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Kao FC, Huang YJ, Chiu PY, Hsieh MK, Tsai TT. Factors Predicting the Surgical Risk of Osteoporotic Vertebral Compression Fractures. J Clin Med 2019; 8:E501. [PMID: 31013728 PMCID: PMC6517994 DOI: 10.3390/jcm8040501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 12/30/2022] Open
Abstract
The aim of our study was to investigate the association between global spinal alignment, spinopelvic parameters, and outcomes of osteoporotic vertebral compression fractures (OVCF). Patients with vertebral compression fractures seen at our hospital between October 2017 and November of 2018 with a bone mineral density (BMD) T-score < -2.5 were recruited for the study. Surgical intervention was performed after eight weeks of conservative treatment depending on clinical symptoms and the willingness of patients. Spinopelvic and sagittal alignment parameters were compared between patients who had surgery and those that did not. Seventy-nine patients were included in the study. Twenty-five patients (31.6%, mean age: 73.28 ± 9.78 years) received surgery, and 54 (68.3%, mean age: 73 ± 8.58 years) conservative treatment only. Pelvic tilt, pelvic incidence, and local kyphotic angle were statistically different between the groups (all p < 0.05). A sagittal vertical axis ≥ 50 mm, distance between the C7 plumb line and the center of the fractured vertebra (DSVA) ≥ 60 mm, pelvic incidence outside of the range of 44 to 62°), and pelvic tilt ≥ 27° were associted with the need for surgical intervention. Measurement of spinopelvic parameters can predict the need for surgery in patients with OVCF.
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Affiliation(s)
- Fu-Cheng Kao
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Yu-Jui Huang
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Ping-Yeh Chiu
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
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Nam HS, Han M, Choi HY, Song K, Kang S, Ahn SM, Lee SU. Effect of reclining angle on lumbar lordosis at driving posture: A radiological evaluation. J Back Musculoskelet Rehabil 2019; 31:923-930. [PMID: 29945341 DOI: 10.3233/bmr-170875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Hyung Seok Nam
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Manyong Han
- Department of Mechanical and System Design Engineering, Hongik University, Seoul, Korea
| | - Hyung Yun Choi
- Department of Mechanical and System Design Engineering, Hongik University, Seoul, Korea
| | - Kyuman Song
- School of Architecture, Hongik University, Seoul, Korea
| | - Seonggyu Kang
- Hyundai Motors Namyang R&D Division, Hwaseong-si, Korea
| | - Sung Min Ahn
- Hyundai Motors Namyang R&D Division, Hwaseong-si, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Rothrock RJ, McNeill IT, Yaeger K, Oermann EK, Cho SK, Caridi JM. Lumbar Lordosis Correction with Interbody Fusion: Systematic Literature Review and Analysis. World Neurosurg 2018; 118:21-31. [DOI: 10.1016/j.wneu.2018.06.216] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/23/2018] [Accepted: 06/26/2018] [Indexed: 01/04/2023]
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Abstract
STUDY DESIGN A population-based birth cohort study. OBJECTIVE To investigate the association between gravidity, parity, and vertebral geometry among middle-aged women. SUMMARY OF BACKGROUND DATA Vertebral size is a recognized determinant of vertebral fracture risk. Yet, only a few lifestyle factors that influence vertebral size are known. Pregnancy is a labile period that may affect the maternal vertebral size or shape. The lumbar lordosis angle is permanently deepened by pregnancy, but it remains unclear whether vertebral shape or size contribute to this deepened angle. METHODS We aimed to investigate whether gravidity and parity were associated with vertebral cross-sectional area (CSA) and height ratio (anterior height to posterior height) among 705 middle-aged women from the Northern Finland Birth Cohort 1966. We measured the corpus of their fourth lumbar vertebra using magnetic resonance imaging of the lumbar spine at the age of 46. Gravidity and parity were elicited using a questionnaire also at the age of 46. Linear regression analysis was used with adjustments for body mass index, vertebral CSA (height ratio models), and vertebral height (CSA models). We also ran a subgroup analysis that did not include nulliparous women, and we compared nulliparous women with grand multiparous women. RESULTS The models found no statistically significant associations between the predictors and outcomes. Crude and adjusted results were highly similar, and the subgroup analyses provided analogous results. CONCLUSION Pregnancy, or even multiple pregnancies, do not seem to have long-term effects on vertebral geometry. In order to enhance the prevention of vertebral fractures, future studies should aim to reveal more lifestyle determinants of vertebral size. LEVEL OF EVIDENCE 3.
