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Breast Hypertrophy: A Real Pain in the Back. Plast Reconstr Surg 2023; 151:498-508. [PMID: 36730482 DOI: 10.1097/prs.0000000000009906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bilateral breast hypertrophy comes with signs and symptoms ranging from mild to debilitating. Bilateral breast reduction (BBR) is one of the most frequently performed plastic surgery procedures, and its effects on parameters such as spinal balance, paraspinal muscle function, and physical performance have not been thoroughly evaluated. The objective of this study was to evaluate the effects of BBR using advanced spine imaging modalities, and pain resolution. METHODS A prospective, observational, cohort study was carried out at the McGill University Health Centre. The following measures were recorded preoperatively and postoperatively for each patient: patient questionnaires (BREAST-Q and Pain), magnetic resonance imaging, and EOS low-radiation spinal scan. RESULTS Significant postoperative pain reduction was recorded, and there was up to 148% improvement in physical tests. Improvement in all questionnaire and BREAST-Q categories was documented. Preoperative and postoperative magnetic resonance imaging did demonstrate a statistically significant absence of permanent anatomical skeletal sequelae. Postoperative improvement in thoracic kyphosis was documented. CONCLUSIONS Quality-of-life scores are uniformly improved following BBR. Key findings following BBR include significant pain reduction and no evidence of spinal skeletal change. This is a finding of major importance in view of the practice of many insurance companies/third-party payer and health care systems that use the Schnur scale. The Schnur scale associates a weight for resection with body size that is not directly predictive of pain relief. This may indicate the need for more precise or different guidelines based on these quantitative findings. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Xu S, Guo C, Liang Y, Zhu Z, Zhang H, Liu H. Posterior instrumented fusion on lumbar stenosis syndrome can bring benefit to proximal degenerative kyphosis: A CONSORT-compliant article. Medicine (Baltimore) 2021; 100:e27711. [PMID: 34766574 PMCID: PMC10545290 DOI: 10.1097/md.0000000000027711] [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: 11/17/2020] [Revised: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The effect on degenerative thoracolumbar kyphosis (DTLK) after short-segment instrument for lumbar spinal stenosis syndrome (LSS) remains controversial. Based on the biomechanics and compensatory of the global spino-pelvic alignment, it was assumed that the interference on the lumbar spine, instead of the thoracolumbar segment, could still make a difference on the proximal spine.To explore whether DTLK could improve with only surgery for LSS and identify influencing factors on postoperative TLK.The study was performed from January 2016 to December 2018. Sixty-nine participants (25 male) diagnosed LSS with DTLK were enrolled and surgery was only for LSS. Radiological parameters included TLK, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, and osteoporosis. Clinical outcomes were visual analogue scale and Oswestry disability index. According to lower instrumented vertebrae (LIV) on L5 or S1, inter-group comparisons were performed between LIV on L5 (L5 group) and S1 (S1 group).Demographics were well-matched between L5 and S1 group with a mean follow-up of 24.3 ± 12.1 (m). TLK improved with a mean of 16.2 ± 7.6 (°) (P < .001). There was no significance on radiological and clinical parameters between L5 and S1 groups except for a larger pelvic tilt in S1 group (P = .046). Visual analogue scale (P = .787) and Oswestry disability index (P = .530) were both indifferent between normal TLK and DTLK at last (P > .05). Postoperative TLK was affected by osteoporosis and sacral slope, the latter was dominated by pelvic incidence and pelvic rotation. Osteoporosis was the risk factor for TLK correction (P = .001, odd risk = 9.58).DTLK decreased if instrument only performed for LSS, where TLK and clinical outcomes are comparably affected whether L5 or S1 is selected as LIV. This study supplements the compensatory mechanism of spino-pelvic alignment, especially for cases with severe osteoporosis.
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Affiliation(s)
- Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, P.R. China
| | - Chen Guo
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, P.R. China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, P.R. China
| | - Zhenqi Zhu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, P.R. China
| | - Hongguang Zhang
- Department of Neurosurgery, Jining Medical College Affiliated Gaotang People's Hospital, Liaocheng, Shandong, P.R. China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, P.R. China
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Shimokawa T, Miyamoto K, Hioki A, Masuda T, Fushimi K, Ogawa H, Ohnishi K, Akiyama H. Compensatory Pelvic Retro-Rotation Associated with a Decreased Quality of Life in Patients with Normal Sagittal Balance. Asian Spine J 2021; 16:241-247. [PMID: 33966366 PMCID: PMC9066255 DOI: 10.31616/asj.2020.0449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022] Open
Abstract
Study Design Cross-sectional observational study. Purpose To examine whether pelvic rotation as a compensatory mechanism for sagittal imbalance is related to quality of life (QOL). Overview of Literature Poor sagittal alignment is associated with compensatory pelvic retroversion and decreased QOL. Whether the compensatory pelvic tilt (PT) influences QOL is unclear. Methods Overall, 134 subjects aged ≥20 years with lower back pain were included (104 females; mean age, 70±9.8 years). Sagittal vertical alignment (SVA) and PT were analyzed radiographically. Patients were stratified into three groups based on SVA values: good alignment (group G), intermediate alignment (group I), and poor sagittal alignment (group P). Patients in group I were further categorized into two groups: low PT and high PT. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for clinical assessment, and the scores were compared between groups. Results As SVA increased, PT and lumbar lordosis (LL) increased and decreased, respectively. PT and LL differed significantly between groups G and P (p<0.01 for each comparison). Within group I, there was no significant difference in SVA between the high PT and low PT groups, suggesting that the high PT group had acquired a compensated sagittal balance. Importantly, all domains in the JOABPEQ (except for lower back pain) were significantly lower in the high PT group than in the low PT group (p<0.05 for every comparison). Conclusions This study showed that focusing solely on SVA as a single indicator can cause important losses in QOL to be overlooked in patients with lumbar disorders. Although pelvic retroversion can compensate for sagittal balance, it is associated with a significant decrease in QOL. To improve the assessment of patients with lumbar disorders, PT should be considered besides SVA.
