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Nakano T, Oyama T, Wada K, Wada K, Kumagai G, Nitobe Y, Aburakawa K, Ishibashi Y. Sex differences in factors affecting spinopelvic sagittal alignment and balance: a cross-sectional observational study in a Japanese community. Sci Rep 2025; 15:17823. [PMID: 40404836 PMCID: PMC12099002 DOI: 10.1038/s41598-025-02735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 05/15/2025] [Indexed: 05/24/2025] Open
Abstract
Understanding how age and sex affect spinopelvic sagittal alignment is important for preventing the progression of adult spinal deformity and optimizing treatment. Here, we analyzed sex differences in age-related changes in spinopelvic sagittal alignment and balance in a Japanese community. Healthy adults (210 men and 300 women) ranging in age from their 20-80 s who participated in a general population health examination were categorized into age groups by decade according to sex. The association between changes in sagittal spinal alignment and balance, vertebral fracture, bone mineral density, bioelectrical impedance analysis, handgrip strength, and gait speed was investigated. In women, we found increased thoracic kyphosis in the 60s and pelvic retroversion in the 70s. In men, slight changes in local sagittal alignment were observed with age. Multiple linear regression analyses revealed that sagittal balance was associated with both age and vertebral fractures in men but only with age in women. Age-related changes in spinopelvic sagittal alignment differed between men and women, with men exhibiting nonstructural changes and women experiencing structural changes. In men, both age and vertebral fracture contributed to sagittal imbalance, whereas in women, only aging was associated with sagittal imbalance.
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Affiliation(s)
- Takaaki Nakano
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Tetsushi Oyama
- Department of Orthopedic Surgery, Aomori Rosai Hospital, Hachinohe, Japan
| | - Kanichiro Wada
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Kairo Wada
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Gentaro Kumagai
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yoshiro Nitobe
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Kotaro Aburakawa
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Asano F, Inami S, Takeuchi D, Moridaira H, Ueda H, Aoki H, Iimura T, Taneichi H. Dynamic Alignment Changes of the Spine, Pelvis, and Lower Limbs during Gait Analyzed Using Inertial Motion Capture in Patients with Adult Spinal Deformity. Spine Surg Relat Res 2024; 8:631-636. [PMID: 39659378 PMCID: PMC11625715 DOI: 10.22603/ssrr.2024-0028] [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: 02/03/2024] [Accepted: 04/16/2024] [Indexed: 12/12/2024] Open
Abstract
Introduction Patients with adult spinal deformity (ASD) lean forward with their trunks when walking, even if they can remain upright during static standing. However, it remains unclear which part of the spinal column is involved in forward trunk tilt and the details of the relationships between sagittal alignment during static standing and changes in dynamic parameters during walking. Therefore, this study aimed to clarify the above by analyzing the walking motion of ASD patients using inertial measurement units (IMUs). Methods Preoperative ASD patients were included in this study. Dynamic parameters during gait were measured by IMUs attached on the skin at the T1, T12, and S1 spinous processes, thigh, and lower leg. Walking data were divided into three phases of 10 s each (initial, middle, and final), and the average dynamic parameters at each phase were statistically compared. The relationships between the standing radiographic and dynamic parameters in the final phase were evaluated by linear regression analyses. Results A total of 34 patients were included in this study. Their mean age was 72 years. The inclination of IMUs on the T1, T12, and S1 and the flexion angle of T12-S1 IMUs significantly increased over time. Pelvic tilt (PT) of standing radiography was positively correlated with the inclination angles of T12 (r2=0.22, p=0.0048) and S1 (r2=0.16, p=0.0178) and the flexion angle of T12-S1 IMUs (r2=0.29, p=0.0011). Conclusions This study showed that anteversion of the trunk in patients with ASD is due to an increase in lumbar forward bending and anterior tilt of the pelvis. Lumbar forward bending was significantly correlated with PT on standing radiography. It is important to consider the presence of poorer posture during gait than during standing when we evaluate patients with high PT.