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Cervical and postural strategies for maintaining horizontal gaze in asymptomatic adults. 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 2018; 27:2700-2709. [PMID: 30194529 DOI: 10.1007/s00586-018-5753-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/06/2018] [Accepted: 09/01/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the different cervical strategies for maintaining horizontal gaze in asymptomatic subjects. METHODS One hundred and forty-four asymptomatic adults filled the SF-36 quality of life questionnaire and underwent full-body biplanar radiographs. Chin brow vertical angle (CBVA) and postural and cervical parameters were measured. Subjects were grouped according to cervical spine curvature (C2-C7 angle): kyphotic (< - 5°), straight [- 5°, 5°], lordotic (> 5°). Demographics, SF-36 component scores and CBVA were compared between groups. All other parameters were compared between groups, while controlling for confounding factors (ANCOVA). A correlation test was conducted between all cervical parameters. RESULTS 32% of subjects had kyphotic (- 12° ± 7°), 27% straight (0° ± 3°) and 41% lordotic (12° ± 7°) cervical spines. While demographic and SF-36 data did not differ between groups, CBVA differed between lordotic and kyphotic groups (2° vs. 6.5°, p = 0.002). Sagittal vertical axis (SVA) and thoracic kyphosis (TK) were lower in the kyphotic group (SVA: K = - 26 ± 20 mm vs. L = - 2 ± 21 mm, p < 0.001; TK: K = 40° ± 6° vs. L = 51° ± 8°, p < 0.001). C2 slope (K = 29° ± 6° vs. L = 18° ± 6°, p < 0.001), C0-C2 (K = 42° ± 8° vs. L = 30° ± 8°, p < 0.001) and C1-C2 (K = 33° ± 6° vs. L = 28° ± 6°, p = 0.004) were higher in the kyphotic group. Significant correlations were found between almost all cervical parameters and C2-C7 angle. CONCLUSIONS Subjects with cervical kyphosis presented with more posterior global alignment and lower TK than subjects with lordosis. In order to maintain horizontal gaze, subjects with cervical kyphosis presented with a more lordotic upper cervical spine than subjects with cervical lordosis. Subjects with straight cervical curvature presented with an intermediate sagittal alignment. These slides can be retrieved under Electronic Supplementary Material.
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Berry DB, Shahidi B, Rodríguez-Soto AE, Hughes-Austin JM, Kelly KR, Ward SR. Lumbar Muscle Structure Predicts Operational Postures in Active-Duty Marines. J Orthop Sports Phys Ther 2018; 48:613-621. [PMID: 29772956 DOI: 10.2519/jospt.2018.7865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The relationship between lumbar spine posture and muscle structure is not well understood. Objectives To investigate the predictive capacity of muscle structure on lumbar spine posture in active-duty Marines. Methods Forty-three Marines were scanned in this cross-sectional study, using an upright magnetic resonance imaging scanner while standing without load and standing, sitting, and prone on elbows with body armor. Cobb, horizontal, and sacral angles were measured. Marines were then scanned while unloaded in supine using a supine magnetic resonance imaging scanner. The imaging protocol consisted of T2 intervertebral disc mapping; high-resolution, anatomical, fat-water separation, and diffusion tensor imaging to quantify disc hydration and muscle volume, fat fraction, and restricted diffusion profiles in the lumbar muscles. A stepwise multiple linear regression model was used to identify physiological measures predictive of lumbar spine posture. Results The multiple regression model demonstrated that fractional anisotropy of the erector spinae was a significant predictor of lumbar posture for 7 of 18 dependent variables measured, and explained 20% to 35% of the variance in each model. Decreased fractional anisotropy of the erector spinae predicted decreased lordosis, lumbosacral extension, and anterior pelvic tilt. Conclusion Fractional anisotropy is inversely related with muscle fiber size, which is associated with the isometric force-generating capacity of a muscle fiber. This suggests that stronger erector spinae muscles predict decreased lordosis, lumbosacral extension, and anterior pelvic tilt in a highly trained population. J Orthop Sports Phys Ther 2018;48(8):613-621. Epub 17 May 2018. doi:10.2519/jospt.2018.7865.
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Gilsanz V, Wren TAL, Ponrartana S, Mora S, Rosen CJ. Sexual Dimorphism and the Origins of Human Spinal Health. Endocr Rev 2018; 39:221-239. [PMID: 29385433 PMCID: PMC5888211 DOI: 10.1210/er.2017-00147] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/24/2018] [Indexed: 12/26/2022]
Abstract
Recent observations indicate that the cross-sectional area (CSA) of vertebral bodies is on average 10% smaller in healthy newborn girls than in newborn boys, a striking difference that increases during infancy and puberty and is greatest by the time of sexual and skeletal maturity. The smaller CSA of female vertebrae is associated with greater spinal flexibility and could represent the human adaptation to fetal load in bipedal posture. Unfortunately, it also imparts a mechanical disadvantage that increases stress within the vertebrae for all physical activities. This review summarizes the potential endocrine, genetic, and environmental determinants of vertebral cross-sectional growth and current knowledge of the association between the small female vertebrae and greater risk for a broad array of spinal conditions across the lifespan.
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Affiliation(s)
- Vicente Gilsanz
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027.,Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027.,Department of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027
| | - Tishya A L Wren
- Department of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027
| | - Skorn Ponrartana
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Clifford J Rosen
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, Maine 04074
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Green DA, Scott JPR. Spinal Health during Unloading and Reloading Associated with Spaceflight. Front Physiol 2018; 8:1126. [PMID: 29403389 PMCID: PMC5778142 DOI: 10.3389/fphys.2017.01126] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/20/2017] [Indexed: 12/17/2022] Open
Abstract
Spinal elongation and back pain are recognized effects of exposure to microgravity, however, spinal health has received relatively little attention. This changed with the report of an increased risk of post-flight intervertebral disc (IVD) herniation and subsequent identification of spinal pathophysiology in some astronauts post-flight. Ground-based analogs, particularly bed rest, suggest that a loss of spinal curvature and IVD swelling may be factors contributing to unloading-induced spinal elongation. In flight, trunk muscle atrophy, in particular multifidus, may precipitate lumbar curvature loss and reduced spinal stability, but in-flight (ultrasound) and pre- and post-flight (MRI) imaging have yet to detect significant IVD changes. Current International Space Station missions involve short periods of moderate-to-high spinal (axial) loading during running and resistance exercise, superimposed upon a background of prolonged unloading (microgravity). Axial loading acting on a dysfunctional spine, weakened by anatomical changes and local muscle atrophy, might increase the risk of damage/injury. Alternatively, regular loading may be beneficial. Spinal pathology has been identified in-flight, but there are few contemporary reports of in-flight back injury and no recent studies of post-flight back injury incidence. Accurate routine in-flight stature measurements, in- and post-flight imaging, and tracking of pain and injury (herniation) for at least 2 years post-flight is thus warranted. These should be complemented by ground-based studies, in particular hyper buoyancy floatation (HBF) a novel analog of spinal unloading, in order to elucidate the mechanisms and risk of spinal injury, and to evaluate countermeasures for exploration where injury could be mission critical.
