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Rassi J, Daher M, Helou A, Farjallah S, Ayoub K, Ghoul A, Sebaaly A. Analysis of the reliability of KEOPS version 2 for the measurement of coronal and sagittal parameters in spinal deformity. Spine Deform 2024:10.1007/s43390-024-00894-z. [PMID: 38865071 DOI: 10.1007/s43390-024-00894-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND The purpose of the study is to evaluate the updated version of this software in patients with various spinal deformity. METHODS Sixty patients were included in this study and were divided into three categories: 20 patients with AIS, 20 patients with ASD, and 20 patients having undergone corrective surgery for spinal deformity. The measurements were performed by two senior and two junior orthopedic surgery residents, and were done at two points in time separated by a 3-week interval with the cases being randomized every time to reduce the risk of memory bias. Measured parameters included coronal, sagittal, global alignment parameters, and pelvic parameters. RESULTS When assessing the inter- and intra-observer reliability across all the groups of patients, none of the coefficients was smaller than 0.8 with a very high level of agreement. The standard error ranged from 0.7° to 1.5° demonstrating a high level of accuracy. Fairly similar results were seen when the groups were divided into the three categories except for the post-operative groups where a strong and not perfect level of agreement was reported. CONCLUSION This is the first study to assess the reproducibility of the new version of KEOPS, showing a very high agreement in all measurements. In the post-operative group, although it showed a strong agreement, the lower performance can be explained by the presence of surgical material making it harder to identify the anatomical landmarks accurately. Nevertheless, we can recommend the usage of this software in a clinical setting.
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Affiliation(s)
- Joe Rassi
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Mohammad Daher
- Department of Orthopedic Surgery, Brown University, Providence, RI, 02906, USA
- School of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Abdo Helou
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Sarah Farjallah
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Karim Ayoub
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Ali Ghoul
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Amer Sebaaly
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
- School of Medicine, Saint Joseph University, Beirut, Lebanon.
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Dos Santos Delgado A, Souza Morais B, Luiz Aparecido Defino H, Neto Montagnoli A. Strategies for Minimizing the Effects of Observer Variability on Sagittal Parameter Measurements of the Spine. Clin Spine Surg 2024:01933606-990000000-00323. [PMID: 38842185 DOI: 10.1097/bsd.0000000000001642] [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: 08/24/2023] [Accepted: 04/29/2024] [Indexed: 06/07/2024]
Abstract
STUDY DESIGN Exploratory-descriptive study. OBJECTIVE Evaluate the influence of observer variability on the measurements of both thoracic kyphosis (TK) and lumbar lordosis (LL) obtained with anatomic and functional spinal segmentation methods. BACKGROUND Parametric analysis for spinal surgery planning typically relies on anatomic parameters. However, incorporating functional parameters that consider the vertebrae orientation is important to minimizing surgical calculation errors. METHODS The authors developed parametric analysis software that integrates traditional and functional methodologies. The proposed method included functional thoracic kyphosis and functional lumbar lordosis calculated from the lines normal to the inflection points of the spine model. Using a synthetic lateral X-ray, the observer variability was computer-simulated generating 20 landmark sets that replicate the annotations of 20 observers. The analysis also included 10 clinical X-rays, annotated twice by 3 judges with a minimum 1-week interval. The spinal curvature angles were derived using the anatomic and functional methods. Statistical analysis were performed for comparison. RESULTS For the synthetic X-ray, the proposed method presented significantly less variability: TK (<±2.5 degrees, P=0.00023) and LL (<±5 degrees, P=0.00012). For the clinical X-rays, the interobserver reliability analysis yielded higher intraclass correlation coefficients (ICC) for functional TK (ICC>0.97) and functional LL (ICC>0.87) than for TK (ICC<0.91) and LL (ICC<0.89). Statistically significant differences were observed for both TK (P=0.001) and LL (P=0.030). Under the traditional method, observer variability led to measurement differences surpassing ±19 degrees, whereas differences with the proposed method were within ±10 degrees for both parameters. CONCLUSION The vertebral endplate is not the most suitable place to measure spinal sagittal curvatures. Small changes in landmark position significantly alter the measured Cobb angle. The proposed method offers a substantial advantage regarding the influence of observer variability, in addition to the more individualized analysis.
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Affiliation(s)
| | - Bruna Souza Morais
- Interunit Graduate Program in Bioengineering, Universidade de São Paulo (USP), São Carlos-SP
| | | | - Arlindo Neto Montagnoli
- Department Electrical Engineering, Universidade Federal de São Carlos (UFSCar), São Carlos-SP, Brasil
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Nikoobakht M, Pourmahmoudian M, Gerszten PC, Pourmahmoudian M. Global sagittal angle and spinopelvic sagittal alignment: a step toward investigation of sagittal plane deformity in upper lumbar disc herniation. Br J Neurosurg 2024; 38:551-555. [PMID: 33983097 DOI: 10.1080/02688697.2021.1923651] [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: 10/05/2020] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Understanding the biomechanical relationship between the spine and the pelvis is important for the management of symptomatic lumbar disease. There are several different metrics that may be used to evaluate the spine in the sagittal plane. The aim of this study is to compare spinopelvic parameters and global sagittal angle (GSA) in a cohort of patients with upper lumbar disc herniations (ULDH) to identify a correlation between the pelvic incidence (PI) and GSA with ULDH. MATERIAL AND METHODS Eighty-six patients with ULDH and 86 asymptomatic control group underwent whole body biplanar stereographs- and magnetic resonance imaging. The spinopelvic parameters and GSA were measured. RESULTS PI, sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis (TK) were all significantly lower than in the control group (p < 0.01) but there was no difference in the pelvic tilt (PT). The two groups were divided into subgroups. PI in the T12-L1 and L1-L2 level groups were significantly smaller than in the control group (p < 0.05). Also, there was a significant difference in TK and LL between the L3-L4 level and control group (p < 0.05), but there was no statistically significant difference in PT between all levels and the control group. CONCLUSION This study demonstrated a unique correlation between several spinopelvic parameters and GSA and the occurrence of ULDH. Lower PI, SS, and LL in T12-L1 and L1-L2 levels indicates a flat lumbar spine which may increase mechanical stress at these levels, thereby leading to disc herniation.
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Affiliation(s)
- Mehdi Nikoobakht
- Department of Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Pourmahmoudian
- Firoozgar Clinical Research and Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Peter Carlos Gerszten
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mostafa Pourmahmoudian
- Firoozgar Clinical Research and Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
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Ibrahim MF, Saeed FS, El-Morshidy EM, Hassan KM, Hassan MG, El-Sharkawi M, Elnady B. Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion for Adult Low-Grade Isthmic Spondylolisthesis: Analysis of Sagittal Radiographic Parameters - A Randomized Controlled Trial. Global Spine J 2024:21925682241254317. [PMID: 38728663 DOI: 10.1177/21925682241254317] [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: 05/12/2024] Open
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVES To compare the effect of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) on sagittal radiographic parameters in patients with low-grade isthmic spondylolisthesis. Additionally, to explore the correlation between changes in these parameters and clinical outcomes. METHODS Forty-six consecutive patients with single-level low-grade isthmic spondylolisthesis were initially enrolled. They were randomly assigned to undergo either PLF or PLIF. Patients were followed up for at least 24 months. Radiographic outcomes included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, sagittal vertical axis, T1 pelvic angle, slip angle, slip degree and disc height. Clinical outcomes were assessed by the Oswestry Disability Index (ODI) and visual analogue scale (VAS). RESULTS Four participants were lost to follow-up. Of the remaining 42 patients, 29 were female. The mean age was 40.23 ± 10.25 years in the PLF group and 35.81 ± 10.58 years in the PLIF group. There was a statistically significant greater correction of all radiographic parameters in the PLIF group. The ODI and VAS improved significantly in both groups, with no significant differences between the two groups. Changes in the ODI and VAS were significantly correlated with changes in disc height, slip angle and lumbar lordosis. CONCLUSIONS In patients with low-grade isthmic spondylolisthesis, PLIF demonstrates superior efficacy compared to PLF in correcting sagittal radiographic parameters. Nevertheless, this distinction does not seem to influence short-term clinical results. Restoring disc height, correcting the slip angle, and reestablishing normal lumbar lordosis are crucial steps in the surgical management of isthmic spondylolisthesis.
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Affiliation(s)
- Mahmoud Fouad Ibrahim
- Department of Orthopedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Fady Samy Saeed
- Department of Orthopedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt
| | | | | | - Mohamed Gamal Hassan
- Department of Orthopedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Mohammad El-Sharkawi
- Department of Orthopedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Belal Elnady
- Department of Orthopedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt
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Pellisé F, Bayo MC, Ruiz de Villa A, Núñez-Pereira S, Haddad S, Barcheni M, Pizones J, Valencia MR, Obeid I, Alanay A, Kleinstueck FS, Mannion AF. The Impact of Unplanned Reoperation Following Adult Spinal Deformity Surgery: A Prospective Longitudinal Cohort Study with 5-Year Follow-up. J Bone Joint Surg Am 2024; 106:681-689. [PMID: 38630053 DOI: 10.2106/jbjs.23.00242] [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: 04/19/2024]
Abstract
BACKGROUND The long-term impact of reoperations following adult spinal deformity (ASD) surgery is still poorly understood. Our aim was to identify the relationship between unplanned reoperation and health-related quality of life (HRQoL) gain at 2 and 5 years of follow-up. METHODS We included patients enrolled in a prospective ASD database who underwent surgery ≥5 years prior to the start of the study and who had 2 years of follow-up data. Adverse events (AEs) leading to an unplanned reoperation, the time of reoperation occurrence, invasiveness (blood loss, surgical time, hospital stay), and AE resolution were assessed. HRQoL was measured with use of the Oswestry Disability Index, Scoliosis Research Society-22, and Short Form-36. Linear models controlling for baseline data and index surgery characteristics were utilized to assess the relationships between HRQoL gain at 2 and 5-year follow-up and the number and invasiveness of reoperations. The association between 5-year HRQoL gain and the time of occurrence of the unplanned reoperation and that between 5-year HRQoL gain and AE resolution were also investigated. RESULTS Of 361 eligible patients, 316 (87.5%) with 2-year follow-up data met the inclusion criteria and 258 (71.5%) had 5-year follow-up data. At the 2-year follow-up, 96 patients (30.4%) had a total of 165 unplanned reoperations (1.72 per patient). At the 5-year follow-up, 73 patients (28.3%) had a total of 117 unplanned reoperations (1.60 per patient). The most common cause of reoperations was mechanical complications (64.9%), followed by surgical site infections (15.7%). At the 5-year follow-up, the AE that led to reoperation was resolved in 67 patients (91.8%). Reoperation invasiveness was not associated with 5-year HRQoL scores. The number of reoperations was associated with lesser HRQoL gain at 5 years for all HRQoL measures. The mean associated reduction in HRQoL gain per unplanned reoperation was 41% (range, 19% to 66%). Reoperations resulting in no resolution of the AE or resolution with sequelae had a greater impact on 5-year follow-up HRQoL scores than reoperations resulting in resolution of the AE. CONCLUSIONS A postoperative, unplanned reoperation following ASD surgery was associated with lesser gain in HRQoL at 5 years of follow-up. The association did not diminish over time and was affected by the number, but not the magnitude, of reoperations. Resolution of the associated AE reduced the impact of the unplanned reoperation. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ferran Pellisé
- Spine Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Sleiman Haddad
- Spine Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maggie Barcheni
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
| | | | | | | | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Anne F Mannion
- Spine Center Division, Schulthess Klinik, Zurich, Switzerland
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Nakarai H, Simon CZ, Adida S, Samuel J, Araghi K, Kim HJ, Lovecchio FC. Reliability of Vertebral Pelvic Angles in Assessment of Spinal Alignment. Global Spine J 2024:21925682241235607. [PMID: 38382044 DOI: 10.1177/21925682241235607] [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: 02/23/2024] Open
Abstract
STUDY DESIGN Reliability analysis. OBJECTIVES Vertebral pelvic angles (VPA) are gaining popularity given their ability to describe the shape of the spine. Understanding the reliability and minimal detectable change (MDC) is necessary to determine how these measurement tools should be used in the manual assessment of spine radiographs. Our aim is to assess intra- and interobserver intraclass correlation coefficients (ICC) and the MDC in the use of VPA for assessing alignment in adult spinal deformity (ASD). METHODS Three independent examiners blindly measured T1, T4, T9, L1, and L4PA twice in ASD patients with a 4-week window after the initial measurements. Patients who had undergone hip or shoulder arthroplasty, fused or transitional vertebrae, or whose hip joints were not visible on radiographs were excluded. Power analysis calculated a minimum sample size of 19. Both intra- and interobserver ICC and MDC, which denotes the smallest detectable change in a true value with 95% confidence, were calculated. RESULTS Out of the 193 patients, 39 were ultimately included in the study, and 390 measurements were performed by 3 raters. Intraobserver ICC values ranged from .90 to .99. The interobserver ICC was .97, .97, .96, .95, and .92, and the MDC was 5.3°, 5.1°, 4.8°, 4.9°, and 4.1° for T1, T4, T9, L1, and L4PA, respectively. CONCLUSION All VPAs showed excellent intra- and interobserver reliability, however, the MDC is relatively high compared to typical ranges for VPA values. Therefore, surgeons must be aware that substantial alignment changes may not be detected by a single VPA.
