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Gao Y, Jiang H, Gao R, Zhou X. Evaluation of lumbar paraspinal muscles degeneration and fatty infiltration in dynamic sagittal imbalance based on magnetic resonance imaging. 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; 33:1840-1849. [PMID: 38043127 DOI: 10.1007/s00586-023-08033-4] [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: 02/16/2023] [Revised: 08/08/2023] [Accepted: 10/26/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To explore degeneration and fatty infiltration (FI) of lumbar paraspinal muscles in patients with dynamic sagittal imbalance (DSI) and the relationship between lumbar paraspinal muscles degeneration, fatty infiltration and severity of the disease. METHODS We recruited 41 DSI patients and selected 22 lumbar spinal stenosis (LSS) patients without osphyalgia as controls. All patients received magnetic resonance imaging (MRI) scan and DSI patients also received pre-walk and post-walk X-rays. DSI patients were divided into 2 subgroups according to their symptom improvement after conservative treatment. We calculated rmCSA and FI of the lumbar paraspinal muscles. The rmCSA and FI between DSI and control and between DSI subgroups were compared by t test. The regression analysis was used to explore the risk factors influencing disease severity. Receiver operating characteristic (ROC) curves and area under curves (AUCs) were used to evaluate the severity of the disease. RESULTS In comparison of rmCSA and FI between DSI and control, there are significant differences of most muscles. In comparison of rmCSA between two subgroups, there are significant differences of most muscles, while in comparison of FI, only muscles in L4 segment have significant different. In logistic regression analysis, total rmCSA and total FI are risk factors influencing disease severity. ROC curves shows that total rmCSA and total FI both achieve an AUC greater than 0.7. CONCLUSION Compared with control, DSI patients have degeneration and fatty infiltration of the lumbar paraspinal muscles. The degeneration and fatty infiltration are risk factors influencing disease severity. The total rmCSA and total FI can be used as an indicator to determine whether a patient has severe DSI.
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Affiliation(s)
- Yuan Gao
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Heng Jiang
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Rui Gao
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Xuhui Zhou
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
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The relationship between spinal alignment and activity of paravertebral muscle during gait in patients with adult spinal deformity: a retrospective study. BMC Musculoskelet Disord 2023; 24:2. [PMID: 36597097 PMCID: PMC9808926 DOI: 10.1186/s12891-022-06121-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Spinal alignment in patients with adult spinal deformity (ASD) changes between rest and during gait. However, it remains unclear at which point the compensated walking posture breaks down and how muscles respond. This study used time-synchronized electromyography (EMG) to investigate the relationship between dynamic spinal alignment and muscle activity during maximum walking duration to reveal compensation mechanisms. METHODS This study collected preoperative three-dimensional gait analysis data from patients who were candidates for corrective surgery for ASD from April 2015 to May 2019. We preoperatively obtained dynamic spinal alignment parameters from initiation to cessation of gait using a motion capture system with time-synchronized surface integrated EMG (iEMG). We compared chronological changes in dynamic spinal alignment parameters and iEMG values 1) immediately after gait initiation (first trial), 2) half of the distance walked (half trial), and 3) immediately before cessation (last trial). RESULTS This study included 26 patients (22 women, four men) with ASD. Spinal sagittal vertical axis distance during gait (SpSVA) increased over time (first vs. half vs. last, 172.4 ± 74.8 mm vs. 179.9 ± 76.8 mm vs. 201.6 ± 83.1 mm; P < 0.001). Cervical paravertebral muscle (PVM) and gluteus maximus activity significantly increased (P < 0.01), but thoracic and lumbar PVM activity did not change. Dynamic spinal alignment showed significant correlation with all muscle activity (cervical PVM, r = 0.41-0.54; thoracic PVM, r = 0.49-0.66; gluteus maximus, r = 0.54-0.69; quadriceps, r = 0.46-0.55) except lumbar PVM activity. CONCLUSION Spinal balance exacerbation occurred continuously in patients with ASD over maximum walking distance and not at specific points. To maintain horizontal gaze, cervical PVM and gluteus maximus were activated to compensate for a dynamic spinal alignment change. All muscle activities, except lumbar PVM, increased to compensate for the spinal malalignment over time.
