Spine curvature analysis between participants with obesity and normal weight participants: a biplanar electromagnetic device measurement

Differences in spinal axial rotation angles during the lumbar-locked rotation test between hyper and normal thoracic rotation groups: A cross-sectional study

BACKGROUND

Trunk rotation is important in many sporting activities The thoracic spine has reciprocal relationships with the lumbar and pelvic spines, such that reduced flexibility in the lumbar or thoracic spine can lead to abnormal patterns of trunk movement and pain. However, few studies have investigated the relative trunk rotation mobilities of the thorax, lumbar, and pelvis.

OBJECTIVE

To compare thoracic, lumbar, and pelvic rotation angles during the lumbar-locked rotation test between hyper and normal thoracic rotation groups.

METHODS

Thirty-two young, active participants were enrolled in this study. After the attachment of inertial measurement units at the T1, T7, T12, L3, and S2 levels, the participants were required to stand in a comfortable upright posture for 5 s to allow postural measurements before performing the lumbar-locked rotation test. The participants were then divided into hyper thoracic rotation and normal thoracic rotation groups based on T1 angle measurements obtained during the lumbar-locked rotation test.

RESULTS

The hyper thoracic rotation group had significantly higher thoracic rotation angles on both the right (p< 0.05) and left (p< 0.05) sides compared with the normal thoracic rotation group. Furthermore, we observed flat lumbar lordosis in the hyper thoracic rotation group compared with the normal thoracic rotation group, particularly in the lower lumbar region in standing posture.

CONCLUSION

Our data suggest that evaluations of thoracic mobility should consider relative thoracic, lumbar, and pelvic motions, rather than the T1 angle alone. This study provides a basis for health professionals to evaluate movement dysfunctions associated with thoracic hypermobility.

Fourteen weeks of multicomponent training associated with flexibility training modifies postural alignment, joint range of motion and modulates blood pressure in physically inactive older women: a randomized clinical trial

Background: Body relaxation and pain reduction are some of the reported benefits of flexibility training (through active stretching exercises), however their effects on posture and blood circulation are uncertain. We aimed to investigate the effects of flexibility training (through active stretching exercises) in combination with multicomponent training (MT) on blood pressure (BP), and the correlation with changes in body alignment and flexibility in physically inactive women. Methods: Women aged 60-70 years were into three groups: multicomponent training group (MT), multicomponent training plus flexibility training group (FT), and control group (CG). After randomization, the resting blood pressure was measured and the participants were reallocated into subgroups according to pressure values >130/80 mmHg (This classification is according to the American Heart Association (AHA), resulting in the subgroups: flexibility training (FT); flexibility training for hypertensive patients (FTSAH); multicomponent training (MT); multicomponent training for hypertensive patients (MTSAH); control group (CG); control group of hypertensive patients (CGSAH). The interventions lasted 14 weeks. Systolic (sBP) and diastolic (dBP) BP, range of motion (flexion and extension), and postural analysis by asymmetry in the frontal plane and asymmetry in the sagittal plane, displacement and the flexibility test were collected before (Pre) and after training (Post). In total, 141 women participated in the study (without SAH: FT = 23, MT = 20, and CG = 21; with SAH: FTSAH = 28, MTSAH = 23, and CGSAH = 26). Results: Systolic blood pressure, in the pre and post moments were: FT (116 ± 6.7 vs. 114 ± 4.7); FTSAH (144 ± 16.5 vs. 121 ± 10.1); MT: (120 ± 6.8 vs. 121 ± 7.3); MTSAH: (137 ± 10.6 vs. 126 ± 13.0); CG: (122 ± 5.3 vs. 133 ± 19.2); and CGSAH: (140 ± 9.7 vs. 143 ± 26.2), presenting an F value (p-value - group x time) of 12.00 (<0.001), with improvement in the groups who trained. The diastolic blood pressure in the pre and post moments were: FT (71 ± 4.7 vs. 74 ± 6.8); FTSAH (88 ± 9.6 vs. 70 ± 12.0); MT: (74 ± 4.5 vs. 77 ± 11.7); MTSAH: (76 ± 10.4 vs. 76 ± 10.2); CG: (69 ± 7.11 vs. 82 ± 11.4); and CGSAH: (76 ± 13.4 vs. 86.6 ± 7.7), presenting an F value (p-value - group x time) of 8.00 (p < 0.001), with improvement in the groups who trained. In the Elastic Net Regression, sBP was influenced by height (β: -0.044); hip flexion (β: 0.071); Shoulder extension (β: 0.104); low back flexion (β: 0.119) and dBP (β: 0.115). In the Elastic Net Regression, dBP was influenced by asymmetry in the sagittal plane variables (0.040); asymmetry in the frontal plane (β: 0.007); knee flexion (β: -0.398); BM (β: 0.007); Shoulder flexion (β: -0.142); Hip flexion (β: -0.004); sBP (β: 0.155) and Ankle Flexion (β: -0.001). Conclusion: The displacement of the asymmetry in the frontal plane and asymmetry in the sagittal plane, and the increase in the flexion position in the hip, lumbar, head, and knee regions, influenced the highest-pressure levels. Multicomponent training associated with flexibility training promoted improvement in body alignment, COM, and joint angles, and decreased blood pressure.