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Affiliation(s)
- David A Green
- KBRwyle GmbH, Cologne, Germany.,Space Medicine Office, European Astronaut Centre, European Space Agency, Cologne, Germany.,Centre of Human and Aerospace Physiological Sciences, King's College London, London, United Kingdom
| | - Jonathan P R Scott
- KBRwyle GmbH, Cologne, Germany.,Space Medicine Office, European Astronaut Centre, European Space Agency, Cologne, Germany
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Bailey JF, Miller SL, Khieu K, O’Neill CW, Healey RM, Coughlin DG, Sayson JV, Chang DG, Hargens AR, Lotz JC. From the international space station to the clinic: how prolonged unloading may disrupt lumbar spine stability. Spine J 2018; 18:7-14. [PMID: 28962911 PMCID: PMC6339989 DOI: 10.1016/j.spinee.2017.08.261] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/09/2017] [Accepted: 08/21/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Prolonged microgravity exposure is associated with localized low back pain and an elevated risk of post-flight disc herniation. Although the mechanisms by which microgravity impairs the spine are unclear, they should be foundational for developing in-flight countermeasures for maintaining astronaut spine health. Because human spine anatomy has adapted to upright posture on Earth, observations of how spaceflight affects the spine should also provide new and potentially important information on spine biomechanics that benefit the general population. PURPOSE This study compares quantitative measures of lumbar spine anatomy, health, and biomechanics in astronauts before and after 6 months of microgravity exposure on board the International Space Station (ISS). STUDY DESIGN This is a prospective longitudinal study. SAMPLE Six astronaut crewmember volunteers from the National Aeronautics and Space Administration (NASA) with 6-month missions aboard the ISS comprised our study sample. OUTCOME MEASURES For multifidus and erector spinae at L3-L4, measures include cross-sectional area (CSA), functional cross-sectional area (FCSA), and FCSA/CSA. Other measures include supine lumbar lordosis (L1-S1), active (standing) and passive (lying) flexion-extension range of motion (FE ROM) for each lumbar disc segment, disc water content from T2-weighted intensity, Pfirrmann grade, vertebral end plate pathology, and subject-reported incidence of chronic low back pain or disc injuries at 1-year follow-up. METHODS 3T magnetic resonance imaging and dynamic fluoroscopy of the lumbar spine were collected for each subject at two time points: approximately 30 days before launch (pre-flight) and 1 day following 6 months spaceflight on the ISS (post-flight). Outcome measures were compared between time points using paired t tests and regression analyses. RESULTS Supine lumbar lordosis decreased (flattened) by an average of 11% (p=.019). Active FE ROM decreased for the middle three lumbar discs (L2-L3: -22.1%, p=.049; L3-L4: -17.3%, p=.016; L4-L5: -30.3%, p=.004). By contrast, no significant passive FE ROM changes in these discs were observed (p>.05). Disc water content did not differ systematically from pre- to post-flight. Multifidus and erector spinae changed variably between subjects, with five of six subjects experiencing an average decrease 20% for FCSA and 8%-9% for CSA in both muscles. For all subjects, changes in multifidus FCSA strongly correlated with changes in lordosis (r2=0.86, p=.008) and active FE ROM at L4-L5 (r2=0.94, p=.007). Additionally, changes in multifidus FCSA/CSA correlated with changes in lordosis (r2=0.69, p=.03). Although multifidus-associated changes in lordosis and ROM were present among all subjects, only those with severe, pre-flight end plate irregularities (two of six subjects) had post-flight lumbar symptoms (including chronic low back pain or disc herniation). CONCLUSIONS We observed that multifidus atrophy, rather than intervertebral disc swelling, associated strongly with lumbar flattening and increased stiffness. Because these changes have been previously linked with detrimental spine biomechanics and pain in terrestrial populations, when combined with evidence of pre-flight vertebral end plate insufficiency, they may elevate injury risk for astronauts upon return to gravity loading. Our results also have implications for deconditioned spines on Earth. We anticipate that our results will inform new astronaut countermeasures that target the multifidus muscles, and research on the role of muscular stability in relation to chronic low back pain and disc injury.