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Affiliation(s)
- Hiroyuki Nakarai
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Chad Z Simon
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Samuel Adida
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Justin Samuel
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Han Jo Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Francis C Lovecchio
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
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Rahmaniar W, Suzuki K, Lin TL. Auto-CA: Automated Cobb Angle Measurement Based on Vertebrae Detection for Assessment of Spinal Curvature Deformity. IEEE Trans Biomed Eng 2024; 71:640-649. [PMID: 37682652 DOI: 10.1109/tbme.2023.3313126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
An accurate identification and localization of vertebrae in X-ray images can assist doctors in measuring Cobb angles for treating patients with adolescent idiopathic scoliosis. It is useful for clinical decision support systems for diagnosis, surgery planning, and spinal health analysis. Currently, publicly available annotated datasets on spinal vertebrae are small, making deep-learning-based detection methods that are highly data-dependent less accurate. In this article, we propose an algorithm based on convolutional neural networks that can be trained to detect vertebrae from a small set of images. This method can display critical information on a patient's spine, display vertebrae and their labels on the thoracic and lumbar, calculate the Cobb angle, and evaluate the severity of spinal deformities. The proposed achieved an average accuracy of 0.958 and 0.962 for classifying spinal deformities (i.e., C-shaped, S-shaped type 1, and S-shaped type 2) and severity of Cobb angle (i.e., normal, mild, moderate, and severe), respectively. The Cobb angle measurement had a median difference of less than 5° from the ground-truth with SMAPE of 5.27% and an error on landmark detection of 19.73. In addition, Lenke classification is used to analyze spinal deformities as types A, B, and C, which have an average accuracy of 0.924. Physicians can use the proposed system in clinical practice by providing X-ray images via the user interface.
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Löchel J, Putzier M, Dreischarf M, Grover P, Urinbayev K, Abbas F, Labbus K, Zahn R. Deep learning algorithm for fully automated measurement of sagittal balance 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 2024:10.1007/s00586-023-08109-1. [PMID: 38231388 DOI: 10.1007/s00586-023-08109-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/03/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
AIM Deep learning (DL) algorithms can be used for automated analysis of medical imaging. The aim of this study was to assess the accuracy of an innovative, fully automated DL algorithm for analysis of sagittal balance in adult spinal deformity (ASD). MATERIAL AND METHODS Sagittal balance (sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis and sagittal vertical axis) was evaluated in 141 preoperative and postoperative radiographs of patients with ASD. The DL, landmark-based measurements, were compared with the ground truth values from validated manual measurements. RESULTS The DL algorithm showed an excellent consistency with the ground truth measurements. The intra-class correlation coefficient between the DL and ground truth measurements was 0.71-0.99 for preoperative and 0.72-0.96 for postoperative measurements. The DL detection rate was 91.5% and 84% for preoperative and postoperative images, respectively. CONCLUSION This is the first study evaluating a complete automated DL algorithm for analysis of sagittal balance with high accuracy for all evaluated parameters. The excellent accuracy in the challenging pathology of ASD with long construct instrumentation demonstrates the eligibility and possibility for implementation in clinical routine.
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Affiliation(s)
- Jannis Löchel
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Michael Putzier
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Marcel Dreischarf
- RAYLYTIC - medical data automation, Petersstr. 32-34, 04109, Leipzig, Germany
| | - Priyanka Grover
- RAYLYTIC - medical data automation, Petersstr. 32-34, 04109, Leipzig, Germany
| | | | - Fahad Abbas
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kirsten Labbus
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Robert Zahn
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Yüksel S, Özmen E, Barış A, Circi E, Beytemür O. Publication Trends in the Pelvic Parameter Related Literature between 1992 and 2022 : A Bibliometric Review. J Korean Neurosurg Soc 2024; 67:50-59. [PMID: 38031402 PMCID: PMC10788557 DOI: 10.3340/jkns.2023.0047] [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: 03/01/2023] [Revised: 05/20/2023] [Accepted: 06/27/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE This study aimed to conduct a bibliometric analysis on pelvic parameter related research over the last 30 years, analyzing trends, hotspots, and influential works within this field. METHODS A comprehensive Web of Science database search was performed. The search yielded 3249 results, focusing on articles and reviews published from 1992 to 2022 in English. Data was analyzed using CiteSpace and VOSviewer for keyword, authorship, and citation burst analysis, co-citation analysis, and clustering. RESULTS The number of publications and citations related to pelvic parameters has increased exponentially over the last 30 years. The USA leads in publication count with 1003 articles. Top publishing journals include the European Spine Journal, Spine, and Journal of Neurosurgery: Spine, with significant contributions by Schwab, Lafage V, and Protoptaltis. The most influential articles were identified using centrality and sigma values, indicating their role as key articles within the field. Research hotspots included spinal deformity, total hip arthroplasty, and sagittal alignment. CONCLUSION Interest in pelvic parameter related research has grown significantly over the last three decades, indicating its relevance in modern orthopedics. The most influential works within this field have contributed to our understanding of spinal deformity, pelvic incidence, and their relation to total hip arthroplasty. This study provides a comprehensive overview of the trends and influential research in the field of pelvic parameters.
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Affiliation(s)
- Serdar Yüksel
- Istanbul Physical Treatment and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Emre Özmen
- Istanbul Physical Treatment and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Alican Barış
- Istanbul Physical Treatment and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Esra Circi
- Istanbul Physical Treatment and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Ozan Beytemür
- SBU Bagcilar Training and Research Hospital, Istanbul, Turkey
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Egea-Gámez RM, Galán-Olleros M, González-Menocal A, González-Díaz R. [Translated article] How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T73-T85. [PMID: 37981198 DOI: 10.1016/j.recot.2023.11.002] [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: 10/26/2022] [Accepted: 11/23/2022] [Indexed: 11/21/2023] Open
Abstract
Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialised paediatric and adolescent spine unit of a referral centre, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low-cost, accessible, reproducible and with an educational character.
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Affiliation(s)
- R M Egea-Gámez
- Unidad de Raquis, Servicio de Cirugía Ortopédica y Traumatología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - M Galán-Olleros
- Ortopedia Infantil, Servicio de Cirugía Ortopédica y Traumatología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - A González-Menocal
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Elena, Madrid, Spain
| | - R González-Díaz
- Unidad de Raquis, Servicio de Cirugía Ortopédica y Traumatología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Egea-Gámez RM, Galán-Olleros M, González-Menocal A, González-Díaz R. How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:73-85. [PMID: 36462724 DOI: 10.1016/j.recot.2022.11.006] [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: 10/26/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022] Open
Abstract
Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.
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Affiliation(s)
- R M Egea-Gámez
- Unidad de Raquis, Servicio de Cirugía Ortopédica y Traumatología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - M Galán-Olleros
- Ortopedia Infantil, Servicio de Cirugía Ortopédica y Traumatología, Hospital Infantil Universitario Niño Jesús, Madrid, España.
| | - A González-Menocal
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Elena, Madrid, España
| | - R González-Díaz
- Unidad de Raquis, Servicio de Cirugía Ortopédica y Traumatología, Hospital Infantil Universitario Niño Jesús, Madrid, España
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Hassan IMI, Keblawy ME, Elsalam MA, Embaby EA. Sagittal trunk excursion and lumbar repositioning error between female and male patients with patellofemoral pain syndrome. Hong Kong Physiother J 2023; 43:81-91. [PMID: 37583919 PMCID: PMC10423672 DOI: 10.1142/s1013702523500051] [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: 06/22/2022] [Accepted: 01/04/2023] [Indexed: 08/17/2023] Open
Abstract
Background Patellofemoral pain syndrome (PFPS) is a challenging clinical problem affecting adults, adolescents, and physically active populations. PFPS impacts the patient's trunk kinematics in the frontal plane. Previous studies have found gender-based biomechanical differences in patients with PFPS; however, sagittal trunk kinematics during mini-squats and lumbar proprioception in PFPS have not been studied previously. Objectives To investigate sagittal trunk excursion (It is defined as the sagittal trunk flexion angle from the start to the end of the mini squat) during mini-squats as well as lumbar repositioning error between individuals with and without PFPS, and determine gender differences in the outcome variables. Methods A sample of 56 participants aged 18-25 years was enrolled; 30 with PFPS (13 males, 17 females) and 26 asymptomatic controls (11 males, 15 females). The sagittal trunk excursion during mini-squats was examined by two-dimensional (2D) photographic analysis using Surgimap software. Active lumbar flexion repositioning error was assessed using an isokinetic dynamometer. Results For sagittal trunk excursion, no significant main effect of group was observed (p = 0 . 136 ). On the other hand, the main effect was significant for gender (p = 0 . 005 ), as was the interaction effect. Compared to the control group, the PFPS group showed significantly (p = 0 . 01 ) lower sagittal trunk excursion in females than in males during mini-squats. For active lumbar flexion repositioning error, no evidence was found for significant main or interaction effects (p > 0 . 05 ). Conclusion Females with PFPS exhibit a more erect sagittal trunk posture than males during mini-squats. Trunk posture should be considered during weight-bearing activities in PFPS, and gender-specific assessment protocols should be developed.
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Zhang Z, Song J, Jia S, Tian Z, Zhang Z, Zheng G, Meng C, Li N. How does the correction in lumbar lordosis affect the spinopelvic realignments in degenerative lumbar scoliosis underwent scoliosis surgery? Eur J Med Res 2023; 28:403. [PMID: 37798787 PMCID: PMC10552202 DOI: 10.1186/s40001-023-01339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 09/02/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND To evaluate the effects of correction in lumbar lordosis (LL) that have on full-body realignments in patients with degenerative lumbar scoliosis (DLS) who had undergone long sacroiliac fusion surgery. METHODS A multi-center retrospective study including 88 DLS patients underwent the surgical procedure of long sacroiliac fusion with instrumentations was performed. Comparisons of radiographic and quality-of-life (QoL) data among that at the pre-operation, the 3rd month and the final follow-up were performed. The correlations between the LL correction and the changes in other spinopelvic parameters were explored using Pearson-correlation linear analysis and linear regression analysis. The correlation coefficient (r) and the adjusted r2 were calculated subsequently. RESULTS All radiographic and QoL data improved significantly (P < 0.001) after the surgical treatments. The LL correction correlated (P < 0.001) with the changes in the sacral slope (SS, r = 0.698), pelvic tilt (PT, r = -0.635), sagittal vertical axis (SVA, r = -0.591), T1 pelvic angle (TPA, r = -0.782), and the mismatch of pelvic incidence minus lumbar lordosis (PI-LL, r = -0.936), respectively. Moreover, LL increased by 1° for each of the following spinopelvic parameter changes (P < 0.001): 2.62° for SS (r2 = 0.488), -4.01° for PT (r2 = 0.404), -4.86° for TPA (r2 = 0.612), -2.08° for the PI-LL (r2 = 0.876) and -15.74 mm for SVA (r2 = 0.349). Changes in the thoracic kyphosis (r = 0.259) and pelvic femur angle (r = 0.12) were independent of the LL correction, respectively. CONCLUSIONS LL correction correlated significantly to the changes in spinopelvic parameters; however, those independent variables including the thoracic spine and hip variables probably be remodeled themselves to maintain the full-body balance in DLS patients underwent the correction surgery.
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Affiliation(s)
- Zifang Zhang
- Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China
- Department of Orthopedics, Shandong University of Traditional Chinese Medicine, Jingshi Road 16369, Jinan, 250014, China
| | - Jianing Song
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Shu Jia
- Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China
| | - Zhikang Tian
- Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China
| | - Zhenyu Zhang
- Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China
| | - Guoquan Zheng
- The Spine Surgery, The first medical center of the Chinese PLA General Hospital, Beijing, China.
| | - Chunyang Meng
- Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China.
| | - Nianhu Li
- Department of Orthopedics, Shandong University of Traditional Chinese Medicine, Jingshi Road 16369, Jinan, 250014, China.
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Wu Y, Chen X, Dong F, He L, Cheng G, Zheng Y, Ma C, Yao H, Zhou S. Performance evaluation of a deep learning-based cascaded HRNet model for automatic measurement of X-ray imaging parameters of lumbar sagittal curvature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023:10.1007/s00586-023-07937-5. [PMID: 37787781 DOI: 10.1007/s00586-023-07937-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/03/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To develop a deep learning-based cascaded HRNet model, in order to automatically measure X-ray imaging parameters of lumbar sagittal curvature and to evaluate its prediction performance. METHODS A total of 3730 lumbar lateral digital radiography (DR) images were collected from picture archiving and communication system (PACS). Among them, 3150 images were randomly selected as the training dataset and validation dataset, and 580 images as the test dataset. The landmarks of the lumbar curve index (LCI), lumbar lordosis angle (LLA), sacral slope (SS), lumbar lordosis index (LLI), and the posterior edge tangent angle of the vertebral body (PTA) were identified and marked. The measured results of landmarks on the test dataset were compared with the mean values of manual measurement as the reference standard. Percentage of correct key-points (PCK), intra-class correlation coefficient (ICC), Pearson correlation coefficient (r), mean absolute error (MAE), mean square error (MSE), root-mean-square error (RMSE), and Bland-Altman plot were used to evaluate the performance of the cascade HRNet model. RESULTS The PCK of the cascaded HRNet model was 97.9-100% in the 3 mm distance threshold. The mean differences between the reference standard and the predicted values for LCI, LLA, SS, LLI, and PTA were 0.43 mm, 0.99°, 1.11°, 0.01 mm, and 0.23°, respectively. There were strong correlation and consistency of the five parameters between the cascaded HRNet model and manual measurements (ICC = 0.989-0.999, R = 0.991-0.999, MAE = 0.63-1.65, MSE = 0.61-4.06, RMSE = 0.78-2.01). CONCLUSION The cascaded HRNet model based on deep learning algorithm could accurately identify the sagittal curvature-related landmarks on lateral lumbar DR images and automatically measure the relevant parameters, which is of great significance in clinical application.
