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Bračun Š, Romolo A, Rehakova V, Leban J, Pukšič Ž, Vengust R, Daniel M, Kralj-Iglič V, Drab M. Correlation between sagittal balance and thoracolumbar elastic energy parameters in 42 spines subject to spondylolisthesis or spinal stenosis and 21 normal spines. Heliyon 2024; 10:e38469. [PMID: 39430542 PMCID: PMC11489354 DOI: 10.1016/j.heliyon.2024.e38469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 09/19/2024] [Accepted: 09/24/2024] [Indexed: 10/22/2024] Open
Abstract
The curvature of the lumbar spine plays a critical role in maintaining spinal function, stability, weight distribution, and load transfer. We have developed a mathematical model of the lumbar spine curve by introducing a novel mechanism: minimization of the elastic bending energy of the spine with respect to two biomechanical parameters: dimensionless lumbosacral spinal curvature c LS and dimensionless curvature increment along the spine CI. While most of the biomechanical studies focus on a particular segment of the spine, the distinction of the presented model is that it describes the shape of the thoracolumbar spine by considering it as a whole (non-locally) and thus includes interactions between the different spinal levels in a holistic approach. From radiographs, we have assessed standard geometrical parameters: lumbar lordosis LL, pelvic incidence PI, pelvic tilt PT, sacral slope ψ0 and sagittal balance parameter SB = sagittal vertical axis (SVA)/sacrum-bicoxofemoral distance (SFD) of 42 patients with lumbar spinal stenosis (SS) or degenerative spondylolisthesis (SL) and 21 radiologically normal subjects. SB statistically significantly correlated with model parameters c L5 (r = -0.34, p = 0.009) and -CI (r = 0.33, p = 0.012) but not with standard geometrical parameters. A statistically significant difference with sufficient statistical power between the patients and the normal groups was obtained for c LS, CI, and SB but not for standard geometrical parameters. The model provides a possibility to predict changes in the thoracolumbar spine shape in surgery planning and in assessment of different spine pathologies.
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Affiliation(s)
- Špela Bračun
- Surgical Centre Rožna Dolina, Rožna dolina cesta IV/45, SI-1000, Ljubljana, Slovenia
- Institution for Higher Education for Physiotherapy Fizioterapevtika, Slovenska cesta 58, SI-1000, Ljubljana, Slovenia
| | - Anna Romolo
- University of Ljubljana, Faculty of Health Sciences, Laboratory of Clinical Biophysics, Zdravstvena 5, SI-1000, Ljubljana, Slovenia
| | - Veronika Rehakova
- Department of Mechanics, Biomechanics and Mechatronics, Faculty of Mechanical Engineering, Czech Technical University in Prague, Technicka 4, CZ166-07 Prague 6, Czech Republic
| | - Jure Leban
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, SI-1000, Ljubljana, Slovenia
| | - Žan Pukšič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, SI-1000, Ljubljana, Slovenia
| | - Rok Vengust
- Surgical Centre Rožna Dolina, Rožna dolina cesta IV/45, SI-1000, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Vrazov trg 2, SI-1000, Ljubljana, Slovenia
| | - Matej Daniel
- Department of Mechanics, Biomechanics and Mechatronics, Faculty of Mechanical Engineering, Czech Technical University in Prague, Technicka 4, CZ166-07 Prague 6, Czech Republic
| | - Veronika Kralj-Iglič
- University of Ljubljana, Faculty of Health Sciences, Laboratory of Clinical Biophysics, Zdravstvena 5, SI-1000, Ljubljana, Slovenia
| | - Mitja Drab
- University of Ljubljana, Faculty of Electrical Engineering, Laboratory of Physics, Tržaška 25, SI-1000, Ljubljana, Slovenia
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Haas JW, Fedorchuk C, Lightstone DF, Oakley PA, Harrison DE. Improvement in Spine Pain, Functional Performance, and Quality of Life in a 26-Year-Old Male With a Failed Spine Fusion Surgery After Chiropractic BioPhysics® Structural Spinal Rehabilitation: A Case Report With a Six-Month Follow-Up. Cureus 2024; 16:e71544. [PMID: 39417063 PMCID: PMC11483166 DOI: 10.7759/cureus.71544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2024] [Indexed: 10/19/2024] Open
Abstract
Neck pain (NP) is a leading cause of disability and can be a consequence of failed cervical spine surgeries. Articles showing successful conservative therapies after a failed surgery in the cervical spine are very rare. A 26-year-old male reported six years of worsening and disabling NP. The short-form 36-question health status questionnaire revealed a decrease in quality-of-life scores, with a physical component score (PCS) of 25.2 and a mental component score (MCS) of 29.9, compared to the normal scores of 46.8 and 52.8, respectively. Grip strength measured 36.7 kg on the left and 37.1 kg on the right (normal range: 45-52 kg). Radiography revealed cervical hypolordosis (absolute rotation angle, ARA, C2-C7) and anterior head translation (Tz C2-C7) measuring -14.6° and 20.6 mm (ideal is -42° and 0 mm). Chiropractic BioPhysics® (CBP®) (CBP Non-Profit, Inc., Eagle, ID) spinal rehabilitation sessions were administered involving Mirror Image® (CBP Non-Profit, Inc.) spinal exercises, traction, and adjustments to correct cervical spinal alignment. Following 30 treatments over nine weeks, the patient reported near-resolution of initial symptoms, discontinued pain medications, and improved quality of life. Posttreatment outcomes included the following: improvement in PCS (45.6) and MCS (37.1), normalized grip strength on the left (45.3 kg) and right (49.4 kg), and improvement in ARA C2-C7 (30.1°) and Tz C2-C7 (15.6 mm). After six months without treatment, a follow-up examination showed sustained improvements in symptoms and outcome measures, including ARA C2-C7 (30.9°) and Tz C2-C7 (10.6 mm). Failed cervical spine surgeries and persistent spine pain syndrome can occur with devastating consequences. CBP® may be an effective, conservative approach to help improve pain and disability in patients with poor surgical outcomes and abnormal spinal alignment.
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Affiliation(s)
- Jason W Haas
- Research, Chiropractic BioPhysics (CBP) Non-profit, Inc., Windsor, USA
| | - Curtis Fedorchuk
- Chiropractic Biophysics, Institute for Spinal Health and Performance, Cumming, USA
| | | | - Paul A Oakley
- Kinesiology and Health Science, York University, Toronto, CAN
- Chiropractic, Innovative Spine and Wellness, Newmarket, CAN
| | - Deed E Harrison
- Research, Chiropractic BioPhysics (CBP) Non-profit, Inc., Eagle, USA
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Harrison DE, Haas JW, Moustafa IM, Betz JW, Oakley PA. Can the Mismatch of Measured Pelvic Morphology vs. Lumbar Lordosis Predict Chronic Low Back Pain Patients? J Clin Med 2024; 13:2178. [PMID: 38673450 PMCID: PMC11050312 DOI: 10.3390/jcm13082178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Measures of lumbar lordosis (LL) and elliptical modeling variables have been shown to discriminate between normal and chronic low back pain (CLBP) patients. Pelvic morphology influences an individual's sagittal lumbar alignment. Our purpose is to investigate the sensitivity and specificity of lumbar sagittal radiographic alignment and modeling variables to identify if these can discriminate between normal controls and CLBP patients. Methods: We conducted a computer analysis of digitized vertebral body corners on lateral lumbar radiographs of normal controls and CLBP patients. Fifty normal controls were attained from a required pre-employment physical examination (29 men; 21 women; mean age of 27.7 ± 8.5 years), with no history of low back pain, a normal spinal examination, no pathologies, anomalies, or instability. Additionally, 50 CLBP patients (29 men; 29.5 ± 8 years of age) were randomly chosen and matched to the characteristics of the controls. The inclusion criteria required no abnormalities on lumbar spine radiographs. The parameters included the following: ARA L1-L5 lordosis, ARA T12-S1 lordosis, Cobb T12-S1, b/a elliptical modelling ratio, sacral base angle (SBA), and S1 posterior tangent to vertical (PTS1). Two measures of pelvic morphology were determined for each person-the angle of pelvic incidence (API) and posterior tangent pelvic incidence angle (PTPIA)-and the relationships between API - ARA T12-S1, API - Cobb T12-S1, and API - ARA L1-5 was determined. Descriptive statistics and correlations among the primary variables were determined. The receiver operating characteristic curves (ROC curves) for primary variables were analyzed. Results: The mean values of LL were statistically different between the normal and CLBP groups (p < 0.001), indicating a hypo-lordotic lumbar spine for the CLBP group. The mean b/a ratio was lower in the chronic pain group (p = 0.0066). The pelvic morphology variables were similar between the groups (p > 0.05). API had a stronger correlation to the SBA and Cobb T12-S1 than PTPIA did, while PTPIA had a stronger correlation to the S1 tangent and ARA T12-S1 than API did. While CLBP patients had a stronger correlation of ARA T12-S1 and Cobb T12-S1 relative to the pelvic morphology, they also had a reduced correlation of ARA L1-L5 lordosis relative to their SBA and pelvic morphology measures. API - T12-S1, API - L1-L5, and API - Cobb T12-S1 were statistically different between the groups, p < 0.001. Using ROC curve analyses, it was identified that ARA L1-L5 lordosis of 36° and ARA T12-S1 of 68° have a good sensitivity and specificity to discriminate between normal and CLBP patients. ROC curve analyses identified that lordosis ARAT12-S1 < 68° (AUC = 0.83), lordosis ARAL1-L5 < 36° (AUC = 0.78), API - ARA T12-S1 < -18° (AUC = 0.75), API - ARAL1-L5 > 35° (AUC = 0.71), and API - Cobb T12-S1 < -5° (AUC = 0.69) had moderate to good discrimination between groups (AUC = 0.83, 0.78, 0.75, and 0.72). Conclusions: Pelvic morphology is similar between normal and CLBP patients. CLBP patients have an abnormal 'fit' of their API - ARAT12-S1 and L1-L5 lumbar lordosis relative to their pelvic morphology and sacral tilt shown as a hypolordosis.
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Affiliation(s)
| | - Jason W. Haas
- Chiropractic Biophysics NonProfit, Inc., Eagle, ID 83616, USA
| | - Ibrahim M. Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS–Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | | | - Paul A. Oakley
- Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada;
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Fedorchuk CA, Fedorchuk CG, Lightstone DF. Improvement in Pain, Quality of Life, and Urinary Dysfunction following Correction of Lumbar Lordosis and Reduction in Lumbar Spondylolistheses Using Chiropractic BioPhysics ® Structural Spinal Rehabilitation: A Case Series with >1-Year Long-Term Follow-Up Exams. J Clin Med 2024; 13:2024. [PMID: 38610790 PMCID: PMC11012333 DOI: 10.3390/jcm13072024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Lumbar spondylolisthesis affects ~20% of the US population and causes spine-related pain and disability. (2) Methods: This series reports on three patients (two females and one male) aged 68-71 years showing improvements in back pain, quality of life (QOL), and urinary dysfunction following correction of lumbar spondylolistheses using CBP® spinal rehabilitation. Pre-treatment radiographs showed lumbar hyperlordosis (-49.6°, ideal is -40°) and anterolisthesis (14.5 mm, ideal is 0 mm). Pre-treatment patient-reported outcome measures (PROMs) included a numeric rating scale (NRS) for back pain (7.3/10, ideal is 0), urinary urgency (8/10, ideal is 0), and SF-36 physical (PCS) and mental component score (MCS) (29.8 and 46.6, ideal is 46.8 and 52.8). Patients underwent 2-3 CBP® sessions per week to correct lumbar hyperlordosis and lumbar anterolistheses. (3) Results: Post-treatment radiographs showed improvements in lumbar curvature (-42.8°) and anterolisthesis (4.2 mm). Post-treatment PROMs showed improvements in NRS for back pain (1/10), urinary urgency (2.3/10), and SF-36 PCS and MCS (50.2 and 57.7). Long-term follow-up radiographs and PROMs showed maintained improvements. (4) Conclusions: This series documents the first-recorded long-term corrections of lumbar spondylolisthesis and concomitant improvements in back pain, urinary urgency, and QOL using CBP®. This series provides evidence for CBP® as a non-surgical approach to lumbar spinal rehabilitation and the possible impacts of spinal alignment on pain, urinary dysfunction, and QOL.