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Affiliation(s)
- Jeannie F. Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco, 513 Parnassus Ave, S1157, San Francisco, CA, 94143-0514, USA
| | - Stephanie L. Miller
- Department of Orthopaedic Surgery, University of California, San Francisco, 513 Parnassus Ave, S1157, San Francisco, CA, 94143-0514, USA
| | - Kristine Khieu
- Department of Orthopaedic Surgery, University of California, San Diego, 9452 Medical Center Drive, La Jolla, CA 92037-0863, USA
| | - Conor W. O’Neill
- Department of Orthopaedic Surgery, University of California, San Francisco, 513 Parnassus Ave, S1157, San Francisco, CA, 94143-0514, USA
| | - Robert M. Healey
- Department of Orthopaedic Surgery, University of California, San Francisco, 513 Parnassus Ave, S1157, San Francisco, CA, 94143-0514, USA
| | - Dezba G. Coughlin
- Department of Orthopaedic Surgery, University of California, San Francisco, 513 Parnassus Ave, S1157, San Francisco, CA, 94143-0514, USA
| | - Jojo V. Sayson
- Ola Grimsby Institute, 8550 United Plaza Blvd. Baton Rouge, LA 70809, USA
| | - Douglas G. Chang
- Department of Orthopaedic Surgery, University of California, San Diego, 9452 Medical Center Drive, La Jolla, CA 92037-0863, USA
| | - Alan R. Hargens
- Department of Orthopaedic Surgery, University of California, San Diego, 9452 Medical Center Drive, La Jolla, CA 92037-0863, USA
| | - Jeffrey C. Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco, 513 Parnassus Ave, S1157, San Francisco, CA, 94143-0514, USA,Corresponding author. Orthopaedic Bioengineering Laboratory, University of California, San Francisco, 513 Parnassus Ave, 11th Floor, S1157, San Francisco, CA 94143-0514, USA. Tel.: 415 476 7881; fax: 415 476 1128. (J.C. Lotz)
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Villafañe JH, Bissolotti L, Zaina F, Arienti C, Donzelli S, Negrini S. Thoracic hyperkyphosis non invasively measured by general practitioners is associated with chronic low back pain: A cross-sectional study of 1364 subjects. J Bodyw Mov Ther 2017; 22:752-756. [PMID: 30100308 DOI: 10.1016/j.jbmt.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/31/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between trunk sagittal posture and nonspecific chronic low back pain (CLBP) by evaluating plumb-line distances in subjects recruited in an everyday clinical setting. METHODS Of the 1364 subjects recruited, 63.1% were female (mean age ± SD: 56.2 ± 16.8 years). Subjects were categorized into CLBP and control groups and were prospectively assessed over a 3-month period. They provided information about their daily activities and their history of CLBP. Prognostic factors were analysed using univariate and multivariate logistic regression analyses. A physical examination was performed to record demographic (i.e. age, height and weight) and pain characteristics, and the intensity of pain was assessed using a numerical visual analogue scale. Disability was assessed using the Roland-Morris Disability Questionnaire (RMDQ). A simple measure generally used for sagittal plane screening purposes during growth was also utilized. RESULTS Multivariate logistic regression analysis revealed that gender (OR = 1.70), RMDQ score (OR = 0.51) and thoracic hyperkyphosis (C7 + L3 at the plumb-line distance) (OR = 1.57) were associated with CLBP. The final regression model explained 85.6% (R2 = 0.56; P < 0.001) of the variability. CONCLUSIONS General practitioners can clinically and easily assess trunk posture in subjects with low back pain to identify subjects at higher risk of CLBP.
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Affiliation(s)
| | - Luciano Bissolotti
- Casa di Cura Domus Salutis, Brescia, Italy; LARIN: Neuromuscular and Adapted Physical Activity Laboratory, Brescia, Italy.
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy.
| | | | | | - Stefano Negrini
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy.
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Yilgor C, Sogunmez N, Yavuz Y, Abul K, Boissiére L, Haddad S, Obeid I, Kleinstück F, Sánchez Pérez-Grueso FJ, Acaroğlu E, Mannion AF, Pellise F, Alanay A, _ _. Relative lumbar lordosis and lordosis distribution index: individualized pelvic incidence–based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis. Neurosurg Focus 2017; 43:E5. [DOI: 10.3171/2017.8.focus17498] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVEThe subtraction of lumbar lordosis (LL) from the pelvic incidence (PI) offers an estimate of the LL required for a given PI value. Relative LL (RLL) and the lordosis distribution index (LDI) are PI-based individualized measures. RLL quantifies the magnitude of lordosis relative to the ideal lordosis as defined by the magnitude of PI. LDI defines the magnitude of lower arc lordosis in proportion to total lordosis. The aim of this study was to compare RLL and PI − LL for their ability to predict postoperative complications and their correlations with health-related quality of life (HRQOL) scores.METHODSInclusion criteria were ≥ 4 levels of fusion and ≥ 2 years of follow-up. Mechanical complications were proximal junctional kyphosis/proximal junctional failure, distal junctional kyphosis/distal junctional failure, rod breakage, and implant-related complications. Correlations between PI − LL, RLL, PI, and HRQOL were analyzed using the Pearson correlation coefficient. Mechanical complication rates in PI − LL, RLL, LDI, RLL, and LDI interpreted together, and RLL subgroups for each PI − LL category were compared using chi-square tests and the exact test. Predictive models for mechanical complications with RLL and PI − LL were analyzed using binomial logistic regressions.RESULTSTwo hundred twenty-two patients (168 women, 54 men) were included. The mean age was 52.2 ± 19.3 years (range 18–84 years). The mean follow-up was 28.8 ± 8.2 months (range 24–62 months). There was a significant correlation between PI − LL and PI (r = 0.441, p < 0.001), threatening the use of PI − LL to quantify spinopelvic mismatch for different PI values. RLL was not correlated with PI (r = −0.093, p > 0.05); therefore, it was able to quantify divergence from ideal lordosis for all PI values. Compared with PI − LL, RLL had stronger correlations with HRQOL scores (p < 0.05). Discrimination performance was better for the model with RLL than for PI − LL. The agreement between RLL and PI − LL was high (κ = 0.943, p < 0.001), moderate (κ = 0.455, p < 0.001), and poor (κ = −0.154, p = 0.343), respectively, for large, average, and small PI sizes. When analyzed by RLL, each PI − LL category was further divided into distinct groups of patients who had different mechanical complication rates (p < 0.001).CONCLUSIONSUsing the formula of PI − LL may be insufficient to quantify normolordosis for the whole spectrum of PI values when applied as an absolute numeric value in conjunction with previously reported population-based average thresholds of 10° and 20°. Schwab PI − LL groups were found to constitute an inhomogeneous group of patients. RLL offers an individualized quantification of LL for all PI sizes. Compared with PI − LL, RLL showed a greater association with both mechanical complications and HRQOL. The use of RLL and LDI together, instead of PI − LL, for surgical planning may result in lower mechanical complication rates and better long-term HRQOL.