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Affiliation(s)
- Futoshi Asano
- Department of Orthopaedic Surgery, Washiya Kinen Hospital, Utsunomiya, Japan
| | - Satoshi Inami
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Japan
| | - Daisaku Takeuchi
- Department of Orthopaedic Surgery, Nasu Red Cross Hospital, Otawara, Japan
| | - Hiroshi Moridaira
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Japan
| | - Haruki Ueda
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Japan
| | - Hiromichi Aoki
- Department of Orthopaedic Surgery, Gotenyama Hospital, Kanuma, Japan
| | - Takuya Iimura
- Department of Orthopaedic Surgery, Kamitsuga General Hospital, Kanuma, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Japan
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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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Kim YC, Ha KY, Kim SM, Li X, Kim DH. Characteristics and standards of severe sagittal imbalance in adult patients with spinal deformities: a retrospective analysis. BMC Musculoskelet Disord 2024; 25:125. [PMID: 38336677 PMCID: PMC10854104 DOI: 10.1186/s12891-024-07231-5] [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: 08/06/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE To analyze the characteristics of "severe" dynamic sagittal imbalance (DSI) in patients with adult spinal deformity (ASD) and establish criteria for them. METHODS We retrospectively analyzed 102 patients with ASD presenting four cardinal signs of lumbar degenerative kyphosis. All patients underwent deformity corrective surgery and were divided into three groups according to the diagnostic criteria based on the Oswestry disability index and dynamic features (△Timewalk: time until C7 sagittal vertical axis [C7SVA] reaches ≥ 20 cm after the start of walking) of sagittal imbalance. The paravertebral back muscles were analyzed and compared using T2-weighted axial imaging. We performed a statistically time-dependent spinopelvic sagittal parameter analysis of full standing lateral lumbar radiographs. Lumbar flexibility was analyzed using dynamic lateral lumbar radiography. RESULTS The patients were classified into the mild (△Timewalk ≥ 180 s, 35 patients), moderate (180 s > △Timewalk ≥ 30 s, 38 patients), and severe (△Timewalk < 30 s, 29 patients) groups. The back muscles in the severe group exhibited a significantly higher signal intensity (533.4 ± 237.5, p < 0.05) and larger area of fat infiltration (35.2 ± 5.4, p < 0.05) than those in the mild (223.8 ± 67.6/22.9 ± 11.9) and moderate groups (294.4 ± 214.7/21.6 ± 10.6). The analysis of lumbar flexibility revealed significantly lower values in the severe group (5.8° ± 2.5°, p < 0.05) than in the mild and moderate groups (14.2° ± 12.4° and 11.4° ± 8.7°, respectively). The severe group had significantly lower lumbar lordosis (LL, 25.1° ± 22.7°, p < 0.05) and Pelvic incidence-LL mismatch (PI-LL, 81.5° ± 26.6°, p < 0.001) than those of the mild (8.2° ± 16.3°/58.7° ± 18.8°) and moderate (14.3° ± 28.6°/66.8° ± 13.4°) groups. On receiver operating characteristic curve analysis, PI-LL was statistically significant, with an area under the curve of 0.810 (95% confidence interval) when the baseline was set at 75.3°. The severe group had more postoperative complications than the other groups. CONCLUSIONS Our results suggest the following criteria for severe DSI: C7SVA > 20 cm within 30 s of walking or standing, a rigid lumbar curve < 10° on dynamic lateral radiographs, and a PI-LL mismatch > 75.3°. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Yong-Chan Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, 05278, Seoul, South Korea.
| | - Kee-Yong Ha
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, 05278, Seoul, South Korea
| | - Sung-Min Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, 05278, Seoul, South Korea
| | - Xiongjie Li
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, 05278, Seoul, South Korea
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyung Hee University, Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea
| | - Dong-Hyun Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, 05278, Seoul, South Korea
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Wang T, Wang J, Hu X, Hao K, Xiang G, Wu Z, Ma Z, Li T, Chen Y, Zhao X, Zhang Y, Ma T, Ren J, Lei W, Feng Y. Diabetes-related Screw Loosening: The Distinction of Surgical Sites and the Relationship among Diabetes, Implant Stabilization and Clinical Outcomes. Orthop Surg 2023; 15:3136-3145. [PMID: 37853938 PMCID: PMC10694010 DOI: 10.1111/os.13915] [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: 03/29/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVES Diabetes mellitus (DM) is correlated with poor clinical outcomes in spinal surgery. However, the effect of it on screw stabilization has not been investigated. The aim of this study was to evaluate the screw loosening rate and postoperative outcomes in diabetic patients and to identify potential risk factors associated with loosening. METHODS This was a retrospective study. Two hundred and forty-three patients who received cervical or lumbar internal fixation between 2015 and 2019 were enrolled. Screw loosening was assessed on radiography, and clinical outcomes were evaluated by the improvement of visual analogue scale (VAS), Oswestry disability index (ODI) or Japanese Orthopaedic Association (JOA) scores. The relationship of DM, screw loosening and clinical outcomes were analyzed with chi-square tests and regression analyses. RESULTS One hundred and twenty-two patients (50.2%) with diabetes were included in this study. Diabetes led to the increase of the rate of screw loosening in the lumbar spine, while the loosening rate did not vary significantly in the cervical spine. The occurrence of screw loosening in the lumbar spine was more likely to be associated with clinical outcomes for motor performance including walking and sitting. However, no significant effect on JOA and VAS scores in the cervical spine of screw loosening was found. Moreover, the history of DM affected the outcomes of the patients who underwent spinal surgery. CONCLUSION DM had an adverse effect on screw stabilization. The impaired improvement of clinical outcomes in diabetics after spinal surgery was related to screw loosening. In addition to the direct effects on operative wounds and neural function, the impact on the screws due to DM was also worth noting.
