Midsagittal anatomy of lumbar lordosis in adult egyptians: MRI study

Measurement of Intervertebral Disc Heights in the Lumbar Spine. Comparison of X-Ray and Magnetic Resonance Imaging, Method of Measurement and Determination of Inter-observer Reliability

PURPOSE

Retrospective radiological examination (X-ray and MRI) aims to investigate the diagnostic value of various methods of measurement with regard to the determination of the intervertebral disc heights of the lumbar spine.

METHODS

Of 130 patients without detectable damage to the intervertebral discs, the X-ray and MRI images of the lumbar spine were evaluated. The measurements were made either in the center line (Hurxthal) or in the 2-point method according to Dabbs or in the 3-point method according to Fyllos.

RESULTS

The average intervertebral disc height for all measured segments was 8.8 mm (SD 1.4 mm). In the Hurxthal measurement, the significantly (p < 0.001) highest values were measured with an average of 9.1 mm (SD 1.3 mm). The average readings for the Fyllos method were 7.5 mm (SD 1.2 mm) and according to Dabbs 6.7 mm (SD 1.2 mm). The measured values of Observer I were on average 1.2 mm (SD 0.3 mm) smaller than those of Observer II (p < 0.001). The highest interobserver correlation was found in the measurements in projection radiography in the AP method according to Dabbs and Fyllos. The measured values in men were 0.5 mm (SD 0.01 mm) larger than in women (p < 0.001), regardless of the method. The height of the intervertebral discs increases significantly until the age of 40, but beyond the age of 40, the height of the intervertebral discs either remains constant or falls off slightly, but not significantly. The lordosis angle of the lumbar spine and the concavity index of the vertebral bodies showed no correlation with the measured disc heights.

CONCLUSIONS

The radiological measurements to determine the intervertebral disc height have only moderate reliability. The results of X-rays are superior to those of MRI examination. The most accurate results are provided by measurements based on exact landmarks of the vertebral bodies. The method according to Dabbs seems to be the most accurate at the moment. There is no clear age-atypical chondrosis in patients without intervertebral disc damage.

The duration of spinal anaesthesia in elective caesarean section in Trendelenburg and reverse Trendelenburg positions: a randomized clinical trial

Objective

One of the common methods of anaesthesia for caesarean sections (CSs) involves the use of spinal anaesthesia in mothers. Various positions are utilized in this method. This study aims to compare the evaluation of two positions, Trendelenburg and reverse Trendelenburg, in candidates for CS to assess the duration of anaesthesia and changes in vital signs in women.

Methods

This study was a randomized clinical trial in which 60 pregnant mothers who met the inclusion criteria entered the study. These mothers were randomly allocated into two equal groups using block randomization. One group of patients received spinal anaesthesia in the Trendelenburg position, while the other group received it in the Reverse Trendelenburg position. Vital signs (systolic and diastolic blood pressure, heart rate, Apgar score, and SPO2) of participants from both groups were evaluated for 1 h after the induction of anaesthesia. Additionally, sensory level and duration of anaesthesia were measured. Finally, the data from both groups were subjected to statistical analysis using SPSS version 26 software.

Results

The mean (SD) age of participating mothers in the Reverse Trendelenburg and Trendelenburg groups was 28.93 (5.82) and 30.97 (4.94), respectively. The two study groups did not significantly differ in baseline characteristics such as age, BMI, which could potentially impact vital sign outcomes or anaesthesia duration, and education (P>0.05). The mean (SD) duration of anaesthesia in the Trendelenburg position was significantly higher than in the Reverse Trendelenburg position [221.57(min) vs. 159.00(min)] (P<0.0001). There was no significant difference between the two positions, Trendelenburg and Reverse Trendelenburg, in terms of sensory level and its extent (P=0.08). The two study groups did not significantly differ in hemodynamic changes measured 13 times, including heart rate, systolic and diastolic blood pressure, and Apgar score (P>0.05).

Conclusion

In spinal anaesthesia with the Trendelenburg position compared to the Reverse Trendelenburg position, there is a longer duration of anaesthesia. This is while the two positions did not differ in terms of hemodynamic changes and sensory level.

Analyzing Pelvic Asymmetry by Sex and Ancestry: Insights From an Osteological Collection

INTRODUCTION

Pelvic asymmetry has been noted in pelvic imaging, and might influence the development of various spinal pathologies, most notably scoliosis. There is a limited understanding of the relationship between pelvic asymmetry and sex and ancestry, and limited use of 3D modeling. The purpose of this study was to identify pelvic asymmetry and morphology differences between sex and ancestry utilizing 3D modeling on young adults in an osteological collection.