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Affiliation(s)
- Caglar Yilgor
- 1Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine
| | - Nuray Sogunmez
- 2Comprehensive Spine Center, Acibadem Maslak Hospital, Istanbul
| | | | - Kadir Abul
- 2Comprehensive Spine Center, Acibadem Maslak Hospital, Istanbul
| | - Louis Boissiére
- 4Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | - Sleiman Haddad
- 5Spine Surgery Unit, Hospital Universitari Vall d’Hebron, Barcelona
| | - Ibrahim Obeid
- 4Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | | | | | | | - Anne F. Mannion
- 9Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Ferran Pellise
- 5Spine Surgery Unit, Hospital Universitari Vall d’Hebron, Barcelona
| | - Ahmet Alanay
- 1Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine
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Viggiani D, Gallagher KM, Sehl M, Callaghan JP. The distribution of lumbar intervertebral angles in upright standing and extension is related to low back pain developed during standing. Clin Biomech (Bristol, Avon) 2017; 49:85-90. [PMID: 28898814 DOI: 10.1016/j.clinbiomech.2017.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/21/2017] [Accepted: 09/04/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumbar lordosis measures are poorly related to clinical low back pain, however using a controlled exposure such as prolonged standing to identify pain groups may clarify this relationship. The purpose of this study was to determine the distribution of lumbar intervertebral angles in asymptomatic persons who do (pain developers) and do not (non-pain developers) develop low back pain during standing. METHODS Sagittal plane lumbar spine radiographs of eight pain developers and eight non-pain developers were taken in three poses: upright standing, full extension and full flexion. Measures of vertebral end plate orientations from L1 to S1 were taken in each pose to compute: intervertebral angles, contribution of each level to the total curve, total lordosis, ranges of motion, relative pose positioning within the range of motion, vertebral shape, and lumbar spine recurve. Measures were compared between pain groups and lumbar levels. FINDINGS Pain group differences in intervertebral angles and level contributions were greatest in the full extension pose, with pain developers having greater contributions from higher lumbar levels and fewer contributions from lower levels than non-pain developers. Pain group differences in intervertebral angle distributions were less pronounced in upright standing and non-existent in full flexion. No other measures differentiated pain groups. INTERPRETATIONS Although participants had similar gross-lumbar spine curvature characteristics, non-pain developers have more curvature at lower levels in upright standing and full extension. These differences in regional vertebral kinematics may partially be responsible for standing-induced low back pain.
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Affiliation(s)
- Daniel Viggiani
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Kaitlin M Gallagher
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR 72701, USA
| | - Michael Sehl
- St Mary's Hospital, Waterloo, ON N2J 1C4, Canada
| | - Jack P Callaghan
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
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Lee CH, Chung CK, Jang JS, Kim SM, Chin DK, Lee JK, Yoon SH, Hong JT, Ha Y, Kim CH, Hyun SJ. Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance: a meta-analysis. J Neurosurg Spine 2017; 27:540-551. [DOI: 10.3171/2017.3.spine161134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEAs life expectancy continues to increase, primary degenerative sagittal imbalance (PDSI) is diagnosed in an increasing number of elderly people. Although corrective surgery for this sagittal deformity is becoming more popular, the effectiveness of the procedure remains unclear. The authors aimed to collate the available evidence on the effectiveness and complications of deformity-correction surgery in patients with PDSI.METHODSThe authors carried out a meta-analysis of clinical studies regarding deformity correction in patients with PDSI. The studies were identified through searches of the PubMed, Embase, Web of Science, and Cochrane databases. Surgery outcomes were evaluated and overall treatment effectiveness was assessed in terms of the minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) values and pain levels according to visual analog scale (VAS) scores and in terms of restoration of spinopelvic parameters to within a normal range. Data are expressed as mean differences with 95% CIs.RESULTSTen studies comprising 327 patients were included. The VAS and ODI values improved after deformity-correction surgery. The smallest treatment effect exceeded the MCID for VAS values (4.15 [95% CI 3.48–4.82]) but not for ODI values (18.11 [95% CI 10.99–25.23]). At the final follow-up visit, the mean lumbar lordosis angle (−38.60° [95% CI −44.19° to −33.01°]), thoracic kyphosis angle (31.10° [95% CI 24.67°–37.53°]), C-7 sagittal vertical axis (65.00 mm [95% CI 35.27–94.72 mm]), and pelvic tilt angle (30.82° [95% CI 24.41°–37.23°]) remained outside their normal ranges. Meta-regression analyses revealed a significant effect of ODI change in relation to lumbar lordosis change (p = 0.004). After a mean of 2 years after deformity correction, the mean lumbar lordosis angle and C-7 sagittal vertical axis decreased by 5.82° and 38.91 mm, respectively, and the mean thoracic kyphosis angle increased by 4.7°. The incidences of proximal junctional kyphosis and pseudarthrosis were 23.7% and 12.8%, respectively.CONCLUSIONSDeformity correction substantially relieves back pain for about 2 years in adult patients with PDSI. Sufficient surgical restoration of lumbar lordosis can lead to substantial improvement in patient disability and reduced decompensation. Deformity correction represents a viable therapeutic option for patients with PDSI, but further technical advancements are necessary to achieve sufficient lumbar lordosis and reduce complication rates.
