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Diebo BG, Balmaceno-Criss M, Lafage R, McDonald CL, Alsoof D, Halayqeh S, DiSilvestro KJ, Kuris EO, Lafage V, Daniels AH. Sagittal Alignment in the Degenerative Lumbar Spine: Surgical Planning. J Bone Joint Surg Am 2024; 106:445-457. [PMID: 38271548 PMCID: PMC10906213 DOI: 10.2106/jbjs.23.00672] [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: 01/27/2024]
Abstract
➤ Sagittal alignment of the spine has gained attention in the field of spinal deformity surgery for decades. However, emerging data support the importance of restoring segmental lumbar lordosis and lumbar spinal shape according to the pelvic morphology when surgically addressing degenerative lumbar pathologies such as degenerative disc disease and spondylolisthesis.➤ The distribution of caudal lordosis (L4-S1) and cranial lordosis (L1-L4) as a percentage of global lordosis varies by pelvic incidence (PI), with cephalad lordosis increasing its contribution to total lordosis as PI increases.➤ Spinal fusion may lead to iatrogenic deformity if performed without attention to lordosis magnitude and location in the lumbar spine.➤ A solid foundation of knowledge with regard to optimal spinal sagittal alignment is beneficial when performing lumbar spinal surgery, and thoughtful planning and execution of lumbar fusions with a focus on alignment may improve patient outcomes.
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Affiliation(s)
- Bassel G. Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Christopher L. McDonald
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Sereen Halayqeh
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kevin J. DiSilvestro
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eren O. Kuris
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Ohba T, Oda K, Tanaka N, Go G, Haro H. Impact of Skeletal Muscle Mass on Physical Function and Locomotive Syndrome of Pre- and Postoperative Adult Spinal Deformity. J Clin Med 2024; 13:697. [PMID: 38337391 PMCID: PMC10856667 DOI: 10.3390/jcm13030697] [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: 11/20/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Background: The purpose of this study is to identify the relationship between locomotive syndrome (LS) status, physical performance and limb and trunk skeletal muscle mass before and after surgery in adult spinal surgery (ASD) patients. Methods: A retrospective observational investigation of 63 consecutive patients with ASD who underwent spinal surgery was conducted. The total skeletal muscle mass of the arms and legs was considered a measure of the total appendicular skeletal muscle mass measured with whole-body dual-energy X-ray absorptiometry. All data pertaining to the physical performance tests and LS were collected preoperatively with follow-up one year postoperatively. Results: Gait speed, the one-leg standing test and the stand-up test were significantly improved one year after surgery compared to preoperative measurements. The lower extremity skeletal muscle mass predominantly influences physical function improvement including gait stride, one-leg standing and the stand-up test after ASD surgery. Conclusions: This study is the first to show that assessing lower extremity muscles prior to ASD surgery is useful in predicting postoperative recovery.
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Affiliation(s)
- Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan; (K.O.); (N.T.); (G.G.); (H.H.)
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Chen P, Zhou Z, Sun L, Yu X, Li K, Li J, He M, Zhou X, Luo F, Zhao J, Chen W. Quantitative multi-parameter assessment of age- and gender-related variation of back extensor muscles in healthy adults using Dixon MR imaging. Eur Radiol 2024; 34:69-79. [PMID: 37537425 DOI: 10.1007/s00330-023-09954-w] [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: 01/12/2023] [Revised: 04/07/2023] [Accepted: 05/20/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Investigate sex differences in age-related back extensor muscle degeneration using Dixon MRI and analyze the relationship between quantitative muscle parameters and back muscle strength in healthy adults. METHODS 105 healthy subjects underwent lumbar Dixon MRI. Fat fraction (FF), cross-sectional area (CSA), functional CSA (FCSA), and relative FCSA (RFCSA) of multifidus muscle (MF) and erector spinae (ES) were quantified. Back extension muscle strength was measured using an external fixation dynamometer. ANOVA with post hoc Tukey correction was used for age group comparisons. Partial and Spearman's correlation analyzed relationships between age, muscle parameters, and muscle strength. RESULTS MF and ES FF significantly increased with age in both genders (r = 0.55-0.85; p < 0.001). Muscle FF increased prominently for females (40-49 years, MF and 50-59 years, ES) and males (60-73 years, MF and ES). In females, total ES FCSA and RFCSA (r = - 0.42, - 0.37; p < 0.01) correlated with age. While in males, all MF and ES muscle size parameters, except total MF CSA, correlated with age (r = - 0.30 to - 0.58; p < 0.05). Back extension muscle strength correlated with mean FF, total CSA, and total FCAS for MF and ES individually (p < 0.001). The combined MF + ES FCSA correlation coefficient (r = 0.63) was higher than FF (r = - 0.51) and CSA (r = 0.59) (p < 0.001). CONCLUSIONS Age-related back extensor muscle degeneration varies by muscle type and sex. FCSA has the highest association with back muscle strength compared to FF and CSA. CLINICAL RELEVANCE STATEMENT The investigation of sex differences in age-related back extensor muscle degeneration utilizing Dixon imaging may hold significant implications for evaluating spine health and enabling earlier intervention. Muscles' FCSA could contribute to acquiring additional evidence for reflecting muscle function change. KEY POINTS • The multifidus muscle (MF) and erector spinae (ES) fat fraction (FF) increased with age at all lumbar disc levels in females and males. • Age-related changes in muscle morphological quantitative parameters of healthy adults were specific by muscle type and gender. • The muscle functional cross-sectional area (FCSA) measured by Dixon imaging may better monitor back extensor muscle strength changes than muscle FF and cross-sectional area (CSA).