METHODS

Thirty-three osteological pelvic specimens aged 18-25 years (average age 21.4 ± 2.0 years) were scanned to create virtual 3D models for analysis. Pelvic asymmetry and morphology were measured and compared across sex (male and female) and ancestry (European American and African American). Multivariate regression analysis was performed to examine the relationship between the variables measured.

RESULTS

Multivariate regression analysis demonstrated statistically significant relationships between innominate-pelvic ring ratio and both sex (p < 0.001) and ancestry (p= 0.003) with larger ratios in male and African American specimens respectively. There was also a statistically significant relationship of greater sacral 1 coronal tilt in European American specimens (p= 0.042). There were no statistically significant differences with sex or ancestry in terms of innominate or sacral asymmetry.

CONCLUSION

Although there are differences in overall pelvic shape between sex and ancestry, there is no relationship between these two variables versus pelvic asymmetry in the axial or sagittal planes in young adult osteological specimens.

Association Between Anterior Hip Capsule Thickening and Sagittal Pelvic Alignment Among Patients With Developmental Dysplasia of the Hip

INTRODUCTION

The pathogenesis and pathology of secondary osteoarthritis (OA) of the hip, which is mainly due to developmental dysplasia of the hip (DDH), in Japan are obscure. There are some reports on the thickening of the hip capsule, but the relationship between the thickness of the hip capsule and the pelvic alignment due to hip deformity is not well known. This research investigated whether the capsular thickness of female DDH patients was related to pelvic alignment.

METHODS

This single-center cross-sectional study included female patients aged 50-79 years (n=13) who had undergone primary total hip arthroplasty (THA) due to secondary hip OA with a background of DDH. The part of the hip capsule including the iliofemoral ligament was resected and measured directly with a digital caliper. The Sharp angle, center-edge (CE) angle, sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and lumbar lordosis angle (LLA) were measured with an X-ray image to investigate the relationship between the capsular thickness and the pelvic posture.

RESULTS

Pearson's correlation coefficient showed a negative correlation between hip capsular thickness and Sharp angle (r=-0.57, p>0.05). No significant correlation was found between the thickness of the hip capsule and the sagittal X-ray parameters including SS, PT, PI, LLA, and CE angle in the coronal plane.

CONCLUSION

The thickness of the hip capsule is moderately associated with the Sharp angle on the coronal plane. The results of this study suggest that the thickness of the joint capsule does not necessarily relate to the degenerative process among patients with DDH and the process can be complex to apply two-dimensional postural indices for the explanation.

Degenerative Cervical Myelopathy: An Overview

Degenerative cervical myelopathy (DCM) is a spinal condition of growing importance due to its increasing prevalence within the ageing population. DCM involves the degeneration of the cervical spine due to various processes such as disc ageing, osteophyte formation, ligament hypertrophy or ossification, as well as coexisting congenital anomalies. This article provides an overview of the literature on DCM and considers areas of focus for future research. A patient with DCM can present with a variety of symptoms ranging from mild hand paraesthesia and loss of dexterity to a more severe presentation of gait disturbance and loss of bowel/bladder control. Hoffman's sign and the inverted brachioradialis reflex are also important signs of this disease. The gold standard imaging modality is MRI which can identify signs of degeneration of the cervical spine. Other modalities include dynamic MRI, myelography, and diffusion tensor imaging. One important scoring system to aid with the diagnosis and categorisation of the severity of DCM is the modified Japanese Orthopaedic Association score. This considers motor, sensory, and bowel/bladder dysfunction, and categorises patients into mild, moderate, or severe DCM. DCM is primarily treated with surgery as this can halt disease progression and may even allow for neurological recovery. The surgical approach will depend on the location of degeneration, the number of cervical levels involved and the pathophysiological process. Surgical approach options include anterior cervical discectomy and fusion, corpectomy, or posterior approach (laminectomy ± fusion). Conservative management is also considered for some patients with mild or non-progressive DCM or for patients where surgery is not an option. Conservative treatment may include physical therapy, traction, or neck immobilisation. Future recommendations include research into the prevalence rate of DCM and if there is a difference between populations. Further research on the benefit of conservative management for patients with mild or non-progressive DCM would be recommended.

Cortical bone trajectory screws in the treatment of lumbar degenerative disc disease in patients with osteoporosis

Lumbar degenerative disc disease (DDD) in the elderly population remains a global health problem, especially in patients with osteoporosis. Osteoporosis in the elderly can cause failure of internal fixation. Cortical bone trajectory (CBT) is an effective, safe and minimally invasive technique for the treatment of lumbar DDD in patients with osteoporosis. In this review, we analyzed the anatomy, biomechanics, and advantages of the CBT technique in lumbar DDD and revision surgery. Additionally, the clinical trials and case reports, indications, advancements and limitations of this technique were further discussed and reviewed. Finally, we concluded that the CBT technique can be a practical, effective and safe alternative to traditional pedicle screw fixation, especially in DDD patients with osteoporosis.

