024), and higher sagittal vertical axis (p = 0.006) was correlated with lower extremity and trunk muscle mass (p < 0.001), independent of lumbar degeneration. Geriatric patients with CLBP have sarcopenic fat accumulation and spinal sagittal malalignment with senescent status, such as elevated RDW and hypovitaminosis D.
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Lenz M, Oikonomidis S, Hartwig R, Gramse R, Meyer C, Scheyerer MJ, Hofstetter C, Eysel P, Bredow J. Clinical outcome after lumbar spinal fusion surgery in degenerative spondylolisthesis: a 3-year follow-up. Arch Orthop Trauma Surg 2022; 142:721-727. [PMID: 33372234 PMCID: PMC8994725 DOI: 10.1007/s00402-020-03697-9] [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] [Received: 06/21/2020] [Accepted: 12/03/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lumbar spinal fusion surgery is a widely accepted surgical treatment in degenerative causes of lumbar spondylolisthesis. The benefit of reduction of anterior displacement and restoration of sagittal parameters is still controversially debated. Purpose of the underlying publication was to analyze the influence of radiographic sagittal parameters of the spine in aspects of changes in postoperative clinical outcome. MATERIALS AND METHODS By prospective analysis, we included patients with low-grade degenerative lumbar spondylolisthesis (Meyerding grades I and II) with mono- or bisegmental fusion surgery with a minimum follow-up data of 3 years. For clinical outcome measures, COMI, ODI and EQ-5D were used. Spinopelvic parameters (sacral inclination, pelvic tilt, sacral slope and pelvic incidence, lumbar lordosis and lumbar index as well as anterior displacement and sagittal rotation) were measured on plain radiographs. RESULTS We could observe a significant benefit in clinical outcome after lumbar fusion surgery in low-grade spondylolisthesis in our mid-term follow-up data including 32 patients. By surgical reduction, we could see significant restoration of anterior displacement and sagittal rotation. Interestingly, a significant correlation between restoration of both sagittal rotation and sacral inclination and clinical outcome score was observed in the 3-year follow-up. CONCLUSION In low-grade spondylolisthesis, spinal fusion surgery is a well-established surgical procedure; however, the impact of sagittal parameters and reduction of anterior displacement remains controversial. Within our findings, restoration of sagittal parameters showed significant correlation to improvement in clinical outcome in our mid-term follow-up data.
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Affiliation(s)
- Maximilian Lenz
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - S. Oikonomidis
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - R. Hartwig
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - R. Gramse
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - C. Meyer
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - M. J. Scheyerer
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - C. Hofstetter
- Department of Neurological Surgery, UW Medicine Seattle, Seattle, WA USA
| | - P. Eysel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - J. Bredow
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Yamazato CO, Ribeiro G, Paula FCD, Soares RO, Cruz PS, Kanas M. Avaliação da confiabilidade e reprodutibilidade da classificação de Roussouly para os tipos de lordose lombar. Rev Bras Ortop 2021; 57:321-326. [PMID: 35652032 PMCID: PMC9142261 DOI: 10.1055/s-0041-1729581] [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: 09/28/2020] [Accepted: 12/01/2020] [Indexed: 12/02/2022] Open
Abstract
Objective
The present study aims to determine the intra- and inter-rater reliability and reproducibility of the Roussouly classification for lumbar lordosis types.
Methods
A database of 104 panoramic, lateral radiographs of the spine of male individuals aged between 18 and 40 years old was used. Six examiners with different expertise levels measured spinopelvic angles and classified lordosis types according to the Roussouly classification using the Surgimap software (Nemaris Inc., New York, NY, USA). After a 1-month interval, the measurements were repeated, and the intra- and inter-rater agreement were calculated using the Fleiss Kappa test.
Results
The study revealed positive evidence regarding the reproducibility of the Roussouly classification, with reasonable to virtually perfect (0.307–0.827) intra-rater agreement, and moderate (0.43) to reasonable (0.369) inter-rater agreement according to the Fleiss kappa test. The most experienced examiners showed greater inter-rater agreement, ranging from substantial (0.619) to moderate (0.439).
Conclusion
The Roussouly classification demonstrated good reliability and reproducibility, with intra- and inter-rater agreements at least reasonable, and reaching substantial to virtually perfect levels in some situations. Evaluators with highest expertise levels showed greater intra and inter-rater agreement.
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Affiliation(s)
- Camila Oda Yamazato
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | | | | | - Paulo Santa Cruz
- Ambulatório de Coluna do Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Michel Kanas
- Ambulatório de Coluna do Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Elabd AM, Elabd OM. Relationships between forward head posture and lumbopelvic sagittal alignment in older adults with chronic low back pain. J Bodyw Mov Ther 2021; 28:150-156. [PMID: 34776134 DOI: 10.1016/j.jbmt.2021.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/19/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Abnormal posture creates abnormal stress and strain in many spinal structures which are considered predisposing factors for chronic mechanical low back pain. PURPOSE To examine the relationships among pain intensity, forward head posture (decreased craniovertebral angle) and lumbopelvic sagittal alignment (pelvic incidence, pelvic tilt, sacral slope, and lumbar lordosis) in chronic mechanical low back pain patients. METHODS A cross-section correlational study was conducted on one hundred patients. A numerical-pain-rating scale was used to determine pain intensity. Standardized standing lateral radiographs were analyzed to measure the spinopelvic angles. Reported data were analyzed using correlation coefficients, and regression analyses. RESULTS Lumbar lordosis had very strong positive correlations with each pain intensity and sacral slope. Pain intensity had a strong positive correlation with sacral slope. Moderate positive correlations highlighted between pelvic tilt and craniovertebral angle. Moreover, the pelvic incidence had weak positive correlations with each sacral slope and pelvic tilt. Negative correlations were strong between pelvic tilt and each of pain intensity, lumbar lordosis and sacral slope. Craniovertebral angle had moderate negative correlations with each of pain, lumbar lordosis, and sacral slope. However, the pelvic incidence had no relations with pain, craniovertebral angle lumbar lordosis. Overall, an association of demographic data and measured variables had a significant effect on the pain multi-regression equation prediction model. They accounted for 76.60% of the variation in pain. CONCLUSION Abnormal spinopelvic posture relates to chronic mechanical low back pain. There are significant associations among pain intensity, FHP and lumbopelvic sagittal alignment in chronic mechanical low back pain patients.