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Affiliation(s)
- Yuhua Wu
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Xiaofei Chen
- Department of Radiology, Gansu Provincial Hospital of Traditional Chinese Medicine (The first affiliated hospital of Gansu University of Traditional Chinese Medicine), Lanzhou, 730050, Gansu, China
| | - Fuwen Dong
- Department of Radiology, Gansu Provincial Hospital of Traditional Chinese Medicine (The first affiliated hospital of Gansu University of Traditional Chinese Medicine), Lanzhou, 730050, Gansu, China
| | - Linyang He
- Hangzhou Jianpei Technology Company Ltd, Hangzhou, 311200, Zhejiang, China
| | - Guohua Cheng
- Hangzhou Jianpei Technology Company Ltd, Hangzhou, 311200, Zhejiang, China
| | - Yuwen Zheng
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Chunyu Ma
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Hongyan Yao
- Department of Radiology, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou, 730000, Gansu, China
| | - Sheng Zhou
- Department of Radiology, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou, 730000, Gansu, China.
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Dalton J, Mohamed A, Akioyamen N, Schwab FJ, Lafage V. PreOperative Planning for Adult Spinal Deformity Goals: Level Selection and Alignment Goals. Neurosurg Clin N Am 2023; 34:527-536. [PMID: 37718099 DOI: 10.1016/j.nec.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Adult Spinal Deformity (ASD) is a complex pathologic condition with significant impact on quality of life, including pain, loss of function, and fatigue. Achieving realignment goals is crucial for long-term results. Reliable preoperative planning strategies, including nomograms, measurement tools, and level selection, are key to maximizing the likelihood of achieving a good outcome following ASD corrective surgery. This review covers recent literature on such strategies, including review of the different targets for realignment and their association with outcomes (both patients-reported outcomes and complications), selection of upper and lower instrumented vertebrae, and the latest innovation in preoperative planning for deformity surgery.
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Affiliation(s)
- Jay Dalton
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Ayman Mohamed
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY 10075, USA
| | - Noel Akioyamen
- Department of Orthopaedic Surgery, Monteriore Medical Center, 1250 Waters Place, Tower 1, 11th Floor, Bronx, NY 10461, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY 10075, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY 10075, USA.
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Zhao K, Bao T, Yang W, Wang C, Wang Y, Wang T, Xiao B, Zhang Q, Gao F, Liu H, Tao X, Gao G, Zhang T. Spinal‑pelvic sagittal imbalance and paraspinal muscle degeneration in patients with degenerative lumbar spinal stenosis: A monocentric, prospective and observational study. Exp Ther Med 2023; 26:479. [PMID: 37745044 PMCID: PMC10515119 DOI: 10.3892/etm.2023.12178] [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: 01/26/2023] [Accepted: 07/14/2023] [Indexed: 09/26/2023] Open
Abstract
Degenerative lumbar spinal stenosis (DLSS) is a condition in which the body is held in a poor posture for a long period of time, resulting in a change in the stress structure of the lumbar spine that causes degenerative changes in the muscles of the spine. The sagittal balance of the spine and pelvis and the degeneration of the paravertebral muscles have been the focus of recent research. To explore the relationship between paraspinal muscle degeneration and changes in spine-pelvic sagittal parameters in patients with DLSS, 95 patients with DLSS (experimental group) and 70 healthy volunteers (control group) hospitalized in the Ordos Central Hospital between January 2020 and January 2022 were included as study subjects. All patients underwent lumbar magnetic resonance imaging and spinal X-ray using uniform criteria. The correlation between paravertebral muscle parameters and sagittal-pelvic sagittal parameters in patients with DLSS was obtained from two imaging examinations, and the data were organized and grouped in order to explore the correlation between these parameters. There was no significant difference in the general data between the two groups (P>0.05). In the L4-5 DLSS patient group, the ratio of fat infiltration in the right erector spinae (ES) muscle was negatively correlated with thoracic kyphosis (TK) (r=-0.536; P<0.05) but not significantly in the left side. The relative cross-sectional area of the left multifidus muscle (MF RCSA) was positively correlated with TK (r=0.685; r=0.615; P<0.05) but not significantly in the right side. In the L5-S1DLSS patient group, the right MF RCSA and right ES RCSA were significantly positively correlated with TK (r=0.685; r=0.615; P<0.05) but not significant in the left side. Thus, paravertebral muscle parameters were correlated with spinal-pelvic sagittal parameters in patients with DLSS.
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Affiliation(s)
- Keyu Zhao
- The Ordos Clinic Medical College, Inner Mongolia Medical University, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Tianlian Bao
- The Ordos Clinic Medical College, Inner Mongolia Medical University, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Wupeng Yang
- The Ordos Clinic Medical College, Inner Mongolia Medical University, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Chunmei Wang
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Yongjiang Wang
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Tiantian Wang
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Bin Xiao
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Qingxin Zhang
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Feng Gao
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Hao Liu
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Xiaoyang Tao
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Gang Gao
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Tinxin Zhang
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
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Rossanez R, de Rezende Pratali R, Smith JS, Nasreddine MA, Pereira da Silva Herrero CF. Internal Chain of Correlation of Sagittal Cervical Alignment in Asymptomatic Subjects. Global Spine J 2023; 13:2439-2445. [PMID: 35343268 PMCID: PMC10538324 DOI: 10.1177/21925682221087185] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional observational study in a prospective cohort. OBJECTIVE To analyze the cervical alignment characteristics and their chain of correlation in a sample of asymptomatic individuals. METHODS Asymptomatic adults who had full spinal radiographs performed. Cervical radiographic parameters were measured, including upper cervical curvature (McGregor line-C2), lower cervical curvature (C2-C7), McGregor slope, and sagittal vertical axis from C2-C7 (CSVA) and T1-slope (T1S). Subjects were stratified by age into 3 groups (18-39 years, 40-59 years, and >60 years), and radiographic parameters were compared across age groups and based on sex. RESULTS 102 asymptomatic subjects (mean age, 50 years) were included. The T1S significantly increased with age, accompanied by an increase in C2-C7 lordosis. The cervical sagittal alignment, represented by CSVA, did not significantly differ based on age. There was a close correlation among the cervical sagittal parameters, such that the CSVA may be predicted based on the T1S and C2-C7 lordosis. Comparisons of the normative values identified in the present study with those reported in previous studies demonstrate variability in what constitutes normal in different populations. CONCLUSION This analysis of cervical alignment in a sample of asymptomatic volunteers revealed that with increasing age there is an observed increase in the sagittal inclination of the base of the cervical spine (T1S) that is accompanied by an increase in cervical lordosis as a means of maintaining cervical sagittal alignment (CSVA). The variability in what constitutes normal values for cervical parameters suggests that further study is warranted using standardized methodologies across diverse populations.
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Affiliation(s)
- Roberto Rossanez
- Health Sciences Applied to the Locomotor System Graduate Program, Ribeirão Preto Medical School of University of São Paulo, Ribeirão Preto, Brazil
| | | | - Justin S Smith
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Mohamed Ahmed Nasreddine
- Spine Surgery Group, Hospital Do Servidor Público Estadual de São Paulo (HSPE), São Paulo, Brazil
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Diebo BG, Tataryn Z, Alsoof D, Lafage R, Hart RA, Passias PG, Ames CP, Scheer JK, Lewis SJ, Shaffrey CI, Burton DC, Deviren V, Line BG, Soroceanu A, Hamilton DK, Klineberg EO, Mundis GM, Kim HJ, Gum JL, Smith JS, Uribe JS, Kelly MP, Kebaish KM, Gupta MC, Nunley PD, Eastlack RK, Hostin R, Protopsaltis TS, Lenke LG, Schwab FJ, Bess S, Lafage V, Daniels AH. Height Gain Following Correction of Adult Spinal Deformity. J Bone Joint Surg Am 2023; 105:1410-1419. [PMID: 37478308 DOI: 10.2106/jbjs.23.00031] [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: 07/23/2023]
Abstract
BACKGROUND Height gain following a surgical procedure for patients with adult spinal deformity (ASD) is incompletely understood, and it is unknown if height gain correlates with patient-reported outcome measures (PROMs). METHODS This was a retrospective cohort study of patients undergoing ASD surgery. Patients with baseline, 6-week, and subanalysis of 1-year postoperative full-body radiographic and PROM data were examined. Correlation analysis examined relationships between vertical height differences and PROMs. Regression analysis was utilized to preoperatively estimate T1-S1 and S1-ankle height changes. RESULTS This study included 198 patients (mean age, 57 years; 69% female); 147 patients (74%) gained height. Patients with height loss, compared with those who gained height, experienced greater increases in thoracolumbar kyphosis (2.81° compared with -7.37°; p < 0.001) and thoracic kyphosis (12.96° compared with 4.42°; p = 0.003). For patients with height gain, sagittal and coronal alignment improved from baseline to postoperatively: 25° to 21° for pelvic tilt (PT), 14° to 3° for pelvic incidence - lumbar lordosis (PI-LL), and 60 mm to 17 mm for sagittal vertical axis (SVA) (all p < 0.001). The full-body mean height gain was 7.6 cm, distributed as follows: sella turcica-C2, 2.9 mm; C2-T1, 2.8 mm; T1-S1 (trunk gain), 3.8 cm; and S1-ankle (lower-extremity gain), 3.3 cm (p < 0.001). T1-S1 height gain correlated with the thoracic Cobb angle correction and the maximum Cobb angle correction (p = 0.002). S1-ankle height gain correlated with the corrections in PT, PI-LL, and SVA (p < 0.001). T1-ankle height gain correlated with the corrections in PT (p < 0.001) and SVA (p = 0.03). Trunk height gain correlated with improved Scoliosis Research Society (SRS-22r) Appearance scores (r = 0.20; p = 0.02). Patient-Reported Outcomes Measurement Information System (PROMIS) Depression scores correlated with S1-ankle height gain (r = -0.19; p = 0.03) and C2-T1 height gain (r = -0.18; p = 0.04). A 1° correction in a thoracic scoliosis Cobb angle corresponded to a 0.2-mm height gain, and a 1° correction in a thoracolumbar scoliosis Cobb angle resulted in a 0.25-mm height gain. A 1° improvement in PI-LL resulted in a 0.2-mm height gain. CONCLUSIONS Most patients undergoing ASD surgery experienced height gain following deformity correction, with a mean full-body height gain of 7.6 cm. Height gain can be estimated preoperatively with predictive ratios, and height gain was correlated with improvements in reported SRS-22r appearance and PROMIS scores. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bassel G Diebo
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Daniel Alsoof
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Renaud Lafage
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, NY
| | | | - Peter G Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY
| | | | - Justin K Scheer
- University of California-San Francisco, San Francisco, California
| | - Stephen J Lewis
- Division of Orthopaedics, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Vedat Deviren
- University of California-San Francisco, San Francisco, California
| | - Breton G Line
- Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Alex Soroceanu
- Department of Orthopedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California-Davis, Davis, California
| | | | - Han Jo Kim
- Hospital for Special Surgery, New York, NY
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, Louisville, Kentucky
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael P Kelly
- Division of Orthopedics & Scoliosis at Rady Children's Hospital-San Diego, San Diego, California
| | - Khaled M Kebaish
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Richard Hostin
- Department of Orthopaedic Surgery, Southwest Scoliosis Institute, Dallas, Texas
| | | | - Lawrence G Lenke
- Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY
| | - Frank J Schwab
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, NY
| | - Shay Bess
- Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Virginie Lafage
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, NY
| | - Alan H Daniels
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Azar M, Babaee T, Kamyab M, Ghandhari H. Effect of the type of brace on head to pelvis sagittal alignment of adolescents with Scheuermann's kyphosis. Assist Technol 2023; 35:399-408. [PMID: 35882059 DOI: 10.1080/10400435.2022.2102092] [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] [Accepted: 07/07/2022] [Indexed: 10/16/2022] Open
Abstract
The aim of this study was to determine the effects of the Milwaukee brace and thoracolumbosacral orthosis (TLSO) on head to pelvis sagittal alignment in adolescents with Scheuermann's kyphosis (SK). A total of 52 adolescents with SK who were under brace treatment were studied. They underwent biplanar radiography of the head to pelvis (EOS Imaging, Paris, France) before and 6 months after the beginning of bracing. We measured T1 slope, neck tilt (NT), cervical sagittal vertical axis (cSVA), thoracic inlet angle (TIA), C0-C2 lordosis, C2-C7 lordosis, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA) and T1 spinopelvic inclination (T1SPi). There were no significant differences in baseline values of TIA, PT, SS, PI, SVA, TK, cSVA, NT and T1 slope between the two groups (p > 0.05). There were significant differences between the baseline and final measurements of T1 slope, cSVA, TK, LL, T1SPi and TIA in both groups (p < 0.05). The results imply that brace treatment can significantly affect head to pelvis sagittal parameters of adolescents with SK. However, there are no significant differences in the values of head to pelvis sagittal parameters when comparing short-term effect of TLSO and the Milwaukee brace.
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Affiliation(s)
- Mohsen Azar
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical sciences, Tehran, Iran
| | - Taher Babaee
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical sciences, Tehran, Iran
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, California State University Dominguez Hills, Carson, California, USA
| | - Hassan Ghandhari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Teaching Hospital, Iran University of Medical Sciences, Tehran, Iran
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Fisk F, Oitment C, Taliaferro K, Pahuta MA. The Hip Center Rule Can be Used to Decide if Measured Pelvic Incidence is Accurate. Global Spine J 2023; 13:1787-1792. [PMID: 34658284 PMCID: PMC10556915 DOI: 10.1177/21925682211049734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Simulation study. OBJECTIVE Pelvic incidence (PI) should be considered during surgical planning. The ideal patient position with both hip centers perfectly aligned for a lateral radiograph is rarely obtained. It has been suggested that a radiograph with axial and coronal rotation up to 20° is acceptable to obtain a measured PI within 6 degrees of the actual PI. We seek to: (1) evaluate the effect of variations in PI and patient malpositioning on measured vs true PI, and (2) determine whether the presence of one hip center within the bony acetabular rim of the contralateral hip can serve as a simple clinical decision rule on the accuracy of measured PI. METHODS Published anthropometric three-dimensional pelvic landmark coordinates were used in this study. Radiographic projections were generated using linear algebra for combinations of axial and coronal rotation from -20° to +20°. True and measured PIs were compared. RESULTS Rotation to 20° cannot be uniformly accepted as decision rule. Pelvises with higher PIs are more sensitive to malpositioning with greater PI deviation with smaller amounts of rotation. Diagnostic performance of the hip center rule demonstrated a sensitivity of 25.58% and a specificity of 100.00%. CONCLUSIONS Rather than assessing the quality of radiographs for PI measurement by magnitude of malpositioning, we recommend clinicians use the "hip center rule." As long as at least one hip center is contained within the bony acetabular rim of the contralateral hip, there is high confidence that measured PI will be within 6° of true PI.