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Affiliation(s)
- Tianji Wang
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Jing Wang
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Xiaofan Hu
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Kaili Hao
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Geng Xiang
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Zixiang Wu
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Zhensheng Ma
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Tianqing Li
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Yu Chen
- Department of Critical Care MedicineXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Xiong Zhao
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Yang Zhang
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Tiancheng Ma
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Jingjuan Ren
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Wei Lei
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Yafei Feng
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
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Symptomatic Sagittal Imbalance and Severe Degeneration of Paraspinal Muscle Predispose Suboptimal Outcomes After Lumbar Short Fusion Surgery for Degenerative Lumbar Spinal Stenosis. World Neurosurg 2022; 164:e741-e748. [PMID: 35580778 DOI: 10.1016/j.wneu.2022.05.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to investigate the risk factors of suboptimal postoperative outcomes after short-segment surgery for degenerative lumbar spinal stenosis and severe sagittal imbalance and to recommend the appropriate candidates for the short fusion. METHODS A total of 101 elderly subjects who underwent short-segment surgery were included. Preoperative sagittal vertical axis decreased to ≤50 mm was determined as sagittal compensation; otherwise, it was determined as sagittal decompensation. At the latest follow-up, 64 patients with sagittal decompensation and 14 patients with proximal junctional kyphosis (PJK) were detected. Sagittal imbalance with the related symptoms was named as symptomatic sagittal imbalance. Preoperative clinical data and spinopelvic parameters were collected and compared between different groups. RESULTS Symptomatic sagittal imbalance and severe degeneration of paravertebral muscle were revealed to be the risk factors for sagittal decompensation and PJK. More sagittal decompensations (100%) and PJKs (60%) were observed in patients with both of these risk factors. On the contrary, postoperative outcomes were superior with less sagittal decompensation (46.9%) and PJK (0%) in those with neither of the 2 factors. CONCLUSIONS Symptomatic sagittal imbalance and severe degeneration of paraspinal muscle are the risk factors predisposing suboptimal surgical outcomes after lumbar short-segment decompression and fusion for degenerative lumbar spinal stenosis. We believe essential spinal function and substantial quality of paraspinal muscle are the keys to long-lasting good outcomes.
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Comparative radiological outcomes and complications of sacral-2-alar iliac screw versus iliac screw for sacropelvic fixation. 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 2021; 30:2257-2270. [PMID: 33987735 DOI: 10.1007/s00586-021-06864-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/13/2020] [Accepted: 05/01/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the outcomes of sacropelvic fixation (SPF) using sacral-2-alar iliac (S2AI) screw with SPF using iliac screw (IS). METHODS A comprehensive search of PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Scopus was performed for comparative studies between S2AI and IS for SPF. Two independent investigators selected qualified studies and extracted data indispensably. With 95% confidence intervals (CI), the odds ratio (OR) was applied to dichotomous outcomes and standardized mean difference (SMD) was applied to continuous outcomes for each item. RESULTS We included data from thirteen studies involving 722 patients (S2AI, 357 patients; IS, 365 patients). In the pediatric population, the S2AI group had a smaller pelvic obliquity (PO) than the IS group at final follow-up (SMD, - 0.38; 95% CI, - 0.72 to - 0.04). Patients who underwent S2AI screws showed reduced rates of re-operation (S2AI, 13%; IS, 28%), implant failure (S2AI, 12%; IS, 26%) [screw loosening (S2AI, 8%; IS, 20%); screw breakage (S2AI, 2%; IS, 12%)], implant prominence (S2AI, 2%; IS, 14%), pseudarthrosis (S2AI, 3%; IS, 15%), wound infection (S2AI, 8%; IS, 22%) and less blood loss (S2AI, 2035.4 ml; IS, 2708.4 ml). CONCLUSION Radiological outcomes indicate an effective maintenance of the correction and arrest of progression of deformity by S2AI, which is equal or better than IS. SPF with S2AI screw has obviously lower incidence of postoperative complications and less blood loss. Given these advantages, the S2AI screw seems to be a beneficial alternative to IS.
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