Relating the Diers formetric measurements with the subjective severity of acute and chronic low back pain

Correlation between sagittal parameters and disability of patients with nonspecific chronic low back pain: a cross-sectional study of 435 subjects

BACKGROUND CONTEXT

Sagittal parameters are significantly correlated with health-related quality of life (HRQoL) in adult spinal deformity patients. Their association with HRQoL in patients with nonspecific chronic low back pain (NSCLBP) is unclear.

PURPOSE

To analyze the correlation between sagittal parameters and disability in NSCLBP patients.

DESIGN

A cross-sectional study.

PATIENT SAMPLE

Subjects included 435 patients with NSCLBP divided into low disability and high disability groups.

OUTCOME MEASURES

Function was measured using the Oswestry Disability Index (ODI). Pain intensity was measured using the Numeric Rating Scale (NRS) and HRQoL was measured using 36-item Short Form Health Survey (SF-36).

METHODS

Sagittal parameters, demographic data, ODI, SF-36 eight-dimensional scores and NRS scores of patients with NSCLBP were collected. Taking ODI=20 as the cut-off value, patients were divided into low disability group (ODI≤20) and high disability group (ODI>20), and ODI were converted to Ranked ODI (RODI) accordingly. Univariate analysis of the correlation among age, gender, body mass index (BMI), sagittal parameters, RODI, SF-36 eight-dimensional scores, NRS scores were then conducted. The variables related to RODI were analyzed by logistic regression to discover their independent influence on RODI. p<.05 was considered to indicate statistical significance.

RESULTS

A total of 435 patients with NSCLBP were included. Univariate correlation analysis showed that the correlation coefficients between age, sacral slope-pelvic tilt (SS-PT), spinosacral angle (SSA) and RODI were (r=0.126, p<.01), (r=-0.115, p<.05), (r=-0.116, p<.05), respectively. The logistic regression analysis indicated that the regression coefficients of age and SSA were 0.030 (p=.001), -0.044 (p=.002), respectively, and the odds ratio and 95% confidence interval (CI) were 1.031 (1.012, 1.050), 0.957 (0.930, 0.985).

CONCLUSIONS

Age and SSA are independent factors for disability of NSCLBP. SSA can comprehensively reflect the sagittal balance of the spine of patients with NSCLBP. Decreased SSA represents poor sagittal balance, which will increase the disability of NSCLBP.

In vivo segmental vertebral kinematics in patients with degenerative lumbar scoliosis

PURPOSE

This study aimed to find a standard of the vertebra kinematics during functional weight-bearing activities in degenerative lumbar scoliosis (DLS) patients.

METHODS

Fifty-four patients were involved into this study with forty-two in DLS group and twelve in the control group. The three-dimensional (3D) vertebral models from L1 to S1 of each participant were reconstructed by computed tomography (CT). Dual-orthogonal fluoroscopic imaging, along with FluoMotion and Rhinoceros software, was used to record segmental vertebral kinematics during functional weight-bearing activities. The primary and coupled motions of each vertebra were analyzed in patients with DLS.

RESULTS

During flexion-extension of the trunk, anteroposterior (AP) translation and craniocaudal (CC) translation at L5-S1 were higher than those at L2-3 (9.3 ± 5.1 mm vs. 6.4 ± 3.5 mm; P < 0.05). The coupled mediolateral (ML) translation at L5-S1 in patients with DLS was approximately three times greater than that in the control group. During left-right bending of the trunk, the coupled ML rotation at L5-S1 was higher in patients with DLS than that in the control group (17.7 ± 10.3° vs. 8.4 ± 4.4°; P < 0.05). The AP and CC translations at L5-S1 were higher than those at L1-2, L2-3, and L3-4. During left-right torsion of the trunk, the AP translation at L5-S1 was higher as compared to other levels.

CONCLUSIONS

The greatest coupled translation was observed at L5-S1 in patients with DLS. Coupled AP and ML translations at L5-S1 were higher than those in healthy participants. These data improved the understanding of DLS motion characteristics.

The Relationship Between the Shape of the Spine and the Width of Linea Alba in Children Aged 6-9 Years. Case-Control Study

INTRODUCTION

Civilization development coupled with contemporary lifestyle leads to a systematic increase in postural disorders. An analysis of factors that may provoke postural disorders indicates that such a stimulus may be the diastasis of the rectus abdominis muscles. Moreover, abnormal activity of the rectus abdominis muscles may affect balance disorders through reduced spinal stabilization and disturbed body statics. There is an increase in body posture abnormalities between the ages of 6 and 9 related to new school duties.

PURPOSE OF THE STUDY

The purpose of the study was to evaluate the relationship between the shape of the spine and the width of the linea alba in children aged 6-9 years.