Role of obesity in less radiographic correction and worse health-related quality-of-life outcomes following minimally invasive deformity surgery

OBJECTIVE

Minimally invasive surgery (MIS) for adult spinal deformity (ASD) can offer deformity correction with less tissue manipulation and damage. However, the impact of obesity on clinical outcomes and radiographic correction following MIS for ASD is poorly understood. The goal of this study was to determine the role, if any, that obesity has on radiographic correction and health-related quality-of-life measures in MIS for ASD.

METHODS

Data were collected from a multicenter database of MIS for ASD. This was a retrospective review of a prospectively collected database. Patient inclusion criteria were age ≥ 18 years and coronal Cobb angle ≥ 20°, pelvic incidence-lumbar lordosis mismatch ≥ 10°, or sagittal vertical axis (SVA) > 5 cm. A group of patients with body mass index (BMI) < 30 kg/m2 was the control cohort; BMI ≥ 30 kg/m2 was used to define obesity. Obesity cohorts were categorized into BMI 30-34.99 and BMI ≥ 35. All patients had at least 1 year of follow-up. Preoperative and postoperative health-related quality-of-life measures and radiographic parameters, as well as complications, were compared via statistical analysis.

RESULTS

A total of 106 patients were available for analysis (69 control, 17 in the BMI 30-34.99 group, and 20 in the BMI ≥ 35 group). The average BMI was 25.24 kg/m2 for the control group versus 32.46 kg/m2 (p < 0.001) and 39.5 kg/m2 (p < 0.001) for the obese groups. Preoperatively, the BMI 30-34.99 group had significantly more prior spine surgery (70.6% vs 42%, p = 0.04) and worse preoperative numeric rating scale leg scores (7.71 vs 5.08, p = 0.001). Postoperatively, the BMI 30-34.99 cohort had worse Oswestry Disability Index scores (33.86 vs 23.55, p = 0.028), greater improvement in numeric rating scale leg scores (-4.88 vs -2.71, p = 0.012), and worse SVA (51.34 vs 26.98, p = 0.042) at 1 year postoperatively. Preoperatively, the BMI ≥ 35 cohort had significantly worse frailty (4.5 vs 3.27, p = 0.001), Oswestry Disability Index scores (52.9 vs 44.83, p = 0.017), and T1 pelvic angle (26.82 vs 20.71, p = 0.038). Postoperatively, after controlling for differences in frailty, the BMI ≥ 35 cohort had significantly less improvement in their Scoliosis Research Society-22 outcomes questionnaire scores (0.603 vs 1.05, p = 0.025), higher SVA (64.71 vs 25.33, p = 0.015) and T1 pelvic angle (22.76 vs 15.48, p = 0.029), and less change in maximum Cobb angle (-3.93 vs -10.71, p = 0.034) at 1 year. The BMI 30-34.99 cohort had significantly more infections (11.8% vs 0%, p = 0.004). The BMI ≥ 35 cohort had significantly more implant complications (30% vs 11.8%, p = 0.014) and revision surgery within 90 days (5% vs 1.4%, p = 0.034).