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Affiliation(s)
- Chang-Hyun Lee
- 1Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang
| | - Chun Kee Chung
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
- 5Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul
| | - Jee-Soo Jang
- 6Department of Neurosurgery, Nanoori Suwon Hospital, Suwon
| | - Sung-Min Kim
- 7Department of Neurosurgery, Spine Center, Kyung Hee University Hospital at Gangdong, Seoul
| | - Dong-Kyu Chin
- 8Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul
| | - Jung-Kil Lee
- 9Department of Neurosurgery, Chonnam University Hospital, Chonnam University College of Medicine, Gwangju
| | - Seung Hwan Yoon
- 10Department of Neurosurgery, Inha University Hospital, Inha University College of Medicine, Incheon
| | - Jae Taek Hong
- 11Department of Neurosurgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon
| | - Yoon Ha
- 12Department of Neurosurgery, Yonsei University College of Medicine, Severance Hospital, Seoul; and
| | - Chi Heon Kim
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
- 4Clinical Research Institute, Seoul National University Hospital
| | - Seung-Jae Hyun
- 13Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Abstract
BACKGROUND Lumbar lordosis is required for bipedalism. OBJECTIVES To investigate age-related changes in lumbar lordosis and to clarify the relationships between lumbar lordosis and vertebral wedging and disc degeneration. METHODS A total of 300 women were included in this retrospective study, 50 in each of six age groups (20-, 30-, 40-, 50-, 60- and 70-year-olds). Patients with vertebral collapse, instable fracture or disc sequestration were excluded. In each patient, lumbar lordosis angle, posterior vertebral wedging, L5-S1 intervertebral disc angle, L5/L1 vertebral height ratio and L5-S1 intervertebral disc/L1-L2 intervertebral disc height ratio were examined. Significance level was set at p< 0.05 and two-sided tests were used. RESULTS Significant differences were found in lumbar lordosis according to age group (p< 0.001). Lumbar lordosis correlated most strongly with L4 posterior vertebral wedging, L5 posterior vertebral wedging and L5-S1 intervertebral disc angle, in that order (r= 0.50, r= 0.40, r= 0.32, respectively; p< 0.001). CONCLUSION In this cohort, strong spinal structure was maintained during physiological aging from 20 to 40 years of age; lumbar lordosis increased by 50 years of age. Increased lordosis correlated with increased posterior vertebral wedging and loss of posterior disc height.
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65
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Tardieu C, Hasegawa K, Haeusler M. How Did the Pelvis and Vertebral Column Become a Functional Unit during the Transition from Occasional to Permanent Bipedalism? Anat Rec (Hoboken) 2017; 300:912-931. [DOI: 10.1002/ar.23577] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 01/17/2017] [Accepted: 01/27/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Christine Tardieu
- UMR 7179 “Mécanismes adaptatifs: des organismes aux communautés”, USM 301-Département E.G.B; Muséum National d'Histoire Naturelle; Paris France
| | | | - Martin Haeusler
- Institute of Evolutionary Medicine, University of Zürich; Zürich Switzerland
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Tempel ZJ, Gandhoke GS, Bolinger BD, Khattar NK, Parry PV, Chang YF, Okonkwo DO, Kanter AS. The Influence of Pelvic Incidence and Lumbar Lordosis Mismatch on Development of Symptomatic Adjacent Level Disease Following Single-Level Transforaminal Lumbar Interbody Fusion. Neurosurgery 2017; 80:880-886. [DOI: 10.1093/neuros/nyw073] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 08/14/2016] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Annual incidence of symptomatic adjacent level disease (ALD) following lumbar fusion surgery ranges from 0.6% to 3.9% per year. Sagittal malalignment may contribute to the development of ALD.
OBJECTIVE: To describe the relationship between pelvic incidence-lumbar lordosis (PI-LL) mismatch and the development of symptomatic ALD requiring revision surgery following single-level transforaminal lumbar interbody fusion for degenerative lumbar spondylosis and/or low-grade spondylolisthesis.
METHODS: All patients who underwent a single-level transforaminal lumbar interbody fusion at either L4/5 or L5/S1 between July 2006 and December 2012 were analyzed for pre- and postoperative spinopelvic parameters. Using univariate and logistic regression analysis, we compared the spinopelvic parameters of those patients who required revision surgery against those patients who did not develop symptomatic ALD. We calculated the predictive value of PI-LL mismatch.
RESULTS: One hundred fifty-nine patients met the inclusion criteria. The results noted that, for a 1° increase in PI-LL mismatch (preop and postop), the odds of developing ALD requiring surgery increased by 1.3 and 1.4 fold, respectively, which were statistically significant increases. Based on our analysis, a PI-LL mismatch of >11° had a positive predictive value of 75% for the development of symptomatic ALD requiring revision surgery.
CONCLUSIONS: A high PI-LL mismatch is strongly associated with the development of symptomatic ALD requiring revision lumbar spine surgery. The development of ALD may represent a global disease process as opposed to a focal condition. Spine surgeons may wish to consider assessment of spinopelvic parameters in the evaluation of degenerative lumbar spine pathology.