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Affiliation(s)
| | | | - Douglas F. Lightstone
- Institute of Spinal Health and Performance, Cumming, GA 30041, USA; (C.A.F.); (C.G.F.)
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Fortner MO, Woodham TJ, Haas JW, Oakley PA, Harrison DE. Failed back surgery syndrome successfully ameliorated with Chiropractic Biophysics ® structural rehabilitation improving pain, disability as well as sagittal and coronal balance: a Chiropractic Biophysics ® case report with a 6 year follow-up. J Phys Ther Sci 2024; 36:44-50. [PMID: 38186967 PMCID: PMC10766406 DOI: 10.1589/jpts.36.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/17/2023] [Indexed: 01/09/2024] Open
Abstract
[Purpose] To present the case of the amelioration of chronic pain and disability in a patient suffering from failed back surgery syndrome. [Participant and Methods] A 27-year-old male with chronic low back pain was treated with a Coflex® intra-spinous instrument, however, it was removed shortly after due to poor outcome including worsening pain and disability. Radiographic assessment revealed significant posterior translation of the thorax complicated by significant loss of the normal lumbar lordosis and a left lateral translated thoracic cage posture. Chiropractic Biophysics® technique was applied over a 5.5-month period leading to structural spine improvements as well as improved pain, Oswestry disability index (ODI) and quality of life (QOL). [Results] There was a 21 mm reduction in posterior thoracic translation, a 6.2° improvement in lumbar lordosis and a 16 mm reduction in lateral thoracic translation corresponding with improved ODI and QOL scores. A 6 year follow-up showed successful outcome despite some degenerative changes in the spine at the prior surgical level. [Conclusion] This case adds to the growing literature showing the efficacy of non-surgical spinal rehabilitative methods in improving outcomes in patients with spinal deformity and associated disabilities. This case also demonstrates necessity of the continued criterion standard of spinal radiography for biomechanical assessment.
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Haas JW, Woodham T, Oakley PA, Fortner MO, Harrison D. The Subjective and Objective Improvement Using Chiropractic Biophysics® Protocols. Cureus 2023; 15:e50533. [PMID: 38107215 PMCID: PMC10723807 DOI: 10.7759/cureus.50533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 12/19/2023] Open
Abstract
The aim of this study is to describe the Chiropractic BioPhysics® (CBP®) (Chiropractic BioPhysics, Eagle, USA) technique in alleviating the persistent spine pain syndrome (PSPS) and dysfunction in a 50-year-old female who suffered for many years. The purpose of this study is to provide clinicians with a potential treatment option for failed back surgery syndrome (FBSS) and PSPS that doesn't respond to other treatments. The patient did not receive benefits from pharmaceutical and conservative therapies following a low back lifting injury in 2004. After several years of suffering from widespread spinal pain and dysfunction, she received a lumbosacral pedicle screw surgical fixation. The initial surgery was unsuccessful and a follow-up revision and expansion of the fusion failed to alleviate the pain and dysfunction as well. After treatment using CBP, the patient received subjective, objective, and radiographic improvements with long-term stability measured at follow-up. Given that spine pain and low back pain are the number one cause of disability in the world, having economical, repeatable, and measurable techniques to improve even difficult cases is important for astute clinicians treating spine pain.
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Affiliation(s)
- Jason W Haas
- Research, Chiropractic BioPhysics (CBP) Non-Profit, Windsor, USA
| | - Thomas Woodham
- Chiropractic, Chiropractic BioPhysics, Gillette, USA
- Chiropractic, Western Plains Chiropractic, Gillette, USA
| | - Paul A Oakley
- Kinesiology and Health Science, York University, Toronto, CAN
- Chiropractic, Private Practice, Newmarket, CAN
| | | | - Deed Harrison
- Chiropractic, Chiropractic BioPhysics (CBP) Non-Profit, Windsor, USA
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7
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Tekeli M, Erdem H, Kilic N, Boyan N, Oguz O, Soames RW. Evaluation of lumbar lordosis in symptomatic individuals and comparative analysis of six different techniques: a retrospective radiologic study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4118-4127. [PMID: 37658171 DOI: 10.1007/s00586-023-07886-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/21/2023] [Accepted: 08/06/2023] [Indexed: 09/03/2023]
Abstract
PURPOSE The aim of this study; evaluate lumbar lordosis (LL) in symptomatic individuals with six different techniques and to examine the techniques comparatively. Thus, to provide an overview of lumbal lordosis and techniques. METHODS Cobb L1-L5, Cobb L1-S1, Posterior Tangent, tangential radiologic assessment of lumbar lordosis (TRALL), vertebral centroid measurement of lumbar lordosis (CLL) and Risser Ferguson measurement techniques were used to assess LL from radiographs of 175 symptomatic adults. Correlations between techniques and relationship between the measurements obtained, gender and age were analyzed. Also ınterclass correlation (ICC) analyzed. Bland-Altman plots were performed to compare the techniques with Cobb. RESULTS ICC for all methods were greater than 0.96. For each method, no difference in LL was observed with respect to gender or age (p > 0.05). High positive correlation was observed between the Risser Ferguson, Posterior Tangent, Cobb L1-L5, Cobb L1-S1 and CLL techniques (p < 0.001), and moderate positive correlation between TRALL and all other techniques (p < 0.001). CONCLUSION In this study, it was found that the mean lumbar lordosis values of symptomatic participants were lower than most of the other asymptomatic studies in the literature and there was no significant difference in lumbar lordosis values in terms of gender and age in symptomatic individuals. Based on statistical findings, Risser Ferguson can be used to assess LL. These results and the data obtained as a result of the comparative examination of techniques according to age groups and gender will benefit clinicians and those working in the field by providing a better understanding LL.
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Affiliation(s)
- Mustafa Tekeli
- Department of Anatomy, Faculty of Medicine, Nigde Omer Halisdemir University, Nigde, Turkey
| | - Huseyin Erdem
- Department of Anatomy, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Nazire Kilic
- Department of Anatomy, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Neslihan Boyan
- Department of Anatomy, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ozkan Oguz
- Department of Anatomy, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | - Roger W Soames
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, UK
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Ochtman AEA, Bisschop A, Bleys RLAW, Öner FC, van Gaalen SM. Surgical techniques in restoration lumbar lordosis: a biomechanical human cadaveric study. Spine Deform 2023; 11:35-40. [PMID: 35951242 PMCID: PMC9768003 DOI: 10.1007/s43390-022-00549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/25/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Degenerative changes of the lumbar spine lead in general to decrease of lumbar lordosis (LL). This change affects the overall balance of the spine, and when surgery is deemed, necessary restoration of the LL is considered. How this restoration can be achieved is a matter of controversy. The main purpose of this cadaveric study was to investigate the different steps of common posterior surgical techniques to understand the contribution of each successive step in restoring LL. METHODS Ten fresh-frozen human lumbar spine specimens were used to perform a sequential correction and instrumentation with a pedicle screw construct. RESULTS The mean LL angle measured at L3-L4 in intact condition was 12.9°; after screw insertion and compression, this increased to 13.8° (+ 7%, p = 0.04), after bilateral facetectomy to 16.3° (+ 20%, p = 0.005), after discectomy and insertion of interbody cage to 18.0º (+ 9%, p = 0.012), after resection of the lamina and the processes spinosus to 19.8° (+ 10%, p = 0.017), and after resection of the anterior longitudinal ligament to 25.4° (+ 22%, p = 0.005). CONCLUSIONS Each step contributed statistically significant to restoration of segmental lordosis with bilateral facetectomy contributing the most in terms of percentage. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A. E. A. Ochtman
- grid.7692.a0000000090126352Department of Orthopedics, University Medical Center Utrecht, PO box 85500, 3508 GA Utrecht, The Netherlands
| | - A. Bisschop
- grid.16872.3a0000 0004 0435 165XDepartment of Orthopedics, VU University Medical Center, Amsterdam, The Netherlands
| | - R. L. A. W. Bleys
- grid.7692.a0000000090126352Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F. C. Öner
- grid.7692.a0000000090126352Department of Orthopedics, University Medical Center Utrecht, PO box 85500, 3508 GA Utrecht, The Netherlands
| | - S. M. van Gaalen
- Acibadem International Medical Center, Arlandaweg 100, 1043 HP Amsterdam, The Netherlands
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McDonnell JM, Evans SR, Ahern DP, Cunniffe G, Kepler C, Vaccaro A, Kaye ID, Morrissey PB, Wagner SC, Sebastian A, Butler JS. Risk factors for distal junctional failure in long-construct instrumentation for adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3654-3661. [PMID: 36178547 DOI: 10.1007/s00586-022-07396-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/02/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study is to identify risk factors associated with postoperative DJF in long constructs for ASD. METHODS A retrospective review was performed at a tertiary referral spine centre from 01/01/2007 to 31/12/2016. Demographic, clinical and radiographic parameters were collated for patients with DJF in the postoperative period and compared to those without DJF. Survival analyses were performed using univariate logistic regression to identify variables with a p value < 0.05 for inclusion in multivariate analysis. Spearman's correlations were performed where applicable. RESULTS One hundred two patients were identified. 41 (40.2%) suffered DJF in the postoperative period, with rod fracture being the most common sign of DJF (13/65; 20.0%). Mean time to failure was 32.4 months. On univariate analysis, pedicle subtraction osteotomy (p = 0.03), transforaminal lumbar interbody fusion (p < 0.001), pre-op LL (p < 0.01), pre-op SVA (p < 0.01), pre-op SS (p = 0.02), postop LL (p = 0.03), postop SVA (p = 0.01), postop PI/LL (p < 0.001), LL correction (p < 0.001), SVA correction (p < 0.001), PT correction (p = 0.03), PI/LL correction (p < 0.001), SS correction (p = 0.03) all proved significant. On multivariate analysis, pedicle subtraction osteotomy (OR 27.3; p = 0.03), postop SVA (p < 0.01) and LL correction (p = 0.02) remained statistically significant as independent risk factors for DJF. CONCLUSION Recently, DJF has received recognition as its own entity due to a notable postoperative incidence. Few studies to date have evaluated risk factors for DJF. The results of our study highlight that pedicle subtraction osteotomy, poor correction of lumbar lordosis, and sagittal vertical axis are significantly associated with postoperative occurrence of DJF.
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Affiliation(s)
- Jake M McDonnell
- Royal College of Surgeons in Ireland, Dublin, Ireland. .,National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Shane R Evans
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Daniel P Ahern
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gráinne Cunniffe
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Christopher Kepler
- Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Alexander Vaccaro
- Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Ian D Kaye
- Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, USA
| | | | - Scott C Wagner
- Department of Orthopaedics, Walter Reed National Military Medical Center, Washington, DC, USA
| | | | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Zhang NZ, Xiong QS, Yao J, Liu BL, Zhang M, Cheng CK. Biomechanical changes at the adjacent segments induced by a lordotic porous interbody fusion cage. Comput Biol Med 2022; 143:105320. [PMID: 35183971 DOI: 10.1016/j.compbiomed.2022.105320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 12/12/2022]
Abstract
Biomechanical changes at the adjacent segments after interbody fusion are common instigators of adjacent segment degeneration (ASD). This study aims to investigate how the presence of a lordotic porous cage affects the biomechanical performance of the adjacent segments. A finite element model (FEM) of a lumbar spine implanted with a lordotic cage at L3-L4 was validated by in-vitro testing. The stress distribution on the cage and range of motion (ROM) of L3-L4 were used to assess the stability of the implant. Three angles of cage (0° = non-restoration, 7° = normal restoration and 11° = over-restoration) were modelled with different porosities (0%, 30% and 60%) and evaluated in the motions of flexion, extension, lateral bending and rotation. The ROM, intervertebral disc pressure (IDP) and facet joint force (FJF) were used to evaluate biomechanical changes at the adjacent segments in each model. The results indicated that porous cages produced more uniform stress distribution, but cage porosity did not influence the ROM, IDP and FJF at L2-L3 and L4-L5. Increasing the cage lordotic angle acted to decrease the ROM and IDP, and increase the FJF of L4-L5, but did not alter the ROM of L2-L3. In conclusion, changes in ROM, IDP and FJF at the adjacent segments were mainly influenced by the lordotic angle of the cage and not by the porosity. A larger angle of lordotic cage was shown to reduce the ROM and IDP, and increase the FJF of the lower segment (L4-L5), but had little effect on the ROM of the upper segment (L2-L3).