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Affiliation(s)
- Felicity Fisk
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Colby Oitment
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Kevin Taliaferro
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Markian A. Pahuta
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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Montanari S, Griffoni C, Cristofolini L, Girolami M, Gasbarrini A, Barbanti Bròdano G. Correlation Between Sagittal Balance and Mechanical Distal Junctional Failure in Degenerative Pathology of the Spine: A Retrospective Analysis. Global Spine J 2023:21925682231195954. [PMID: 37562976 DOI: 10.1177/21925682231195954] [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: 08/12/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study aimed to investigate the failure of the caudal end of lumbar posterior fixation in terms of pre-operative and post-operative spinopelvic parameters, correction performed, demographic and clinical data. METHODS The lumbar, thoraco-lumbar and lumbo-sacral posterior fixations performed with pedicle screws and rods in 2017-2019 were retrospectively analyzed. As 81% failures occurred within 4 years, an observational period of 4 years was chosen. The revision surgeries due to the failure in the caudal end were collected in the junctional group. Fixations which have not failed were gathered in the control group. The main spinopelvic parameters were measured for each patient on standing lateral radiographs with the software Surgimap. Demographic and clinical data were extracted for both groups. RESULTS Among the 457 patients who met the inclusion criteria, the junctional group included 101 patients, who required a revision surgery. The control group collected 356 primary fixations. The two most common causes of revision surgeries were screws pullout (57 cases) and rod breakage (53 cases). SVA, PT, LL, PI-LL and TPA differed significantly between the two groups (P = .021 for LL, P < .0001 for all the others). The interaction between the two groups and the pre-operative and post-operative conditions was significant for PT, SS, LL, TK, PI-LL and TPA (P < .005). Sex and BMI did not affect the failure onset. CONCLUSIONS Mechanical failure is more likely to occur in patients older than 40 years with a thoraco-lumbar fixation where PT, PI-LL and TPA were not properly restored.
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Affiliation(s)
- Sara Montanari
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Cristiana Griffoni
- Spine Surgery Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Marco Girolami
- Spine Surgery Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
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Kim YT, Jeong TS, Kim YJ, Kim WS, Kim KG, Yee GT. Automatic Spine Segmentation and Parameter Measurement for Radiological Analysis of Whole-Spine Lateral Radiographs Using Deep Learning and Computer Vision. J Digit Imaging 2023; 36:1447-1459. [PMID: 37131065 PMCID: PMC10406753 DOI: 10.1007/s10278-023-00830-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/04/2023] Open
Abstract
Radiographic examination is essential for diagnosing spinal disorders, and the measurement of spino-pelvic parameters provides important information for the diagnosis and treatment planning of spinal sagittal deformities. While manual measurement methods are the golden standard for measuring parameters, they can be time consuming, inefficient, and rater dependent. Previous studies that have used automatic measurement methods to alleviate the downsides of manual measurements showed low accuracy or could not be applied to general films. We propose a pipeline for automated measurement of spinal parameters by combining a Mask R-CNN model for spine segmentation with computer vision algorithms. This pipeline can be incorporated into clinical workflows to provide clinical utility in diagnosis and treatment planning. A total of 1807 lateral radiographs were used for the training (n = 1607) and validation (n = 200) of the spine segmentation model. An additional 200 radiographs, which were also used for validation, were examined by three surgeons to evaluate the performance of the pipeline. Parameters automatically measured by the algorithm in the test set were statistically compared to parameters measured manually by the three surgeons. The Mask R-CNN model achieved an average precision at 50% intersection over union (AP50) of 96.2% and a Dice score of 92.6% for the spine segmentation task in the test set. The mean absolute error values of the spino-pelvic parameters measurement results were within the range of 0.4° (pelvic tilt) to 3.0° (lumbar lordosis, pelvic incidence), and the standard error of estimate was within the range of 0.5° (pelvic tilt) to 4.0° (pelvic incidence). The intraclass correlation coefficient values ranged from 0.86 (sacral slope) to 0.99 (pelvic tilt, sagittal vertical axis).
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Affiliation(s)
- Yong-Tae Kim
- Department of Biomedical Engineering, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Tae Seok Jeong
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young Jae Kim
- Department of Biomedical Engineering, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woo Seok Kim
- Department of Traumatology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
| | - Gi Taek Yee
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
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23
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Pelc M, Vilimkova Kahankova R, Blaszczyszyn M, Mikolajewski D, Konieczny M, Khoma V, Bara G, Zygarlicki J, Martinek R, Gupta MK, Gorzelanczyk EJ, Pawłowski M, Czapiga B, Zygarlicka M, Kawala-Sterniuk A. Initial study on an expert system for spine diseases screening using inertial measurement unit. Sci Rep 2023; 13:10440. [PMID: 37369726 PMCID: PMC10300108 DOI: 10.1038/s41598-023-36798-7] [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: 11/24/2022] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
In recent times, widely understood spine diseases have advanced to one of the most urgetn problems where quick diagnosis and treatment are needed. To diagnose its specifics (e.g. to decide whether this is a scoliosis or sagittal imbalance) and assess its extend, various kind of imaging diagnostic methods (such as X-Ray, CT, MRI scan or ST) are used. However, despite their common use, some may be regarded as (to a level) invasive methods and there are cases where there are contraindications to using them. Besides, which is even more of a problem, these are very expensive methods and whilst their use for pure diagnostic purposes is absolutely valid, then due to their cost, they cannot rather be considered as tools which would be equally valid for bad posture screening programs purposes. This paper provides an initial evaluation of the alternative approach to the spine diseases diagnostic/screening using inertial measurement unit and we propose policy-based computing as the core for the inference systems. Although the methodology presented herein is potentially applicable to a variety of spine diseases, in the nearest future we will focus specifically on sagittal imbalance detection.
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Affiliation(s)
- Mariusz Pelc
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758, Opole, Poland.
- School of Computing and Mathematical Sciences, University of Greenwich, London, SE10 9LS, UK.
| | - Radana Vilimkova Kahankova
- Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava-Poruba, Czech Republic
| | - Monika Blaszczyszyn
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758, Opole, Poland
| | - Dariusz Mikolajewski
- Faculty of Computer Science, Kazimierz Wielki University, 85-064, Bydgoszcz, Poland
| | - Mariusz Konieczny
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758, Opole, Poland
| | - Volodymir Khoma
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758, Opole, Poland
- Lviv Polytechnic National University, Institute of Computer Technologies, Automation and Metrology, Lviv, Ukraine
| | - Gregor Bara
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Jaroslaw Zygarlicki
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758, Opole, Poland
| | - Radek Martinek
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758, Opole, Poland
- Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava-Poruba, Czech Republic
| | - Munish K Gupta
- Faculty of Mechanical Engineering, Opole University of Technology, 45-271, Opole, Poland
- Department of Mechanical Engineering, Graphic Era University, Dehradun, India
| | - Edward Jacek Gorzelanczyk
- Faculty of Philosophy, Kazimierz Wielki University, Bydgoszcz, 85-092, Poland
- Faculty of Mathematics and Computer Science, Adam Mickiewicz University in Poznan, Poznan, 61-614, Poland
- Department of Theoretical Basis of Biomedical Sciences and Medical Informatics, Nicolaus Copernicus University, Collegium Medicum, 85-067, Bydgoszcz, Poland
- The Society for the Substitution Treatment of Addiction "Medically Assisted Recovery", 85-791, Bydgoszcz, Poland
- Psychiatric Department of Children and Adolescents Psychiatric Center in Warta, 98-290, Warta, Poland
| | - Mateusz Pawłowski
- Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
- Department of Neurosurgery, "Vital Medic" Hospital, Kluczbork, Poland
| | - Bogdan Czapiga
- Department of Neurosurgery, 4th Military Hospital in Wrocław, Wrocław, Poland
| | - Malgorzata Zygarlicka
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758, Opole, Poland
| | - Aleksandra Kawala-Sterniuk
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758, Opole, Poland.
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24
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Jain D, Vigdorchik JM, Abotsi E, Montes DV, Delsole EM, Lord E, Zuckerman JD, Protopsaltis T, Passias PG, Buckland AJ. The Impact of Global Spinal Alignment on Standing Spinopelvic Alignment Change After Total Hip Arthroplasty. Global Spine J 2023; 13:1252-1256. [PMID: 34142571 PMCID: PMC10416580 DOI: 10.1177/21925682211026633] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The interactions between hip osteoarthritis (OA) and spinal malalignment are poorly understood. The purpose of this study was to assess the influence of total hip arthroplasty (THA) on standing spinopelvic alignment. METHODS In this retrospective cohort study, patients undergoing THA for OA with pre-and postoperative full-body radiographs were included. Standing spinopelvic parameters were measured. Contralateral hip was graded on the Kellgren-Lawrence scale. Pre-and postoperative alignment parameters were compared by paired t-test. The severity of preoperative thoracolumbar deformity was measured using TPA. Linear regression was performed to assess the impact of preoperative TPA and changes in spinal alignment. Patients were separated into low and high TPA (<20 or >/=20 deg) and change in parameters were compared between groups by t-test. Similarly, the influence of K-L grade, age, and PI were also tested. RESULTS 95 patients were included (mean age 58.6 yrs, BMI 28.7 kg/m2, 48.2% F). Follow-up radiographs were performed at mean 220 days. Overall, the following significant changes were found from pre-to postoperative: SPT (14.2 vs. 16.1, P = 0.021), CL (-8.9 vs. -5.3, P = .001), TS-CL (18.2 vs. 20.5, P = .037) and SVA (42.6 vs. 32.1, P = .004). Preoperative TPA was significantly associated with the change in PI-LL, SVA, and TPA. High TPA patients significantly decreased SVA more than low TPA patients. There was no significant impact of contralateral hip OA, PI, or age on change in alignment parameters. CONCLUSION Spinopelvic alignment changes after THA, evident by a reduction in SVA. Preoperative spinal sagittal deformity impacts this change. Level of evidence: III.
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Affiliation(s)
- Deeptee Jain
- Division of Spine Surgery, Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA
| | | | - Edem Abotsi
- Division of Spine Surgery, Department of Orthopaedic Surgery, New York University, NY, USA
| | - Dennis Vasquez Montes
- Division of Spine Surgery, Department of Orthopaedic Surgery, New York University, NY, USA
| | | | - Elizabeth Lord
- Department of Orthopaedic Surgery, University of California, CA, USA
| | - Joseph D. Zuckerman
- Division of Spine Surgery, Department of Orthopaedic Surgery, New York University, NY, USA
| | | | - Peter G. Passias
- Division of Spine Surgery, Department of Orthopaedic Surgery, New York University, NY, USA
| | - Aaron J. Buckland
- Division of Spine Surgery, Department of Orthopaedic Surgery, New York University, NY, USA
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Fleiderman Valenzuela JG, Cirillo Totera JI, Turkieltaub DH, Echaurren CV, Álvarez Lemos FL, Arriagada Ramos FI. Spino-pelvic radiological parameters: Comparison of measurements obtained by radiologists using the traditional method versus spine surgeons using a semi-automated software (Surgimap). Acta Radiol Open 2023; 12:20584601231177404. [PMID: 37223123 PMCID: PMC10201147 DOI: 10.1177/20584601231177404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
Background Spinopelvic balance measurement is a key point to get an appropriate diagnosis and treatment in a group of spine pathologies; thus, it seems necessary the evaluation of different methods for obtaining the most reliable values. For that reason, different automatic and semi-automatic computer-assisted tools have been developed, and one example of them is Surgimap. Purpose To demonstrate that the sagittal balance measurements with Surgimap are equal and more time-efficient than with Agfa-Enterprise. Material and Methods Retrospective-prospective study. Biased comparative analysis of radiographic measurements performed on two different occasions (96 h interval), between two spine surgeons using Surgimap and two radiologists using the traditional Cobb method (TCM) with the Agfa-Enterprise program in 36 full spine lateral X-ray, determining inter- and intra-observer reliability and the mean time required to obtain the measurements. Results Measurements with both methods demonstrated an excellent intra-observer correlation (Surgimap: PCC 0.95 [0.85-0.99]; TCM: PCC 0.90 [0.81-0.99]). Inter-observer correlation also demonstrated an excellent relationship (PCC >0.95). Thoracic kyphosis (TK) demonstrated the lowest levels of inter-observer correlation (PCC: 0.75). The average time in seconds with TCM was 154.6, while with the Surgimap it was 41.8 s. Conclusion Surgimap proved to be equally reliable and 3.5 times faster. Therefore, in consistency with the available literature, our results would allow us to promote the use of Surgimap as a clinical diagnostic tool considering precision and efficiency.