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Affiliation(s)
- Aliaa M Elabd
- Basic Science Department, Faculty of Physical Therapy, Pharos University in Alexandria, Egypt.
| | - Omar M Elabd
- Department of Physical Therapy for Musculoskeletal Disorders, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt
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Effect of Spinal Alignment Changes on Lower Back Pain in Patients Treated with Total Hip Arthroplasty for Hip Osteoarthritis. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111219. [PMID: 34833437 PMCID: PMC8618046 DOI: 10.3390/medicina57111219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: The influence of changes in spinal alignment after total hip arthroplasty (THA) on improvement in lower back pain (LBP) remains controversial. To evaluate how changes in spinal malalignment correlate with improvement in preoperative LBP in patients who underwent THA for hip osteoarthritis. Materials and Methods: From November 2015 to January 2017, 104 consecutive patients who underwent unilateral THA were prospectively registered. Whole spine X-rays and patient-reported outcomes (PROs) were obtained preoperatively and 12 months postoperatively. The PROs used were the Numerical Rating Scale (NRS) for back pain, EuroQol 5 Dimension, and Short Form-12. Results: Seventy-four (71%) patients with complete data were eligible for the analysis. The sagittal parameters changed slightly but significantly. Coronal alignment significantly improved. Twenty-six (37%) patients had LBP preoperatively. These patients had smaller lumbar lordosis (LL), larger PT, and larger PI minus LL than the patients without LBP. Fourteen (54%) of the 26 patients with preoperative LBP showed pain improvement, but there were no significant differences in the radiographic parameters. Conclusions: Although preoperative LBP was likely to be resolved after THA, there were no significant correlations between alignment changes and LBP improvement. The cause of LBP in patients with hip osteoarthritis (OA) patients might be multifactorial.
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Iwasa M, Ando W, Uemura K, Hamada H, Takao M, Sugano N. Pelvic incidence is not associated with the development of hip osteoarthritis. Bone Joint J 2021; 103-B:1656-1661. [PMID: 34719275 DOI: 10.1302/0301-620x.103b11.bjj-2021-0472.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Pelvic incidence (PI) is considered an important anatomical parameter for determining the sagittal balance of the spine. The contribution of an abnormal PI to hip osteoarthritis (OA) remains controversial. In this study, we aimed to investigate the relationship between PI and hip OA, and the difference in PI between hip OA without anatomical abnormalities (primary OA) and hip OA with developmental dysplasia of the hip (DDH-OA). METHODS In this study, 100 patients each of primary OA, DDH-OA, and control subjects with no history of hip disease were included. CT images were used to measure PI, sagittal femoral head coverage, α angle, and acetabular anteversion. PI was also subdivided into three categories: high PI (larger than 64.0°), medium PI (42.0° to 64.0°), and low PI (less than 42.0°). The anterior centre edge angles, posterior centre edge angles, and total sagittal femoral head coverage were measured. The correlations between PI and sagittal femoral head coverage, α angle, and acetabular anteversion were examined. RESULTS No significant difference in PI was observed between the three groups. There was no significant difference between the groups in terms of the category distribution of PI. The DDH-OA group had lower mean sagittal femoral head coverage than the other groups. There were no significant correlations between PI and other anatomical factors, including sagittal femoral head coverage, α angle, and acetabular anteversion. CONCLUSION No associations were found between mean PI values or PI categories and hip OA. Furthermore, there was no difference in PI between patients with primary OA and DDH-OA. From our evaluation, we found no evidence of PI being an independent factor associated with the development of hip OA. Cite this article: Bone Joint J 2021;103-B(11):1656-1661.
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Affiliation(s)
- Makoto Iwasa
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- 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
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, 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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Yazici Sacaklidir G, Sencan S, Sacaklidir R, Gunduz OH. The effect of spinopelvic parameters on transforaminal epidural steroid injection treatment success in lumbar disc herniation. Int J Clin Pract 2021; 75:e14708. [PMID: 34370361 DOI: 10.1111/ijcp.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Spinopelvic parameters (SPP) is closely associated with diseases such as lumbar disc herniation (LDH), disc degeneration and spondylolisthesis. Although there exist many known clinical and radiological factors affecting the success of the transforaminal epidural steroid injection (TFESI) treatment, the effect of SPP has not yet been investigated. This study aims to examine the effects of SPP on treatment success in patients who undergo TFESI because of lumbar disc herniation and to investigate the correlation among multifidus cross-sectional area (MFCSA). METHODS This was a prospective, observational study. Patients with low back and/or leg pain, unilateral nerve root compression were applied TFESI. Outcome measures included the numerical rating scale (NRS), Oswestry Disability Index (ODI) and Beck Depression Inventory (BDI). The patients were evaluated at the first hour, third week and third month. The SPP and MFCSA measurements were made on direct radiographs and MRIs. RESULTS A total of 58 patients, 24 women and 34 men, with an average age of 42.0 ± 9.5 were included. NRS, ODI and BDI scores improved significantly up to three months follow-up (P < .001). Moderately positive correlations were found between leg NRS and PT/PI scores immediately after treatment (r: 0.307 and r: 0.334) and a weak positive correlation was found between BDI and PT at third week (r: 0.269). The MFCSA/vertebral sectional area (VSA) and MFCSA/total multifidus cross-sectional area (TMFCSA) of the affected side was found to be significantly low (P < .001). CONCLUSIONS Subjects with high PI and PT reported less improvement in leg pain immediately after treatment and patients with high PT had fewer BDI improvements. MFCSA had no correlations with SPPs in patients who underwent TFESI.