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Affiliation(s)
- Ning-Ze Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Qi-Sheng Xiong
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Jie Yao
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Bo-Lun Liu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Min Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.
| | - Cheng-Kung Cheng
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China; School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.
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11
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Han L, Li Y, Li Z, Ma H, Wang C, Chen Q, Lu X. Biomechanical and Clinical Study of Rod Curvature in Single-Segment Posterior Lumbar Interbody Fusion. Front Bioeng Biotechnol 2022; 10:824688. [PMID: 35309996 PMCID: PMC8929399 DOI: 10.3389/fbioe.2022.824688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Pedicle screw fixation is a common technique used in posterior lumbar interbody fusion (PLIF) surgery for lumbar disorders. During operation, rod contouring is often subjective and not satisfactory, but only few studies focused on the rod-contouring issue previously. The aim of the study was to explore the effect of the rod contouring on the single-segment PLIF by the finite element (FE) method and retrospective study. Methods: A FE model of the lumbosacral vertebrae was first reconstructed, and subsequently single-segmental (L4/5) PLIF surgeries with four rod curvatures (RCs) were simulated. Herein, three RCs were designed by referring to centroid, Cobb, and posterior tangent methods applied in the lumbar lordosis measurement, and zero RC indicating straight rods was included as well. Clinical data of patients subjected to L4/5 segmental PLIF were also analyzed to verify the correlation between RCs and clinical outcome. Results: No difference was observed among the four RC models in the range of motion (ROM), intersegmental rotation angle (IRA), and intradiscal pressure (IDP) under four actions. The posterior tangent model had less maximum stress in fixation (MSF) in flexion, extension, and axial rotation than the other RC models. Patients with favorable prognosis had larger RC and positive RC minus posterior tangent angle (RC-PTA) of fused segments with respect to those who had poor prognosis and received revision surgery. Conclusion: All RC models had similar biomechanical behaviors under four actions. The posterior tangent-based RC model was superior in fixation stress distribution compared to centroid, Cobb, and straight models. The retrospective study demonstrated that moderate RC and positive RC-PTA were associated with better postoperative results.
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Affiliation(s)
- Lin Han
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yongheng Li
- Biomechanics Laboratory, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Zhiyong Li
- Biomechanics Laboratory, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- School of Mechanical Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Hongdao Ma
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chenfeng Wang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qiang Chen
- Biomechanics Laboratory, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- *Correspondence: Qiang Chen, ; Xuhua Lu,
| | - Xuhua Lu
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- *Correspondence: Qiang Chen, ; Xuhua Lu,
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12
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Kallan SZ, Oakley PA, Harrison DE. Reduction of lumbar hyperlordosis in a pediatric: a Chiropractic Biophysics<sup>®</sup> case report. J Phys Ther Sci 2022; 34:646-650. [PMID: 36118660 PMCID: PMC9444519 DOI: 10.1589/jpts.34.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/18/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To demonstrate the reduction of lumbar hyperlordosis, sacral base angle and
anterior thoracic translation posture in an 11-year-old female. [Participant and Methods]
A pediatric patient presented with lumbar hyperlordosis and underwent Chiropractic
BioPhysics® treatment protocols to reduce her spinal deformity and correlated
symptoms. Symptoms included thoracolumbar, hip, knee and ankle pains and lower extremity
weakness. Radiographs confirmed lumbar hyperlordosis, increased sacral base angle and a
forward translated thoracic posture. Spinal traction as well as corrective exercises and
spinal manipulative therapy was performed over an 11-month period. [Results] After 57
treatments, there was a 13.4° reduction in L1-L5 lordosis, an 11.8° reduction in sacral
base angle and a 13.8 mm reduction in anterior thoracic translation. The improved
structural changes correlated with improved symptoms. [Conclusion] Lumbar hyperlordosis
can be reduced in pediatric patients presenting with hyperlordosis and associated
symptomatology. Routine radiography may be warranted in the diagnosis of lumbar spine
deformities in pediatrics. Further research into the non-surgical reduction of lumbar
spine hyperlordosis is needed.
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13
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Faundez AA, Tsoupras A, Le Huec JC. Rationale and techniques for Posterior Opening Wedge Osteotomy (POWO) in proximal junctional failure due to iatrogenic lumbar hyperlordosis. Orthop Traumatol Surg Res 2021; 107:102657. [PMID: 32778438 DOI: 10.1016/j.otsr.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 02/03/2023]
Abstract
Proximal junctional kyphosis (PJK) is a compensatory phenomenon in reaction to pathologic lumbar hyperlordosis. Inappropriate spinal curve harmony incurs risk of PJK. Postoperative failure of posterior instrumentation, with kyphosis resistant to revision surgery at the proximal junction, may be caused by excessive iatrogenic lumbar lordosis. The surgical attitude should be to decrease lumbar lordosis by posterior opening wedge osteotomy (POWO). We describe the rationale for POWO and surgical techniques at L3. The technique is illustrated by a case report at 24 months' follow-up. Based on rational analysis of the distribution of lordosis along the lumbar spine and of adaptation of the sitting position, POWO may be indicated to avoid PJK after revision surgery in adult spinal Deformation revision surgery.
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Affiliation(s)
- Antonio A Faundez
- Orthopaedic Surgery Division, Department of Surgery, Geneva University Hospitals, Hôpital La Tour Meyrin, 4, rue Perret-Gentil, 1211 Geneva, Switzerland.
| | - Andreas Tsoupras
- Orthopaedic Surgery Division, Department of Surgery, Geneva University Hospitals, Hôpital La Tour Meyrin, 4, rue Perret-Gentil, 1211 Geneva, Switzerland
| | - Jean-Charles Le Huec
- Polyclinique Bordeaux Nord, Centre Vertebra, 15, rue Boucher, 33000 Bordeaux, France
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14
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Tanaka M, Sonawane S, Fujiwara Y, Uotani K, Yamauchi T, Omori T, Hashizume K. Surgical treatment for spondyloptosis: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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Oakley PA, Betz JW, Harrison DE, Siskin LA, Hirsh DW. Radiophobia Overreaction: College of Chiropractors of British Columbia Revoke Full X-Ray Rights Based on Flawed Study and Radiation Fear-Mongering. Dose Response 2021; 19:15593258211033142. [PMID: 34421439 PMCID: PMC8375354 DOI: 10.1177/15593258211033142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 01/11/2023] Open
Abstract
Fears over radiation have created irrational pressures to dissuade radiography use within chiropractic. Recently, the regulatory body for chiropractors practicing in British Columbia, Canada, the College of Chiropractors of British Columbia (CCBC), contracted Pierre Côté to review the clinical use of X-rays within the chiropractic profession. A "rapid review" was performed and published quickly and included only 9 papers, the most recent dating from 2005; they concluded, "Given the inherent risks of radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine." The CCBC then launched an immediate review of the use of X-rays by chiropractors in their jurisdiction. Member and public opinion were gathered but not presented to their members. On February 4, 2021, the College announced amendments to their Professional Conduct Handbook that revoked X-ray rights for routine/repeat assessment and management of patients with spine disorders. Here, we highlight current and historical evidence that substantiates that X-rays are not a public health threat. We also point out critical and insurmountable flaws in the single paper used to support irrational and unscientific policy that discriminates against chiropractors who practice certain forms of evidence-based X-ray-guided methods.
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Affiliation(s)
| | | | | | | | | | - International Chiropractors Association Rapid Response Research Review Subcommittee
- Private Practice, Newmarket, ON, Canada
- Private Practice, Boise, ID, USA
- CBP NonProfit, Inc, Eagle, ID, USA
- Private Practice, Green Brook, NJ, USA
- Private Practice, Laurel, MD, USA
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16
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Athertya JS, Saravana Kumar G. Classification of certain vertebral degenerations using MRI image features. Biomed Phys Eng Express 2021; 7. [PMID: 33984847 DOI: 10.1088/2057-1976/ac00d2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/12/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVE This article describes a fully automatic system for classifying various spinal degenerative phenotypes namely Modic changes, endplate defects and focal changes which are associated with lower back pain. These are obtained from T1/T2 Magnetic Resonance Imaging (MRI) scans. Lower back pain is a predominantly occurring ailment, which is prone to have various roots including the anatomical and pathophysciological aspects. Clinicians and radiologist use MRI to assess and evaluate the extent of damage, cause, and to decide on the future course of treatment. In large healthcare systems, to circumvent the manual reading of various image slices, we describe a system to automate the classification of various vertebral degeneracies that cause lower back pain. METHODS We implement a combination of feature extraction, image analysis based on geometry and classification using machine learning techniques for identifying vertebral degeneracies. Image features like local binary pattern, Hu's moments and gray level co-occurrence matrix (GLCM) based features are extracted to identify Modic changes, endplate defects, and presence of any focal changes. A combination of feature set is used for describing the extent of Modic change on the end plate. Feature sensitivity studies towards efficient classification is presented. A STIR based acute/chronic classification is also attempted in the current work. RESULTS The implemented method is tested and validated over a dataset containing 100 patients. The proposed framework for detecting the extent of Modic change achieves an accuracy of 85.91%. From the feature sensitivity analysis, it is revealed that entropy based measure obtained from gray level co-occurrence matrix alone is sufficient for detection of focal changes. The classification performance for detecting endplate defect is highly sensitive to the first 2 Hu's moments. CONCLUSION A novel approach to identify the allied vertebral degenerations and extent of Modic changes in vertebrae by exploiting image features and classification through machine learning is proposed. This shall assist radiologists in detecting abnormalities and in treatment planning.
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Affiliation(s)
- Jiyo S Athertya
- Department of Engineering Design, IIT - Madras, Chennai-600036, Tamil Nadu, India
| | - G Saravana Kumar
- Department of Engineering Design Indian Institute of Technology, Madras Chennai-600036, Tamil Nadu, India
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17
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Hasegawa T, Ushirozako H, Yamato Y, Yoshida G, Yasuda T, Banno T, Arima H, Oe S, Yamada T, Ide K, Watanabe Y, Matsuyama Y. Impact of Spinal Correction Surgeries with Osteotomy and Pelvic Fixation in Patients with Kyphosis Due to Osteoporotic Vertebral Fractures. Asian Spine J 2020; 15:523-532. [PMID: 32872756 PMCID: PMC8377210 DOI: 10.31616/asj.2020.0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/10/2020] [Indexed: 11/24/2022] Open
Abstract
Study Design Combination of retrospective and prospective study. Purpose We aimed to compare the clinical outcomes between local fixation surgery and spinopelvic fixation surgery for the treatment of kyphosis secondary to osteoporotic vertebral fractures with spinopelvic malalignment. Overview of Literature The clinical characteristics of patients with rigid kyphosis due to osteoporotic vertebral fracture differ from that of middle-aged patients with vertebral fractures in terms of bone fragility and presence of spinopelvic malalignment. Little is known about the surgical strategies for these deformities, most especially the extent of fusion of vertebra involved. Methods We analyzed 24 patients with vertebral osteotomy at the level of the fracture and spinal fixation without pelvic fixation (local group), and 22 patients with vertebral osteotomy and pelvic fixation (pelvic group). Radiographic parameters, the incidence of proximal junctional kyphosis (PJK), distal junctional kyphosis (DJK), rod fractures, and the Oswestry Disability Index (ODI) were compared between the two groups over a 2-year follow-up period. Results In the pelvic group, postoperative spinopelvic parameters significantly improved, with the improvements maintained. No remarkable changes in spinopelvic parameters were seen in the local group. The mean ODI scores 2 years after surgery were 45.3 and 33.0 in the local and pelvic group, respectively (p-value <0.05). There was no significant difference in the incidence of PJK in the local and pelvic groups, but there was a higher rate of DJK (41.7%) in the local group. In contrast, rod fractures were more common in the pelvic group (45.5%). Patients with DJK had higher ODI scores 2 years after surgery (52.0 in DJK patients vs. 34.8 in non-DJK patients; p-value <0.05). Conclusions For patients with rigid kyphosis due to osteoporotic vertebral fractures, better spinopelvic alignment and health-related quality of life can be achieved through extensive corrective surgery with pelvic fixation.