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67
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Lee CH, Chung CK, Jang JS, Kim SM, Chin DK, Lee JK. 'Lumbar Degenerative Kyphosis' Is Not Byword for Degenerative Sagittal Imbalance: Time to Replace a Misconception. J Korean Neurosurg Soc 2017; 60:125-129. [PMID: 28264231 PMCID: PMC5365292 DOI: 10.3340/jkns.2016.0607.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/20/2016] [Accepted: 09/22/2016] [Indexed: 01/22/2023] Open
Abstract
Lumbar degenerative kyphosis (LDK) is a subgroup of the flat-back syndrome and is most commonly caused by unique life styles, such as a prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Unfortunately, LDK has been used as a byword for degenerative sagittal imbalance, and this sometimes causes confusion. The aim of this review was to evaluate the exact territory of LDK, and to introduce another appropriate term for degenerative sagittal deformity. Unlike what its name suggests, LDK does not only include sagittal balance disorder of the lumbar spine and kyphosis, but also sagittal balance disorder of the whole spine and little lordosis of the lumbar spine. Moreover, this disease is closely related to the occupation of female farmers and an outdated Asian life style. These reasons necessitate a change in the nomenclature of this disorder to prevent misunderstanding. We suggest the name “primary degenerative sagittal imbalance” (PDSI), which encompasses degenerative sagittal misalignments of unknown origin in the whole spine in older-age patients, and is associated with back muscle wasting. LDK may be regarded as a subgroup of PDSI related to an occupation in agriculture. Conservative treatments such as exercise and physiotherapy are recommended as first-line treatments for patients with PDSI, and surgical treatment is considered only if conservative treatments failed. The measurement of spinopelvic parameters for sagittal balance is important prior to deformity corrective surgery. LDK can be considered a subtype of PDSI that is more likely to occur in female farmers, and hence the use of LDK as a global term for all degenerative sagittal imbalance disorders is better avoided. To avoid confusion, we recommend PDSI as a newer, more accurate diagnostic term instead of LDK.
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Affiliation(s)
- Chang-Hyun Lee
- Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Jee-Soo Jang
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, Korea
| | - Sung-Min Kim
- Department of Neurosurgery, Spine Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Dong-Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Kil Lee
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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68
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Curry WH, Pintar FA, Doan NB, Nguyen HS, Eckardt G, Baisden JL, Maiman DJ, Paskoff GR, Shender BS, Stemper BD. Lumbar spine endplate fractures: Biomechanical evaluation and clinical considerations through experimental induction of injury. J Orthop Res 2016; 34:1084-91. [PMID: 26610067 DOI: 10.1002/jor.23112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/25/2015] [Indexed: 02/04/2023]
Abstract
Lumbar endplate fractures were investigated in different experimental scenarios, however the biomechanical effect of segmental alignment was not outlined. The objectives of this study were to quantify effects of spinal orientation on lumbar spine injuries during single-cycle compressive loads and understand lumbar spine endplate injury tolerance. Twenty lumbar motion segments were compressed to failure. Two methods were used in the preparation of the lumbar motion segments. Group 1 (n = 7) preparation maintained pre-test sagittal lordosis, whereas Group 2 (n = 13) specimens had a free-rotational end condition for the cranial vertebra, allowing sagittal rotation of the cranial vertebra to create parallel endplates. Five Group 1 specimens experienced posterior vertebral body fracture prior to endplate fracture, whereas two sustained endplate fracture only. Group 2 specimens sustained isolated endplate fractures. Group 2 fractures occurred at approximately 41% of the axial force required for Group 1 fracture (p < 0.05). Imaging and specimen dissection indicate endplate injury consistently took place within the confines of the endplate boundaries, away from the vertebral periphery. These findings indicate that spinal alignment during compressive loading influences the resulting injury pattern. This investigation identified the specific mechanical conditions under which an endplate breach will take place. Development of endplate injuries has significant clinical implication as previous research identified internal disc disruption (IDD) and degenerative disc disease (DDD) as long-term consequences of the axial load-shift that occurs following a breach of the endplate. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1084-1091, 2016.
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Affiliation(s)
- William H Curry
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Frank A Pintar
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Ninh B Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gerald Eckardt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jamie L Baisden
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dennis J Maiman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Glenn R Paskoff
- Naval Air Warfare Center, Aircraft Division, Patuxent River, Maryland
| | - Barry S Shender
- Naval Air Warfare Center, Aircraft Division, Patuxent River, Maryland
| | - Brian D Stemper
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
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69
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Claus AP, Hides JA, Moseley GL, Hodges PW. Thoracic and lumbar posture behaviour in sitting tasks and standing: Progressing the biomechanics from observations to measurements. APPLIED ERGONOMICS 2016; 53 Pt A:161-168. [PMID: 26476893 DOI: 10.1016/j.apergo.2015.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 09/10/2015] [Accepted: 09/17/2015] [Indexed: 06/05/2023]
Abstract
Few studies quantify spinal posture behaviour at both the thoracolumbar and lumbar spinal regions. This study compared spontaneous spinal posture in 50 asymptomatic participants (21 males) during three conditions: 10-min computer task in sitting (participants naïve to the measure), during their perceived 'correct' sitting posture, and standing. Three-dimensional optical tracking quantified surface spinal angles at the thoracolumbar and lumbar regions, and spinal orientation with respect to the vertical. Despite popular belief that lordotic lumbar angles are 'correct' for sitting, this was rarely adopted for 10-min sitting. In 10-min sitting, spinal angles flexed 24(7-9)deg at lumbar and 12(6-8)deg at thoracolumbar regions relative to standing (P < 0.001). When participants 'corrected' their sitting posture, their thoracolumbar angle -2(7)deg was similar to the angle in standing -1(6)deg (P = 1.00). Males were flexed at the lumbar angle relative to females for 10-min sitting, 'correct' sitting and standing, but showed no difference at the thoracolumbar region.