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Pepke W, Morani W, Schiltenwolf M, Bruckner T, Renkawitz T, Hemmer S, Akbar M. Outcome of Conservative Therapy of Adolescent Idiopathic Scoliosis (AIS) with Chêneau-Brace. J Clin Med 2023; 12:jcm12072507. [PMID: 37048593 PMCID: PMC10095099 DOI: 10.3390/jcm12072507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/07/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Chêneau-brace (C-Brace) is a potential tool for the treatment of adolescent idiopathic scoliosis (AIS) with a Cobb angle between 20° and 45° for the primary curve. The aim of the present study was (1) to estimate study cohorts with C-brace therapy success and therapy failure and (2) to analyze possible factors that influence the therapy outcome. Seventy-eight patients with AIS were assessed before the initiation of C-brace treatment. Each patient underwent radiography examinations before the brace, in-brace, and at the therapy end. Cobb angle was considered as increased when the value at the end of therapy was increased more than 5° (Δ > 5°), unchanged—when the value was unchanged within ± 5° and decreased- when the value was decreased more than 5° (Δ < −5°). The study cohort was stratified due to curve topography in the thoracic, thoracolumbar, and lumbar scoliosis groups. Global analysis revealed no statistically significant modification of the Cobb angle (Cobb angle pre-brace vs. Cobb angle post-brace: 30.8° ± 8.2 vs. 29.3° ± 15.2, p = 0.26). However, at the end of C-brace therapy, the primary Cobb angle was decreased by more than 5° in 27 patients (35%), unchanged (Δ within the range of ±5°) in 36 patients (46%), and increased more than 5° in 15 patients (19%). Sub-group analysis due to curve topography and skeletal maturity has shown higher rates of brace therapy failure in thoracic curves and in younger patients (Risser grade 0). Patients with higher Cobb angle correction with C-brace had lower rates of therapy failure. The C-brace can be useful for the prevention of scoliotic curve progression in patients with AIS. However, many factors influence the therapy effect.
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Affiliation(s)
- Wojciech Pepke
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - William Morani
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Marcus Schiltenwolf
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Tom Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69120 Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Stefan Hemmer
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Michael Akbar
- Meoclinic, Friedrichstraße 71, 10117 Berlin, Germany
- Correspondence: ; Tel.: +49-30-2094-400
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27
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Sardi JP, Ames CP, Coffey S, Good C, Dahl B, Kraemer P, Gum J, Devito D, Brayda-Bruno M, Lee R, Bell CP, Bess S, Smith JS. Accuracy of Rod Contouring to Desired Angles With and Without a Template: Implications for Achieving Desired Spinal Alignment and Outcomes. Global Spine J 2023; 13:425-431. [PMID: 33631976 PMCID: PMC9972287 DOI: 10.1177/2192568221998371] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Biomechanical Study. OBJECTIVE The search for optimal spinal alignment has led to the development of sophisticated formulas and software for preoperative planning. However, preoperative plans are not always appropriately executed since rod contouring during surgery is often subjective and estimated by the surgeon. We aimed to assess whether rods contoured to specific angles with a French rod bender using a template guide will be more accurate than rods contoured without a template. METHODS Ten experienced spine surgeons were requested to contour two 125 × 5.5 mm Ti64 rods to 40°, 60° and 80° without templates and then 2 more rods using 2D metallic templates with the same angles. Rod angles were then measured for accuracy and compared. RESULTS Average angles for rods bent without a template to 40°, 60° and 80° were 60.2°, 78.9° and 97.5°, respectively. Without a template, rods were overbent by a mean of 18.9°. When using templates of 40°, 60° and 80°, mean bend angles were 41.5°, 59.1° and 78.7°, respectively, with an average underbend of 0.2°. Differences between the template and non-template groups for each target angle were all significant (p < 0.001). CONCLUSIONS Without the template, surgeons tend to overbend rods compared to the desired angle, while surgeons improved markedly with a template guide. This tendency to overbend could have significant impact on patient outcomes and risk of proximal junctional failure and warrants further research to better enable surgeons to more accurately execute preoperative alignment plans.
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Affiliation(s)
- Juan Pablo Sardi
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Christopher P. Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Skye Coffey
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Benny Dahl
- Department of Orthopedic Surgery, Texas Children’s Hospital & Baylor College of Medicine, Houston, TX, USA
| | | | - Jeffrey Gum
- Norton Leatherman Spine Center, Louisville, KY, USA
| | | | - Marco Brayda-Bruno
- Scoliosis Department, IRCCS Orthopaedic Institute Galeazzi, Spine Surgery, Milano, Italy
| | - Robert Lee
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Shay Bess
- Denver International Spine Center, Presbyterian St. Luke’s/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Justin S. Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA,Justin S. Smith, MD, PhD, Department of Neurosurgery, University of Virginia Health Sciences Center, PO Box 800212 Charlottesville, VA 22908, USA.
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Evaluating Outcomes of Spinopelvic Fixation for Patients Undergoing Long Segment Thoracolumbar Fusion with a Prior Total Hip Arthroplasty. J Am Acad Orthop Surg 2023; 31:e435-e444. [PMID: 36689642 DOI: 10.5435/jaaos-d-22-00897] [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: 09/27/2022] [Accepted: 12/04/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Understanding the relationship between spinal fusion and its effects on relative spinopelvic alignment in patients with prior total hip arthroplasty (THA) is critical. However, limited data exist on the effects of long spinal fusions on hip alignment in patients with a prior THA. Our objective was to compare clinical outcomes and changes in hip alignment between patients undergoing long fusion to the sacrum versus to the pelvis in the setting of prior THA. METHODS Patients with a prior THA who underwent elective thoracolumbar spinal fusion starting at L2 or above were retrospectively identified. Patients were placed into one of two groups: fusion to the sacrum or pelvis. Preoperative, six-month postoperative, one-year postoperative, and delta spinopelvic and acetabular measurements were measured from standing lumbar radiographs. RESULTS A total of 112 patients (55 sacral fusions, 57 pelvic fusions) were included. Patients who underwent fusion to the pelvis experienced longer length of stay (LOS) (8.31 vs. 4.21, P < 0.001) and less frequent home discharges (30.8% vs. 61.9%, P = 0.010), but fewer spinal revisions (12.3% vs. 30.9%, P = 0.030). No difference was observed in hip dislocation rates (3.51% vs. 1.82%, P = 1.000) or hip revisions (5.26% vs. 3.64%, P = 1.000) based on fusion construct. Fusion to the sacrum alone was an independent predictor of an increased spine revision rate (odds ratio: 3.56, P = 0.023). Patients in the pelvic fusion group had lower baseline lumbar lordosis (LL) (29.2 vs. 42.9, P < 0.001), six-month postoperative LL (38.7 vs. 47.3, P = 0.038), and greater 1-year ∆ pelvic incidence-lumbar lordosis (-7.98 vs. 0.21, P = 0.032). CONCLUSION Patients with prior THA undergoing long fusion to the pelvis experienced longer LOS, more surgical complications, and lower rate of spinal revisions. Patients with instrumentation to the pelvis had lower LL preoperatively with greater changes in LL and pelvic incidence-lumbar lordosis postoperatively. No differences were observed in acetabular positioning, hip dislocations, or THA revision rates between groups.
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Platz U, Halm H, Thomsen B, Pecsi F, Köszegvary M, Bürger N, Berlin C, Quante M. Anterior Lumbar Interbody Fusion (ALIF) or Transforaminal Lumbar Interbody Fusion (TLIF) for Fusion Surgery in L5/S1 - What Is the Best Way to Restore a physiological Alignment? ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:646-656. [PMID: 34496423 DOI: 10.1055/a-1560-3106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
STUDY DESIGN A retrospective single center cohort study with prospective collected data from an institutional spine registry. OBJECTIVES To determine whether restoration of lordosis L5/S1 is possible with both anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF) and to find out which technique is superior to recreate lordosis in L5/S1. METHODS Seventy-seven patients with ALIF and seventy-nine with TLIF L5/S1 were included. Operation time, estimated blood loss), and complications were evaluated. Segmental lordosis L5/S1 and L4/5, overall lordosis, and proximal lordosis (L1 to L4) were measured in X-rays before and after surgery. Oswesery disability index and EQ-5D were assessed before surgery, and 3 and 12 months after surgery. RESULTS Mean operation time was 176.9 minutes for ALIF and 195.7 minutes for TLIF (p = 0.048). Estimated blood loss was 249.2 cc for ALIF and 362.9 cc for TLIF (p = 0.005). In terms of complications, only a difference in dural tears were found (TLIF 6, ALIF none; p = 0.014). Lordosis L5/S1 increased in the ALIF group (15.8 to 24.6°; p < 0.001), whereas no difference was noted in the TLIF group (18.4 to 19.4°; p = 0.360). Clinical results showed significant improvement in the Oswesery disability index (ALIF: 43 to 21.9, TLIF: 45.2 to 23.0) and EQ-5D (ALIF: 0.494 to 0.732, TLIF: 0.393 to 0.764) after 12 months in both groups, without differences between the groups. CONCLUSION ALIF and TLIF are comparable methods for performing fusion at L5/S1, with good clinical outcomes and comparable rates of complications. However, there is only a limited potential for recreating lordosis at L5/S1 with a TLIF.
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Affiliation(s)
- Uwe Platz
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Henry Halm
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Björn Thomsen
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Ferenc Pecsi
- Klinik für Wirbelsäulenchirurgie, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Mark Köszegvary
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Nina Bürger
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Clara Berlin
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Markus Quante
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Neustadt in Holstein, Germany
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Orosz LD, Bhatt FR, Jazini E, Dreischarf M, Grover P, Grigorian J, Roy R, Schuler TC, Good CR, Haines CM. Novel artificial intelligence algorithm: an accurate and independent measure of spinopelvic parameters. J Neurosurg Spine 2022; 37:893-901. [PMID: 35901700 DOI: 10.3171/2022.5.spine22109] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The analysis of sagittal alignment by measuring spinopelvic parameters has been widely adopted among spine surgeons globally, and sagittal imbalance is a well-documented cause of poor quality of life. These measurements are time-consuming but necessary to make, which creates a growing need for an automated analysis tool that measures spinopelvic parameters with speed, precision, and reproducibility without relying on user input. This study introduces and evaluates an algorithm based on artificial intelligence (AI) that fully automatically measures spinopelvic parameters. METHODS Two hundred lateral lumbar radiographs (pre- and postoperative images from 100 patients undergoing lumbar fusion) were retrospectively analyzed by board-certified spine surgeons who digitally measured lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope. The novel AI algorithm was also used to measure the same parameters. To evaluate the agreement between human and AI-automated measurements, the mean error (95% CI, SD) was calculated and interrater reliability was assessed using the 2-way random single-measure intraclass correlation coefficient (ICC). ICC values larger than 0.75 were considered excellent. RESULTS The AI algorithm determined all parameters in 98% of preoperative and in 95% of postoperative images with excellent ICC values (preoperative range 0.85-0.92, postoperative range 0.81-0.87). The mean errors were smallest for pelvic incidence both pre- and postoperatively (preoperatively -0.5° [95% CI -1.5° to 0.6°] and postoperatively 0.0° [95% CI -1.1° to 1.2°]) and largest preoperatively for sacral slope (-2.2° [95% CI -3.0° to -1.5°]) and postoperatively for lumbar lordosis (3.8° [95% CI 2.5° to 5.0°]). CONCLUSIONS Advancements in AI translate to the arena of medical imaging analysis. This method of measuring spinopelvic parameters on spine radiographs has excellent reliability comparable to expert human raters. This application allows users to accurately obtain critical spinopelvic measurements automatically, which can be applied to clinical practice. This solution can assist physicians by saving time in routine work and by avoiding error-prone manual measurements.
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Affiliation(s)
- Lindsay D Orosz
- 1Department of Research, National Spine Health Foundation, Reston
| | - Fenil R Bhatt
- 2Department of Spine Surgery, Virginia Spine Institute, Reston, Virginia
| | - Ehsan Jazini
- 2Department of Spine Surgery, Virginia Spine Institute, Reston, Virginia
| | - Marcel Dreischarf
- 3Department of Research and Development, RAYLYTIC GmbH, Leipzig, Germany
| | - Priyanka Grover
- 3Department of Research and Development, RAYLYTIC GmbH, Leipzig, Germany
| | - Julia Grigorian
- 1Department of Research, National Spine Health Foundation, Reston
| | - Rita Roy
- 1Department of Research, National Spine Health Foundation, Reston
| | - Thomas C Schuler
- 2Department of Spine Surgery, Virginia Spine Institute, Reston, Virginia
| | - Christopher R Good
- 2Department of Spine Surgery, Virginia Spine Institute, Reston, Virginia
| | - Colin M Haines
- 2Department of Spine Surgery, Virginia Spine Institute, Reston, Virginia
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Obo T, Fujishiro T, Mizutani M, Nakano A, Nakaya Y, Hayama S, Usami Y, Neo M. Segmental cervical instability does not drive the loss of cervical lordosis after laminoplasty in patients with cervical spondylotic myelopathy. Spine J 2022; 22:1837-1847. [PMID: 35724810 DOI: 10.1016/j.spinee.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND/CONTEXT Kyphotic deformity after cervical laminoplasty (CLP) often leads to unfavorable neurological recovery due to insufficient indirect decompression of the spinal cord. Existing literature has described that segmental cervical instability is a contraindication for CLP because it is a potential risk factor for kyphotic changes after surgery; however, this has never been confirmed in any clinical studies. PURPOSE To confirm whether segmental cervical instability was an independent risk factor for postoperative kyphotic change and to examine whether segmental cervical instability led to poor neurological outcomes after CLP for cervical spondylotic myelopathy (CSM). STUDY DESIGN/SETTING A retrospective study PATIENT SAMPLE: Patients who underwent CLP for CSM between January 2013 and January 2021 with a follow-up period of ≥1 year were enrolled. OUTCOME MEASURES Cervical radiographic measurements including C2-C7 lordosis (C2-7 angle), cervical sagittal vertical axis, C7 slope, flexion range of motion (fROM) and extension ROM (eROM) were assessed using neutral and flexion-extension views. Segmental cervical instability was classified into anterolisthesis (AL) of ≥2 mm displacement, retrolisthesis (RL) of ≥2 mm displacement, and translational instability (TI) of ≥3 mm translational motion. The amount of C2-7 angle loss at the follow-up period compared to the preoperative measurements was defined as cervical lordosis loss (CLL). Neurological outcomes were assessed using the recovery rate of the Japanese Orthopedic Association score (JOA-RR). METHODS CLL was compared among patients with and without segmental cervical instability. Further, multiple linear regression model for CLL was built for the evaluation with adjustment of the reported risks, including cervical sagittal vertical axis, C7 slope, fROM, eROM, and patient age together with AL, RL, and TI, as independent variables. The JOA-RR was also compared between patients with and without segmental cervical instability. RESULTS A total of 138 patients (mean age, 68.7 years; 65.9% male) were included in the analysis. AL, RL, and TI were found in 12 (8.7%), 33 (23.9%), and 16 (11.6%) patients, respectively. Comparisons among the groups showed that AL led to greater CLL; however, RL and TI did not. Multiple linear regression analysis revealed that greater CLL is significantly associated with greater fROM and smaller eROM (regression coefficient [β]=0.328, 95% confidence interval: 0.178 to 0.478, p<.001; β=-0.372, 95% confidence interval: -0.591 to -0.153, p=.001, respectively). However, there were no significant statistical associations in the AL, RL, and TI. Whereas, patients with AL tended to exhibit lower JOA-RR than those without AL (37.8% vs. 52.0%, p=.108). CONCLUSIONS Segmental cervical instability is not the definitive driver for loss of cervical lordosis after CLP in patients with CSM; thus, is not a contraindication in and of itself. However, it is necessary to consider the indications for CLP, according to individual cases of patients with AL on baseline radiograph, which is a sign of poor neurological recovery.