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Affiliation(s)
- Gonca Yazici Sacaklidir
- Department of Physical Medicine and Rehabilitation, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, İstanbul, Turkey
| | - Savas Sencan
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Rekib Sacaklidir
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Osman Hakan Gunduz
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, İstanbul, Turkey
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Fujita N, Yagi M, Watanabe K, Nakamura M, Matsumoto M, Yokoyama Y, Yamada M, Yamada Y, Nagura T, Jinzaki M. Determining the validity and reliability of spinopelvic parameters through comparing standing whole spinal radiographs and upright computed tomography images. BMC Musculoskelet Disord 2021; 22:899. [PMID: 34696744 PMCID: PMC8546937 DOI: 10.1186/s12891-021-04786-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/13/2021] [Indexed: 12/22/2022] Open
Abstract
Background Standing whole spinal radiographs are used to evaluate spinal alignment in adult spinal deformity (ASD), yet some studies have reported that pelvic incidence, pelvic tilt, and thoracic kyphosis (TK) intra- and inter-observer reliability is low. This study aimed to evaluate the accuracy of spinopelvic parameters through comparing standing whole spinal radiographs and upright CT images. Methods We enrolled 26 patients with ASD. All standing whole spinal posterior/anterior and lateral radiographs and upright whole spinal CT had been obtained in a natural standing position. Two examiners independently measured 13 radiographic parameters. Interclass correlation coefficients (ICCs) were used to analyze measurement intra- and inter-observer reliability. Paired t- and Pearson’s correlation tests were used to analyze validity of the standing whole spinal radiographs. Results ICCs of upright CT were excellent in both intra- and inter-observer reliability. However, intra-observer ICCs for TK2–12, TK1–5, TK2–5, and TK5–12 on standing lateral radiographs were relatively low, as were inter-observer ICCs for TK2–12, TK1–5, TK2–5, and TK5–12. Concerning TK values, the difference between the radiographs and CT in TK1–12 and TK2–12 were 4.4 ± 3.1 and 6.6 ± 4.6, respectively, and TK values from T2 showed greater measurement error (p < 0.05). Conclusions Upright CT showed excellent intra- and inter-observer reliability in the measurement of spinopelvic parameters. Measurement of TK with T2 on standing whole spinal radiographs resulted in a greater measurement error of up to 6.6°. Surgeons need to consider this when planning surgery and measuring postoperative TK changes in patients with ASD. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04786-5.
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Affiliation(s)
- Naruhito Fujita
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, shinjyuku, Tokyo, 160-8582, Japan
| | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, shinjyuku, Tokyo, 160-8582, Japan.
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, shinjyuku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, shinjyuku, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, shinjyuku, Tokyo, 160-8582, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, shinjyuku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan
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Kim KR, Le Huec JC, Jang HJ, Noh SH, Park JY, Ha Y, Kuh SU, Chin DK, Kim KS, Jin BH, Cho YE, Kim KH. Which Is More Predictive Value for Mechanical Complications: Fixed Thoracolumbar Alignment (T1 Pelvic Angle) Versus Dynamic Global Balance Parameter (Odontoid-Hip Axis Angle). Neurospine 2021; 18:597-607. [PMID: 34610691 PMCID: PMC8497258 DOI: 10.14245/ns.2142452.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
Objective In this study, we investigate about relationship between postoperative global sagittal imbalance and occurrence of mechanical complications after adult spinal deformity (ASD) surgery. In global sagittal balance parameters, odontoid-hip axis (OD-HA) angle and T1 pelvic angle (TPA) were analyzed.
Methods Between January 2009 and December 2016, 199 consecutive patients (26 males and 173 females) with ASD underwent corrective fusion of more than 4 levels and were followed up for more than 2 years. Immediate postoperative and postoperative 2 years whole spine x-rays were checked for evaluating immediate postoperative OD-HA, TPA, and other parameters. In clinical outcomes, back and leg pain visual analogue scale, Scoliosis Research Society-22 spinal deformity questionnaire (SRS-22), Oswestry Disability Index (ODI), 36-item Short Form Health Survey (SF-36) were evaluated.
Results Based on the occurrence of mechanical complications, a comparative analysis was performed for each parameter. In univariable analysis, mechanical complications were significantly much more occurred in OD-HA abnormal group (odds ratio [OR], 3.296; p<0.001; area under the curve [AUC]=0.645). In multivariable analysis, the result was much more related (OR, 2.924; p=0.001; AUC=0.727). In contrast, there was no significant difference between normal and the occurrence of mechanical complications in TPA. In clinical outcomes (normal vs. abnormal), the differences of SRS-22 (0.88±0.73 vs. 0.68±0.64, p=0.042), ODI (-24.72±20.16 vs. -19.01±19.95, p=0.046), SF-36 physical composite score (19.33±18.55 vs. 12.90±16.73, p=0.011) were significantly improved in OD-HA normal group.