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Affiliation(s)
- Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- Division of Geriatric Musculoskeletal Health, Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsuya Yasuda
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Banno
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- Division of Geriatric Musculoskeletal Health, Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Yamada
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Koichiro Ide
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuh Watanabe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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18
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Oakley PA, Ehsani NN, Moustafa IM, Harrison DE. Restoring lumbar lordosis: a systematic review of controlled trials utilizing Chiropractic Bio Physics ® (CBP ®) non-surgical approach to increasing lumbar lordosis in the treatment of low back disorders. J Phys Ther Sci 2020; 32:601-610. [PMID: 32982058 PMCID: PMC7509154 DOI: 10.1589/jpts.32.601] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
[Purpose] To systematically review controlled trial evidence for the use of lumbar
extension traction by Chiropractic BioPhysics® methods for the purpose of
increasing lumbar lordosis in those with hypolordosis and low back disorders. [Methods]
Literature searches were performed in Pubmed, PEDro, CINAHL, Cochrane, and ICL databases.
Search terms included iterations related to the lumbar spine, low back pain and extension
traction rehabilitation. [Results] Four articles detailing 2 randomized and 1
non-randomized trial were located. Trials demonstrated increases in radiographic measured
lordosis of 7–11°, over 10–12 weeks, after 30–36 treatment sessions. Randomized trials
demonstrated traction treated groups mostly maintained lordosis correction, pain relief,
and disability after 6-months follow-up. The non-randomized trial showed lordosis and pain
intensity were maintained with periodic maintenance care for 1.5 years. Importantly,
control/comparison groups had no increase in lumbar lordosis. Randomized trials showed
comparison groups receiving physiotherapy-less the traction, had temporary pain reduction
during treatment that regressed towards baseline levels as early as 3-months after
treatment. [Conclusion] Limited but good quality evidence substantiates that the use of
extension traction methods in rehabilitation programs definitively increases lumbar
hypolordosis. Preliminarily, these studies indicate these methods provide longer-term
relief to patients with low back disorders versus conventional rehabilitation approaches
tested.
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Affiliation(s)
| | | | - Ibrahim M Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, UAE.,Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt
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PRATALI RAPHAELDEREZENDE, PASSOS LUIZEDUARDOMOREIRA, OLIVEIRA CARLOSEDUARDOALGAVESSOARESDE, HERRERO CARLOSFERNANDOPS. SPINOPELVIC VARIABILITY ACCORDING TO THE ROUSSOULY CLASSIFICATON CURVE TYPE. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201902224176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective To evaluate the variability of spinopelvic sagittal parameters and the distribution of lordosis in the lumbar spine in a sample of patients. Methods This is a cross-sectional study considering full-spine radiographs of a patient sample. The patients were classified according to the Roussouly classification and both radiographic spinopelvic alignment parameters and the lordosis measurement of each lumbar spinal segment were considered. The radiographic parameters were correlated with the Roussouly classification type. Results Ninety patients were included in the study. There was significant correlation between pelvic incidence (PI) and lumbar lordosis (LL) (R=0.89; p<0.0001). The values of PI were significantly higher in Roussouly types 3 and 4 than in types 1 and 2 (p<0.001), as were the values of LL L1-S1(p<0.001). Considering the total sample, 67% of LL L1-S1 was located between L4-S1, but with variations by the Roussouly classification curve types. Conclusion This study demonstrated a high correlation between the values of PI and LL, as well as the importance of the distal lumbar segment (L4-S1) in the overall value of LL L1-S1, which was even higher in patients with a lower PI value (Roussouly types 1 and 2). Level of evidence II; Retrospective analysis of a prospective database (Cohort); Diagnostic study.
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20
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Marouby S, Coulomb R, Maury E, Assi C, Mares O, Kouyoumdjian P. Prospective Evaluation of Spino-Pelvic Parameters with Clinical Correlation in Patients Operated with an Anterior Lumbar Interbody Fusion. Asian Spine J 2019; 14:88-96. [PMID: 31608612 PMCID: PMC7010506 DOI: 10.31616/asj.2019.0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/03/2019] [Indexed: 12/14/2022] Open
Abstract
Study Design Prospective study. Purpose The goal of this study was to evaluate the impact of anterior lumbar interbody fusion (ALIF) on L5–S1 level for restitution of distal segmental lordosis and to investigate its consequences on spino-pelvic parameters and the global sagittal balance. Overview of Literature Lumbar surgery must be adapted to the spinal morphology in order to restore an adequate relation between pelvic and spinal parameters and especially to the pelvic incidence. Methods An observational, prospective study was conducted between January 2013 and May 2017. Eighty-six patients were treated by L5–S1 ALIF procedure regardless of disc replacement above L5–S1 level. Thirty-seven patients were included and subset analyses were performed on 25 patients operated on an isolated ALIF L5–S1 (group 1), and 12 patients with hybrid surgery consisting of an L5– S1 ALIF procedure and a L4–L5 lumbar disc replacement (group 2). Clinical parameters were analyzed using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at M0 (preoperative) and M12 (12 months). Lumbo-pelvic parameters were assessed on a standingfull-spine X-ray, preoperatively and at M12 after surgery. Results We observed a significant evolution of L1–S1 lumbar lordosis (p <0.001) with a significant increase of the distal arch L4–S1 lordosis (p <0.001) and decrease of the proximal arch lordosis (p =0.03). Preoperatively, 27% of the patients were unbalanced. Significant variation in sagittal balance parameters was observed, with a decrease of the sagittal vertebral axis (p <0.001). VAS and ODI improved significantly but no correlation was found. An evolution in the same direction was found in the two subgroup analyses. Conclusions ALIF procedure on L5–S1 level allowed a reconstruction of lumbosacral segmental lordosis, modification of global lordosis, without variation of spino-pelvic parameters except an improvement in sagittal balance.
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Affiliation(s)
- Stanislas Marouby
- Department of Orthopedic Surgery, Caremeau University Hospital, Nimes, France
| | - Remy Coulomb
- Department of Orthopedic Surgery, Caremeau University Hospital, Nimes, France
| | - Etienne Maury
- Department of Orthopedic Surgery, Caremeau University Hospital, Nimes, France
| | - Chahine Assi
- Department of Orthopedic Surgery, Caremeau University Hospital, Nimes, France
| | - Olivier Mares
- Department of Orthopedic Surgery, Caremeau University Hospital, Nimes, France
| | - Pascal Kouyoumdjian
- Department of Orthopedic Surgery, Caremeau University Hospital, Nimes, France
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Oakley PA, Ehsani NN, Harrison DE. Non-surgical reduction of lumbar hyperlordosis, forward sagittal balance and sacral tilt to relieve low back pain by Chiropractic BioPhysics ® methods: a case report. J Phys Ther Sci 2019; 31:860-864. [PMID: 31645820 PMCID: PMC6801353 DOI: 10.1589/jpts.31.860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/27/2019] [Indexed: 12/19/2022] Open
Abstract
[Purpose] To present the reduction of both lumbar spine hyperlordosis and anterior sagittal balance in a symptomatic patient as treated by Chiropractic BioPhysics® technique. [Participant and Methods] A 46 year old reported with low back and hip pains for six years. Oswestry disability index scored 28%. Radiographic assessment revealed pronounced anterior sagittal balance with lumbar hyperlordosis. The patient was treated by Chiropractic BioPhysics technique to reverse the spinal deformity subluxation via mirror image corrective exercises and spinal traction, as well as spinal manipulative therapy. [Results] Assessments after 36 and 74 treatments corresponding to the 4-month and 13-month check-ups demonstrated a continuous structural improvement in lumbar spine biomechanical parameters. There was a near complete resolution in low back and hip pains with an Oswestry score of 4%. [Conclusion] This case documents the reduction of lumbar spine hyperlordosis and forward sagittal balance by contemporary spine rehabilitation methods. It is essential to screen spinal subluxation patterns via standing radiography which obviously, as demonstrated in this case determines treatment approach as most low back pain patients present with lumbar hypolordosis. Routine initial and repeat radiography is safe in the screening and monitoring of treatment efficacy and is the standard for evidence-based, patient-centred structural rehabilitation.
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22
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Gubbels CM, Werner JT, Oakley PA, Harrison DE. Reduction of thoraco-lumbar junctional kyphosis, posterior sagittal balance, and increase of lumbar lordosis and sacral inclination by Chiropractic BioPhysics ® methods in an adolescent with back pain: a case report. J Phys Ther Sci 2019; 31:839-843. [PMID: 31645816 PMCID: PMC6801338 DOI: 10.1589/jpts.31.839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022] Open
Abstract
[Purpose] To present the structural improvement of an excessive junctional thoracolumbar kyphosis and related biomechanical parameters in an adolescent. [Participant and Methods] A 16 year old female presented with chronic back pains. Radiographic assessment revealed excessive posterior sagittal balance and thoracolumbar kyphosis and reduced lumbar lordosis and sacral inclination. Chiropractic BioPhysics® technique including mirror image®, anterior thoracic translation and thoracolumbar hyperextension traction was performed as well as spinal manipulation and postural exercises over an 8-week period. [Results] After 24 in-office treatments and a daily home program the patient reported a minimization of back pains and a better mood. Follow-up X-rays demonstrated a 48 mm reduction of posterior sagittal balance, a 22° reduction of thoracolumbar kyphosis, an 11° increase in lumbar lordosis, and a 10° increase in sacral inclination. [Conclusion] This is the first case documenting the non-surgical reduction of excessive thoracolumbar junctional kyphosis and related biomechanical parameters in an adolescent. Precise analysis of radiologic assessment for adolescents presenting with back pains is advised and are safe for the screening of postural disorders. There is a growing evidence base for the Chiropractic BioPhysics® technique approach in the correction of lumbar spine disorders; more research is encouraged to further evaluate this unique treatment.