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Affiliation(s)
- Pinzhen Chen
- Department of Radiology, The First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China
| | - Zhou Zhou
- Department of Radiology, The First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China
| | - Li Sun
- Health Management Center, The First Affiliated Hospital, Army Medical University, Chongqing, 400038, China
| | - Xueke Yu
- Department of Orthopedics, The First Affiliated Hospital, Army Medical University, Chongqing, 400038, China
| | - Kai Li
- Department of Orthopedics, The First Affiliated Hospital, Army Medical University, Chongqing, 400038, China
| | - Jin Li
- Department of Radiology, The First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China
| | - Min He
- Department of Radiology, The First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China
| | - Xiaoyue Zhou
- MR Collaboration NEA, Siemens Healthcare Ltd, Shanghai, 201318, China
| | - Fei Luo
- Department of Orthopedics, The First Affiliated Hospital, Army Medical University, Chongqing, 400038, China
| | - Jun Zhao
- Department of Radiology, The First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China.
| | - Wei Chen
- Department of Radiology, The First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China.
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Quantitative evaluation of correlation between lumbosacral lordosis and pelvic incidence in standing position among asymptomatic Asian adults: a prospective study. Sci Rep 2022; 12:18965. [PMID: 36347920 PMCID: PMC9643535 DOI: 10.1038/s41598-022-21840-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
The determination of lumbopelvic alignment is essential for planning adult spinal deformity surgery and for ensuring favorable surgical outcomes. This prospective study investigated the correlation between the lumbar section of lumbar spine lordosis and increasing pelvic incidence in 324 Asian adults with a mean age of 55 ± 13 years (range: 20-80 years), comprising 115 male and 209 female volunteers. Participants were divided into three groups based on pelvic incidence (G1, G2, and G3 had pelvic incidence of < 45°, 45-55°, and ≥ 55°, respectively). We determined that distal and proximal lumbar lordosis contributed differentially to the increase in pelvic incidence, whereas the lordosis ratio of the L3-L4 and L4-L5 segments mostly remained constant. The mean contribution ratio of the segmental lordosis from L1 to S1 was as follows: L1-L2, 2.3%; L2-L3, 11.7%; L3-L4, 18.1%; L4-L5, 25.2%; and L5-S1, 42.7%. Pelvic incidence had a stronger correlation with proximal lumbar lordosis than did distal lumbar lordosis. The ratios of proximal lumbar lordosis to distal lumbar lordosis were 37.8% in G1, 45.8% in G2, and 55.9% in G3. These findings serve as a reference for future lumbar spine correction or fusion surgery for Asian adults.
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Huang W, Cai XH, Li YR, Xu F, Jiang XH, Wang D, Tu M. The association between paraspinal muscle degeneration and osteoporotic vertebral compression fracture severity in postmenopausal women. J Back Musculoskelet Rehabil 2022; 36:323-329. [PMID: 36155499 PMCID: PMC10041424 DOI: 10.3233/bmr-220059] [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: 02/04/2023]
Abstract
BACKGROUND According to reports in the literature, osteoporotic vertebral compression fracture (OVCF) is associated with paraspinal muscle degeneration; however, the association between the severity of OVCF and paraspinal muscle degeneration is not clear. OBJECTIVE The purpose of this study was to investigate the association between paraspinal muscle degeneration and OVCF severity in postmenopausal women. METHODS Three hundred and seventy-six MRI images from 47 patients were collected and analyzed. Sagittal and axial coronal T2-weighted images were used to measure the fractured vertebra sagittal cross-sectional area (FSCSA), the adjacent normal vertebral body sagittal cross-sectional area (NSCSA), paraspinal muscle cross-sectional area (CSA), and the fat cross-sectional area (FCSA). The ratio of fractured vertebra compressed sagittal cross-sectional area (RCSA) and fatty infiltration ratio (FIR) was subsequently calculated. The formulas for RCSA and FIR calculations are as follows: RCSA = (NSCSA-FSCSA)/NSCSA; FIR = FCSA/CSA. RCSA and FIR represent the severity of OVCF and paraspinal muscle degeneration, respectively. RESULTS The correlation between paraspinal muscle degeneration and OVCF severity was analyzed using the Pearson correlation, and multiple regression analysis was performed to explore related risk factors. OVCF severity was closely associated with paraspinal muscle degeneration (L3/4 FIR r= 0.704, P< 0.05; L4/5 FIR r= 0.578, P< 0.05; L5/S1 FIR r= 0.581, P< 0.05). Multiple regression analysis demonstrated that the risk factor for OVCF severity was L3/4 FIR (β= 0.421, P= 0.033). CONCLUSION OVCF severity was associated with the FIR of paraspinal muscles, and L3/4 FIR was a predictive factor for OVCF severity in postmenopausal women.