Conclusion The goal of ASD surgery is to improve patient life quality through correction. In our study, TPA was associated with spinopelvic parameter and OD-HA angle was associated with health-related quality of life and complications. OD-HA angle is predictable factor for mechanical complications after ASD surgery.
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Affiliation(s)
- Kwang-Ryeol Kim
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Jean-Charles Le Huec
- Department of Orthopedic Surgery, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Hyun-Jun Jang
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Hyun Noh
- Department of Neurosurgery, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Uk Kuh
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keun-Su Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Ho Jin
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Yong-Eun Cho
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
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Cejudo A, Centenera-Centenera JM, Santonja-Medina F. Sagittal Integral Morphotype of Competitive Amateur Athletes and Its Potential Relation with Recurrent Low Back Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168262. [PMID: 34444009 PMCID: PMC8392335 DOI: 10.3390/ijerph18168262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022]
Abstract
Athletes have higher thoracic and lumbar curvature in standing than the reference values of the non-athletic population. The sagittal integral morphotype method (SIM) assessment has not previously been applied to competitive amateur athletes (CAA). The propose of the present study was to determine the SIM of CAA treated at a sports-medicine center and to identify spinal misalignments associated with recurrent low back pain (LBP). An observational analysis was developed to describe the SIM in 94 CAA. The thoracic and lumbar curvatures of the CAA were measured in standing, sitting, and trunk forward flexion. Association analysis (Pearson’s chi-square and Cramér’s V tests) was then performed to identify the SIM misalignments associated with LBP. Effect size was analyzed based on Hedges’ g. The most common thoracic SIMs in CAA were total hyperkyphosis (male = 59.02%; female = 42.42%) and static hyperkyphosis (male = 11.48%; female = 6.06%). Hyperlordotic attitude (female = 30.30%; male = 4.92%), static-functional hyperkyphosis (male = 16.39%; female = 3.03%), and structured hyperlordosis (female = 21.21%; male = 1.64%) were the most common lumbar SIMs. Hyperlordotic attitude, static functional lumbar hyperkyphosis, and structured hyperlordosis were associated with LBP in male and female athletes.
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Affiliation(s)
- Antonio Cejudo
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30100 Murcia, Spain
- Correspondence: (A.C.); (J.M.C.-C.); Tel.: +34-868-88-84-30 (A.C.); +34-972-20-43-50 (J.M.C.-C.)
| | - Josep María Centenera-Centenera
- Department of Surgery, Traumatology and Orthopedics, Bofill Clinic, ProActive Health, 17002 Gerona, Spain
- Correspondence: (A.C.); (J.M.C.-C.); Tel.: +34-868-88-84-30 (A.C.); +34-972-20-43-50 (J.M.C.-C.)
| | - Fernando Santonja-Medina
- Department of Surgery, Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30100 Murcia, Spain;
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Effects of Total Knee Arthroplasty on Coronal and Sagittal Whole-Body Alignments: Serial Assessments Using Whole-Body EOS. J Clin Med 2021; 10:jcm10153242. [PMID: 34362027 PMCID: PMC8348330 DOI: 10.3390/jcm10153242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The aims of this study were to evaluate the effects of correcting lower limb alignment by total knee arthroplasty (TKA) on the spinopelvic alignment and to identify patients with difference in the knee joint between clinically measured passive motion and the actual standing posture. METHODS In this retrospective study, 101 patients who underwent TKA and whose serial whole-body EOS X-ray were available were included. The relationship of the knee and spinopelvic alignment was analyzed by evaluating the parameters of standing anterior-posterior and lateral whole-body EOS X-ray. The differences between postoperative passive motion and weight-bearing posture in the knee joint were assessed in both coronal and sagittal planes. Furthermore, the causes of such differences were analyzed. RESULTS Significant correlations between Δpelvic obliquity and coronal ΔHip-Knee-Ankle (HKA)Rt-Lt angle between the preoperative and 3-month and 1-year postoperative data (p < 0.001 and p < 0.005, respectively) and improved with coronal lower limb alignment close to neutral resulted in decreased pelvic obliquity (p < 0.001, ß = 0.085 and p = 0.005, ß = 0.065, respectively) were observed. The correlations between Δpelvic tilt (PT) and Δsacral slope (SS) and sagittal ΔHKARt-Lt angle were statistically significant (PT: p < 0.001 and p < 0.045; SS: p = 0.002 and p < 0.001, respectively). The improved sagittal alignment close to neutral resulted in decreased PT and increased SS. The difference between postoperative passive motion and the weight-bearing posture of the knee joint was correlated with lumbar lordosis and sagittal C7 plumb line-sacrum distance (p = 0.042 and p < 0.001, respectively). CONCLUSIONS The correction of lower limb alignment with TKA affected pelvic parameters dominantly; however, there was little effect on the spinal alignment. Additionally, patients with anterior stooping or lumbar flat back demonstrated difference in extension between passive knee motion and standing. Therefore, rather than only focusing on changes in the knee alignment correction, knee surgeons should also evaluate the spinopelvic alignment before surgery to consider the prognosis of the standing and predict the possible changes in the whole-body alignment. This preoperative assessment may improve the prognosis of TKA.