CONCLUSIONS

Obese patients who undergo MIS for ASD have less correction of their deformity, worse quality-of-life outcomes, more implant complications and infections, and an increased rate of revision surgery compared with their nonobese counterparts, although both groups benefit from surgery. Appropriate counseling should be provided to obese patients.

Does passive hip stiffness or range of motion correlate with spinal curvature and posture during quiet standing?

BACKGROUND

It has been postulated that hip muscle stiffness can be inferred from postural assessment, and that predictable relationships exist between passive stiffness of opposing muscles. Despite a lack of evidence to demonstrate such relationships, manual therapy textbooks continue to direct clinicians to treat hip muscles following postural analysis.

RESEARCH QUESTION

Do significant correlations exist between standing posture, and hip muscle stiffness and range of motion?

METHODS

20 participants volunteered for this observational study. Passive hip stiffness was calculated as the derivative of the moment-angle curve measured during leg raising in a variety of lying postures. Stiffness was measured during hip flexion, extension, abduction and adduction. Stiffness data was obtained during the first degree and at ROM, and at the highest common angle achieved by participants in each posture Spinal curvature and other postural components were measured using a motion tracking device. Spearman rank coefficients were determined to assess any correlations between passive stiffness, range of motion, spinal curvature and other postural components.

RESULTS

Consistent relationships were found between maximum range of motion and hip stiffness at the common angles (P < 0.01), but not at maximum stiffness (P > 0.05). Consistent correlations were found between abductor stiffness and Q-angle (P < 0.05). Hip extensor range of motion correlated with lumbar lordosis (r = -0.472, P = 0.036). Other correlations were reported, but typically lacked consistency between left and right sides. Spinal curvature did not correlate with hip stiffness in frontal or sagittal planes (P > 0.05).

SIGNIFICANCE

Significant correlations were few compared with where correlations lacked statistical significance. This study demonstrates that overly simplistic assumptions about spinal posture and hip stiffness cannot be supported. Hip muscle stiffness should only be targeted in treatments where testing has demonstrated a direct need, and not assumed based upon postural assessment alone.

Analyzing Spinal Shape Changes During Posture Training Using a Wearable Device

Lower back pain is one of the most prevalent diseases in Western societies. A large percentage of European and American populations suffer from back pain at some point in their lives. One successful approach to address lower back pain is postural training, which can be supported by wearable devices, providing real-time feedback about the user’s posture. In this work, we analyze the changes in posture induced by postural training. To this end, we compare snapshots before and after training, as measured by the Gokhale SpineTracker™. Considering pairs of before and after snapshots in different positions (standing, sitting, and bending), we introduce a feature space, that allows for unsupervised clustering. We show that resulting clusters represent certain groups of postural changes, which are meaningful to professional posture trainers.

Back pain and sagittal spine alignment in obese patients eligible for bariatric surgery

OBJECTIVE

The objective of this research was to evaluate the prevalence of cervical and lumbar pain in obese patients eligible for bariatric surgery and to investigate possible changes in sagittal spine alignment in these patients.

METHODS

The following parameters were compared in 30 obese patients and a control group of 25 non-obese volunteers: body mass index, prevalence of cervical and lumbar pain assessed by visual analog scale (VAS), Neck Disability Index [NDI] and Oswestry Disability Index [ODI], as well as radiographic parameters of the spine and pelvis measured with Surgimap software.

RESULTS

The cervical and lumbar VAS and the NDI and ODI were significantly worse in obese patients. Compared with the control group, the cervical sagittal vertical axis (cSVA) of the obese group had higher variance (p value = 0.0025) and the cervical lordosis was diminished (p value = 0.0023). Thoracic kyphosis, lumbar lordosis, and the pelvic parameters were not significantly different between the groups.

CONCLUSIONS

Obese patients demonstrated lower functional performance compared with their non-obese counterparts, while cervical lordosis was diminished and the cSVA was increased in obese patients. These slides can be retrieved under Electronic Supplementary Material.

Effect of reclining angle on lumbar lordosis at driving posture: A radiological evaluation

BACKGROUND

Optimal seatback angles for automobile drivers' seats have been investigated based on comfort and back muscle activities; however, radiology supported evidences are scarce.