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Affiliation(s)
- Takuya Obo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686 Japan; Department of Orthopedic Surgery, First Towakai Hospital, 2-17, Miyano-machi, Takatsuki, Osaka, 569-0081, Japan
| | - Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686 Japan; Department of Orthopedic Surgery, First Towakai Hospital, 2-17, Miyano-machi, Takatsuki, Osaka, 569-0081, Japan.
| | - Masahiro Mizutani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686 Japan
| | - Atsushi Nakano
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686 Japan
| | - Yoshiharu Nakaya
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686 Japan
| | - Sachio Hayama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686 Japan
| | - Yoshitada Usami
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686 Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686 Japan
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Development of artificial intelligence for automated measurement of cervical lordosis on lateral radiographs. Sci Rep 2022; 12:15732. [PMID: 36130962 PMCID: PMC9492662 DOI: 10.1038/s41598-022-19914-x] [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: 05/13/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Cervical sagittal alignment is an essential parameter for the evaluation of spine disorders. Manual measurement is time-consuming and burdensome to measurers. Artificial intelligence (AI) in the form of convolutional neural networks has begun to be used to measure x-rays. This study aimed to develop AI for automated measurement of lordosis on lateral cervical x-rays. We included 4546 cervical x-rays from 1674 patients. For all x-rays, the caudal endplates of C2 and C7 were labeled based on consensus among well-experienced spine surgeons, the data for which were used as ground truth. This ground truth was split into training data and test data, and the AI model learned the training data. The absolute error of the AI measurements relative to the ground truth for 4546 x-rays was determined by fivefold cross-validation. Additionally, the absolute error of AI measurements was compared with the error of other 2 surgeons’ measurements on 415 radiographs of 168 randomly selected patients. In fivefold cross-validation, the absolute error of the AI model was 3.3° in the average and 2.2° in the median. For comparison of other surgeons, the mean absolute error for measurement of 168 patients was 3.1° ± 3.4° for the AI model, 3.9° ± 3.4° for Surgeon 1, and 3.8° ± 4.7° for Surgeon 2. The AI model had a significantly smaller error than Surgeon 1 and Surgeon 2 (P = 0.002 and 0.036). This algorithm is available at (https://ykszk.github.io/c2c7demo/). The AI model measured cervical spine alignment with better accuracy than surgeons. AI can assist in routine medical care and can be helpful in research that measures large numbers of images. However, because of the large errors in rare cases such as highly deformed ones, AI may, in principle, be limited to assisting humans.
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Huang H, Chen Y, Chen Z, Zhao C. Reliability and Validity Analysis of Pelvic Sagittal Inclination Calculated by Inverse Cosine Function Method on Pelvic Anteroposterior Radiographs. Orthop Surg 2022; 14:2721-2729. [PMID: 36102214 PMCID: PMC9531102 DOI: 10.1111/os.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/12/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Evaluation of sagittal pelvic tilt is significant for hip surgeons. However, the accurate measurement of pelvic sagittal inclination (PSI) is still a challenge. The objective of this study is to propose a new method for measurement of PSI from pelvic anteroposterior radiograph based on the inverse cosine function obtained from individualized pelvic model. Methods Collecting the imaging data of 30 patients with both pelvic CT and full‐length spine radiographs. Establishing pelvic model by customized 3D reconstruction software. The length of three groups of longitudinal and transverse line segments (A′p and B′) were measured from full‐length spine anteroposterior radiographs. The corresponding anatomical parameters, including A, B, b, ∠α, ∠γ, were measured and calculated on the same patient's pelvic model. The estimated PSI (ePSI) based on three groups of anatomical landmarks, including ePSI‐1, ePSI‐2, and ePSI‐3, were calculated by equation, ePSI=arccosA′pb*B′−∠α, and compared with the actual PSI (aPSI) measured by Surgamap software. For the reliability and validation evaluation, three observers measured these parameters in two rounds. Intra‐class correlation and inter‐class correlation were both calculated. Bland–Altman method was used to evaluate the consistency between the estimated PSI (ePSI) and the actual PSI (aPSI). Results ePSI‐1 and ePSI‐2 showed excellent intra‐observer reliability (0.921–0.997, p < 0.001) and inter‐observer reliability (0.801–0.977, p < 0.001). ePSI‐3 had a fair inter‐observer reliability (0.239–0.823, p < 0.001). ePSI‐1 showed the strongest correlation with aPSI (r = 0.917, p < 0.001). Mean (maximum) absolute difference of ePSI‐1, ePSI‐2, and ePSI‐3 is 2.62° (7.42°), 4.23° (13.78°), and 7.74° (31.47°), respectively. The proportion of cases with absolute difference less than 5° in three groups were 86.7% (ePSI‐1), 66.7% (ePSI‐2), 56.7% (ePSI‐3). Conclusion This new method based on inverse cosine function has good reliability and validity when used in the evaluation of PSI on pelvic anteroposterior radiographs.
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Affiliation(s)
- Hao‐han Huang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yan Chen
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Zhao‐xun Chen
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Chang‐qing Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
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[Translated article] Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T348-T354. [DOI: 10.1016/j.recot.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/13/2021] [Indexed: 11/19/2022] Open
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Passias PG, Segreto FA, Imbo B, Williamson T, Joujon-Roche R, Tretiakov P, Krol O, Naessig S, Bortz CA, Horn SR, Ahmad W, Pierce K, Ihejirika YU, Lafage V. Defining age-adjusted spinopelvic alignment thresholds: should we integrate BMI? Spine Deform 2022; 10:1077-1084. [PMID: 35657561 DOI: 10.1007/s43390-022-00522-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To develop age- and BMI-adjusted alignment targets to improve patient-specific management and operative treatment outcomes. METHODS Retrospective review of a single-center stereographic database. ASD patients receiving operative or non-operative treatment, ≥ 18y/o with complete baseline (BL) ODI scores and radiographic parameters (PT, SVA, PILL, TPA) were included. Patients were stratified by age consistent with US-Normative values (norms) of SF-36(< 35, 35-55, 45-54, 55-64, 65-74, ≥ 75y/o), and dichotomized by BMI (Non-Obese < 30; Obese ≥ 30). Linear regression analysis established normative age- and BMI-specific radiographic thresholds, utilizing previously published age-specific US-Normative ODI values converted from SF-36 PCS (Lafage et al.), in conjunction with BL age and BMI means. RESULTS 486 patients were included (Age: 52.5, Gender: 68.7%F, mean BMI: 26.2, mean ODI: 32.7), 135 of which were obese. Linear regression analysis developed age- and BMI-specific alignment thresholds, indicating PT, SVA, PILL, and TPA to increase with both increased age and increased BMI (all R > 0.5, p < 0.001). For non-obese patients, PT, SVA, PILL, and TPA ranged from 10.0, - 25.8, - 9.0, 3.1 in patients < 35y/o to 27.8, 53.4, 17.7, 25.8 in patients ≥ 75 y/o. Obese patients' PT, SVA, PILL, and TPA ranged from 10.5, - 7.6, - 7.1, 5.8 in patients < 35 y/o to 28.3, 67.0, 19.15, 27.7 in patients ≥ 75y/o. Normative SVA values in obese patients were consistently ≥ 10 mm greater compared to non-obese values, at all ages. CONCLUSION Significant associations exist between age, BMI, and sagittal alignment. While BMI influenced age-adjusted alignment norms for PT, SVA, PILL, and TPA at all ages, obesity most greatly influenced SVA, with normative values similar to non-obese patients who were 10 years older. Age-adjusted alignment thresholds should take BMI into account, calling for less rigorous alignment objectives in older and obese patients.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA. .,Division of Spinal Surgery, Department of Orthopaedic and Neurological Surgery, NYU School of Medicine, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
| | - Frank A Segreto
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Bailey Imbo
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Tyler Williamson
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Rachel Joujon-Roche
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Peter Tretiakov
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Oscar Krol
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Sara Naessig
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Cole A Bortz
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Samantha R Horn
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Waleed Ahmad
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Katherine Pierce
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Yael U Ihejirika
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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Spinopelvic measurements of sagittal balance with deep learning: systematic review and critical evaluation. 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; 31:2031-2045. [PMID: 35278146 DOI: 10.1007/s00586-022-07155-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE To summarize and critically evaluate the existing studies for spinopelvic measurements of sagittal balance that are based on deep learning (DL). METHODS Three databases (PubMed, WoS and Scopus) were queried for records using keywords related to DL and measurement of sagittal balance. After screening the resulting 529 records that were augmented with specific web search, 34 studies published between 2017 and 2022 were included in the final review, and evaluated from the perspective of the observed sagittal spinopelvic parameters, properties of spine image datasets, applied DL methodology and resulting measurement performance. RESULTS Studies reported DL measurement of up to 18 different spinopelvic parameters, but the actual number depended on the image field of view. Image datasets were composed of lateral lumbar spine and whole spine X-rays, biplanar whole spine X-rays and lumbar spine magnetic resonance cross sections, and were increasing in size or enriched by augmentation techniques. Spinopelvic parameter measurement was approached either by landmark detection or structure segmentation, and U-Net was the most frequently applied DL architecture. The latest DL methods achieved excellent performance in terms of mean absolute error against reference manual measurements (~ 2° or ~ 1 mm). CONCLUSION Although the application of relatively complex DL architectures resulted in an improved measurement accuracy of sagittal spinopelvic parameters, future methods should focus on multi-institution and multi-observer analyses as well as uncertainty estimation and error handling implementations for integration into the clinical workflow. Further advances will enhance the predictive analytics of DL methods for spinopelvic parameter measurement. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
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Zhang Z, Liu T, Wang Y, Wang Z, Zheng G. Factors Related to Preoperative Coronal Malalignment in Degenerative Lumbar Scoliosis: An Analysis on Coronal Parameters. Orthop Surg 2022; 14:1846-1852. [PMID: 35795967 PMCID: PMC9363746 DOI: 10.1111/os.13379] [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: 02/21/2022] [Revised: 05/29/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Recently the effects of coronal malalignment (CM) in degenerative lumbar scoliosis (DLS) have been reported, however, there was few studies on the correlated parameters of coronal alignments at pre‐operation. The aims of this current study were to investigate the associations of coronal parameters with scoliosis and coronal alignment, and to explore the relationships between the coronal pelvic tilt and coronal alignment in DLS. Methods One hundred and sixty‐one DLS patients in our hospital from May 2016 to December 2020 were reviewed and documented. The coronal balance distance (CBD, the offset between the center of C7 and the plumb line drawn from the center of S1), major Cobb (MC), fractional Cobb (FC), L4 coronal tilt, L5 coronal tilt, coronal pelvic tilt, apical rotation, and the vertebras in major curve were measured and documented. CM was considered if the CBD ≥ 30mm. All of those participants were assigned into group A (CBD ≥ 30 mm) and group B (CBD < 30 mm). Comparisons of demographic and radiographic data were performed between groups A and B. Pearson correlation and further multiple regression with stepwise method analysis were used to investigate those coronal parameters correlated to MC and CBD, respectively. Results Thirty‐one patients suffering from CM were assigned into group A, and the rest of 130 patients were assigned to group B accordingly. Then the incidence of CM was about 19.3% (31/161). Patients in group A had less vertebras in the main curve (P = 0.009), however, the apical rotation (P < 0.001) and the L4 coronal tilt (P = 0.007) were much larger. Although the MC (P = 0.426) and FC (P = 0.06) had no difference between the two groups, the match between MC and FC was much smaller (p = 0.021) in group A. The coronal pelvic tilt correlated significantly with FC (r = 0.552, p < 0.001), but mildly with MC (r = −0.366, p < 0.001), L4 coronal tilt (r = 0.348, p < 0.001), and L5 coronal tilt (r = 0.351, p < 0.001), respectively. The CBD correlated strongly with L4 coronal tilt (r = −0.471, p < 0.001) and L5 coronal tilt (r = −0.468, p < 0.001), respectively, but mildly with FC (r = −0.255, p = 0.016). Further multiple regression analysis revealed that only L4 coronal tilt was the independent factor for MC (r2 = 0.549, p < 0.001) and CBD (r2 = 0.221, p < 0.001), respectively. Conclusions The prevalence of CM in DLS patients is about 19% at pre‐operation. With similar major Cobb, the less the vertebras in the major curve, the larger the CBD. L4 coronal tilt may correlate significantly to scoliosis and CBD. Coronal pelvic tilt may be just one of the compensations for the scoliosis deformity but effects CBD directly.