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Is Sacral Dysmorphism Protective Against Spinopelvic Dissociation? Multicenter Case Series. J Orthop Trauma 2021; 35:366-370. [PMID: 34131087 DOI: 10.1097/bot.0000000000002009] [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] [Accepted: 11/04/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Investigate the incidence of sacral dysmorphism (SD) in patients with spinopelvic dissociation (SPD). DESIGN Retrospective case series. SETTING Two academic level 1 trauma centers. PATIENTS/PARTICIPANTS One thousand eight hundred fifty adult patients with sacral and pelvic fractures (OTA/AO 61-A, B, C). INTERVENTION Plain pelvic radiographs and CT scans. MAIN OUTCOME MEASUREMENTS Incidence of SD in patients with SPD. Secondary radiographic evaluation of fracture classification and deformity on sagittal imaging. RESULTS Eighty-two patients with SPD were identified, and 12.2% displayed features of SD, significantly less than reported in the literature. The S2 sacral body was the most common horizontal fracture location in patients with SD and nondysmorphic sacra (ND). Roy-Camille type I patterns were more common in ND (35%), versus type II in SD patients (40%). SD patients had lower body mass indexes (19.7 vs. 25.2, P = 0.001). Segmental kyphosis (22.5 degrees ND vs. 23.8 degrees SD, P = 0.838) and sacral kyphosis (26 degrees ND vs. 31 degrees SD, P = 0.605) were similar between groups. Percutaneous fixation was the most common surgical technique. CONCLUSIONS We report a significantly lower prevalence of SD in patients with SPD than previously reported in the literature. This suggests that variations in sacral osseous anatomy alter force transmission across the sacrum during traumatic loading, which may be protective against certain high-energy fracture patterns. Preoperative evaluation of sacral anatomy is critical, not only in determining the size and orientation of sacral segment safe zones for screw placement, but also to better understand the pathomechanics involved in sacral trauma. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Arima H, Yamato Y, Sato K, Uchida Y, Tsuruta T, Hashiguchi K, Hamamoto H, Watanabe E, Yamanaka K, Hasegawa T, Yoshida G, Yasuda T, Banno T, Oe S, Ushirozako H, Yamada T, Ide K, Watanabe Y, Matsuyama Y. Characteristics affecting cervical sagittal alignment in patients with chronic low back pain. J Orthop Sci 2021; 26:577-583. [PMID: 32800526 DOI: 10.1016/j.jos.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/07/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sagittal spino-pelvic malalignment in patients with chronic low back pain (CLBP) have been reported in the past, which may also affect cervical spine lesions. The purpose of this study is to investigate the cervical alignment in patients with CLBP. METHOD Of the patients who visited an orthopedic specialist due to low back pain lasting more than three months, 121 cases (average 71.5-years-old, 46 male and 75 female) with whole standing spinal screening radiographs were reviewed (CLBP group). Cervical parameters included cervical lordosis (CL), C2-C7 sagittal vertical axis (C2-7 SVA), and the T1 slope minus CL (T1S-CL). Cervical spine deformity was defined as C2-7 SVA >4 cm, CL <0°, or T1S-CL ≧20°. We compared the cervical alignment of these patients with 121 age and gender matched volunteers (control group). RESULTS The prevalence of cervical spine deformity was significantly higher in the CLBP group than in the control group (20.7% vs. 10.7%, P = 0.034). The mean CL was smaller in the CLBP group than in the control group (16.1° vs. 21.4°, P = 0.002). The mean C2-7 SVA was 17.6 mm vs. 18.7 mm in the CLBP group and in the control group, respectively (P = 0.817). The mean T1S-CL was larger in the CLBP group than in the control group (9.1° vs. 3.5°, P < 0.001). Multivariate analysis showed that people with CLBP were more likely to have cervical deformities than people without CLBP (odds ratio 2.16, 95% confidence interval 1.006 to 4.637). CONCLUSIONS This study results suggest that people with CLBP present with worse cervical sagittal alignment and higher prevalence of cervical spine deformities than age and gender matched volunteers with no CLBP. This means CLBP impacts cervical spine lesions negatively. LEVEL OF EVIDENCE Ⅳ.
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Affiliation(s)
- Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu city, Shizuoka 431-3192, Japan.