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Affiliation(s)
| | | | - Paul A. Oakley
- Private Practice: 11A-1100 Gorham Street, Newmarket, ON,
L3Y 8Y8, Canada
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23
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Du CZ, Li S, Xu L, Zhou QS, Zhu ZZ, Sun X, Qiu Y. Sagittal reconstruction of lumbosacral contiguous double-level spondylolytic spondylolisthesis: a comparison of double-level and single-level transforaminal lumbar interbody fusion. J Orthop Surg Res 2019; 14:148. [PMID: 31122245 PMCID: PMC6533736 DOI: 10.1186/s13018-019-1197-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/14/2019] [Indexed: 12/24/2022] Open
Abstract
Background Contiguous double-level lumbar spondylolytic spondylolisthesis is an extremely rare condition. There is a paucity of data of lumbosacral deformity and sagittal spino-pelvic malalignment among these patients. Moreover, the effect of transforaminal lumbar interbody fusion (TLIF) on sagittal realignment still remains largely unknown. The aim of the study is to investigate the reconstruction of sagittal alignment and the improvement of clinical outcomes after posterior instrumented double-level or single-level TLIF. Methods From January 2010 to September 2018, the records of patients with contiguous L4/5 and L5/S1 double-level spondylolytic spondylolisthesis were retrospectively reviewed. Patients who had undergone double-level or single-level TLIF and a minimum of 2 years’ follow-up were included. The slippage parameters and spino-pelvic parameters were measured preoperatively, postoperatively, and at the latest follow-up. Results A total of 58 patients (21 males and 37 females, mean age of 57.1 ± 6.9 years) were enrolled. Thirty-eight patients were treated with double-level TLIF and the remaining 20 with single-level TLIF (L4/5 in 14; L5/S1 in 6). After surgery, the spondylolisthesis was significantly reduced at both L4/5 and L5/S1 level (all P < 0.001). There was a significant reduction in pelvic tilt (P < 0.001) and a significant increase in sacral slope (P < 0.001). Significant increase in L4–S1 height (P < 0.001) and L4–S1 lordosis (P = 0.012) and decrease in L5 slope (P = 0.004) and L5 incidence (P = 0.001) were also observed. Compared to single-level TLIF, double-level TLIF increased L4–S1 height (P < 0.001) and L4–S1 lordosis (P < 0.001) and reduced L4-SVA (P = 0.007) and L5 incidence (P = 0.013) more obviously, and the sagittal balance was better corrected in double-level TLIF group (P = 0.006). Double-level TLIF group showed larger increase in VAS scores for low back pain. The incidence of implant-related complications was lower in the double-level group. Conclusion Posterior short-segment instrumented TLIF can bring favorable radiographic and clinical outcomes in patients with lumbosacral contiguous double-level spondylolytic spondylolisthesis. Double-level TLIF is more efficient to improve L4–S1 height, regional lumbar lordosis, and global sagittal balance.
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Affiliation(s)
- Chang-Zhi Du
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China
| | - Song Li
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Liang Xu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Qing-Shuang Zhou
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China
| | - Ze-Zhang Zhu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Xu Sun
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China.
| | - Yong Qiu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China.
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Ehsani NN, Oakley PA, Harrison DE. Scheuermann’s disease: non-surgical improvement in whole spine sagittal alignment in the treatment of a symptomatic patient using Chiropractic BioPhysics<sup>®</sup> technique. J Phys Ther Sci 2019; 31:965-970. [PMID: 31871386 PMCID: PMC6879408 DOI: 10.1589/jpts.31.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/14/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To present the dramatic improvement of sagittal posture in a young male with
Scheuermann’s disease suffering from pain ailments as treated by Chiropractic
BioPhysics® technique. [Participant and Methods] An 18 year old reported low
back pain and headaches for several years. Full spine radiographic assessment revealed
pronounced thoracic hyperkyphosis, anterior head translation, posterior thoracolumbar
sagittal balance, and a reduced sacral base orientation. The patient was treated by
Chiropractic BioPhysics methods incorporating mirror image® exercises,
traction, as well as spinal manipulation. [Results] Assessment after 35 treatment sessions
over 14-weeks revealed a dramatic improvement in postural parameters. The thoracic
kyphosis reduced by 13°, and was accompanied by a reduction in forward head posture,
reduction in posterior sagittal balance, and an increase in sacral base angle to normal.
The low back pain and headaches were alleviated. [Conclusion] This case adds to the
accumulating evidence demonstrating CBP methods offers an effective approach to reduce the
burden of postural disorders including those with Scheuermann’s disease. Since thoracic
hyperkyphosis is a serious disorder, the routine comprehensive assessment via full-spine
radiography is essential for the quantification of relevant postural parameters.
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Han S, Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Factors for the acquisition of 10° angular change at the lumbar spine through posterior column osteotomy in adult spinal deformity surgery. J Neurosurg Spine 2018; 29:667-673. [PMID: 30265224 DOI: 10.3171/2018.5.spine1858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/22/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPosterior column osteotomy (PCO) has been known to provide an angular change (AC) of approximately 10° in sagittal plane deformity. However, whether PCO can actually obtain an AC of ≥ 10° depending on the particular level in the lumbar spine and which factors can effect a gain of ≥ 10° AC after PCO remain to be elucidated. The aim of this study was to identify the factors that effect a gain of ≥ 10° AC through PCO by comparing radiographic measurements between an AC group and a control group before and after adult spinal deformity (ASD) surgery.METHODSForty consecutive patients who underwent multilevel PCOs for ASD at a single institution between 2012 and 2016 were included in this study. PCO was performed in 142 disc space levels in the lumbar spine. The authors defined the disc space level that obtained ≥ 10° AC in the sagittal plane by PCO as the AC group and the remaining patients as controls. The modified Pfirrmann grade, surgical level, implementation of the transforaminal lumbar interbody fusion (TLIF), and radiographic measurements were compared between the groups.RESULTSThere were 67 levels in the AC group and 75 in the control group. Multivariate analysis identified the surgical level at L4-5 (OR 3.802, 95% CI 1.127-12.827, p = 0.031), performing TLIF with PCO (OR 3.303, 95% CI 1.258-8.674, p = 0.015), and a preoperative kyphotic disc space angle (OR 1.397, 95% CI 1.231-1.585, p < 0.001) as the factors that significantly effected ≥ 10° AC in the sagittal plane after PCO.CONCLUSIONSIn ASD surgery, PCO cannot always achieve ≥ 10° AC in the sagittal plane. The factors that effected ≥ 10° AC in PCO for ASD were surgical level at L4-5, performing TLIF with PCO, and the preoperative kyphotic disc space angle.
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Affiliation(s)
- Sanghyun Han
- 1Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, DaeJeon; and
| | - Seung-Jae Hyun
- 2Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ki-Jeong Kim
- 2Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Tae-Ahn Jahng
- 2Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hyun-Jib Kim
- 2Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Weiner MT, Oakley PA, Dennis AK, Shapiro DA, Harrison DE. Increasing the cervical and lumbar lordosis is possible despite overt osteoarthritis and spinal stenosis using extension traction to relieve low back and leg pain in a 66-year-old surgical candidate: a CBP ® case report. J Phys Ther Sci 2018; 30:1364-1369. [PMID: 30464366 PMCID: PMC6220102 DOI: 10.1589/jpts.30.1364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/02/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To present the case of the dramatic relief of low back pain, leg pain and
disability in an older female with osteoarthritis, lumbar spinal stenosis and hypolordosis
of the cervical and lumbar spine. [Participant and Methods] A 66-year-old female presented
with chronic low back pain, right leg pain, numbness and weakness. Despite being
recommended for surgery, the patient sought alternative treatment. The patient was treated
with Chiropractic BioPhysics® rehabilitation of the spine with the objective to
increase the lumbar and cervical lordoses. Cervical and lumbar extension exercises and
traction were performed as well as spinal manipulation. Treatment was performed
approximately three times per week for 6.5 months. [Results] Re-assessment after treatment
demonstrated significant reduction of low back pain, leg pain and other health
improvements. X-rays showed structural improvements in the cervical and lumbar spine
despite advanced osteoarthritis. [Conclusion] Lumbar and cervical hypolordosis subluxation
may be increased in those with spinal deformity caused symptoms, despite the presence of
osteoarthritis and degenerative stenosis of the spine. Spinal x-rays as used in the
assessment and monitoring of patients being treated with contemporary spinal
rehabilitation methods are not harmful and should be used for routine screening
purposes.
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Le Huec JC, Gille O, Fabre T. Sagittal balance and spine-pelvis relation: A French speciality? Orthop Traumatol Surg Res 2018; 104:551-554. [PMID: 29906521 DOI: 10.1016/j.otsr.2018.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Jean-Charles Le Huec
- Service orthopédie traumatologie 1, 2, 3, pôle chirurgie, CHU Pellegrin-Tripode, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Ollivier Gille
- Service orthopédie traumatologie 1, 2, 3, pôle chirurgie, CHU Pellegrin-Tripode, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Thierry Fabre
- Service orthopédie traumatologie 1, 2, 3, pôle chirurgie, CHU Pellegrin-Tripode, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Harrison DE, Oakley PA. Non-operative correction of flat back syndrome using lumbar extension traction: a CBP ® case series of two. J Phys Ther Sci 2018; 30:1131-1137. [PMID: 30154615 PMCID: PMC6110233 DOI: 10.1589/jpts.30.1131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/30/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To document the non-operative rehabilitation of lumbar lordosis in two cases
with chronic low back pain and flexible flat back syndrome. [Participants and Methods] Two
young adult males reported suffering from chronic low back pain associated with anterior
sagittal balance and severe loss of lumbar lordosis, aka ‘flat back syndrome.’ Lumbar
extension traction was applied 3–5 times per week for 16.5–20 weeks. A torsion type lumbar
spinal manipulative therapy was provided in the initial 3 weeks for short-term pain
relief. [Results] Both patients had dramatic improvement in lumbar lordosis with
simultaneous reduction in pain levels. One patient had a 50° lordosis improvement in 100
treatments over 20 weeks; the other had a 26° lordosis improvement in 70 treatments over
16.5 weeks. There were also improvements in sacral base angle, pelvic tilt and sagittal
balance. One patient demonstrated stability of health status and further improvements in
radiographic measures including lordosis angle nearly 10-months post-treatment.
[Conclusion] This is the first successful non-operative correction of flat back syndrome.
This approach seems highly effective, is a fraction of the cost of spinal surgery
typically used to treat this condition, and offers no health risks including those assumed
from radiography necessary for screening and follow-up.
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Affiliation(s)
| | - Paul A Oakley
- Private Practice: 11A-1100 Gorham Street, Newmarket, Ontario, L3Y8Y8, Canada
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Tono O, Hasegawa K, Okamoto M, Hatsushikano S, Shimoda H, Watanabe K, Harimaya K. Lumbar lordosis does not correlate with pelvic incidence in the cases with the lordosis apex located at L3 or above. 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; 28:1948-1954. [DOI: 10.1007/s00586-018-5695-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/22/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
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Redaelli A, Berjano P, Aebi M. Focal disorders of the spine with compensatory deformities: how to define them. 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; 27:59-69. [PMID: 29383486 DOI: 10.1007/s00586-018-5501-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE In this paper, the authors propose classifying the epiphenomenon of spinal deformity in two different categories: structural deformity, when the main driver of the observed deformity is a fixed and stiff alteration of the spinal segments, and compensatory deformity, which includes cases where the observed deformity is due to focal abnormalities. This last category comprises, but is not limited to, spinal stenosis, spondylolisthesis, disc herniation, infection or tumor, hip disease or neurological disease (such as Parkinson's disease). METHOD Narrative review article. RESULTS We analyzed the focal diseases of the spine that may cause a compensatory deformity inducing adaptation in the unaffected part of the spine. CONCLUSION The compensatory mechanisms involved in adaptive deformity represent an attempt to maintain a global alignment, to escape from pain or to control body posture. These slides can be retrieved under Electronic Supplementary material.