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Nyayapati P, Booker J, Wu PIK, Theologis A, Dziesinski L, O'Neill C, Zheng P, Lotz JC, Matthew RP, Bailey JF. Compensatory biomechanics and spinal loading during dynamic maneuvers in patients with chronic low back pain. 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 2022; 31:1889-1896. [PMID: 35604457 PMCID: PMC9252943 DOI: 10.1007/s00586-022-07253-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 04/06/2022] [Accepted: 04/30/2022] [Indexed: 12/04/2022]
Abstract
Purpose This study explores the biomechanics underlying the sit-to-stand (STS) functional maneuver in chronic LBP patients to understand how different spinal disorders and levels of pain severity relate to unique compensatory biomechanical behaviors. This work stands to further our understanding of the relationship between spinal loading and symptoms in LBP patients. Methods We collected in-clinic motion data from 44 non-specific LBP (NS-LBP) and 42 spinal deformity LBP (SD-LBP) patients during routine clinical visits. An RGB-depth camera tracked 3D joint positions from the frontal view during unassisted, repeated STS maneuvers. Patient-reported outcomes (PROs) for back pain (VAS) and low back disability (ODI) were collected during the same clinical visit. Results Between patient groups, SD-LBP patients had 14.3% greater dynamic sagittal vertical alignment (dSVA) and 10.1% greater peak spine torque compared to NS-LBP patients (p < 0.001). SD-LBP patients also had 11.8% greater hip torque (p < 0.001) and 86.7% greater knee torque (p = 0.04) compared to NS-LBP patients. There were no significant differences between patient groups in regard to anterior or vertical torso velocities, but anterior and vertical torso velocities correlated with both VAS (r = − 0.38, p < 0.001) and ODI (r = − 0.29, p = 0.01). PROs did not correlate with other variables. Conclusion Patients with LBP differ in movement biomechanics during an STS transfer as severity of symptoms may relate to different compensatory strategies that affect spinal loading. Further research aims to establish relationships between movement and PROs and to inform targeted rehabilitation approaches.
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Affiliation(s)
- Priya Nyayapati
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA.,Albany Medical College, Albany, NY, USA
| | - Jacqueline Booker
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA.,School of Medicine, University of California, San Francisco, CA, USA
| | - Peter I-Kung Wu
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Alekos Theologis
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Lucas Dziesinski
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Conor O'Neill
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Patricia Zheng
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Robert P Matthew
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Jeannie F Bailey
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA.
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Severijns P, Overbergh T, Desloovere K, Moke L, Scheys L. Spinopelvic movement strategies during sit-to-stand and stand-to-sit in adult spinal deformity. Gait Posture 2022; 92:15-23. [PMID: 34801951 DOI: 10.1016/j.gaitpost.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/18/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Research interest on the impact of adult spinal deformity (ASD) on spinopelvic and whole body motion has increased over the past years. Studies focusing on overground walking, showed that patients with ASD indeed present with functional impairments. Functional tasks challenging the spinopelvic complex, such as sit-to-stand-to-sit, might identify clinically relevant biomechanical parameters and could further increase our insights on how ASD impacts functioning and disability. RESEARCH QUESTION Do patients with ASD use different spinopelvic strategies during sit-to-stand (STSt) and stand-to-sit (StTS) compared to healthy controls? METHODS In this prospective study, marker-based motion analysis and a subject-specific polynomial fit were used to assess spinopelvic kinematics (thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), trunk, pelvis) during STSt/StTS in 42 patients with ASD and 18 control subjects. All parameters were compared between controls and patients with ASD, divided in three groups based on their sagittal alignment (ASD 1: decompensated sagittal malalignment; ASD 2: compensated sagittal malalignment; ASD 3: scoliosis and normal sagittal alignment). Continuous kinematic and kinetic data were analyzed through statistical parametric mapping. RESULTS Patients with ASD showed decreased LL and increased trunk flexion and SVA during STSt/StTS compared to controls. These differences were mainly observed in sagittal deformity patients (ASD 1 and 2). In contrast, coronal patients (ASD 3) did not differ from controls. Dynamic LL and SVA significantly correlated with radiographic LL and SVA, however these relations decreased during the middle third of the motion cycle. SIGNIFICANCE Patients with ASD use aberrant spinopelvic strategies during STSt/StTS compared to healthy controls. Only partial correlation to static radiographic parameters suggests other mechanisms need to be identified in addition to spinal malalignment. These might include impaired neuromuscular control or muscle weakness. Further research on movement patterns during functional tasks might ultimately result in treatment strategies that aim to augment activity participation by targeting improvements in movement function.