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Kimihito Sato
- Sato Orthopedic Clinic, 5-4-1-16 Nakakasai, Edogawa-ku, Tokyo, 134-0084, Japan
| | - Yoshihiro Uchida
- Seisen Clinic, 191-1 Kakita, Shimizu-cho, Sunto-gun, Shizuoka, 411-0904, Japan
| | - Toshiyuki Tsuruta
- Tsuruta Orthopedic Clinic, 1241-6 Ushizuchoukatsu, Ogi city, Saga, 840-0306, Japan
| | - Kanehisa Hashiguchi
- Hashiguchi Orthopedic Clinic, 1-41-3 Komatsubara, Kagoshima city, Kagoshima, 891-0114, Japan
| | - Hajime Hamamoto
- Hamamoto Orthopedic Clinic, 40-5 Johoku, Aoi-ku, Shizuoka city, Shizuoka, 420-0805, Japan
| | - Eiichiro Watanabe
- Fuji Orthopedic Hospital, 1-4-23 K|Nishiki-cho, Fuji city, Shizuoka, 417-0045, Japan
| | - Kaoru Yamanaka
- Yamanaka Orthopedic Clinic, 1-28-6 Shikiji, Suruga-ku, Shizuoka city, Shizuoka, 422-8036, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Tatsuya Yasuda
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Hiroki Ushirozako
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Yuh Watanabe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu city, Shizuoka 431-3192, Japan
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Liang CL, Wang SW, Chen HJ, Tsai YD, Chen JS, Wang HK, Wang KW. Optimal Cut-Off Points of Sagittal Spinopelvic Parameters as a Morphological Parameter to Predict Efficiency in Nerve Block and Pulsed Radiofrequency for Lumbar Facet Joint Pain: A Retrospective Study. J Pain Res 2021; 14:1949-1957. [PMID: 34234541 PMCID: PMC8253931 DOI: 10.2147/jpr.s303979] [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: 02/03/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background After proper patient selection, anatomically correct pulsed radiofrequency of the lumbar facet joints provide long-term pain relief in a routine clinical setting. In the study, we performed an analysis of clinical and radiological predictive factors and provide the scientific basis for this promising modality. Methods The study included 198 patients with lower back pain due to lumbar facet joint disease who underwent medial branch block and pulsed radiofrequency during the period 2015–2019. According to the improvement in pain score, the patients were divided into good and poor outcome groups. Clinical and radiological data were collected and analyzed. Results The multivariable analysis revealed the predictive factors, including lumbar lordosis, lower lumbar lordosis, pelvic tilt, the number of facet joints, old compression fracture with/without vertebroplasty, and post lumbar fusion procedures. Conclusion With the results of this study, we demonstrated that the improved outcome after the surgery was related to lumbar lordosis, lower lumbar lordosis, pelvic tilt, the number of facet joints, old compression fracture with/without vertebroplasty, and the lumbar fusion procedures. Old compression fractures and lumbar fusion would change the radiological factors and cause refractory lumbar facet joint pain.
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Affiliation(s)
- Cheng-Loong Liang
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shih-Wei Wang
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,Department of Rheumatology, E-DA Hospital, Kaohsiung, Taiwan
| | - Han-Jung Chen
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Duan Tsai
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Jui-Sheng Chen
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hao-Kuang Wang
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Wei Wang
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Neurosurgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
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Farrokhi MR, Eghbal K, Mousavi SR, Moumani M, Bazyari K, chaurasia B. Comparative Study between Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion for Treatment of Spondylolisthesis: Clinical Outcomes and Spino-Pelvic Sagittal Balance Parameters. INDIAN JOURNAL OF NEUROTRAUMA 2021. [DOI: 10.1055/s-0040-1718781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Objective This retrospective study aims to compare the clinical and radiological outcomes of posterolateral fusion (PLF) with transforaminal lumbar interbody fusion (TLIF + PLF) for the treatment of patients with low-grade spondylolisthesis.
Methodology A total of 77 adult patients ≥18 years with low-grade spondylolisthesis, Meyerding grades I and II, were assigned into two groups: 36 patients treated with PLF and 41 patients treated with TLIF + PLF. The PLF group is composed of the patients that were operated with pedicle screw and the TLIF + PLF group is composed of the ones that were operated with fixation and TILF by autografting. Clinical evaluation was performed using the spino-pelvic sagittal balance, Numeric Rating Scale, Oswestry Disability Index, blood loss, operation times, and postoperative hospital stay of the PLF vs TLIF groups. The incidences of postoperative low back pain and radicular pain in the two groups were also recorded. Radiography was performed preoperatively and postoperatively to assess spino-pelvic parameters.
Results Significant restoration of spino-pelvic sagittal balance was observed in the TLIF group after surgery, and all spino-pelvic sagittal balance parameters showed significant improvement in the TLIF group after surgery, while in the PLF group, all spino-pelvic sagittal parameters had improved except the segmental angle lordosis (p = 0.316), which showed no significant difference after surgery in the PLF group. Postoperative pelvic incidence and pelvic tilt significantly improved in the TLIF group in comparison to PLF groups. Hence, TLIF can achieve better postoperative spino-pelvic sagittal balance parameters than PLF. There was no difference in the complication rates for each group. Both groups achieved significant improvement in postoperative clinical outcomes, and there was no significant difference in the incidence of postoperative low back pain or radicular pain between the two groups.
Conclusion Both surgical procedures PLF and TLIF were effective. PLF and TLIF can result in improved clinical and radiological outcomes for patients treated for low-grade spondylolisthesis. TLIF can achieve better restoration of spino-pelvic sagittal balance parameters than PLF alone.
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Affiliation(s)
- Majid Reza Farrokhi
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keyvan Eghbal
- Shiraz Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Reza Mousavi
- Shiraz Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mustafa Moumani
- Shiraz Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khshayar Bazyari
- Shiraz Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bipin chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Characteristics of the spinopelvic parameters of patients with sacroiliac joint pain. Sci Rep 2021; 11:5189. [PMID: 33664386 PMCID: PMC7970840 DOI: 10.1038/s41598-021-84737-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/17/2021] [Indexed: 12/15/2022] Open
Abstract
To evaluate the characteristics of the spinopelvic parameters on radiography in patients with sacroiliac joint pain (SIJP). Two hundred fifty patients were included and divided into the SIJP group (those diagnosed with SIJP based on physical findings and response to analgesic periarticular injections; n = 53) and the non-SIJP group (those with low back pain [LBP] because of other reasons; n = 197). We compared their demographic characteristics and spinopelvic parameters using radiography. All differences found in the patients' demographic characteristics and spinopelvic parameters were analyzed. More female participants experienced SIJP than male participants (P = 0.0179). Univariate analyses revealed significant differences in pelvic incidence (PI) (P = 0.0122), sacral slope (SS) (P = 0.0034), and lumbar lordosis (LL) (P = 0.0078) between the groups. The detection powers for PI, SS, and LL were 0.71, 0.84, and 0.66, respectively. Logistic regression analyses, after adjustment for age and sex, revealed significant differences in PI (P = 0.0308) and SS (P = 0.0153) between the groups, with odds ratios of 1.03 and 1.05, respectively. More female participants experienced SIJP than male participants. Higher PI and SS values were related to SIJP among LBP patients.