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Affiliation(s)
- Andrea Redaelli
- IRCCS Istituto Ortopedico Galeazzi, Gspine4, via Riccardo Galeazzi 4, 20161, Milan, Italy.
| | - Pedro Berjano
- IRCCS Istituto Ortopedico Galeazzi, Gspine4, via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Max Aebi
- IRCCS Istituto Ortopedico Galeazzi, Gspine4, via Riccardo Galeazzi 4, 20161, Milan, Italy
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Afathi M, Zairi F, Devos P, Allaoui M, Marinho P, Chopin D, Assaker R. Anterior lumbar sagittal alignment after anterior or lateral interbody fusion. Orthop Traumatol Surg Res 2017; 103:1245-1250. [PMID: 28987526 DOI: 10.1016/j.otsr.2017.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/31/2017] [Accepted: 09/04/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Anterior or lateral interbody fusion is a treatment option for lumbar disc disease. A segmental change occurs after such surgery. This study was designed to evaluate the changes in the lumbar regional alignment after a single or two-level standalone anterior or lateral interbody fusion (ALIF or LLIF). METHODS Data from patients referred to our institution between March 2013 and November 2015 for standalone ALIF or LLIF for low-grade isthmic spondylolisthesis or degenerative discopathy were retrospectively included in our analysis. Patients with a history of spinal fusion were excluded. Global and regional alignments were analyzed pre- and postoperatively. Pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), lumbar lordosis (LL), index segmental lordosis (ISL) and L4S1 lordosis were compared. Three groups according to the pelvic incidence (PI) (low, normal and high) were separately analyzed then compared. RESULTS Forty-one women and 27 men (mean age was 46 years; range 25-66) were included. The mean follow-up was 10.8 (range 3-34 months). The patients were globally well balanced preoperatively and remained after surgery (SVA stagnated from 16.76±28.42mm to 15.97±28.20mm, P=0.75). PT and LL did not vary. L4S1 lordosis, and ISL were significantly increased respectively from 30.56±8.59 to 34.58±7.47 (P=0.0026) and from 5.94±5.25 to 12.99±5.87 (P<0.0001) at latest follow-up. CONCLUSION Despite effective changes in the segmental lordosis at the index levels, our findings suggest that one or two-levels standalone ALIF or LLIF had no effect on the global balance and the lumbar lordosis. The three groups behaved similarly, the regional lordosis was redistributed in a better harmony (L4S1/LL ratio went up from 55% to 61%, P=0.01). STUDY TYPE Retrospective study. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Afathi
- Department of Neurosurgery C, P.-Wertheimer Hospital, hospices civils de Lyon, university Claude-Bernard - Lyon 1, 69003 Lyon, France.
| | - F Zairi
- Department of Neurosurgery, University Hospital, 59000 Lille, France
| | - P Devos
- University of Lille, CHU de Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, 59000 Lille, France
| | - M Allaoui
- Department of Neurosurgery, University Hospital, 59000 Lille, France
| | - P Marinho
- Department of Neurosurgery, University Hospital, 59000 Lille, France
| | - D Chopin
- Department of Neurosurgery, University Hospital, 59000 Lille, France
| | - R Assaker
- Department of Neurosurgery, University Hospital, 59000 Lille, France
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Alzakri A, Boissière L, Cawley DT, Bourghli A, Pointillart V, Gille O, Vital JM, Obeid I. L5 pedicle subtraction osteotomy: indication, surgical technique and specificities. 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 2017; 27:644-651. [PMID: 29188373 DOI: 10.1007/s00586-017-5403-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 08/30/2017] [Accepted: 11/18/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the radiographic, functional outcomes, complications and surgical specificities of L5 pedicle subtraction osteotomy for fixed sagittal and coronal malalignment. METHODS A retrospective cohort of consecutive patients with prospectively collected data. Ten patients who underwent PSO at L5 were eligible for a 2-year minimum follow-up (average, 4.0 years). Patients were evaluated by standardized upright radiographs. Preoperative and postoperative radiographies, surgical data and complications were collected. RESULTS All surgeries were revision surgeries. The mean lumbar lordosis before surgery was - 22.5° (range, 8° to - 33°) and improved to - 58.5° (range, - 40° to - 79°). The sagittal vertical axis demonstrated a preoperative mean sagittal malalignment of 13.7 cm (range 3.5 to 20 cm), with correction to 4.6 cm postoperatively. Three patients required additional surgery at the latest follow-up for rod breakage. CONCLUSIONS PSO of L5 can be a safe and effective technique to treat and correct fixed sagittal imbalance and provide biomechanical stability. The high complication rate mandates a careful assessment of the risk/benefit ratio of such a major surgery. Most patients are satisfied, particularly when sagittal balance is achieved.
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Affiliation(s)
- Abdulmajeed Alzakri
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France. .,Orthopaedic Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Louis Boissière
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Derek T Cawley
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Vincent Pointillart
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Olivier Gille
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Jean-Marc Vital
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Ibrahim Obeid
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
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Oakley PA, Harrison DE. Lumbar extension traction alleviates symptoms and facilitates healing of disc herniation/sequestration in 6-weeks, following failed treatment from three previous chiropractors: a CBP ® case report with an 8 year follow-up. J Phys Ther Sci 2017; 29:2051-2057. [PMID: 29200655 PMCID: PMC5702845 DOI: 10.1589/jpts.29.2051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/23/2017] [Indexed: 12/28/2022] Open
Abstract
[Purpose] To present the outcome of a patient, having sciatica and MRI-verified disc
herniation/sequestration who underwent Chiropractic BioPhysics®
(CBP®) protocol designed to improve the lumbar lordosis. [Subject and
Methods] A 56-year-old male suffered from chronic low back pain and recent sciatica due to
lumbar disc herniation despite being under continuous care from three previous
chiropractors. Radiographic analysis revealed a lumbar hypolordosis and MRI confirmed disc
herniation and sequestration at L4–L5. Generalized decreased lumbar range of motion and
multiple positive orthopedic and neurologic tests were present. [Results] After 26
treatments of CBP lumbar extension traction over 9-weeks a total reduction of the disc
herniation and sequestration occurred with concomitant improvement in neurologic symptoms.
Continuing maintenance treatments, an 8 year follow-up shows no relapse of condition and
patient remained in good health. [Conclusion] A patient with lumbar disc
herniation/sequestration was successfully treated with CBP technique procedures including
lumbar extension traction that achieved a significant healing of herniation and
significant reduction in symptoms not obtained following traditional chiropractic
procedures alone. The quick reduction in lumbar disc herniation would appear to be related
to a segmental disc unloading force produced during extension traction procedures for
increasing the lumbar curvature.
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Fedorchuk C, Lightstone DF, McRae C, Kaczor D. Correction of Grade 2 Spondylolisthesis Following a Non-Surgical Structural Spinal Rehabilitation Protocol Using Lumbar Traction: A Case Study and Selective Review of Literature. J Radiol Case Rep 2017; 11:13-26. [PMID: 29299090 DOI: 10.3941/jrcr.v11i5.2924] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective Discuss the use of non-surgical spinal rehabilitation protocol in the case of a 69-year-old female with a grade 2 spondylolisthesis. A selective literature review and discussion are provided. Clinical Features A 69-year-old female presented with moderate low back pain (7/10 pain) and severe leg cramping (7/10 pain). Initial lateral lumbar x-ray revealed a grade 2 spondylolisthesis at L4-L5 measuring 13.3 mm. Interventions and Outcomes The patient completed 60 sessions of Mirror Image® spinal exercises, adjustments, and traction over 45 weeks. Post-treatment lateral lumbar x-ray showed a decrease in translation of L4-L5 from 13.3 mm to 2.4 mm, within normal limits. Conclusions This case provides the first documented evidence of a non-surgical or chiropractic treatment, specifically Chiropractic BioPhysics®, protocols of lumbar spondylolisthesis where spinal alignment was corrected. Additional research is needed to investigate the clinical implications and treatment methods.
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Affiliation(s)
| | | | - Christi McRae
- Private Practice, St. Thomas, US Virgin Islands, USA
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Kim JS, Kim SM. Surgical Outcomes of Post-Fusion Lumbar Flatback Deformity with Sagittal Imbalance. J Korean Neurosurg Soc 2016; 59:615-621. [PMID: 27847576 PMCID: PMC5106362 DOI: 10.3340/jkns.2016.59.6.615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 11/27/2022] Open
Abstract
Objectives To review surgical results of post-fusion lumbar flatback treated with pedicle subtraction osteotomy (PSO) or Smith-Petersen osteotomies (SPOs). Methods Twenty-eight patients underwent osteotomies. Radiological outcomes by sagittal vertical axis (SVA), and pelvic tilt (PT), T1 pelvic angle (T1PA), and pelvic incidence (PI)-lumbar lordosis (LL) at preoperative, postoperative 1 month, and final were evaluated. Oswestry Disability Index (ODI), visual analog scale (VAS) score of back pain/leg pain, and Scoliosis Research Society-22 score (SRS-22r) were analyzed and compared. Patients were divided into 2 groups (SVA ≤5 cm : normal, SVA >5 cm : positive) at final and compared outcomes. Results Nineteen patients (68%) had PSO and the other 9 patients had SPOs with anterior lumbar interbody fusions (ALIFs) (Mean age : 65 years, follow-up : 31 months). The PT, PI-LL, SVA, T1PA were significantly improved at 1 month and at final (p<0.01). VAS score, ODI, and SRS-22r were also significantly improved at the final (p<0.01). 23 patients were restored with normal SVA and the rest 5 patients demonstrated to positive SVA. SVA and T1PA at 1 month and SVA, PI-LL, and T1PA at final were significantly different (p<0.05) while the ODI, VAS, and SRS-22r did not differ significantly between the groups (p>0.05). Common reoperations were early 4 proximal junctional failures (14%) and late four rod fractures. Conclusion Our results demonstrate that PSO and SPOs with ALIFs at the lower lumbar are significantly improves sagittal balance. For maintenance of normal SVA, PI-LL might be made negative value and T1PA might be less than 11° even though positive SVA group was also significantly improved clinical outcomes.
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Affiliation(s)
- Jin Seong Kim
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sung Min Kim
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Le Huec JC, Hasegawa K. Normative values for the spine shape parameters using 3D standing analysis from a database of 268 asymptomatic Caucasian and Japanese subjects. 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 2016; 25:3630-3637. [PMID: 26951168 DOI: 10.1007/s00586-016-4485-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE Sagittal balance analysis has gained importance and the measure of the radiographic spinopelvic parameters is now a routine part of many interventions of spine surgery. Indeed, surgical correction of lumbar lordosis must be proportional to the pelvic incidence (PI). The compensatory mechanisms [pelvic retroversion with increased pelvic tilt (PT) and decreased thoracic kyphosis] spontaneously reverse after successful surgery. MATERIALS AND METHODS This study is the first to provide 3D standing spinopelvic reference values from a large database of Caucasian (n = 137) and Japanese (n = 131) asymptomatic subjects. RESULTS The key spinopelvic parameters [e.g., PI, PT, sacral slope (SS)] were comparable in Japanese and Caucasian populations. Three equations, namely lumbar lordosis based on PI, PT based on PI and SS based on PI, were calculated after linear regression modeling and were comparable in both populations: lumbar lordosis (L1-S1) = 0.54*PI + 27.6, PT = 0.44*PI - 11.4 and SS = 0.54*PI + 11.90. CONCLUSION We showed that the key spinopelvic parameters obtained from a large database of healthy subjects were comparable for Causasian and Japanese populations. The normative values provided in this study and the equations obtained after linear regression modeling could help to estimate pre-operatively the lumbar lordosis restoration and could be also used as guidelines for spinopelvic sagittal balance.
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Affiliation(s)
- Jean Charles Le Huec
- Spine Unit 2, Surgical Research Lab, Bordeaux University Hospital, 33076, Bordeaux, France.