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Affiliation(s)
- Pieter Severijns
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium.
| | - Thomas Overbergh
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium
| | - Lieven Moke
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium; Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Lennart Scheys
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium; Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
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Saad E, Semaan K, Kawkabani G, Massaad A, Salibv RM, Mekhael M, Fakhoury M, Karam KA, Jaber E, Ghanem I, Lafage V, Skalli W, Rachkidi R, Assi A. Alteration of the Sitting and Standing Movement in Adult Spinal Deformity. Front Bioeng Biotechnol 2022; 9:751193. [PMID: 35096787 PMCID: PMC8792509 DOI: 10.3389/fbioe.2021.751193] [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: 07/31/2021] [Accepted: 12/03/2021] [Indexed: 12/03/2022] Open
Abstract
Adults with spinal deformity (ASD) are known to have spinal malalignment affecting their quality of life and daily life activities. While walking kinematics were shown to be altered in ASD, other functional activities are yet to be evaluated such as sitting and standing, which are essential for patients’ autonomy and quality of life perception. In this cross-sectional study, 93 ASD subjects (50 ± 20 years; 71 F) age and sex matched to 31 controls (45 ± 15 years; 18 F) underwent biplanar radiographic imaging with subsequent calculation of standing radiographic spinopelvic parameters. All subjects filled HRQOL questionnaires such as SF36 and ODI. ASD were further divided into 34 ASD-sag (with PT > 25° and/or SVA >5 cm and/or PI-LL >10°), 32 ASD-hyperTK (with only TK >60°), and 27 ASD-front (with only frontal malalignment: Cobb >20°). All subjects underwent 3D motion analysis during the sit-to-stand and stand-to-sit movements. The range of motion (ROM) and mean values of pelvis, lower limbs, thorax, head, and spinal segments were calculated on the kinematic waveforms. Kinematics were compared between groups and correlations to radiographic and HRQOL scores were computed. During sit-to-stand and stand-to-sit movements, ASD-sag had decreased pelvic anteversion (12.2 vs 15.2°), hip flexion (53.0 vs 62.2°), sagittal mobility in knees (87.1 vs 93.9°), and lumbar mobility (L1L3-L3L5: −9.1 vs −6.8°, all p < 0.05) compared with controls. ASD-hyperTK showed increased dynamic lordosis (L1L3–L3L5: −9.1 vs −6.8°), segmental thoracic kyphosis (T2T10–T10L1: 32.0 vs 17.2°, C7T2–T2T10: 30.4 vs 17.7°), and thoracolumbar extension (T10L1–L1L3: −12.4 vs −5.5°, all p < 0.05) compared with controls. They also had increased mobility at the thoracolumbar and upper-thoracic spine. Both ASD-sag and ASD-hyperTK maintained a flexed trunk, an extended head along with an increased trunk and head sagittal ROM. Kinematic alterations were correlated to radiographic parameters and HRQOL scores. Even after controlling for demographic factors, dynamic trunk flexion was determined by TK and PI-LL mismatch (adj. R2 = 0.44). Lumbar sagittal ROM was determined by PI-LL mismatch (adj. R2 = 0.13). In conclusion, the type of spinal deformity in ASD seems to determine the strategy used for sitting and standing. Future studies should evaluate whether surgical correction of the deformity could restore sitting and standing kinematics and ultimately improve quality of life.
