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Dharia AA, Guillotte AR, De Stefano FA, Birney MJ, Rouse AG, Ohiorhenuan IE. Coronal Deformity is Associated With Uptake on Single Photon Emission Computed Tomography in Patients With Low Back Pain. Global Spine J 2024:21925682241265302. [PMID: 38896877 DOI: 10.1177/21925682241265302] [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] [Indexed: 06/21/2024] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) is emerging as a valuable imaging test for identifying pain generators within the lumbar spine. The relationship between radiotracer uptake on SPECT/CT and anatomic biomechanical parameters has not been previously studied. METHODS We performed a retrospective review of all patients seen at our institution between 2021-2023 who obtained SPECT/CT scans for workup of thoracolumbar back pain. Patient data including demographic, clinical symptoms, and surgical history were collected. Radiology reports were reviewed for evidence of pathologic degeneration and increased bone metabolism on SPECT/CT. Biomechanical parameters were measured from standing scoliosis plain radiographs. Patients were stratified into two cohorts by either presence or absence of asymmetric coronal uptake on SPECT/CT. RESULTS 160 patients met inclusion criteria. Patients were primarily male (55%) with average age 55 ± 15 years. 87 (54%) patients demonstrated asymmetric uptake on SPECT/CT. These patients were older (P < 0.001), but with similar gender, prior fusion history, sacroiliitis, adjacent segment degeneration, and pseudoarthrosis (P > 0.05). This cohort had more disc disease, facet arthropathy, and greater degree of coronal scoliosis and coronal imbalance (P < 0.001). There were significantly more sites of uptake in the asymmetric cohort, and uptake was preferentially observed in the concavity of the lumbar curve (P < 0.001). There were no significant differences in sagittal balance or spinopelvic mismatch between cohorts (P > 0.05). CONCLUSION Asymmetric uptake on SPECT/CT was associated with coronal deformity in patients with low back pain. Further prospective studies are warranted to assess the effect of coronal deformity on pain generation.
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Affiliation(s)
- Anand A Dharia
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas, KS, USA
| | - Andrew R Guillotte
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas, KS, USA
| | - Frank A De Stefano
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas, KS, USA
| | - Mia J Birney
- University of Kansas School of Medicine, Kansas, KS, USA
| | - Adam G Rouse
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas, KS, USA
| | - Ifije E Ohiorhenuan
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas, KS, USA
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Vatandoost S, Kowalski K, Lanting B, Ng KCG, Soltanabadi S, Rushton A. Association between physical measures of spinopelvic alignment and physical functioning with patient reported outcome measures (PROMs) after total hip arthroplasty: Protocol for systematic review and meta-analysis. PLoS One 2024; 19:e0304382. [PMID: 38787884 PMCID: PMC11125517 DOI: 10.1371/journal.pone.0304382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Prevalence of total hip arthroplasty (THA) has trended upwards over past decades and is projected to increase further. Optimizing outcomes after surgery is essential to avoid surgical revision and maximize outcomes. Low back pain is reported as a problem post THA. Patient-reported outcome measures (PROMs) are commonly used to evaluate THA outcomes but have limitations (e.g., ceiling effects). It is therefore important to assess a comprehensive range of outcomes. Physical outcome measures of spinopelvic alignment and physical functioning demonstrate potential value, but no evidence synthesis has investigated their association with PROMs. The objectives of this systematic review are to evaluate the association between spinopelvic alignment and physical outcome measures of physical functioning with PROMs and characteristics of low back pain after THA. METHODS AND ANALYSIS This protocol is aligned with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Cross-sectional and longitudinal cohort studies evaluating the association between the physical outcome measures and PROMs (any outcome measures reported) following THA by any approach/implant will be included except surface replacement and revision THA. Studies investigating THA for developmental pathology and inflammatory conditions will be excluded. A systematic search in MEDLINE (Ovid), Embase (Ovid), Scopus, Web of Science, CINAHL, and the grey literature will be carried out from inception to July 31, 2023. Two independent reviewers will evaluate eligibility of retrieved articles, extract data and assess risk of bias (NIH quality assessment tool) of included studies. A third reviewer will mediate disagreements. Random-effects meta-analyses will be conducted if studies are sufficiently homogeneous in design, population, physical measures and PROMs; reporting odds ratios and 95% confidence intervals. Where meta-analyses are not possible, a narrative synthesis will be conducted. Confidence in cumulative evidence will be assessed using a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation). PROSPERO REGISTRATION NUMBER PROSPERO Registration number CRD42023412744.