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Affiliation(s)
- Zifang Zhang
- The Spinal Surgery Department of the Affiliated Hospital of Jining Medical University, Jining, China.,The Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Tao Liu
- The Department of Orthopaedics, Yanzhou Branch of Affiliated Hospital of Jining Medial University, Jining, China
| | - Yan Wang
- The Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Zheng Wang
- The Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Guoquan Zheng
- The Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
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Bouknaitir JB, Carreon LY, Brorson S, Andersen MØ. Change in sagittal alignment after decompression alone in patients with lumbar spinal stenosis without significant deformity: a prospective cohort study. J Neurosurg Spine 2022; 37:57-63. [PMID: 34996042 DOI: 10.3171/2021.10.spine21445] [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: 03/26/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' objective was to investigate whether sagittal balance improves in patients with spinal stenosis after decompression alone. METHODS This prospective longitudinal cohort study compared preoperative and 6-month postoperative 36-inch full-length radiographs in patients aged older than 60 years. Patients underwent decompression alone for central lumbar spinal stenosis with either a minimally invasive bilateral laminotomy for central decompression, unilateral laminectomy as an over-the-top procedure for bilateral decompression, or traditional wide laminectomy with removal of the spinous processes on both sides. The following radiographic parameters were measured: sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), PI-LL mismatch, coronal Cobb angle, and sacral slope (SS). Patient-reported outcome measures (PROMs) were collected, including scores on the Oswestry Disability Index (ODI), visual analog scale (VAS) for leg and back pain, and EQ-5D. RESULTS Forty-five patients (24 males) with a mean ± SD age of 71.8 ± 5.6 years were included. Sagittal balance showed statistically significant improvement, with the mean SVA decreasing from 52.3 mm preoperatively to 33.9 mm postoperatively (p = 0.0001). The authors found an increase in LL, from mean -41.5° preoperatively to -43.9° postoperatively, but this was not statistically significant (p = 0.055). A statistically significant decrease in PI-LL mismatch from mean 8.4° preoperatively to 5.8° postoperatively was found (p = 0.002). All PROM scores showed significant improvement after spinal decompression surgery. The correlations between SVA and all PROMs were statistically significant at both preoperative and postoperative time points, although most correlations were weak except for those between preoperative SVA and ODI (r = 0.55) and between SVA and VAS for leg pain (r = 0.58). CONCLUSIONS Sagittal balance and PROMs show improvement at short-term follow-up evaluations in patients who have undergone decompression alone for lumbar spinal stenosis.
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Affiliation(s)
- Jamal Bech Bouknaitir
- 1Spine Unit, Department of Orthopedic Surgery, Zealand University Hospital, Køge, Denmark; and
- 2Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | - Leah Y Carreon
- 2Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | - Stig Brorson
- 1Spine Unit, Department of Orthopedic Surgery, Zealand University Hospital, Køge, Denmark; and
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Hills JM, Weisenthal BM, Wanner JP, Gupta R, Steinle A, Pennings JS, Stephens BF. A Patient-specific Approach to Alignment and Proximal Junctional Kyphosis Risk Assessment in Adult Spinal Deformity Surgery: Development and Validation of a Predictive Tool. Clin Spine Surg 2022; 35:256-263. [PMID: 35034047 DOI: 10.1097/bsd.0000000000001296] [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: 09/04/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a single-institution, retrospective cohort study. OBJECTIVE We aimed to develop a predictive model for proximal junctional kyphosis (PJK) severity that considers multiple preoperative variables and modifiable surgical alignment. SUMMARY OF BACKGROUND DATA PJK is a common complication following adult deformity surgery. Current alignment targets account for age and pelvic incidence but not other risk factors. MATERIALS AND METHODS This is a single-institution, retrospective cohort study of adult deformity patients with a minimum 2-year follow-up undergoing instrumented fusion between 2009 and 2018. A proportional odds regression model was fit to estimate PJK probability and Hart-International Spine Study Group (ISSG) PJK severity score. Predictors included preoperative Charlson Comorbidity Index, vertebral Hounsfield Units near the upper instrumented vertebrae, pelvic incidence, T1-pelvic angle, and postoperative L1-L4 and L4-S1 lordosis. Predictor effects were assessed using adjusted odds ratios and a nomogram constructed for estimating PJK probability. Bootstrap resampling was used for internal validation. RESULTS Of 145 patients, 47 (32%) developed PJK. The median PJK severity score was 6 (interquartile range, 4-7.5). After adjusting for predictors, Charlson Comorbidity Index, Hounsfield Units, preoperative T1-pelvic angle, and postoperative L1-L4 and L4-S1 lordosis were significantly associated with PJK severity ( P <0.05). After adjusting for potential overfitting, the model showed acceptable discrimination [ C -statistic (area under the curve)=0.75] and accuracy (Brier score=0.10). CONCLUSIONS We developed a model to predict PJK probability, adjusted for preoperative alignment, comorbidity burden, vertebral bone density, and modifiable postoperative L1-L4 and L4-S1 lordosis. This approach may help surgeons assess the patient-specific risk of developing PJK and provide a framework for future predictive models assessing PJK risk after adult deformity surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jeffrey M Hills
- Department of Orthopedics, Washington University School of Medicine
| | | | | | - Rishabh Gupta
- Department of Orthopaedic Surgery
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- University of Minnesota School of Medicine, Minneapolis, MN
| | - Anthony Steinle
- Department of Orthopaedic Surgery
- St. Louis University School of Medicine, St. Louis, MO
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
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Ali EMS, El-Hewala TA, Eladawy AM, Sheta RA. Does minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) influence functional outcomes and spinopelvic parameters in isthmic spondylolisthesis? J Orthop Surg Res 2022; 17:272. [PMID: 35570302 PMCID: PMC9107691 DOI: 10.1186/s13018-022-03144-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE We assessed the efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with low-grade isthmic spondylolisthesis. METHODS We included 24 symptomatic patients who underwent MIS-TLIF between December 2017 and December 2020. Patients were followed up clinically by the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and VAS for leg pain, as well as radiological radiographs after 6 weeks, 6 months, and at final follow-up (at least 12 months). Measured parameters included C7 sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), Meyerding slip grades, lumbar lordosis (LL), L1-L4 angle, L4-S1 angle, and segmental lordosis (SL) of the affected segment. The mismatch between the PI and LL was also measured. RESULTS VAS for back, VAS for leg pain, and ODI significantly improved postoperatively (all p < 0.001). We observed significantly decreased mean values of PT and slip percentage and increased mean values of SS and LL (all p < 0.05). We observed a significant reduction in L1-L4 lordosis and a significant increase in L4-S1 lordosis. The final PT, SS, and LL (total and L1-L4) were significantly higher in group III patients (n = 15) than the values of group II patients (n = 9). None of the patients became unbalanced postoperative, and all patients had a normal matching between the PI and the LL postoperatively. CONCLUSIONS MIS-TLIF is a safe procedure for managing low-grade isthmic spondylolisthesis with significant improvement in clinical and radiological outcomes. It can correct and maintain a proper spinopelvic alignment.
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Affiliation(s)
| | | | - Amr Mohamed Eladawy
- Orthopedic Department, Zagazig University Hospital, Qumia, Nour Hoda Street, Zagazig, Egypt
| | - Reda Ali Sheta
- Al-Ahrar Specialist Hospital, 1st Talaat Harb Street from El Salm Street, Beside Sednawey Hospital, Zagazig, Al-Sharkia, 44759 Egypt
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Kitab SA, Wakefield AE, Benzel EC. Postlaminectomy lumbopelvic sagittal changes in patients with developmental lumbar spinal stenosis grouped into Roussouly lumbopelvic sagittal profiles: 2- to 10-year prospective follow-up. J Neurosurg Spine 2022; 36:695-703. [PMID: 34826807 DOI: 10.3171/2021.8.spine21797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Roussouly lumbopelvic sagittal profiles are associated with distinct pathologies or distinct natural histories and prognoses. The associations between developmental lumbar spinal stenosis (DLSS) and native lumbopelvic sagittal profiles are unknown. Moreover, the relative effects of multilevel decompression on lumbar sagittal alignment, geometrical parameters of the pelvis, and compensatory mechanisms for each of the Roussouly subtypes are unknown. This study aimed to explore the association between DLSS and native lumbar lordosis (LL) subtypes. It also attempts to understand the natural history of postlaminectomy lumbopelvic sagittal changes and compensatory mechanisms for each of the Roussouly subtypes and to define the critical lumbar segment or specific lordosis arc that is recruited after relief of the stenosis effect. METHODS A total of 418 patients with multilevel DLSS were grouped into various Roussouly subtypes, and lumbopelvic sagittal parameters were prospectively compared at follow-up intervals of preoperative to < 2 years, 2 to < 5 years, and 5 to ≥ 10 years after laminectomy. The variables analyzed included LL, upper lordosis arc from L1 to L4, lower lordosis arc from L4 to S1, and segmental lordosis from L1 to S1. Pelvic parameters included pelvic incidence, sacral slope, pelvic tilt, and pelvic incidence minus LL values. RESULTS Of the 329 patients who were followed up throughout this study, 33.7% had Roussouly type 1 native lordosis, whereas the incidence rates of types 2, 3, and 4 were 33.4%, 21.9%, and 10.9%, respectively. LL was not reduced in any of the Roussouly subtypes after multilevel decompressions. Instead, LL increased by 4.5° (SD 11.9°-from 27.3° [SD 11.5°] to 31.8° [SD 9.8°]) in Roussouly type 1 and by 3.1° (SD 11.6°-from 41.3° [SD 9.5°] to 44.4° [SD = 9.7°]) in Roussouly type 2. The other Roussouly types showed no significant changes. Pelvic tilt decreased significantly-by 2.8°, whereas sacral slope increased significantly-by 2.9° in Roussouly type 1 and by 1.7° in Roussouly type 2. The critical lumbar segment that recruits LL differs between Roussouly subtypes. Increments and changes were sustained until the final follow-up. CONCLUSIONS The study findings are important in predicting patient prognosis, LL evolution, and the need for prophylactic or corrective deformity surgery. Multilevel involvement in DLSS and the high prevalence of Roussouly types 1 and 2 suggest that spinal canal dimensions are closely linked to the developmental evolution of LL.
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Affiliation(s)
| | - Andrew E Wakefield
- 2Connecticut Neurosurgery and Spine Associates, Windsor, Connecticut; and
| | - Edward C Benzel
- 3Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
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Buyukaslan A, Abul K, Berk H, Yilmaz H. Leg length discrepancy and adolescent idiopathic scoliosis: clinical and radiological characteristics. Spine Deform 2022; 10:307-314. [PMID: 34581993 DOI: 10.1007/s43390-021-00417-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/19/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This retrospective study aimed to present the clinical and radiological features of functional scoliosis due to LLD and LLD concurrent with AIS; it also aimed to define their relationships for differentiating functional scoliosis due to LLD and LLD concurrent with AIS. METHODS This study was conducted as a single-center retrospective comparative study on 47 scoliosis patients with diagnosed LLD, aged 10-18 years. Cases with a diagnosis of structural LLD were divided into two groups according to the presence or absence of concurrent AIS. Data on demographics and the angle of trunk rotation on a sacral basis (ATRsacrum) were recorded. Limb length was clinically measured with a tape measure and clinical LLD (C-LLD) scoliometer test. Cobb angle, axial rotation, pelvic obliquity, and radiological LLD (R-LLD) were obtained from standing spine radiographs and measured by two blinded orthopedic spine surgeons. RESULTS The prevalence of LLD was 6.7% in scoliosis patients in our study population. Cobb angle and apical rotation were higher in the LLD concurrent with AIS group than in the LLD group (p ≤ 0.05). The C-LLDscoliometer test results were strongly correlated with both C-LLDtape measure (r = 0.651; p = 0.000) and ATRsacrum (r = 0.688; p = 0.000). CONCLUSION LLD may develop as a result of adaptive changes due to scoliosis, or a concurrent condition to scoliosis. Cobb angle and apical rotation are the features that differentiate AIS from functional scoliosis in patients with LLD. The C-LLD scoliometer test can be an effective, practical, and useful method for measuring C-LLD, but its validity and reliability should be determined. TRIAL REGISTRATION This study was retrospectively registered at ClinicalTrials.gov (number: NCT04713397, date of registration: 01/14/2021). LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ahsen Buyukaslan
- Formed Healthcare Scoliosis Treatment and Brace Center, Istanbul, Turkey.
- Department of Physical Therapy and Rehabilitation, Graduate School of Health Sciences, Medipol University, Istanbul, Turkey.
| | - Kadir Abul
- Department of Orthopaedics and Traumatology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Haluk Berk
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hurriyet Yilmaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Halic University, Istanbul, Turkey
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Pratali RDR, Battisti R, Oliveira CEASD, Maranho DAC, Herrero CFPS. Correlação entre a gravidade da doença degenerativa lombar e o alinhamento espinopélvico. Rev Bras Ortop 2022; 57:41-46. [PMID: 35198107 PMCID: PMC8856864 DOI: 10.1055/s-0041-1729579] [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: 07/22/2020] [Accepted: 11/03/2020] [Indexed: 11/21/2022] Open
Abstract
Objective
To evaluate the impact of the severity of lumbar degenerative disease (LDD) on sagittal spinopelvic alignment.
Methods
In total, 130 patients (mean age: 57 years; 75% female) with LDD-associated low-back pain were prospectively included. The severity of the LDD was defined by the following findings on anteroposterior and lateral lumbar spine radiographs: osteophytosis; loss of of height of the intervertebral disc; terminal vertebral plate sclerosis; number of affected segments; deformities; and objective instability. The disease was classified as follows: grade 0–absence of signs of LDD in the lumbar spine; grade I – signs of LDD in up to two segments; grade II – three or more segments involved; grade III – association with scoliosis, spondylolisthesis, or laterolisthesis. Spinopelvic radiographic parameters, including pelvic incidence (PI), lumbar lordosis (LL), discrepancy between the PI and LL (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA), were analyzed according to the LDD grades.