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Affiliation(s)
- Eddy Saad
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Karl Semaan
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | | | - Abir Massaad
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | | | - Mario Mekhael
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Marc Fakhoury
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | | | - Elena Jaber
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Ismat Ghanem
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Virginie Lafage
- Orthopaedics Surgery, Lenox Hill Hospital, New York, NY, United States
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France
| | - Rami Rachkidi
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Ayman Assi
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France
- *Correspondence: Ayman Assi,
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Hey HWD, Lim JXY, Tan CS, Liu GKP, Wong HK. Audit and Comparison Between Radiographic Markers of Gaze Direction Using EOS Imaging - An Essential Step to Streamline Existing Methods. Spine (Phila Pa 1976) 2021; 46:E1202-E1210. [PMID: 34474453 DOI: 10.1097/brs.0000000000004213] [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] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study on prospectively implemented EOS protocol. OBJECTIVE This study aims to audit and compare existing radiological definitions of gaze direction-chin brow vertical angle (CBVA), McGregor slope (McGS), slope of line of sight (SLS), orbital-internal occipital protuberance (OIOP) slope angle, and Tangent to the hard palate (THP) in a neutral, healthy, and asymptomatic cohort. SUMMARY OF BACKGROUND DATA The ability to accurately define direction of gaze is the first step when striving for horizontal gaze restoration in any affected individual with rigid sagittal deformity. Yet, the radiological definition of gaze direction remains poorly standardized. METHODS Hundred healthy subjects who could achieve horizontal gaze underwent whole-body standing EOS radiographs taken under a strictly standardized protocol. Radiographic measurements of global spinal sagittal parameters and surrogate measures of horizontal gaze were analyzed and compared. RESULTS The mean age was 45 ± 15.9 years, with a balanced male-to-female-ratio. Their C7 SVA was -7.7 mm ± 24.8 mm, PI was 51.0o ± 11.4o, PI-LL was -0.9o ± 13.0o and T1-slope was 21.2o ± 9.2o. Measured horizontal gaze parameters were as follows: CBVA (1.07o ± 5.48o), McGS (-3.23o ± 5.63o), SLS (0.45o ± 5.34o), OIOP (5.03o ± 4.66o), THP (-0.17o ± 6.27o). CBVA correlated strongly with McGS (r = 0.679, P < 0.001), SLS (r = 0.592, P < 0.001), OIOP (r = 0.697, P < 0.001), and THP (r = -0.504, P < 0.001). OIOP had the lowest variance amongst all parameters and showed less variability compared to CBVA (SD 4.66 Var 21.69 vs. SD 5.48 Var 30.08, P = .012). Multivariate analysis showed that C2-7 angle was the only parameter found to be associated with OIOP values (P = 0.006). CONCLUSION OIOP is the least variable, and most robust radiological method in determining gaze direction. It uses easily recognizable anatomical landmarks and an angular criterion, which makes it advantageous both with x-rays or slot scanners.Level of Evidence: 3.
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Affiliation(s)
| | - Joel Xue Yi Lim
- Department of Orthopedic Surgery, National University Health System, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Gabriel Ka Po Liu
- Department of Orthopedic Surgery, National University Health System, Singapore
| | - Hee Kit Wong
- Department of Orthopedic Surgery, National University of Singapore, Singapore
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Girase H, Nyayapati P, Booker J, Lotz JC, Bailey JF, Matthew RP. Automated assessment and classification of spine, hip, and knee pathologies from sit-to-stand movements collected in clinical practice. J Biomech 2021; 128:110786. [PMID: 34656825 DOI: 10.1016/j.jbiomech.2021.110786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
Efficient, cost-effective methods for quantifying patient biomechanics at the point of care can facilitate faster and more accurate diagnoses. This work presents a new method to diagnose pre-surgical back, hip, and knee patients by analysing their sit-to-stand motion captured by a Kinect camera. Kinematic and dynamic time-series features were extracted from patient movements collected in clinic. These features were used to test a variety of machine learning methods for patient classification. The performance of models trained on time-series features were compared against models trained on domain-knowledge features, highlighting the importance of using time-series data for the classification of human movement. Additionally, the effectiveness of using semi-supervised learning is tested on partially labelled datasets, providing insight on how to boost classification performance in situations where labelled patient data is difficult to obtain. The best semi-supervised model achieves ∼73% accuracy in distinguishing individuals with low-back pain, and hip and knee degeneration from control subjects.