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Niu J, Feng T, Huang C, Yan Q, Song D, Gan M, Yang H, Zou J. Characteristics of Osteoporotic Low Lumbar Vertebral Fracture and Related Lumbosacral Sagittal Imbalance. Orthopedics 2021; 44:e7-e12. [PMID: 33141233 DOI: 10.3928/01477447-20201028-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/07/2019] [Indexed: 02/03/2023]
Abstract
Osteoporotic vertebral fracture (OVF) usually occurs in the thoracolumbar region and rarely affects the low lumbar region. The characteristics of osteoporotic low lumbar fracture (OLLF) have not been reported. Lumbosacral sagittal balance plays an important role in preserving the normal physiologic function of the spine. However, it is unknown how lumbosacral parameters vary in patients with OLLF. The authors retrospectively analyzed the clinical and radiologic characteristics of patients with OLLF and osteoporotic thoracolumbar vertebral fracture (OTVF) who were treated at their institution. Vertebral height, local deformity angle, and visual analog scale and Oswestry Disability Index scores were assessed preoperatively and postoperatively for both groups. The changes in lumbosacral parameters were measured for patients with OLLF. The results showed that OLLF was more likely to occur at L3 (53.66%) and that the prevalence of severe trauma (29.27%) was higher among patients with OLLF (P<.05). The most common morphologic type of the vertebrae affected by OLLF was biconcave (58.54%, P<.05). Patients who had OLLF showed an apparent increase in pelvic tilt and a decrease in local lordosis and sacral slope. Postoperatively, vertebral height, local deformity angle, and visual analog scale and Oswestry Disability Index scores were significantly improved compared with preoperative values (P<.05). Among patients with OLLF, local lordosis and sacral slope increased significantly, whereas pelvic tilt decreased significantly after percutaneous kyphoplasty. Restoration of local lordosis had a mean value of 6.29°±4.80°. These results indicate that OLLF has unique characteristics compared with OTVF and that it results in lumbosacral sagittal imbalance. Percutaneous kyphoplasty is effective and safe for the treatment of OLLF and plays an important role in postoperative improvement of sagittal imbalance. [Orthopedics. 2021;44(1):e7-e12.].
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Jones M, Mills C, Exell T, Wakefield-Scurr J. A novel multi-study intervention investigating the short and long term effects of a posture bra on whole body and breast kinematics. Gait Posture 2021; 83:194-200. [PMID: 33161276 DOI: 10.1016/j.gaitpost.2020.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Poor standing posture has been reported in women with larger breasts, increasing the risk of back pain. Whilst breast reduction surgery can improve posture, conservative measures such as special bras may offer short or long-term relief of symptoms without surgical intervention. RESEARCH QUESTION This study aimed to utilise a multi-study intervention to investigate the short and long-term kinematic effects of wearing a posture bra. METHODS Study one utilised biomechanics and physiotherapy expertise to modify the design of a prototype bra to improve posture and breast kinematics; resulting in a second-generation posture bra. To test this bra, 24 females were randomly assigned to control and intervention groups. The control group wore their everyday bra; the intervention group wore the generation 2 posture bra in place of their everyday bra for three months. Pre and post intervention, posture (spine curvature, scapula position, whole body alignment) and breast kinematics were assessed during sitting, standing and walking. Short-term effects of the posture bra were compared to an everyday bra and no bra (study two), whilst the long-term effects were compared using the no bra condition (study three). RESULTS Biomechanical intervention improved posture and breast kinematics in a prototype posture bra resulting in a second-generation prototype. Pre-intervention, the generation 2 posture bra significantly improved scapula retraction by 6° during both sitting and standing, but also increased deviation of whole body alignment compared to everyday bra and no bra conditions. During walking the posture bra reduced breast motion by 17 % compared to the everyday bra. Following the three-month wearer intervention, scapula depression significantly improved in the intervention group. SIGNIFICANCE A biomechanically informed posture bra was able to effectively support the breasts and improve scapula position without compromising spinal curvature, reducing the risk of musculoskeletal pain associated with poor posture.
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Affiliation(s)
- Melissa Jones
- School of Sport, Health and Exercise Science, Spinnaker Building, University of Portsmouth, PO1 2ER, United Kingdom
| | - Chris Mills
- School of Sport, Health and Exercise Science, Spinnaker Building, University of Portsmouth, PO1 2ER, United Kingdom.
