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Meng D, Li D, Guo X, Li W. Evaluation of the effectiveness of the femoro-sacral posterior angle system for measuring spino-pelvic morphology in high-dysplastic developmental spondylolisthesis. 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 2024:10.1007/s00586-024-08418-z. [PMID: 39044021 DOI: 10.1007/s00586-024-08418-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/03/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE The Femoro-Sacral Posterior Angle (FSPA) system and the pelvic incidence (PI) system are utilized for measuring sagittal spino-pelvic morphology in patients with high-dysplastic developmental spondylolisthesis (HDDS). This study aimed to analyze the accuracy and stability of these two systems. METHODS A retrospective analysis was conducted on 45 patients diagnosed with HDDS who underwent surgical treatment at our hospital (HDDS group), along with 45 patients without spondylolisthesis (normal group). Three orthopedic surgeons utilized the FSPA and PI systems to measure various parameters, including FSPA, pelvic angle(PA), sacral incidence (SI), PI, pelvic tilt (PT), and sacral slope (SS), respectively. The intraclass correlation coefficient (ICC) was employed to assess the inter-observer consistency of measurements. RESULTS There was significant differences in all the parameters between the normal and HDDS groups (p < 0.05), except for SS (p = 0.508). Specifically, SI was lower in HDDS group than in the normal group (23.0 ± 13.4 vs. 38.6 ± 7.1), whereas SS was higher (35.3 ± 15.7 vs. 33.6 ± 7.4). Within HDDS group, there was no statistically significant difference in PI (p = 0.159), SS (p = 0.319), and FSPA (p = 0.173) between pre- and post-surgery measurements. The ICC results indicated superior reliability for the FSPA system (0.842-0.885) compared to the PI system (0.682-0.720) within the HDDS group. CONCLUSION Compared with the PI system, the FSPA system demonstrated higher accuracy in evaluating spino-pelvic morphology in HDDS patients. Moreover, it exhibited higher ICC values, indicating higher inter-observer reliability, thus serving as an effective method for assessing spino-pelvic morphology in HDDS patients.
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Affiliation(s)
- Defu Meng
- Department of Orthopaedics, Peking University Third Hospital, No.49 Huayuan Bei Road, Haidian District, Beijing, 100191, China
- Department of Orthopaedics, Zibo Municipal Hospital, No.139, Huangong Road, Linzi District, Zibo, 255400, China
| | - Dong Li
- Department of Orthopaedics, Zibo Municipal Hospital, No.139, Huangong Road, Linzi District, Zibo, 255400, China
| | - Xinhu Guo
- Department of Orthopaedics, Peking University Third Hospital, No.49 Huayuan Bei Road, Haidian District, Beijing, 100191, China.
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No.49 Huayuan Bei Road, Haidian District, Beijing, 100191, China
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Bone Formation During Correction of Vertebral Rounding Deformity in a Rat Model of Pediatric Spondylolisthesis. Spine (Phila Pa 1976) 2021; 46:E294-E302. [PMID: 33156272 DOI: 10.1097/brs.0000000000003779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A study using rat spondylolisthesis models. OBJECTIVE The aim of this study was to elucidate the mechanism for correction of vertebral rounding deformity. SUMMARY OF BACKGROUND DATA Vertebral rounding deformity is the strongest risk factor for high-grade slippage associated with spondylolisthesis in adolescents. We previously reported that inadequate endochondral ossification of the anterior upper corner of the vertebral growth plate in response to mechanical stress could be the pathological mechanism of vertebral rounding deformity. METHODS We created a model of spondylolisthesis using 4-week-old rats. They were divided into a tail suspension group that underwent tail suspension to decrease mechanical stress starting at 2 weeks postoperatively and a ground control group with no intervention. Radiographs and microcomputed tomography scans were obtained once weekly for 6 weeks postoperatively. The lumbar spines were then harvested for histological analysis. Immunohistochemical studies detected types I, II, and X collagen in the growth plate cartilage. Bone histomorphometrical analysis was also performed. RESULTS Radiological and histological evidence in the ground control group showed progress the rounding deformity with time as previously reported. Formation of normal cancellous bone was observed radiologically over time in the tail suspension group, indicating correction of rounding deformity. Histologically, the site showing radiological evidence of correction was derived from cartilage tissue. After starting tail suspension, the growth plate stained positive for type X collagen and the corrected site stained for types II and X collagen in a mosaic pattern. Chondrocytes expressing types I and II collagen and tartrate-resistant acid phosphatase-positive cells were also present at the corrected site. Histomorphometrically, more endochondral bone was detected at the corrected site than in the posterior aspect of the normal growth plate. CONCLUSION Correction of vertebral rounding deformity was associated with improvement of chondrocyte differentiation; furthermore, there is possible involvement of a third mechanism, namely transchondroid bone ossification.Level of Evidence: N/A.
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Yamashita K, Higashino K, Sakai T, Takata Y, Nagamachi A, Sairyo K. Natural Correction and Adaptation of a Severely Deformed Sacral Dome in an Adolescent with Isthmic Spondylolisthesis: A Case Report. JBJS Case Connect 2017; 7:e26. [PMID: 29244666 DOI: 10.2106/jbjs.cc.16.00117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A spinal deformity with wedging of L5 and rounding of the surface of the sacral dome is very common in pediatric patients with spondylolisthesis at the L5 vertebral level, and it has been well documented that severe spondylolisthesis is a good indication for spinal arthrodesis. We report the natural correction and adaptation of a severely deformed sacral dome with slippage (40.8%) in a pediatric patient with nonoperative treatment. CONCLUSION Vertebral deformity in children can be reversible. Orthopaedic surgeons should be aware that pediatric patients with a severe deformity of the sacral dome and vertebral slippage can be managed nonoperatively.