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Affiliation(s)
- Harshayu Girase
- Department of Electrical Engineering and Computer Science, University of California at Berkeley, Berkeley, 94720, CA, USA
| | - Priya Nyayapati
- Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, 94158, CA, USA
| | - Jacqueline Booker
- School of Medicine, University of California at San Francisco, San Francisco, 94158, CA, USA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, 94158, CA, USA
| | - Jeannie F Bailey
- Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, 94158, CA, USA
| | - Robert P Matthew
- Department of Physical Therapy and Rehabilitation Science, University of California at San Francisco, San Francisco, 94158, CA, USA.
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Terai H, Takahashi S, Yasuda H, Konishi S, Maeno T, Kono H, Matsumura A, Namikawa T, Kato M, Hoshino M, Tamai K, Toyoda H, Suzuki A, Nakamura H. Direct Lateral Corpectomy and Reconstruction Using an Expandable Cage Improves Local Kyphosis but Not Global Sagittal Alignment. J Clin Med 2021; 10:jcm10174012. [PMID: 34501460 PMCID: PMC8432512 DOI: 10.3390/jcm10174012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 01/07/2023] Open
Abstract
Recently, an expandable cage equipped with rectangular footplates has been used for anterior vertebral replacement in osteoporotic vertebral fracture (OVF). However, the postoperative changes in global alignment have not been elucidated. The purpose of this study was to evaluate local and global spinal alignment after anterior and posterior spinal fixation (APSF) using an expandable cage in elderly OVF patients. This retrospective multicenter review assessed 54 consecutive patients who underwent APSF for OVF. Clinical outcomes were compared between postoperative sagittal vertical axis (SVA) > 95 mm and ≤95 mm groups to investigate the impact of malalignment. SVA improved by only 18.7 mm (from 111.8 mm to 93.1 mm). VAS score of back pain at final follow-up was significantly higher in patients with SVA > 95 mm than SVA ≤ 95 mm (42.4 vs. 22.6, p = 0.007). Adjacent vertebral fracture after surgery was significantly more frequent in the SVA > 95 mm (37% vs. 11%, p = 0.038). Multiple logistic regression showed significantly increased OR for developing adjacent vertebral fracture (OR = 4.76, 95% CI 1.10–20.58). APSF using the newly developed cage improves local kyphotic angle but not SVA. The main cause for the spinal malalignment after surgery was postoperative development of adjacent vertebral fractures.
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Affiliation(s)
- Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
- Correspondence: ; Tel.: +81-06-6645-3851
| | - Hiroyuki Yasuda
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan; (H.Y.); (S.K.)
| | - Sadahiko Konishi
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan; (H.Y.); (S.K.)
| | - Takafumi Maeno
- Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Osaka 579-8026, Japan; (T.M.); (H.K.)
| | - Hiroshi Kono
- Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Osaka 579-8026, Japan; (T.M.); (H.K.)
| | - Akira Matsumura
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka 534-0021, Japan; (A.M.); (T.N.); (M.K.)
| | - Takashi Namikawa
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka 534-0021, Japan; (A.M.); (T.N.); (M.K.)
| | - Minori Kato
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka 534-0021, Japan; (A.M.); (T.N.); (M.K.)
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
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Matthew RP, Seko S, Kurillo G, Bajcsy R, Cheng L, Han JJ, Lotz J. Reachable Workspace and Proximal Function Measures for Quantifying Upper Limb Motion. IEEE J Biomed Health Inform 2020; 24:3285-3294. [PMID: 32340969 DOI: 10.1109/jbhi.2020.2989722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There are a lack of quantitative measures for clinically assessing upper limb function. Conventional biomechanical performance measures are restricted to specialist labs due to hardware cost and complexity, while the resulting measurements require specialists for analysis. Depth cameras are low cost and portable systems that can track surrogate joint positions. However, these motions may not be biologically consistent, which can result in noisy, inaccurate movements. This paper introduces a rigid body modelling method to enforce biological feasibility of the recovered motions. This method is evaluated on an existing depth camera assessment: the reachable workspace (RW) measure for assessing gross shoulder function. As a rigid body model is used, position estimates of new proximal targets can be added, resulting in a proximal function (PF) measure for assessing a subject's ability to touch specific body landmarks. The accuracy, and repeatability of these measures is assessed on ten asymptomatic subjects, with and without rigid body constraints. This analysis is performed both on a low-cost depth camera system and a gold-standard active motion capture system. The addition of rigid body constraints was found to improve accuracy and concordance of the depth camera system, particularly in lateral reaching movements. Both RW and PF measures were found to be feasible candidates for clinical assessment, with future analysis needed to determine their ability to detect changes within specific patient populations.