| | - Tim Exell
- School of Sport, Health and Exercise Science, Spinnaker Building, University of Portsmouth, PO1 2ER, United Kingdom
| | - Joanna Wakefield-Scurr
- School of Sport, Health and Exercise Science, Spinnaker Building, University of Portsmouth, PO1 2ER, United Kingdom
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Efficacy of Integrating Cervical Posture Correction With Lumbar Stabilization Exercises for Mechanical Low Back Pain: A Randomized Blinded Clinical Trial. J Appl Biomech 2020; 37:43-51. [PMID: 33176277 DOI: 10.1123/jab.2020-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 08/15/2020] [Accepted: 08/27/2020] [Indexed: 11/18/2022]
Abstract
Although current lumbar stabilization exercises are beneficial for chronic mechanical low back pain, further research is recommended focusing on global spinal alignment normalization. This randomized, controlled, blinded trial was conducted to determine the effects of adding cervical posture correction to lumber stabilization on chronic mechanical low back pain. Fifty adult patients (24 males) with chronic mechanical low back pain and forward head posture received 12 weeks treatment of either both programs (group A) or lumbar stabilization (group B). The primary outcome was back pain. The secondary outcomes included the craniovertebral angle, Oswestry Disability Index, C7-S1 sagittal vertical axis, and sagittal intervertebral movements. The multivariate analysis of variance indicated a significant group-by-time interaction (P = .001, partial η2 = .609). Pain, disability, C7-S1 sagittal vertical axis, and l2-l3 intervertebral rotation were reduced in group A more than B (P = .008, .001, .025, and .001). Craniovertebral angle was increased in A when compared to B (P = .001). However, there were no significant group-by-time interactions for other intervertebral movements. Within-group comparisons were significant for all outcomes except for craniovertebral angle within patients in the control group. Adding cervical posture correction with lumber stabilization for management of chronic low back pain seemed to have better effects than the application of a stabilization program only.
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Wang X, Qureshi A, Vepa A, Rahman U, Palit A, Williams MA, King R, Elliott MT. A Sensor-Based Screening Tool for Identifying High Pelvic Mobility in Patients Due to Undergo Total Hip Arthroplasty. SENSORS 2020; 20:s20216182. [PMID: 33143034 PMCID: PMC7663251 DOI: 10.3390/s20216182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022]
Abstract
There is increasing evidence that pelvic mobility is a critical factor to consider in implant alignment during total hip arthroplasty (THA). Here, we test the feasibility of using an inertial sensor fitted across the sacrum to measure change in pelvic tilt, and hence screen for patients with high pelvic mobility. Patients (n = 32, mean age: 57.4 years) due to receive THA surgery participated in the study. Measures of pelvic tilt were captured simultaneously using the device and radiograph in three functional positions: Standing, flexed-seated, and step-up. We found a strong correlation between the device and radiograph measures for the change in pelvic tilt measure from standing to flexed-seated position (R2 = 0.911); 75% of absolute errors were under 5 degrees. We demonstrated that the device can be used as a screening tool to rapidly identify patients who would benefit from more detailed surgical planning of implant positioning to reduce future risks of impingement and dislocation.
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Affiliation(s)
- Xueyang Wang
- WMG, University of Warwick, Coventry CV4 7AL, UK; (X.W.); (A.P.); (M.A.W.)
| | - Arham Qureshi
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; (A.Q.); (A.V.); (U.R.); (R.K.)
| | - Abhinav Vepa
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; (A.Q.); (A.V.); (U.R.); (R.K.)
| | - Usama Rahman
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; (A.Q.); (A.V.); (U.R.); (R.K.)
| | - Arnab Palit
- WMG, University of Warwick, Coventry CV4 7AL, UK; (X.W.); (A.P.); (M.A.W.)
| | - Mark A. Williams
- WMG, University of Warwick, Coventry CV4 7AL, UK; (X.W.); (A.P.); (M.A.W.)
| | - Richard King
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; (A.Q.); (A.V.); (U.R.); (R.K.)
| | - Mark T. Elliott
- WMG, University of Warwick, Coventry CV4 7AL, UK; (X.W.); (A.P.); (M.A.W.)
- Correspondence:
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Spinal Flexibility Is an Important Factor for Improvement in Spinal and Knee Alignment after Total Knee Arthroplasty: Evaluation Using a Whole Body EOS System. J Clin Med 2020; 9:jcm9113498. [PMID: 33138143 PMCID: PMC7693723 DOI: 10.3390/jcm9113498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022] Open
Abstract
The purposes of this study were (1) to evaluate the relationship between lumbosacral flexibility and the effects of total knee arthroplasty (TKA) on whole-body alignment; and (2) to determine the prerequisites of the adjacent joints for successful TKA. A total of 116 patients (156 cases) who had whole-body X-ray and flexion-extension lumbar radiograph available were enrolled. For the sagittal alignment evaluation, hip-knee-ankle (HKA) angle, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and C7 plumb line-sacrum distance (SVA) were evaluated on the whole-body radiographs. Lumbar flexibility (LF) was evaluated using the flexion-extension lumbar radiographs, and pelvic flexibility (PF) was evaluated using the pelvic incidence (PI). The disparities in the knee joint between postoperative passive motion and weight-bearing posture were assessed. LF was significantly correlated with ΔLL and ΔSVA (LL: p = 0.039, SVA: p = 0.040; Pearson correlation coefficient (PCC): -0.206 and 0.205, respectively). There were correlations between PF and ΔSS (p < 0.001, PCC: -0.362), and between the disparity and LF (p = 0.005, PCC = -0.275). Linear regression analysis demonstrated that LF was significantly associated with the presence of disparity (p = 0.005, β = -0.205). LF is an important factor for improved spinal and lower limb alignment after TKA. Additionally, reduced LF may result in knee joint disparity between passive extension and standing extension status. Therefore, surgeons should consider spinopelvic alignment, including lower limb alignment preoperatively, to be able to predict possible changes in whole-body alignment following TKA.
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