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Affiliation(s)
- Sima Vatandoost
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Katie Kowalski
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Brent Lanting
- Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - K. C. Geoffrey Ng
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Alison Rushton
- School of Physical Therapy, Western University, London, Ontario, Canada
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Eren B, Karagoz Guzey F, Gulec I, Sahin T, Tufan A, Bas NS. The Importance of Spinopelvic Parameters in Recurrent Lumbar Disk Herniation. Clin Spine Surg 2024; 37:E113-E118. [PMID: 37941103 DOI: 10.1097/bsd.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
STUDY DESIGN Retrospective clinical study. OBJECTIVES We aimed to investigate preoperative spinopelvic mismatch as a risk factor for recurrent lumbar disk herniation (RLDH) in patients undergoing lumbar disk herniation (LDH) surgery. SUMMARY OF BACKGROUND DATA Spinopelvic parameters have been associated with lumbar degenerative diseases, particularly LDH. However, the relationship between these parameters and RLDH has yet to be studied. MATERIALS AND METHODS Data of 1453 patients aged ≥18 who underwent single-level, unilateral fenestration microdiscectomy for the first time in our hospital between 2013 and 2019 were reviewed. The study group comprised 88 patients who underwent surgery for RLDH. The control group comprised 101 randomly selected patients who underwent surgery for LDH but not RLDH. Age, sex, body mass index, occupational activity level, operative level, Roussouly classification type, and time to recurrence were recorded. Moreover, pelvic incidence, lumbar lordosis (LL), interverteberal disk height (IDH), segmental lordosis, sacral slope (SS), pelvic tilt (PT), and sacral table angle (ST) were measured for each patient. Pelvic mismatch was calculated. RESULTS Mean age was 46.5±11.4 y (range, 20-70). Both groups were similar concerning age, sex, body mass index, occupational activity level, and level of surgery. The mean time to recurrence was 167.3±36.6 d (range, 62-363). Measurements in the RLDH group were as follows: IDH=7.6±1.5 mm, pelvic incidence =54.4°±10.1°, LL=47.3°±13°, segmental lordosis =9.3°±5°, SS=35.1°±9.9°, and PT=19.3°±7.3°. Mean IDH was significantly lower in the RLDH group ( P =0.02). Less LL and lower PT at L3-4 level and increased SS at L5-S1 level were considered risk factors for RLDH. CONCLUSION This study showed that preoperative low IDH is at higher risk for RLDH in patients undergoing LDH surgery. LL, PT, and SS may be risk factors for specific levels.
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Affiliation(s)
- Burak Eren
- Department of Neurosurgery, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Lukas KJ, Verhaegen JCF, Livock H, Kowalski E, Phan P, Grammatopoulos G. The effect of ethnicity on the age-related changes of spinopelvic characteristics: a systematic review. Bone Joint Res 2023; 12:231-244. [PMID: 37051815 PMCID: PMC10065848 DOI: 10.1302/2046-3758.124.bjr-2022-0335.r1] [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] [Indexed: 04/03/2023] Open
Abstract
Aims Spinopelvic characteristics influence the hip’s biomechanical behaviour. However, to date there is little knowledge defining what ‘normal’ spinopelvic characteristics are. This study aims to determine how static spinopelvic characteristics change with age and ethnicity among asymptomatic, healthy individuals. Methods This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify English studies, including ≥ 18-year-old participants, without evidence of hip or spine pathology or a history of previous surgery or interventional treatment, documenting lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). From a total of 2,543 articles retrieved after the initial database search, 61 articles were eventually selected for data extraction. Results When all ethnicities were combined the mean values for LL, SS, PT, and PI were: 47.4° (SD 11.0°), 35.8° (SD 7.8°), 14.0° (SD 7.2°), and 48.8° (SD 10°), respectively. LL, SS, and PT had statistically significant (p < 0.001) changes per decade at: −1.5° (SD 0.3°), −1.3° (SD 0.3°), and 1.4° (SD 0.1°). Asian populations had the largest age-dependent change in LL, SS, and PT compared to any other ethnicity per decade at: −1.3° (SD 0.3°) to −0.5° (SD 1.3°), –1.2° (SD 0.2°) to −0.3° (SD 0.3°), and 1.7° (SD 0.2°) versus 1.1° (SD 0.1°), respectively. Conclusion Ageing alters the orientation between the spine and pelvis, causing LL, SS, and PT to modify their orientations in a compensatory mechanism to maintain sagittal alignment for balance when standing. Asian populations have the largest degree of age-dependent change to their spinopelvic parameters compared to any other ethnicity, likely due to their lower PI. Cite this article: Bone Joint Res 2023;12(4):231–244.