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Yin J, Ma X, Lin T, Gao R, Zhou X. Characteristics and treatment of dynamic sagittal imbalance in adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2340-2353. [PMID: 32488439 DOI: 10.1007/s00586-020-06459-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/10/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To raise the diagnostic criteria, classification and treatment strategy of dynamic sagittal imbalance (DSI). METHODS One hundred thirty-three adult spinal deformity (ASD) patients with stooping and back pain after walking were retrospectively analyzed. Based on the radiographic parameters and Oswestry Disability Index (ODI) scores, the diagnostic criteria of DSI were raised. DSI patients received nonoperative treatment and (or) surgery. Radiographic parameters and health-related quality of life (HRQOL) outcomes would be measured and compared between prewalk and postwalk and among each subgroup. RESULTS One hundred thirty-three ASD patients with stooping and back pain after walking were enrolled in our study. The quantitative diagnostic criteria was prewalk SVA < 40 mm and postwalk SVA-prewalk SVA ≥ 20 mm after 10-min walk. Based on the quantitative diagnostic criteria of DSI raised by our team, DSI patients could be classified into three groups: 20 mm ≤ ΔSVA < 60 mm (mild, 31.0%), 60 mm ≤ ΔSVA < 100 mm (moderate, 42.1%) and ΔSVA ≥ 100 mm (severe, 27.0%). After nonoperative treatment, the ΔSVA in mild and moderate group was prominently decreased (P < 0.001) with the significant improvement of HRQOL outcomes (P < 0.001), while there was no significant change in ΔSVA and clinical outcomes in group C (P > 0.05). Patients who received the operative treatment showed prominent improvement in ΔSVA and clinical outcomes (P < 0.001). CONCLUSION Our study proposed a quantitative diagnostic criteria and novel classification of DSI. Nonoperative treatment is effective for most DSI patients with ΔSVA < 100 mm, while the majority of DSI patients with ΔSVA ≥ 100 mm need operative intervention.
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Affiliation(s)
- Jia Yin
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Xiao Ma
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Tao Lin
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Rui Gao
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Xuhui Zhou
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
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Computation of Intersegmental Moments during Standing Posture: Can We Neglect the Horizontal Ground Reaction Force? Results from an Experimental Study. Adv Orthop 2019; 2019:7129682. [PMID: 31827933 PMCID: PMC6885162 DOI: 10.1155/2019/7129682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/15/2019] [Accepted: 10/31/2019] [Indexed: 11/17/2022] Open
Abstract
Background The development of postural analysis thanks to force and pressure platforms, in order to determine the center of pressure, can be valuable in the setting of spinal malalignment. The purpose of this study was to compare “pressure” and “force” platforms for the evaluation of the center of pressure. In other words, can we neglect the horizontal ground reaction force in the evaluation of intersegmental moments during standing posture? Methods. Postural data from two healthy adult volunteers were analyzed. Analysis of the posture was done according to a protocol providing sagittal intersegmental moments. A set of 36 markers was used to divide the body in 10 segments. Postacquisition calculations were done in order to obtain the sagittal net intersegmental moments. To evaluate the differences in intersegmental moments between force and pressure platforms, the postacquisition calculations were done with a simulated pressure platform. Mean intersegmental moments between each body segment for each volunteer were compared. Findings There were significant differences between the 2 platforms in intersegmental moments for the lumbo-sacral junction, hips, knees, and ankles (p < 0.005). All differences were inferior to intrasubject variability measured with the force platform (p < 0.001). Results from intra- and interobserver comparisons showed that differences measured with the pressure platform were all inferior to the standard error obtained with the force platform for every intersegmental moment (p < 0.001). Interpretation The use of a simulated pressure platform to determine intersegmental moments has the same clinical efficiency as force platforms. Moreover, the possibility to set the platform into the radiograph room will allow in a second time a correlation between radiographic parameters and biomechanical constraints applied to the spine.
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