MATERIAL AND METHOD

The study was designed to evaluate parameters determining the shape of the spine, and the width of the linea alba in healthy children aged 6-9 years. The study participants were divided into two groups based on the width of the linea alba. The study group with the width of the linea alba >10 mm and the control group with the width of the linea alba ≤ 10 mm. The study group were included 37 children and the control group 24 children. The examination of the linea alba width was performed by a radiology specialist using a linear transducer and SAOTE- My Lab Classc-type ultrasound at rest and during contraction of the rectus abdominis muscles. Parameters describing the shape of the spine were measured using the Diers Formetric 4D system: trunk inclination, trunk imbalance, pelvis tilt, pelvic torsion, kyphotic apex, lordotic apex, kyphotic angle, lordotic angle, rotation angle, trunk torsion, lateral deviation. The obtained results were statistically analyzed using a Paired t test for comparison of differences between the results in the study and control groups and Pearson's test to assess the correlation between the width of the linea alba and parameters describing spinal alignment.

RESULTS

In both groups, the parameters describing the shape of the spine did not differ from the norms accepted as typical for the age norm. The only statistically significant difference between the study and control group concerned the trunk inclination, which was negative in the study group, signifying a shift of the entire spine axis backwards beyond the vertical.

CONCLUSIONS

There is a correlation between the shape of spine and the width of the linea alba in terms of selected parameters determining the body posture in the sagittal plane, which concern: the position of the lumbar lordotic apex, trunk inclination and the depth of the lumbar lordotic angle. The width of the linea alba is not explicitly related to abnormalities of pelvic and spinal alignment in the frontal and transverse planes.

Can formetric 4D measurements predict the development of adjacent segment degeneration after single-segment PLIF?: Relative rotation angle as a sensitive predictor

BACKGROUND

Adjacent segment degeneration (ASD) is a major issue after posterior lumbar interbody fusion (PLIF). The postoperative dynamic change of adjacent segments remains unknown. Hence, this study using the formetric 4D system (DIERS, International GmbH of Schlangenbad, Germany) to determine the impact of PLIF on ASD, and to compare the effectiveness with traditional radiography for the predication of ASD.

METHODS

Eighty-five consecutive patients who underwent PLIF of a single-segment were included. The formetric 4D system was used to calculate the relative rotation angle between the fusion segment and the upper and lower adjacent vertebrae before and at 6, 12 and 24 months after surgery. The range of motion (ROM) and disc height (DH) of adjacent segments were measured using radiography before surgery and 24 months postoperatively. At the final follow-up, the visual analogue scale (VAS) and Oswestry disability index were used to evaluate the surgical outcome. The patients were divided into two groups according to the occurrence of radiographic ASD: the ASD group with progression of degeneration and the N-ASD group without progression of degeneration.

RESULTS

The index fusion segments included L2-3 to L5-S1. Preoperatively, the relative rotation angles formed by the fusion segment with the upper and lower adjacent vertebrae were 5.1° ± 2.2° and 3.3° ± 2.0°, respectively, and both angles increased significantly at all time points after surgery (p < 0.05). The angles changed most significantly during L2-3 fusion. Radiographic ASD developed in 13 of 85 patients (15.3%) at 24 months. And the relative rotation angle with the upper adjacent vertebra was larger in the ASD group than in the N-ASD group (p < 0.05).

CONCLUSION

The relative rotation angle with adjacent vertebra increased significantly after lumbar fusion surgery. It may be a more sensitive predictor than the flexion-extension ROM and DH for the development of radiographic ASD.

Assessment of Body Posture of Children With Chest Pain

Objective: An increase in the appearance of chest pain among children is observed globally. The authors present various reasons for their appearance. As can be seen from numerous observations, the majority of cases are not related to the pathology of the circulatory system. Increasingly, studies on the causes of chest pain in children show their association with musculoskeletal disorders. Aim: of the work was assessment of body posture in children with chest pain using the Diers Formetric 4D system. Methods: The study involved a group of 184 female and male children, aged 7-12 years. The study group consisted of 64 patients with chest pain. The children from this group were diagnosed with functional chest pain by a cardiologist. The control group consisted of 120 patients without chest pain. The study included the assessment of body posture using the DIERS Formetric system. Results: The analysis of the results obtained during the study showed that among the children with chest pain, there are statistically significant irregularities in the parameters determining body posture compared to the control group. Comparing the study group with the control group, there is a statistically significant difference in the lateral deviation of VPDM (rms) (mm) (p = 0.001). Both children from the test group aged 9-10 and 11-12 obtained higher results than their peers from the control group. In the group of the youngest children in terms of the lateral deviation of VPDM (rms) (mm), increasing the number of children under study would contribute to significant differences in this variable. In the study group, among children aged 9-10 years, there were also statistically significant abnormalities regarding trunk imbalance and pelvic skewness compared to the children of the same age in the control group. Conclusions: Irregularities in the parameters determining body posture may cause chest pain in children.