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Affiliation(s)
- Kenneth J. Lukas
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Jeroen C. F. Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, Antwerp, Belgium
| | - Holly Livock
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Philippe Phan
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Correspondence should be sent to George Grammatopoulos. E-mail:
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Saleh I, Librianto D, Dilogo IH, Supriadi S, Indriatmi W, Octaviana F, Prasetyo M, Noor Z. Radiological Outcomes of Reduction Surgery for Degenerative Lumbar Spondylolisthesis Using Long Arm Pedicle Screws. Orthop Res Rev 2022; 14:365-372. [PMID: 36329906 PMCID: PMC9624213 DOI: 10.2147/orr.s382232] [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: 07/18/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
Abstract
Objective Until now, the spondylolisthesis reduction technique has relied on posterior instrumentation using long arm pedicle screws. In this way, the segments will be brought into alignment with the other vertebrae with the pedicle mats being tightened. The aim of this study is to acknowledge whether reduction surgery for degenerative lumbar spondylolisthesis (DLS) using long arm pedicle screws is able to correct the listhesis and spinopelvic parameters. Methods We carried out a retrospective study of patients with degenerative lumbar spondylolisthesis who went through reduction surgery using long arm pedicle screws in our institutions from January 2019 to March 2022. Preoperative and postoperative radiological outcomes consisting of listhesis and spinopelvic parameters were assessed. Results We found a statistical difference between the magnitude of listhesis immediately after surgery and preoperatively (p<0.001), with a successful correction of 85.85%. There was significant decrease in the value of pelvic tilt (p=0.044) and increase in the value of sacral slope (p=0.008) after surgery. Conclusion Reduction surgery using long arm pedicle screws for DLS was able to reduce the listhesis effectively up to 85.5%, and also to restore the parts of spinopelvic parameters, the pelvic tilt and sacral slope, approaching normal values.
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Affiliation(s)
- Ifran Saleh
- Orthopaedic Spine Surgeon, Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia,Correspondence: Ifran Saleh, Department of Orthopaedic & Traumatology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia, Tel +62 811111221, Email
| | - Didik Librianto
- Orthopaedic Spine Surgeon, Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia – Fatmawati Hospital, Jakarta Pusat, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Orthopaedic Surgeon, Consultant of Hip and Knee, Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | - Sugeng Supriadi
- Department of Mechanical Engineering, Faculty of Engineering, Universitas Indonesia, Depok City, Indonesia
| | - Wresti Indriatmi
- Consultant Dermatologist, Department of Dermatology and Venerology, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | - Fitri Octaviana
- Consultant Neurologist, Department of Neurology, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | - Marcel Prasetyo
- Consultant Radiologist, Department of Radiology, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | - Zairin Noor
- Orthopaedic Spine Surgeon, Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Lambung Mangkurat, Jakarta Pusat, Indonesia
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Mulkalwar A, Gantaguru A, Marathe N, Mallepally A. Prognostic factors to predict the progression of adolescent idiopathic scoliosis: A narrative review. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2022. [DOI: 10.4103/jodp.jodp_36_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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