Sex- and Age-related Differences in Spinal Degeneration: An Anatomical and Magnetic Resonance Imaging Study of the Human Spine

Objectives:

A precise anatomical understanding of the morphology of the spine is indispensable for neck and low back pain therapy including rehabilitation. However, few studies have directly addressed spinal morphology with a focus on the height of the vertebral body and discs. The aim of the current study was to analyze sex- and age-related changes in the spine by measuring the distance between adjacent centers of the intervertebral disc spaces from the posterior aspect in cadavers and by using magnetic resonance imaging (MRI) measurements at the cervical and lumbar vertebral levels.

Methods:

In the cadaveric study, the posterior distance between the adjacent centers of the disc spaces was measured for 58 spinal canals. The equivalent distances were examined using MRI in 370 and 660 subjects who presented with neck pain and back pain, respectively.

Results:

The distance between the adjacent centers of the intervertebral disc spaces in male cadavers was larger than that in female cadavers from C3 to L5/S1. The MRI results showed that the distance between the adjacent centers of the intervertebral disc spaces decreased with age in all spinal areas in men and women. Cadaveric values were significantly lower than the MRI values in men, whereas in women, no significant differences were observed.

Conclusions:

These results suggest that age-related changes in the cervical and lumbar spine are associated with differences between men and women in the degrees of progressive vertebral body and disc degeneration.

The effect of age, BMI, and bone mineral density on the various lumbar vertebral measurements in females

PURPOSE

Healthy spinal balance is dependent on spinal sagittal alignment. It is evaluated by several spinopelvic measures. The objective of this study is to investigate the effect of age and body mass index and the bone mineral density on the several vertebral measures and sagittal spinopelvic measurements.

METHODS

In this cross-sectional study, a total of 89 female patients were grouped according to age (> 70, < 70); to BMI (underweight (< 18.5 kg/m²), normal weight (18.5-25 kg/m²), overweight (25-30 kg/m²); and to spine T scores (normal, osteopenia, and osteoporosis). On lateral lumbar X-ray, lumbar lordosis (LL) angle and pelvic incidence (PI) are measured. On sagittal T2 MRI images, anterior and posterior vertebral heights and foraminal height and area of the L1-L5 segments were measured.

RESULTS

The mean age of the participants was 70.54 ± 6.49. The distribution of the patients in BMI groups and BMD groups were even. Mean lumber lordosis (LL) was 48.27 ± 18.06, and the mean pelvic incidence (PI) was 60.20 ± 15.74. In the younger age group, LL was found to be higher than the older age group. The vertebral and spinopelvic angle measures within the different BMI and BMD groups revealed no difference in between. There were no statistically significant difference in correlation analysis.

CONCLUSION

In this cross-sectional study, the results revealed that younger patients have higher lordosis angle, and normal BMD patients have higher foraminal height and area measures than osteoporotic and osteopenic patients. Obesity seemed not to have any influence on vertebral measures. Spinopelvic parameters seem not to be effected by BMD and BMI.

Comparison of Four Radiographic Angular Measures of Lumbar Lordosis

Background

Several attempts (radiographic and nonradiographic) have been made to measure the lumbar lordosis (LL), but the results differ substantially as investigators have used different parameters. Radiography is the gold standard, and the methods include lumbosacral angle (LSA), lumbosacral joint angle (LSJA), Cobb angle, and tangential radiologic assessment of LL (TRALL) angle. The traditional method, the Cobb technique, has a wide range of normal mean values, with a large standard deviation. Using a more reliable radiographic angle will hopefully simply and standardize LL measurement in the diagnosis, treatment, and follow-up of patients.

Aim

To compare in normal individuals with fully developed LL the LSA, LSJA, TRALL, and Cobb angles, by determining (a) if any correlation exists between them and (b) the most reliable measures of LL, based on, least (i) number of measurement lines, (ii) range of values, (iii) mean, (iv) standard deviation, and (v) variance.

Materials and Methods

The four angles were retrospectively measured in each supine lateral lumbosacral radiograph of 100 males and 100 females, aged 15 years and above. Data were analyzed with IBM SPSS Statistics 23.0 (NY, USA); P < 0.05 was considered statistically significant.

Results

No correlation existed between the mean values of the four angles, and in each angle, there was no male-versus-female correlation. LSJA had the best reliability criteria for LL measurement.

Conclusion

The mean LSA, LSJA, TRALL, and Cobb angles have no significant Pearson's correlation, and of the four angular measures of LL, LSJA was the most reliable.