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Affiliation(s)
- Wei Huang
- Hubei University of Chinese Medicine, Wuhan, China.,Department of Spine Surgery, Jingmen No. 2 People's Hospital, Jingmen, Wuhan, China.,Department of Orthopedics, PLA Middle Military Command General Hospital, Wuhan, China
| | - Xian-Hua Cai
- Hubei University of Chinese Medicine, Wuhan, China.,Department of Orthopedics, PLA Middle Military Command General Hospital, Wuhan, China
| | - Yi-Rong Li
- Department of Spine Surgery, Jingmen No. 2 People's Hospital, Jingmen, Wuhan, China
| | - Feng Xu
- Department of Orthopedics, PLA Middle Military Command General Hospital, Wuhan, China
| | - Xin-Hao Jiang
- Department of Spine Surgery, Jingmen No. 2 People's Hospital, Jingmen, Wuhan, China
| | - Dan Wang
- Department of Spine Surgery, Jingmen No. 2 People's Hospital, Jingmen, Wuhan, China
| | - Min Tu
- Department of Spine Surgery, Jingmen No. 2 People's Hospital, Jingmen, Wuhan, China
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Bae J, Sathe A, Lee SM, Theologis AA, Deviren V, Lee SH. Correlation of Paraspinal Muscle Mass With Decompensation of Sagittal Adult Spinal Deformity After Setting of Fatigue Post 10-Minute Walk. Neurospine 2021; 18:495-503. [PMID: 34610681 PMCID: PMC8497245 DOI: 10.14245/ns.2142510.255] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/21/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the changes in spinopelvic parameters before and after the setting of muscle fatigue along with its correlation with pre-existing paraspinal and psoas muscle mass. METHODS Single-center retrospective review of prospectively collected data was conducted on 145-adults with symptomatic loss of lumbar lordosis (LL). Radiographs were taken before and after walking for 10 minutes. Magnetic resonance imaging was used to calculate paraspinal muscle (PSM) cross-sectional area (CSA), mean signal intensity, fatty infiltration (FI), and lean muscle mass at thoracolumbar junction (T12) and lower lumbar level (L4). Psoas CSA was calculated at L3. Patients were divided into 2 groups namely compensated sagittal deformity (CSD) (SVA ≤ 4 cm, PT > 20°) and decompensated sagittal deformity (DSD) (SVA > 4 cm, PT > 20°) based on prewalk measurements. RESULTS Initial mean SVA was 1.8 cm and 11 cm for CSD and DSD respectively (p < 0.01). After walking, significant deteriorations in SVA, PT-LL (p < 0.01) were observed in CSD without significant change in thoracic kyphosis (TK). All sagittal parameters in DSD deteriorated significantly. DSD group had significantly poorer PSM quality at T12 and L4 compared to CSD group. In CSD group, sagittal decompensation correlated with muscle quality, i.e. , decreases in LL (ΔLL) correlated with CSA of PSM/vertebral body (VB) at L4 (r = -0.412, p = 0.046) while increases in TK (ΔTK) correlated with CSA of PSM/VB at T12 (r = 0.477, p = 0.018). ΔSVA and ΔPT correlated with FI at L4 (r = 0.577, p = 0.003 and r = -0.407, p = 0.048, respectively). DSD group, had weak correlations (-0.3 < r < -0.1) between changes in sagittal and PSM parameters. CONCLUSION PSM quality in adults with spinal deformity correlates with patients' ability to maintain an upright posture and sagittal decompensation after walking for 10 minutes.
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Affiliation(s)
- Junseok Bae
- Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, Korea
| | - Ashwin Sathe
- Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, Korea
| | - Shih-Min Lee
- Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, Korea
| | - Alexander A Theologis
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, CA, USA
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, CA, USA
| | - Sang-Ho Lee
- Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, Korea
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