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Affiliation(s)
- Andrew P Claus
- The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, 4072, Australia.
| | - Julie A Hides
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia.
| | - G Lorimer Moseley
- Sansom Institute for Health Research, University of South Australia, North Terrace, Adelaide, 5000, Australia; Neuroscience Research Australia, Sydney, NSW, Australia.
| | - Paul W Hodges
- The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, 4072, Australia.
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70
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Bailey JF, Sparrey CJ, Been E, Kramer PA. Morphological and postural sexual dimorphism of the lumbar spine facilitates greater lordosis in females. J Anat 2016; 229:82-91. [PMID: 26916466 DOI: 10.1111/joa.12451] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Jeannie F Bailey
- Anthropology and Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA.,Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Carolyn J Sparrey
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
| | - Ella Been
- Anatomy & Anthropology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Physical Therapy, Faculty of Health Professions, Ono Academic College, Kiryat Ono, Israel
| | - Patricia A Kramer
- Anthropology and Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA
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71
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Ames CP, Smith JS, Eastlack R, Blaskiewicz DJ, Shaffrey CI, Schwab F, Bess S, Kim HJ, Mundis GM, Klineberg E, Gupta M, O’Brien M, Hostin R, Scheer JK, Protopsaltis TS, Fu KMG, Hart R, Albert TJ, Riew KD, Fehlings MG, Deviren V, Lafage V, _ _. Reliability assessment of a novel cervical spine deformity classification system. J Neurosurg Spine 2015; 23:673-83. [DOI: 10.3171/2014.12.spine14780] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Despite the complexity of cervical spine deformity (CSD) and its significant impact on patient quality of life, there exists no comprehensive classification system. The objective of this study was to develop a novel classification system based on a modified Delphi approach and to characterize the intra- and interobserver reliability of this classification.
METHODS
Based on an extensive literature review and a modified Delphi approach with an expert panel, a CSD classification system was generated. The classification system included a deformity descriptor and 5 modifiers that incorporated sagittal, regional, and global spinopelvic alignment and neurological status. The descriptors included: “C,” “CT,” and “T” for primary cervical kyphotic deformities with an apex in the cervical spine, cervicothoracic junction, or thoracic spine, respectively; “S” for primary coronal deformity with a coronal Cobb angle ≥ 15°; and “CVJ” for primary craniovertebral junction deformity. The modifiers included C2–7 sagittal vertical axis (SVA), horizontal gaze (chin-brow to vertical angle [CBVA]), T1 slope (TS) minus C2–7 lordosis (TS–CL), myelopathy (modified Japanese Orthopaedic Association [mJOA] scale score), and the Scoliosis Research Society (SRS)-Schwab classification for thoracolumbar deformity. Application of the classification system requires the following: 1) full-length standing posteroanterior (PA) and lateral spine radiographs that include the cervical spine and femoral heads; 2) standing PA and lateral cervical spine radiographs; 3) completed and scored mJOA questionnaire; and 4) a clinical photograph or radiograph that includes the skull for measurement of the CBVA. A series of 10 CSD cases, broadly representative of the classification system, were selected and sufficient radiographic and clinical history to enable classification were assembled. A panel of spinal deformity surgeons was queried to classify each case twice, with a minimum of 1 intervening week. Inter- and intrarater reliability measures were based on calculations of Fleiss k coefficient values.
RESULTS
Twenty spinal deformity surgeons participated in this study. Interrater reliability (Fleiss k coefficients) for the deformity descriptor rounds 1 and 2 were 0.489 and 0.280, respectively, and mean intrarater reliability was 0.584. For the modifiers, including the SRS-Schwab components, the interrater (round 1/round 2) and intrarater reliabilities (Fleiss k coefficients) were: C2–7 SVA (0.338/0.412, 0.584), horizontal gaze (0.779/0.430, 0.768), TS-CL (0.721/0.567, 0.720), myelopathy (0.602/0.477, 0.746), SRS-Schwab curve type (0.590/0.433, 0.564), pelvic incidence-lumbar lordosis (0.554/0.386, 0.826), pelvic tilt (0.714/0.627, 0.633), and C7-S1 SVA (0.071/0.064, 0.233), respectively. The parameter with the poorest reliability was the C7–S1 SVA, which may have resulted from differences in interpretation of positive and negative measurements.
CONCLUSIONS
The proposed classification provides a mechanism to assess CSD within the framework of global spinopelvic malalignment and clinically relevant parameters. The intra- and interobserver reliabilities suggest moderate agreement and serve as the basis for subsequent improvement and study of the proposed classification.
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Affiliation(s)
- Christopher P. Ames
- 1Department of Neurosurgery, University of California, San Francisco, California
| | - Justin S. Smith
- 2Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Robert Eastlack
- 3San Diego Center for Spinal Disorders, San Diego, California
| | | | - Christopher I. Shaffrey
- 2Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Frank Schwab
- 4Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Shay Bess
- 5Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado
| | - Han Jo Kim
- 6Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Eric Klineberg
- 7Department of Orthopedic Surgery, University of California, Davis, Sacramento, California
| | - Munish Gupta
- 7Department of Orthopedic Surgery, University of California, Davis, Sacramento, California
| | - Michael O’Brien
- 8Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Richard Hostin
- 8Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Justin K. Scheer
- 9Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kai-Ming G. Fu
- 10Department of Neurosurgery, Weill Cornell Medical College, New York, New York
| | - Robert Hart
- 11Department of Orthopedic Surgery, Oregon Health Sciences University, Portland, Oregon
| | - Todd J. Albert
- 12Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - K. Daniel Riew
- 13Department of Orthopedic Surgery, Washington University, St Louis, Missouri
| | | | - Vedat Deviren
- 15Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Virginie Lafage
- 4Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York
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