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Affiliation(s)
- Kazuta Yamashita
- Department of Orthopedics, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
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Abstract
The pathogenesis of slippage in pediatric spondylolisthesis is still unclear, although epiphyseal injury may account for many cases based on preclinical studies. However, no reports have described a pediatric case of isthmic spondylolisthesis showing radiologic evidence of epiphyseal injury. We report such evidence in a 13-year-old boy with low-back pain. Radiography revealed rounding of the S1 surface, a fracture line below the S1 endplate surface, and a bone marrow lesion in addition to slippage. Slippage and the rounding deformity were partially reversed (from 20 to 14% and from 42 to 27%, respectively) with conservative treatment and natural bone remodeling.
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Yamashita, MD K, Higashino, MD, PhD K, Sakai, MD, PhD T, Takata, MD, PhD Y, Hayashi, MD F, Tezuka, MD F, Morimoto MD M, Nagamachi, MD, PhD A, Sairyo, MD, PhD K. The reduction and direct repair of isthmic spondylolisthesis using the smiley face rod method in adolescent athlete: Technical note. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 64:168-172. [DOI: 10.2152/jmi.64.168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kazuta Yamashita, MD
- Department of Orthopedics, Institute of Health Biosciences, the University of Tokushima Graduate School
| | - Kosaku Higashino, MD, PhD
- Department of Orthopedics, Institute of Health Biosciences, the University of Tokushima Graduate School
| | - Toshinori Sakai, MD, PhD
- Department of Orthopedics, Institute of Health Biosciences, the University of Tokushima Graduate School
| | - Yoichiro Takata, MD, PhD
- Department of Orthopedics, Institute of Health Biosciences, the University of Tokushima Graduate School
| | - Fumio Hayashi, MD
- Department of Orthopedics, Institute of Health Biosciences, the University of Tokushima Graduate School
| | - Fumitake Tezuka, MD
- Department of Orthopedics, Institute of Health Biosciences, the University of Tokushima Graduate School
| | - Masatoshi Morimoto MD
- Department of Orthopedics, Institute of Health Biosciences, the University of Tokushima Graduate School
| | | | - Koichi Sairyo, MD, PhD
- Department of Orthopedics, Institute of Health Biosciences, the University of Tokushima Graduate School
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A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior Endplate Lesion after Recurrent Disc Herniation. Case Rep Orthop 2016; 2016:5963924. [PMID: 27648326 PMCID: PMC5018346 DOI: 10.1155/2016/5963924] [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: 06/13/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 11/21/2022] Open
Abstract
A lesion of the lumbar posterior endplate is sometimes identified in the spinal canal of children and adolescents; it causes symptoms similar to those of a herniated disc. However, the pathology of the endplate lesion and the pathology of the herniated disc are different. We present a rare case of a 23-year-old woman who developed progressive palsy of the lower leg caused by huge lumbar posterior endplate lesion after recurrent disc herniation.
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Mo J, Zhang W, Zhong D, Xu H, Wang L, Yu J, Luo Z. Is Preventative Long-Segment Surgery for Multi-Level Spondylolysis Necessary? A Finite Element Analysis Study. PLoS One 2016; 11:e0149707. [PMID: 26918333 PMCID: PMC4769328 DOI: 10.1371/journal.pone.0149707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/04/2016] [Indexed: 01/31/2023] Open
Abstract
Objective For multi-level spondylolysis patients, surgeons commonly choose to fix all the segments with pars interarticularis defect even those without slippage and not responsible for clinical symptoms. In this study, we tried to study the necessity of the preventative long-segment surgery for the defected segment without slippage in treatment of multi-level spondylolysis patients from a biomechanical perspective. Method We established a bi-level spondylolysis model with pars defects at L4 and L5 segments, and simulated posterior lumbar interbody fusion (PLIF) and pedicle screw fixation at L5-S1 level. Then we compared the biomechanical changes at L4 segment before and after surgery in neutral, flexion, extension, lateral bending and axial rotation position. Results The stress on L4 pars interarticularis was very similar before and after surgery, and reached the highest in axial rotation. The L3-L4 intradiscal pressure was almost the same, while L4-L5 intradiscal pressure changed a little in lateral bending (increase from 1.993 to 2.160 MPa) and axial rotation (decrease from 1.639 to 1.307 MPa) after surgery. The PLIF surgery caused a little increase of range of motion at adjacent L4-L5 and L3-L4 levels, but the change is very tiny (1 degree). Conclusion The PLIF surgery will not cause significant biomechanical change at adjacent segment with pars defect in multi-level spondylolysis. On the contrary, excessive long-segment surgery will damage surrounding soft tissues which are important for maintaining the stability of spine. So a preventative long-segment surgery is not necessary for multi-level spondylolysis as long as there are no soft tissue degeneration signs at adjacent level.
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Affiliation(s)
- Jianqiang Mo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Wen Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Dongyan Zhong
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hao Xu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Lan Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jia Yu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Zongping Luo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
- * E-mail:
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Terai T, Yamada H, Asano K, Nawata A, Iwasaki T, Henmi T, Sairyo K. Effectiveness of three types of lumbar orthosis for restricting extension motion. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 24 Suppl 1:S239-43. [PMID: 24728780 DOI: 10.1007/s00590-014-1446-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/24/2014] [Indexed: 01/23/2023]
Affiliation(s)
- Tomoya Terai
- Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, 32 Kotani Kurosaki Muya-cho Naruto, Tokushima, 772-8503, Japan,
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