OBJECTIVE

The aim of this study was to evaluate optimal range of the seatback reclining regarding torso angles for an automobile driver's seat to preserve lumbar lordosis.

METHODS

Thirty-one healthy volunteers were recruited among five body type categories. Lateral lumbar spine X-rays were obtained for the neutral sitting posture without seatback (reference), and with reclining angles of 23∘ to 33∘ by 2∘ intervals. The Cobb angles for the L1-L4, L4-S1, and L1-S1 segments were measured.

RESULTS

The Cobb angle for L4-S1 was nearest to the reference (18.74 ± 1.57∘, mean ± standard error mean) at reclining angles of 29∘ and 31∘ (14.51 ± 1.41∘ and 14.47 ± 1.43∘, respectively). The Cobb angle at L4-S1 between reclining angles of 27∘(12.02 ± 1.31∘) and 29∘ (14.51 ± 1.41∘) were significantly different (p< 0.001). Tall men showed relatively preserved lordosis angles at all reclining angles. Fat men and short women demonstrated prominent loss of lordosis with excessively kyphotic L1-L4 segment.

CONCLUSIONS

Reclining angles of 29∘ to 31∘ revealed to be optimal for preserving lordosis at the L4-S1 segment. Individualized healthcare-related guideline for driver's seat adjustment setting is necessary.

Is the occiput-wall distance valid and reliable to determine the presence of thoracic hyperkyphosis?

BACKGROUND

Hyperkyphosis may be frequently found nowadays due to the change in current lifestyles of sustained flexion postures and age-related system decline. The occiput-wall distance (OWD) is a practical measure that is commonly used to screen and monitor thoracic hyperkyphosis in epidemiologic studies. However, there was no clear evidence to support the clinical utility of the tool as compared to the data from direct standard measures.

OBJECTIVES

To investigate psychometric properties-including validity, reliability, and appropriate cut-off point-of the OWD to determine the presence of thoracic hyperkyphosis, as compared to a standard Cobb's method.

DESIGN

Observational study.

METHODS

This study was conducted in ninety-nine participants, aged 10 years and above who had different degrees of thoracic hyperkyphosis from several communities. All participants were assessed for their severity of thoracic hyperkyphosis using the OWD, and 14 participants were involved in a reliability study. Within 7 days later, all participants were at a hospital to complete a radiographic examination.

RESULTS

Outcomes from OWD had good concurrent validity with the Cobb angles (r = 0.683, P < 0.001) and excellent rater reliability when assessed by well-trained health professionals (ICCs > 0.9, P < 0.001). The OWD of at least 6.5 cm had the best diagnostic properties to determine the presence of thoracic hyperkyphosis (sensitivity = 71.4%, specificity = 76.6%, and area under the curve = 0.846).

CONCLUSION

The findings support validity and reliability of OWD, and offer a clear cut-off point to determine the presence of thoracic hyperkyphosis for clinical utility in various settings.

Effect of age and sex on lumbar lordosis and the range of motion. A systematic review and meta-analysis

Lumbar lordosis (LL) and the range of motion (RoM) are important physiological measurements when initiating any diagnosis and treatment plan for patients with low back pain. Numerous studies reported differences in LL and the RoM due to age and sex. However, these findings remain contradictory. A systematic review and meta-analysis were performed to synthesize mean values and the differences in LL and the RoM because of age and sex. The quality assessment tool for quantitative studies was applied to assess the methodological quality of the studies included. We identified 2372 papers through electronic (2309) and physical (63) searches. We assessed 218 full-text studies reporting measurements of LL or the RoM. In total, 65 studies were included, and a normative database for LL and the RoM is provided as supplementary material. Among these, 11 were included in the meta-analysis. LL and the RoM displayed non-monotonic variations with significant age and sex differences. Young females showed a significantly greater LL and the range of extension (RoE), whereas young males exhibited a greater range of flexion (RoF). Sex differences in the range of lateral bending (RoLB) were small but were significant for the axial rotation (RoAR). For the RoF, RoE and RoLB, differences because of age were significant among most of the age groups in both sexes, whereas for the RoAR, differences were significant only between the 20s vs the 30s-40s (males) and 40s vs 50s (females). Significant differences because of age/sex were identified. However, the age-dependent reduction in LL and the RoM was non-monotonic and differed in both sexes. These findings will help to better distinguish between functional deficits caused by spinal disorders and natural factors/conditions related to age and sex.