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Affiliation(s)
- Tetsuya Shimokawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Gifu, Japan.,Department of Orthopaedic Surgery, School of Medicine, Gifu University, Gifu, Japan
| | - Kei Miyamoto
- Department of Orthopaedic Surgery, Gifu Municipal Hospital, Gifu, Japan
| | - Akira Hioki
- Spine Center, Matsunami General Hospital, Gifu, Japan
| | | | - Kazunari Fushimi
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, Gifu, Japan
| | - Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Gifu, Japan
| | - Kazuichiro Ohnishi
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, Gifu, Japan
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Vanni D, Berjano P. Spinal pseudogout is a joker. Commentary on "Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two cases". NORTH AMERICAN SPINE SOCIETY JOURNAL 2020; 3:100028. [PMID: 35141596 PMCID: PMC8820059 DOI: 10.1016/j.xnsj.2020.100028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 06/14/2023]
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Redaelli A, Pun A, Aebi M. The problems associated with revision surgery. 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 2019; 29:2-5. [PMID: 31734807 DOI: 10.1007/s00586-019-06221-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 10/12/2019] [Accepted: 11/14/2019] [Indexed: 01/01/2023]
Abstract
This article highlights the issue related to revision surgery in spine and the possible implications in the next future. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Andrea Redaelli
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
| | | | - Max Aebi
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
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Papanastasiou C, Ouellet JA, Lessard L. The Effects of Breast Reduction on Back Pain and Spine Measurements: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2324. [PMID: 31592372 PMCID: PMC6756677 DOI: 10.1097/gox.0000000000002324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/29/2019] [Indexed: 11/30/2022]
Abstract
The aim of this review article was to synthesize the literature on reduction mammaplasty and its effects on the spine. The particular focus was to find these few radiological studies and those investigating changes in spinal angles, posture, center of gravity, and back pain reduction.
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Affiliation(s)
- Constantine Papanastasiou
- Department of Surgery, Division of Plastic Surgery, McGill University Health Centre (MUHC), Montreal, Quebec, Canada.,Department of Orthopedic Surgery, Spine Surgery, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Jean A Ouellet
- Department of Orthopedic Surgery, Spine Surgery, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Lucie Lessard
- Department of Surgery, Division of Plastic Surgery, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
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Alzakri A, Labelle H, Hresko MT, Parent S, Sucato DJ, Lenke LG, Marks MC, Mac-Thiong JM. Restoration of normal pelvic balance from surgical reduction in high-grade spondylolisthesis. 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 2019; 28:2087-2094. [PMID: 30989359 DOI: 10.1007/s00586-019-05973-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/24/2019] [Accepted: 04/05/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the effectiveness of surgical reduction in high-grade spondylolisthesis in maintaining or restoring a normal pelvic balance, as related to the QoL. METHODS It is a retrospective analysis of prospectively collected data of 60 patients (17 males, 43 females) aged 15 ± 3.1 years who underwent surgery for high-grade spondylolisthesis and were followed for a minimum of 2 years after surgery. Patients with a residual high-grade slip following surgery were referred to the postoperative high-grade (PHG) group, while patients with a residual low-grade slip were referred to the postoperative low-grade (PLG) group. Pelvic balance was assessed from pelvic tilt and sacral slope, in order to identify patients with a balanced pelvis or unbalanced pelvis. The SRS-22 questionnaire was completed before surgery and at last follow-up. RESULTS Postoperatively, there were 36 patients with a balanced pelvis and 24 patients with an unbalanced pelvis. The improvement in QoL was better in patients with a postoperative balanced pelvis. There were 14 patients in the PHG group and 46 patients in the PLG group. Four of seven patients (57%) in the PHG group and 21 of 26 patients (81%) in the PLG group with a preoperative balanced pelvis maintained a balanced pelvis postoperatively (P = 0.1). None of the patients in the PHG group and 11 of 20 patients (55%) in the PLG group improved from an unbalanced to a balanced pelvis postoperatively (P < 0.05). CONCLUSIONS Surgical reduction in high- to low-grade slip is more effective in maintaining and restoring a normal pelvic balance postoperatively. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Abdulmajeed Alzakri
- University of Montreal, Montreal, Canada.,Hôpital du Sacré-Cœur, Montreal, Canada.,Orthopedic Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hubert Labelle
- University of Montreal, Montreal, Canada.,Division of Orthopaedic Surgery, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Michael T Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan Parent
- University of Montreal, Montreal, Canada.,Hôpital du Sacré-Cœur, Montreal, Canada.,Division of Orthopaedic Surgery, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | | | - Lawrence G Lenke
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - Jean-Marc Mac-Thiong
- University of Montreal, Montreal, Canada. .,Hôpital du Sacré-Cœur, Montreal, Canada. .,Division of Orthopaedic Surgery, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada. .,Department of Surgery, Hôpital du Sacré-Coeur de Montréal, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada.
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The Michel Benoist and Robert Mulholland yearly European Spine Journal review: a survey of the "surgical and research" articles in the European Spine Journal, 2018. 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 2019; 28:1-9. [PMID: 30604293 DOI: 10.1007/s00586-018-5856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
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