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Makirov SK, Yuz AA, Jahaf MT, Nikulina AA. Quantitative evaluation of the lumbosacral sagittal alignment in degenerative lumbar spinal stenosis. Int J Spine Surg 2015; 9:68. [PMID: 26767160 DOI: 10.14444/2068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
GOAL OF THE STUDY This study intends to develop a method of quantitative sagittal balance parameters assessment, based on a geometrical model of lumbar spine and sacrum. METHODS One hundred eight patients were divided into 2 groups. In the experimental group have been included 59 patients with lumbar spinal stenosis on L1-5 level. Forty-nine healthy volunteers without history of any lumbar spine pathlogy were included in the control group. All patients have been examined with supine MRI. Lumbar lordosis has been adopted as circular arc and described either anatomical (lumbar lordosis angle), or geometrical (chord length, circle segment height, the central angle, circle radius) parameters. Moreover, 2 sacral parameters have been assessed for all patients: sacral slope and sacral deviation angle. Both parameters characterize sacrum disposition in horizontal and vertical axis respectively. RESULTS Significant correlation was observed between anatomical and geometrical lumbo-sacral parameters. Significant differences between stenosis group and control group were observed in the value of the "central angle" and "sacral deviation" parameters. We propose additional parameters: lumbar coefficient, as ratio of the lordosis angle to the segmental angle (Kl); sacral coefficient, as ratio of the sacral tilt (ST) to the sacral deviation (SD) angle (Ks); and assessment modulus of the mathematical difference between sacral and lumbar coefficients has been used for determining lumbosacral balance (LSB). Statistically significant differences between main and control group have been obtained for all described coefficients (p = 0.006, p = 0.0001, p = 0.0001, accordingly). Median of LSB value of was 0.18 and 0.34 for stenosis and control groups, accordingly. CONCLUSION Based on these results we believe that that spinal stenosis is associated with an acquired deformity that is measureable by the described parameters. It's possible that spinal stenosis occurs in patients with an LSB of 0.2 or less, so this value can be predictable for its development. It may suggest that spinal stenosis is more likely to occur in patients with the spinal curvature of this type because of abnormal distribution of the spine loads. This fact may have prognostic significance for develop vertebral column disease and evaluation of treatment results.
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Barrey C, Darnis A. Current strategies for the restoration of adequate lordosis during lumbar fusion. World J Orthop 2015; 6:117-126. [PMID: 25621216 PMCID: PMC4303780 DOI: 10.5312/wjo.v6.i1.117] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 07/14/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery.
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Age-related loss of lumbar spinal lordosis and mobility--a study of 323 asymptomatic volunteers. PLoS One 2014; 9:e116186. [PMID: 25549085 PMCID: PMC4280226 DOI: 10.1371/journal.pone.0116186] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/03/2014] [Indexed: 11/22/2022] Open
Abstract
Background The understanding of the individual shape and mobility of the lumbar spine are key factors for the prevention and treatment of low back pain. The influence of age and sex on the total lumbar lordosis and the range of motion as well as on different lumbar sub-regions (lower, middle and upper lordosis) in asymptomatic subjects still merits discussion, since it is essential for patient-specific treatment and evidence-based distinction between painful degenerative pathologies and asymptomatic aging. Methods and Findings A novel non-invasive measuring system was used to assess the total and local lumbar shape and its mobility of 323 asymptomatic volunteers (age: 20–75 yrs; BMI <26.0 kg/m2; males/females: 139/184). The lumbar lordosis for standing and the range of motion for maximal upper body flexion (RoF) and extension (RoE) were determined. The total lordosis was significantly reduced by approximately 20%, the RoF by 12% and the RoE by 31% in the oldest (>50 yrs) compared to the youngest age cohort (20–29 yrs). Locally, these decreases mostly occurred in the middle part of the lordosis and less towards the lumbo-sacral and thoraco-lumbar transitions. The sex only affected the RoE. Conclusions During aging, the lower lumbar spine retains its lordosis and mobility, whereas the middle part flattens and becomes less mobile. These findings lay the ground for a better understanding of the incidence of level- and age-dependent spinal disorders, and may have important implications for the clinical long-term success of different surgical interventions.
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Le Huec JC, Faundez A, Dominguez D, Hoffmeyer P, Aunoble S. Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. INTERNATIONAL ORTHOPAEDICS 2014; 39:87-95. [PMID: 25192690 DOI: 10.1007/s00264-014-2516-6] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
The measure of radiographic pelvic and spinal parameters for sagittal balance analysis has gained importance in reconstructive surgery of the spine and particularly in degenerative spinal diseases (DSD). Fusion in the lumbar spine may result in loss of lumbar lordosis (LL), with possible compensatory mechanisms: decreased sacral slope (SS), increased pelvic tilt (PT) and decreased thoracic kyphosis (TK). An increase in PT after surgery is correlated with postoperative back pain. A decreased SS and/or abnormal sagittal vertical axis (SVA) after fusion have a higher risk of adjacent segment degeneration. High pelvic incidence (PI) increases the risk of sagittal imbalance after spine fusion and is a predictive factor for degenerative spondylolisthesis. Restoration of a normal PT after surgery is correlated with good clinical outcome. Therefore, there is a need for comparative prospective studies that include pre- and postoperative spinopelvic parameters and compare complication rate, degree of disability, pain and quality of life.
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Affiliation(s)
- Jean-Charles Le Huec
- Spine Unit 2, Surgical Research Lab, Bordeaux University Hospital, Bordeaux, 33076, France,
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Marchiori DM, Olatunji TA. Roentgenometrics. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ranavolo A, Don R, Draicchio F, Bartolo M, Serrao M, Padua L, Cipolla G, Pierelli F, Iavicoli S, Sandrini G. Modelling the spine as a deformable body: Feasibility of reconstruction using an optoelectronic system. APPLIED ERGONOMICS 2013; 44:192-9. [PMID: 22871315 DOI: 10.1016/j.apergo.2012.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 04/23/2012] [Accepted: 07/04/2012] [Indexed: 05/13/2023]
Abstract
The aims of this study were to develop a kinematic model of the spine, seen as a continuous deformable body and to identify the smallest set of surface markers allowing adequate measurements of spine motion. The spine is widely considered as a rigid body or as a kinematic chain made up of a smaller number of segments, thereby introducing an approximation. It would be useful to have at our disposal a technique ensuring accurate and repeatable measurement of the shape of the whole spine. Ten healthy subjects underwent a whole-spine radiographic assessment and, simultaneously, an optoelectronic recording. Polynomial interpolations of the vertebral centroids, of the whole set of markers were performed. The similarity of the resulting curves was assessed. Our findings indicate that spine shape can be reproduced by 5th order polynomial interpolation. The best approximating curves are obtained from either 10- or 9-marker sets. Sagittal angles are systematically underestimated.
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Affiliation(s)
- Alberto Ranavolo
- Department of Occupational Medicine, INAIL, Via Fontana Candida 1, 00040 Monte Porzio Catone, Rome, Italy.
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Magee J, McClelland B, Winder J. Current issues with standards in the measurement and documentation of human skeletal anatomy. J Anat 2012; 221:240-51. [PMID: 22747678 PMCID: PMC3458629 DOI: 10.1111/j.1469-7580.2012.01535.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2012] [Indexed: 01/16/2023] Open
Abstract
Digital modeling of human anatomy has become increasingly important and relies on well-documented quantitative anatomy literature. This type of documentation is common for the spine and pelvis; however, significant issues exist due to the lack of standardization in measurement and technique. Existing literature on quantitative anatomy for the spine and pelvis of white adults (aged 18-65 years, separated into decadal categories) was reviewed from the disciplines of anatomy, manipulative therapy, anthropometrics, occupational ergonomics, biomechanics and forensic science. The data were unified into a single normative model of the sub-axial spine. Two-dimensional orthographic drawings were produced from the 590 individual measurements identified, which informed the development of a 3D digital model. A similar review of full range of motion data was conducted as a meta-analysis and the results were applied to the existing model, providing an inter-connected, articulated digital spine. During these data analysis processes several inconsistencies were observed accompanied by an evidential lack of standardization with measurement and recording of data. These have been categorized as: anatomical terminology; scaling of measurements; measurement methodology, dimension and anatomical reference positions; global coordinate systems. There is inconsistency in anatomical terminology where independent researchers use the same terms to describe different aspects of anatomy or different terms for the same anatomy. Published standards exist for measurement methods of the human body regarding spatial interaction, anthropometric databases, automotive applications, clothing industries and for computer manikins, but none exists for skeletal anatomy. Presentation of measurements often lacks formal structure in clinical publications, seldom providing geometric reference points, therefore making digital reconstruction difficult. Published quantitative data does not follow existing international published standards relating to engineering drawing and visual communication. Large variations are also evident in standards or guidelines used for global coordinate systems across biomechanics, ergonomics, software systems and 3D software applications. This paper identifies where established good practice exists and suggests additional recommendations, informing an improved communication protocol, to assist reconstruction of skeletal anatomy using 3D digital modeling.
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Affiliation(s)
- Justin Magee
- Research Institute for Art and Design, School of Creative Arts, University of Ulster, Derry/Londonderry, UK.
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Roussouly P, Pinheiro-Franco JL. Sagittal parameters of the spine: biomechanical approach. 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 2011; 20 Suppl 5:578-85. [PMID: 21796394 DOI: 10.1007/s00586-011-1924-1] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 07/11/2011] [Indexed: 11/30/2022]
Abstract
According to the anatomical segmentation, spine curves are the sacral kyphosis (sacrum), lumbar lordosis (L1 to L5), thoracic kyphosis (T1 to T12) and cervical lordosis (C1 to C7). From the morphological point of view the vertebrae of a curve are not identical: from cranial to caudal and vice versa there is a progressive anatomical modification. Both curves of the thoraco-lumbar spine may be divided at the Inflexion Point where lordosis turns into kyphosis. A geometrical construct of each curve by two tangent arcs of circle allows understanding the reciprocal changes between both curves. Lumbar Lordosis is mainly dependent on SS orientation, and the top of thoracic curve on C7 is very stable over the sacrum. Thoracic curve is dependent on lumbar lordosis orientation and C7 positioning. On a reverse effect, structural changing of thoracic kyphosis may affect the shape of the lumbar lordosis and the orientation of the pelvis.
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Affiliation(s)
- Pierre Roussouly
- Chirurgie de la colonne vertébrale, Croix Rouge Française, CMCR des Massues, 92 Rue Edmond Locard, 69322, Lyon Cedex 05, France.
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Morningstar MW, Strauchman MN, Gilmour G. Adolescent idiopathic scoliosis treatment using pettibon corrective procedures: a case report. J Chiropr Med 2011; 3:96-103. [PMID: 19674630 DOI: 10.1016/s0899-3467(07)60093-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2003] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate the possible benefits of using Pettibon corrective procedures to reduce the curvature associated with idiopathic scoliosis. These procedures were tested to determine potential effectiveness in a single patient. CLINICAL FEATURES A patient with a 35 degrees left convex thoracolumbar scoliosis was treated using Pettibon corrective procedures. Initial and follow-up outcome measures included a Borg pain scale, a Functional Rating Index, a balance test, and radiographic analysis. INTERVENTION AND OUTCOME The patient was treated using a combination of manipulative and rehabilitative procedures designed to restore normal sagittal curves and reduce the severity of the coronal curvatures. After six weeks of treatment, the post treatment radiograph revealed a 20 degrees left convex thoracolumbar scoliosis, as well as decreases in the Borg pain scale from six to two, and Functional Rating Index score from 18/40 to 7/40 after the trial period. Her balance time increased from 18 seconds to 56 seconds. CONCLUSION Pettibon corrective procedures seemed to be effective at reducing the thoracolumbar scoliosis 15 degrees (43%) after six weeks. The subjective and objective results of this case study warrant further such investigations.
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Vrtovec T, Pernus F, Likar B. A review of methods for quantitative evaluation of spinal curvature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:593-607. [PMID: 19247697 PMCID: PMC3233998 DOI: 10.1007/s00586-009-0913-0] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Revised: 01/06/2009] [Accepted: 02/09/2009] [Indexed: 11/29/2022]
Abstract
The aim of this paper is to provide a complete overview of the existing methods for quantitative evaluation of spinal curvature from medical images, and to summarize the relevant publications, which may not only assist in the introduction of other researchers to the field, but also be a valuable resource for studying the existing methods or developing new methods and evaluation strategies. Key evaluation issues and future considerations, supported by the results of the overview, are also discussed.