Body mass index and waist circumference in early adulthood are associated with thoracolumbar spine shape at age 60-64: The Medical Research Council National Survey of Health and Development

This study investigated associations between measures of adiposity from age 36 and spine shape at 60-64 years. Thoracolumbar spine shape was characterised using statistical shape modelling on lateral dual-energy x-ray absorptiometry images of the spine from 1529 participants of the MRC National Survey of Health and Development, acquired at age 60-64. Associations of spine shape modes with: 1) contemporaneous measures of total and central adiposity (body mass index (BMI), waist circumference (WC)) and body composition (android:gynoid fat mass ratio and lean and fat mass indices, calculated as whole body (excluding the head) lean or fat mass (kg) divided by height2 (m)2); 2) changes in total and central adiposity between age 36 and 60-64 and 3) age at onset of overweight, were tested using linear regression models. Four modes described 79% of the total variance in spine shape. In men, greater lean mass index was associated with a larger lordosis whereas greater fat mass index was associated with straighter spines. Greater current BMI was associated with a more uneven curvature in men and with larger anterior-posterior (a-p) vertebral diameters in both sexes. Greater WC and fat mass index were also associated with a-p diameter in both sexes. There was no clear evidence that gains in BMI and WC during earlier stages of adulthood were associated with spine shape but younger onset of overweight was associated with a more uneven spine and greater a-p diameter. In conclusion, sagittal spine shapes had different associations with total and central adiposity; earlier onset of overweight and prior measures of WC were particularly important.

Improvement of thoracic myelopathy following bariatric surgery in an obese patient

Revision spine surgery is extremely challenging in super-super obese patients (body mass index (BMI) ≥60 kg/m²). This is the first report describing how bariatric surgery was useful for a super-super obese patient with progressing myelopathy. A 44-year-old man with a BMI of 62.9 kg/m² presented with an ambulatory disorder caused by thoracic ossification of the posterior longitudinal ligament (T7-8). Before this paraparesis, he had undergone four spinal operations, and was not considered a good candidate for a fifth spine surgery. At the time of the fourth operation, he had reached a maximum weight of 205 kg (BMI 69.3 kg/m²). Instead, he underwent a laparoscopic sleeve gastrectomy. Sixteen months later, his body weight had decreased to BMI 35.2 kg/m², and he could walk without a walker. In addition to reducing our patient's load, a 'non-operative' form of dekyphosis due to altered thoracic spinal alignment secondary to weight loss may explain the improvement in his myelopathy.

A preliminary study of static and dynamic balance in sedentary obese young adults: the relationship between BMI, posture and postural balance

The aim of this study was to evaluate the postural control of obese young adults with normal body mass index during different static (bipedic and unipedic support) and dynamic postural conditions (gait velocity and limits of stability) in order to compare the static and dynamic balance of these individuals. A cross-sectional quantitative study was carried out to evaluate static and dynamic balance in 25 sedentary individuals. The sample was divided into two groups, 10 in the normal-weight group (24.70 ± 3.89 years and 21.5 ± 1.66 kg m^-2 ) and 15 in the obese group (26.80 ± 5.16 years and 35.66 ± 4.29 kg m^-2 ). Postural evaluation was performed through visual inspection, and balance analyses were performed using the Timed Up & Go test (TUGT) and Balance System (Biodex). Descriptive analyses, Fisher's exact test and Mann Whitney U-tests were performed using the Statistical Package for Social Sciences (SPSS - 20.0, Armonk, NY) software. Most of the obese volunteers presented postural alterations, such as head protrusion (47.6%), hyperkyphosis (46.7%) and hyperlordosis (26.7%). Medial-lateral dynamic displacement, risk of falls and mean time to perform the limits of stability test and TUGT were higher for obese subjects (P < 0.05), while there were no significant differences between the groups (P > 0.05) for static balance tests for either bipedal or unipedal tasks. The disadvantage presented by the young obese subjects occurs in dynamic activities, representing worse balance and an increase in time needed to accomplish these activities.