Results
The radiographic parameters differed according to the LDD grades; grade-III patients presented higher SVA (
p
= 0.001) and PT (
p
= 0.0005) values, denoting greater anterior inclination of the trunk and pelvic retroversion when compared to grade-0 andgrade-I subjects. In addition, grade-III patients had higher PI-LL values, which indicates loss of PI-related lordosis, than grade-I subjects (
p
= 0.04).
Conclusion
Patients with more severe LDD tend to present greater spinopelvic sagittal misalignment compared to patients with a milder disease.
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Affiliation(s)
- Raphael de Rezende Pratali
- Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil
| | - Raphael Battisti
- Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil
| | | | - Daniel Augusto Carvalho Maranho
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Carlos Fernando P. S. Herrero
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, SP, Brasil
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Topolniak R, Astur N, Santos WZ, Mendonça RGMD, Gotfryd AO, Caffaro MFS, Meves R. IMPACT OF THE SITTING POSITION ON LUMBAR LORDOSIS AND ITS CORRELATION WITH PELVIC PARAMETERS. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222104262613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACT Objective: To evaluateboth the correlation between lumbar accommodation and pelvic parametersin different types of lordosis and the participation of different lumbar segments in the accommodation of lordosis in the standing and sitting positions. Methods: A retrospective study analyzingpatient images in standing and sitting positions. Correlations were conducted among the measured data: Cobb angle of the lumbar lordosis (LL,type of lordosis, pelvic incidence (PI),sacral slope (SS),pelvic tilt (PT), and the angulation of the L1-L2/L2-L3/L3-L4/L4-L5/L5-S1 segments. Results: Fortypatients were included, 20 men and 20 women. The mean age was 60.8 (±11.5). Of these patients, 10.3% were classified as Roussouly type 2, 35.9% as type 3, 25.6% as type 3A, and 28.2%as type 4.There was a weakcorrelation between LL and PT, however, an inverse correlation between the two (r=-0.183 and p=0.264) was observed. SS hadthe strongest correlation with LL (r> 0.75). Only the correlation between LL and PI was stronger when sitting than standing (p=0.014). The pelvic parameters and angulations of the segments and lumbar discs when standing and sitting were different (p<0.05). In both positions, there was a difference in the contribution of the segments to the LL (p<0.001). On average, the differences in LL between standing and sitting wereequal among theRoussouly classifications (p=0.332). Conclusions: There was a correlation between the LL and the pelvic parameters, being more evident with the SS than with the other parameters. There was no difference in the accommodation of the LL in the different Roussouly types either standing or sitting. Regardless of the position,the L4-S1 segments were predominant in the composition of LL. Level of evidence IV; Retrospective.
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Affiliation(s)
| | - Nelson Astur
- Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
| | | | | | | | | | - Robert Meves
- Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil; Santa Casa de São Paulo, Brazil
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RODRIGUES FERNANDOMANSANO, TANEJA ATULKUMAR, NARAHASHI ERICA, SILVA FLAVIODUARTE, FERNANDES ARTURROCHACORRÊA, FALOTICO GUILHERMEG, YAMADA ANDRÉFUKUNISHI. PELVIC INCIDENCE AND OSTEITIS PUBIS IN PROFESSIONAL SOCCER PLAYERS. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e244380. [PMID: 35431631 PMCID: PMC8979358 DOI: 10.1590/1413-785220223001e244380] [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: 10/07/2020] [Accepted: 02/10/2021] [Indexed: 05/31/2023]
Abstract
Introduction. Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players. Materials and Methods. An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV). Results. A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001). Conclusion. There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis. Leve of Evidence II; Diagnostic study.
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Affiliation(s)
| | - ATUL KUMAR TANEJA
- Hospital do Coração, Brazil; Hospital Israelita Albert Einstein, Brazil
| | | | | | | | | | - ANDRÉ FUKUNISHI YAMADA
- Universidade Federal de São Paulo, Brazil; Hospital do Coração, Brazil; Diagnósticos da América SA, Brazil
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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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Artificial intelligence X-ray measurement technology of anatomical parameters related to lumbosacral stability. Eur J Radiol 2021; 146:110071. [PMID: 34864427 DOI: 10.1016/j.ejrad.2021.110071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/30/2021] [Accepted: 11/22/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE To develop a deep learning-based model for measuring automatic lumbosacral anatomical parameters from lateral lumbar radiographs and compare its performance to that of attending-level radiologists. METHODS A total of 1791 lateral lumbar radiographs were collected through the PACS system and used to develop the deep learning-based model. Landmarks for the four used parameters, including the lumbosacral lordosis angle (LSLA), lumbosacral angle (LSA), sacral horizontal angle (SHA), and sacral inclination angle (SIA), were identified and automatically labeled by the model. At the same time, the measurement results were obtained through landmarks on the test set compared to manual measurements as the reference standard. Statistical analyses of the Percentage of Correct Key Points (PCK), intra-class correlation coefficient (ICC), Pearson correlation coefficient, mean absolute error (MAE), root mean square error (RMSE), and Bland-Altman plots were performed to evaluate the performance of the model. RESULTS The mean differences between the reference standard and the model for LSLA, LSA, SHA, and SIA, were 0.39°, 0.09°, 0.13°, and 0.12°, respectively. A strong correlation and consistency between the four parameters were found between the model and reference standard (ICC = 0.92-0.98, r = 0.92-0.97, MAE = 1.35-1.84, RMSE = 1.82-2.51), while with statistically significant difference for LSLA (p = 0.02). CONCLUSIONS The presented model revealed clinically equivalent measurements in terms of accuracy, while superior measurements were obtained in terms of cost-effectiveness, reliability, and reproducibility. The model may help clinicians improve their understanding and evaluation of lumbar diseases and LBP from a quantitative perspective in practical work. (ChiCTR2100048250).
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Shah NV, Gold R, Dar QA, Diebo BG, Paulino CB, Naziri Q. Smart Technology and Orthopaedic Surgery: Current Concepts Regarding the Impact of Smartphones and Wearable Technology on Our Patients and Practice. Curr Rev Musculoskelet Med 2021; 14:378-391. [PMID: 34729710 PMCID: PMC8733100 DOI: 10.1007/s12178-021-09723-6] [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] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW While limited to case reports or small case series, emerging evidence advocates the inclusion of smartphone-interfacing mobile platforms and wearable technologies, consisting of internet-powered mobile and wearable devices that interface with smartphones, in the orthopaedic surgery practice. The purpose of this review is to investigate the relevance and impact of this technology in orthopaedic surgery. RECENT FINDINGS Smartphone-interfacing mobile platforms and wearable technologies are capable of improving the patients' quality of life as well as the extent of their therapeutic engagement, while promoting the orthopaedic surgeons' abilities and level of care. Offered advantages include improvements in diagnosis and examination, preoperative templating and planning, and intraoperative assistance, as well as postoperative monitoring and rehabilitation. Supplemental surgical exposure, through haptic feedback and realism of audio and video, may add another perspective to these innovations by simulating the operative environment and potentially adding a virtual tactile feature to the operator's visual experience. Although encouraging in the field of orthopaedic surgery, surgeons should be cautious when using smartphone-interfacing mobile platforms and wearable technologies, given the lack of a current academic governing board certification and clinical practice validation processes.
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Affiliation(s)
- Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
| | - Richard Gold
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- School of Medicine, Saint George's University, True Blue, West Indies, Grenada
| | - Qurratul-Ain Dar
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- Department of Orthopaedic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
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Lafage R, Smith JS, Sheikh Alshabab B, Ames C, Passias PG, Shaffrey CI, Mundis G, Protopsaltis T, Gupta M, Klineberg E, Kim HJ, Bess S, Schwab F, Lafage V. When can we expect global sagittal alignment to reach a stable value following cervical deformity surgery? J Neurosurg Spine 2021; 36:616-623. [PMID: 34740177 DOI: 10.3171/2021.7.spine21306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical deformity (CD) is a complex condition with a clear impact on patient quality of life, which can be improved with surgical treatment. Previous study following thoracolumbar surgery demonstrated a spontaneous and maintained improvement in cervical alignment following lumbar pedicle subtraction osteotomy (PSO). In this study the authors aimed to investigate the complementary questions of whether cervical alignment induces a change in global alignment and whether this change stabilizes over time. METHODS To analyze spontaneous changes, this study included only patients with at least 5 levels remaining unfused following surgery. After data were obtained for the entire cohort, repeated-measures analyses were conducted between preoperative baseline and 3-month and 1-year follow-ups with a post hoc analysis and Bonferroni correction. A subanalysis of patients with 2-year follow-up was performed. RESULTS One-year follow-up data were available for 121 of 168 patients (72%), and 89 patients had at least 5 levels remaining unfused following surgery. Preoperatively there was a moderate anterior cervical alignment (C2-7, -7.7° [kyphosis]; T1 slope minus cervical lordosis, 37.1°; cervical sagittal vertebral axis [cSVA], 37 mm) combined with a posterior global alignment (SVA, -8 mm) with lumbar hyperextension (pelvic incidence [PI] minus lumbar lordosis [LL] mismatch [PI-LL], -0.6°). Patients underwent a significant correction of the cervical alignment (median ΔC2-7, 13.6°). Simultaneously, PI-LL, T1 pelvic angle (TPA), and SVA increased significantly (all p < 0.05) between baseline and 3-month and 1-year follow-ups. Post hoc analysis demonstrated that all of the changes occurred between baseline and 3 months. Subanalysis of patients with complete 2-year follow-up demonstrated similar results, with stable postoperative thoracolumbar alignment achieved at 3 months. CONCLUSIONS Correction of cervical malalignment can have a significant impact on thoracolumbar regional and global alignment. Peak relaxation of compensatory mechanisms is achieved by the 3-month follow-up and tends to remain stable. Subanalysis with 2-year data further supports this finding. These findings can help to identify when the results of cervical surgery on global alignment can be best evaluated.
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Zhang ZF, Qi DB, Wang TH, Wang Z, Zheng GQ, Wang Y. Correlation of Acetabular Anteversion and Thoracic Kyphosis Postoperatively with Proximal Junctional Failure in Adult Spinal Deformity Fused to Pelvis. Orthop Surg 2021; 13:2289-2300. [PMID: 34708550 PMCID: PMC8654664 DOI: 10.1111/os.13159] [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: 02/26/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives To investigate whether the immediate thoracic kyphosis (TK) and acetabular anteversion (AA) postoperatively are correlated with proximal junctional failure (PJF) in adult spinal deformity (ASD) patients underwent surgical treatment. Methods This is a retrospective study. Following institutional ethics approval, a total of 57 patients (49 Female, eight Male) with ASD underwent surgery fused to sacroiliac bone (S1, S2, or ilium) from March 2014 to January 2019 were included. All of those patients were followed up for at least 2 years. Demographic, radiographic and surgical data were recorded. The maximum range of flexion motion (F‐ROM) and extension motion (E‐ROM) actively of hip joints was measured and recorded at pre‐ and postoperation. The sum of F‐ROM and E‐ROM was defined as the range of hip motion (H‐ROM). Receiver operating characteristic (ROC) curve analysis was used to obtain the cut off value of parameters for PJF. A Kaplan–Meier curve and log‐rank test were used to analyze the differences in PJF‐free survival. Results In all, 14 patients developed PJF during follow‐up. Comparisons between patients with and without PJF showed significant differences in immediate TK (P < 0.001) and AA (P = 0.027) postoperatively. ROC curve analysis determined an optimal threshold of 13° for immediate AA postoperatively (sensitivity = 74.3%, specificity = 85.7%, area under the ROC curve [AUC] = 0.806, 95% CI [0.686–0.926]). Nineteen patients with post‐AA ≤13° were assigned into the observational group, and 38 patients with post‐AA >13° were being as the control group. Patients in the observational group had smaller H‐ROM (P = 0.016) and F‐ROM (P < 0.001), but much larger E‐ROM (P < 0.001). There were 10 patients showing PJF in the observational group and four in the control group (10/9 vs 4/34, P < 0.001). PJF‐free survival time significantly decreased in the observational group (P = 0.001, log‐rank test). Furthermore, patients in the observational group had much larger TK (post‐TK, P = 0.015). The optimal threshold for post‐TK (sensitivity = 85.7%, specificity = 76.7%; AUC = 0.823, 95% CI [0.672–0.974]) was 28.1° after the ROC curve was analyzed. In the observational group, those patients with post‐TK ≥28.1° had significantly higher incidence of PJF (9/2 vs 1/7, P < 0.001) than those with post‐TK < 28.1°. Moreover, PJF‐free survival time in those patients significantly decreased (P = 0.001, log‐rank test). Conclusions ASD patients with acetabular anteversion of ≤13° at early postoperation may suffer significantly restricted hip motion and much higher incidence of PJF during follow‐up, moreover, in those patients, postoperative TK ≥28.1° would be a significant risk factor for PJF developing.
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Affiliation(s)
- Zi-Fang Zhang
- Medical College of Nankai University, Tianjin, China
| | - Deng-Bin Qi
- Chinese PLA General Hospital Department of Orthopaedics, Beijing, China
| | - Tian-Hao Wang
- Chinese PLA General Hospital Department of Orthopaedics, Beijing, China
| | - Zheng Wang
- Chinese PLA General Hospital Department of Orthopaedics, Beijing, China
| | - Guo-Quan Zheng
- Chinese PLA General Hospital Department of Orthopaedics, Beijing, China
| | - Yan Wang
- Chinese PLA General Hospital Department of Orthopaedics, Beijing, China
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