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Affiliation(s)
- Tomaz Vrtovec
- Laboratory of Imaging Technologies, Faculty of Electrical Engineering, University of Ljubljana, Trzaska cesta 25, 1000, Ljubljana, Slovenia.
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Characterizing the shape of the lumbar spine using an active shape model: reliability and precision of the method. Spine (Phila Pa 1976) 2008; 33:807-13. [PMID: 18379410 DOI: 10.1097/brs.0b013e31816949e6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Analysis of positional magnetic resonance images of normal volunteers. OBJECTIVE To compare the reliability and precision of an active shape model to that of conventional lordosis measurements. SUMMARY OF BACKGROUND DATA Characterization of lumbar lordosis commonly relies on measurement of angles; these have been found to have errors of around 10 degrees . METHODS T2 weighted sagittal images of the lumbar spines of 24 male volunteers in the standing posture were acquired using a positional magnetic resonance scanner. An active shape model of the vertebral bodies from S1 to L1 was created. Lumbar lordosis was also determined by measuring the angles of the superior endplates. All measurements were performed twice by one observer and once by a second observer. RESULTS The shape model identified 2 modes of variation to describe the shape of the lumbar spine (mode 1 described curvature and mode 2 described evenness of curvature). Significant correlations were found between mode 1 and total lordosis (R = 0.97, P < 0.001) and between mode 2 and mean absolute deviation of segmental lordosis (R = 0.80, P < 0.001). Intra- and interobserver reliability was higher for the shape model (intraclass correlation coefficients, 0.98-1.00) than for the lordosis angle measurements (intraclass correlation coefficients, 0.68-0.99). The relative error of the shape model (mode 1 = 4%; mode 2 = 9%) was lower than the conventional measurements (total lordosis = 10%). CONCLUSION The shape of the lumbar spine in the sagittal plane can be comprehensively characterized using a shape model. The results are more reliable and precise than measurements of lordosis calculated from endplate angles.
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Morningstar MW, Joy T. Scoliosis treatment using spinal manipulation and the Pettibon Weighting System: a summary of 3 atypical presentations. CHIROPRACTIC & OSTEOPATHY 2006; 14:1. [PMID: 16409627 PMCID: PMC1363725 DOI: 10.1186/1746-1340-14-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 01/12/2006] [Indexed: 12/18/2022]
Abstract
Background Given the relative lack of treatment options for mild to moderate scoliosis, when the Cobb angle measurements fall below the 25–30° range, conservative manual therapies for scoliosis treatment have been increasingly investigated in recent years. In this case series, we present 3 specific cases of scoliosis. Case presentation Patient presentation, examination, intervention and outcomes are detailed for each case. The types of scoliosis presented here are left thoracic, idiopathic scoliosis after Harrington rod instrumentation, and a left thoracic scoliosis secondary to Scheuermann's Kyphosis. Each case carries its own clinical significance, in relation to clinical presentation. The first patient presented for chiropractic treatment with a 35° thoracic dextroscoliosis 18 years following Harrington Rod instrumentation and fusion. The second patient presented with a 22° thoracic levoscoliosis and concomitant Scheuermann's Disease. Finally, the third case summarizes the treatment of a patient with a primary 37° idiopathic thoracic levoscoliosis. Each patient was treated with a novel active rehabilitation program for varying lengths of time, including spinal manipulation and a patented external head and body weighting system. Following a course of treatment, consisting of clinic and home care treatments, post-treatment radiographs and examinations were conducted. Improvement in symptoms and daily function was obtained in all 3 cases. Concerning Cobb angle measurements, there was an apparent reduction in Cobb angle of 13°, 8°, and 16° over a maximum of 12 weeks of treatment. Conclusion Although mild to moderate reductions in Cobb angle measurements were achieved in these cases, these improvements may not be related to the symptomatic and functional improvements. The lack of a control also includes the possibility of a placebo effect. However, this study adds to the growing body of literature investigating methods by which mild to moderate cases of scoliosis can be treated conservatively. Further investigation is necessary to determine whether curve reduction and/or manipulation and/or placebo was responsible for the symptomatic and functional improvements noted in these cases.
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Affiliation(s)
- Mark W Morningstar
- Director of Research, The Pettibon Institute; 3416-A 57St Ct NW Gig Harbor WA 98335, USA
| | - Timothy Joy
- Evergreen Spine & Posture Correction Center; 6615 6th Ave Tacoma, WA 98406, USA
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Morningstar MW, Pettibon BR, Schlappi H, Schlappi M, Ireland TV. Reflex control of the spine and posture: a review of the literature from a chiropractic perspective. CHIROPRACTIC & OSTEOPATHY 2005; 13:16. [PMID: 16091134 PMCID: PMC1198239 DOI: 10.1186/1746-1340-13-16] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Accepted: 08/09/2005] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This review details the anatomy and interactions of the postural and somatosensory reflexes. We attempt to identify the important role the nervous system plays in maintaining reflex control of the spine and posture. We also review, illustrate, and discuss how the human vertebral column develops, functions, and adapts to Earth's gravity in an upright position. We identify functional characteristics of the postural reflexes by reporting previous observations of subjects during periods of microgravity or weightlessness. BACKGROUND Historically, chiropractic has centered around the concept that the nervous system controls and regulates all other bodily systems; and that disruption to normal nervous system function can contribute to a wide variety of common ailments. Surprisingly, the chiropractic literature has paid relatively little attention to the importance of neurological regulation of static upright human posture. With so much information available on how posture may affect health and function, we felt it important to review the neuroanatomical structures and pathways responsible for maintaining the spine and posture. Maintenance of static upright posture is regulated by the nervous system through the various postural reflexes. Hence, from a chiropractic standpoint, it is clinically beneficial to understand how the individual postural reflexes work, as it may explain some of the clinical presentations seen in chiropractic practice. METHOD We performed a manual search for available relevant textbooks, and a computer search of the MEDLINE, MANTIS, and Index to Chiropractic Literature databases from 1970 to present, using the following key words and phrases: "posture," "ocular," "vestibular," "cervical facet joint," "afferent," "vestibulocollic," "cervicocollic," "postural reflexes," "spaceflight," "microgravity," "weightlessness," "gravity," "posture," and "postural." Studies were selected if they specifically tested any or all of the postural reflexes either in Earth's gravity or in microgravitational environments. Studies testing the function of each postural component, as well as those discussing postural reflex interactions, were also included in this review. DISCUSSION It is quite apparent from the indexed literature we searched that posture is largely maintained by reflexive, involuntary control. While reflexive components for postural control are found in skin and joint receptors, somatic graviceptors, and baroreceptors throughout the body, much of the reflexive postural control mechanisms are housed, or occur, within the head and neck region primarily. We suggest that the postural reflexes may function in a hierarchical fashion. This hierarchy may well be based on the gravity-dependent or gravity-independent nature of each postural reflex. Some or all of these postural reflexes may contribute to the development of a postural body scheme, a conceptual internal representation of the external environment under normal gravity. This model may be the framework through which the postural reflexes anticipate and adapt to new gravitational environments. CONCLUSION Visual and vestibular input, as well as joint and soft tissue mechanoreceptors, are major players in the regulation of static upright posture. Each of these input sources detects and responds to specific types of postural stimulus and perturbations, and each region has specific pathways by which it communicates with other postural reflexes, as well as higher central nervous system structures. This review of the postural reflex structures and mechanisms adds to the growing body of posture rehabilitation literature relating specifically to chiropractic treatment. Chiropractic interest in these reflexes may enhance the ability of chiropractic physicians to treat and correct global spine and posture disorders. With the knowledge and understanding of these postural reflexes, chiropractors can evaluate spinal configurations not only from a segmental perspective, but can also determine how spinal dysfunction may be the ultimate consequence of maintaining an upright posture in the presence of other postural deficits. These perspectives need to be explored in more detail.
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Affiliation(s)
- Mark W Morningstar
- Director of Research; The Pettibon Institute, 3416-A 57 St Ct NW Gig Harbor, WA 98335, USA; Private practice of chiropractic, 10683 S Saginaw St, Suite B, Grand Blanc, MI 48439, USA
| | - Burl R Pettibon
- Executive Director; The Pettibon Institute, 3416-A 57 St Ct NW Gig Harbor, WA 98335, USA
| | - Heidi Schlappi
- Doctor of Chiropractic Candidate; Palmer College of Chiropractic. 1000 Brady St Davenport, IA 52803, USA
| | - Mark Schlappi
- Doctor of Chiropractic Candidate; Palmer College of Chiropractic. 1000 Brady St Davenport, IA 52803, USA
| | - Trevor V Ireland
- Board of Trustees; Palmer College of Chiropractic. 1000 Brady St Davenport, IA 52803, USA
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Keller TS, Colloca CJ, Harrison DE, Harrison DD, Janik TJ. Influence of spine morphology on intervertebral disc loads and stresses in asymptomatic adults: implications for the ideal spine. Spine J 2005; 5:297-309. [PMID: 15863086 DOI: 10.1016/j.spinee.2004.10.050] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Accepted: 10/29/2004] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Sagittal profiles of the spine have been hypothesized to influence spinal coupling and loads on spinal tissues. PURPOSE To assess the relationship between thoracolumbar spine sagittal morphology and intervertebral disc loads and stresses. STUDY DESIGN A cross-sectional study evaluating sagittal X-ray geometry and postural loading in asymptomatic men and women. PATIENT SAMPLE Sixty-seven young and asymptomatic subjects (chiropractic students) formed the study group. OUTCOME MEASURES Morphological data derived from radiographs (anatomic angles and sagittal balance parameters) and biomechanical parameters (intervertebral disc loads and stresses) derived from a postural loading model. METHODS An anatomically accurate, sagittal plane, upright posture, quadrilateral element model of the anterior spinal column (C2-S1) was created by digitizing lateral full-spine X-rays of 67 human subjects (51 males, 16 females). Morphological measurements of sagittal curvature and balance were compared with intervertebral disc loads and stresses obtained using a quadrilateral element postural loading model. RESULTS In this young (mean 26.7, SD 4.8 years), asymptomatic male and female population, the neutral posture spine was characterized by an average thoracic angle (T1-T12) = +43.7 degrees (SD 11.4 degrees ), lumbar angle (T12-S1) = -63.2 degrees (SD 10.0 degrees ), and pelvic angle = +49.4 degrees (SD 9.9 degrees ). Sagittal curvatures exhibited relatively broad frequency distributions, with the pelvic angle showing the least variance and the thoracic angle showing the greatest variance. Sagittal balance parameters, C7-S1 and T1-T12, showed the best average vertical alignment (5.3 mm and -0.04 mm, respectively). Anterior and posterior disc postural loads were balanced at T8-T9 and showed the greatest difference at L5-S1. Disc compressive stresses were greatest in the mid-thoracic region of the spine, whereas shear stresses were highest at L5-S1. Significant linear correlations (p < .001) were found between a number of biomechanical and morphological parameters. Notably, thoracic shear stresses and compressive stresses were correlated to T1-T12 and T4-hip axis (HA) sagittal balance, respectively, but not to sagittal angles. Lumbar shear stresses and body weight (BW) normalized shear loads were correlated with T12-S1 balance, lumbar angle, and sacral angle. BW normalized lumbar compressive loads were correlated with T12-S1 balance and sacral angle. BW normalized lumbar disc shear (compressive) loads increased (decreased) significantly with decreasing lumbar lordosis. Cervical compressive stresses and loads were correlated with all sagittal balance parameters except S1-HA and T12-S1. A neutral spine sagittal model was constructed from the 67 subjects. CONCLUSIONS The analyses suggest that sagittal spine balance and curvature are important parameters for postural load balance in healthy male and female subjects. Morphological predictors of altered disc load outcomes were sagittal balance parameters in the thoracic spine and anatomic angles in the lumbar spine.
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Affiliation(s)
- Tony S Keller
- Department of Mechanical Engineering, University of Vermont, 33 Cochester Avenue, Burlington, VT 05405-0156, USA.
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