Normative spino-pelvic sagittal alignment of Lebanese asymptomatic adults: Comparisons with different ethnicities

BACKGROUND

Normative values of sagittal alignment are used as references for the diagnosis and treatment of spinal pathologies. There are currently no reference values for the normative sagittal alignment of Lebanese subjects. The objective is to describe normative values of full body sagittal alignment parameters in asymptomatic Lebanese adults and to compare the sagittal alignment of this population to that of populations of various origins.

METHODS

Included subjects were aged 18 to 28 years old. Each subject underwent a full body biplanar X-ray exam with measurement of spine, pelvis and lower limb parameters of sagittal alignment. The sagittal alignment of the Lebanese population was compared to that of other ethnicities, previously reported in the literature, using one-way ANOVA.

RESULTS

Ninety-two asymptomatic Lebanese young adult volunteers (48 males, 44 females, age=21.5±2.2 years) were enrolled in this study. The mean curvature in the cervical spine was kyphotic (-4.3°) in women, while it was lordotic in men (5.4°). Men were found to be significantly more kyphotic than women (-58.3° vs. -53.0°; p<0.01) but both sexes were found to have similar lordosis (61.6°) and pelvic incidence (52.0°). Lebanese subjects had intermediate pelvic incidence compared to other ethnicities but showed significantly higher thoracic kyphosis (p<0.01) and lumbar lordosis (p<0.01) compared to all other ethnicities.

CONCLUSIONS

This study established reference normative values for young adult Lebanese subjects. Most women were found to have kyphotic cervical spines. The sagittal alignment of Lebanese subjects differed significantly compared to that of other ethnicities.

LEVEL OF EVIDENCE

Level IV - cross sectional study.

Relationship between anthropometric measures and sagittal spinal curvatures in adult male handball players

Purpose. Increasing anthropometric measures bring considerable spinal loads during sports practice, which inversely affects the adaptation abilities of the spinal structures; this in turn influences the spinal curvatures. The study was conducted to explore the relationship between anthropometric measures and sagittal spinal curvatures in handball players. Method. The total of 83 male handball players were divided into 2 groups, depending on their body height: group 1 (age, 23.62 ± 2.07 years) consisted of 40 handball players with height above average, group 2 (age, 24.63 ± 2.58 years) consisted of 43 handball players with height below average. The thoracic and lumbar curvatures and trunk height were measured with the Formetric III 4D spine and posture analysis system. Results. The thoracic kyphosis of group 1 was significantly higher than that of group 2 (p = 0.038), without a significant difference in lumbar lordosis (p = 0.312), and significant difference in the coefficient of compensation between thoracic kyphosis and lumbar lordosis (p = 0.026). Group 1 showed strong positive correlation between body height and kyphotic angle (r = 0.897), and moderate positive correlation with lordosis angle (r = 0.496). In group 2, there was weak positive correlation with kyphotic angle (r = 0.381), and weak negative correlation with lumbar lordosis angle (r = -0.355). Conclusions. Increasing body height of handball players is associated with bigger kyphotic and lordotic angles. Owing to frequent sagittal asymmetric overloading of the spine during handball training, exercises that help maintain good posture and correct the thoracic kyphosis are required, especially for taller players.

Morphological and postural sexual dimorphism of the lumbar spine facilitates greater lordosis in females

Previous work suggests females are evolutionarily adapted to have greater lumbar lordosis than males to aid in pregnancy load-bearing, but no consensus exists. To explore further sex-differences in the lumbar spine, and to understand contradictions in the literature, we conducted a cross-sectional retrospective study of sex-differences in lumbar spine morphology and sacral orientation. In addition, our sample includes data for separate standing and supine samples of males and females to examine potential sex-differences in postural loading on lumbosacral morphology. We measured sagittal lumbosacral morphology on 200 radiographs. Measurements include: lumbar angle (L1-S1), lumbar vertebral body and disc wedging angles, sacral slope and pelvic incidence. Lumbar angle, representative of lordotic curvature between L1 and S1, was 7.3° greater in females than males, when standing. There were no significant sex-differences in lumbar angle when supine. This difference in standing lumbar angle can be explained by greater lordotic wedging of the lumbar vertebrae (L1-L5) in females. Additionally, sacral slope was greater in females than males, when standing. There were no significant sex-differences in pelvic incidence. Our results support that females have greater lumbar lordosis than males when standing, but not when supine - suggesting a potentially greater range of motion in the female spine. Furthermore, sex-differences in the lumbar spine appear to be supported by postural differences in sacral-orientation and morphological differences in the vertebral body wedging. A better understanding of sex-differences in lumbosacral morphology may explain sex-differences in spinal conditions, as well as promote necessary sex-specific treatments.