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Newhouse AC, Alter TD, Handoklow LA, Espinoza Orías AA, Inoue N, Nho SJ. 3.0T magnetic resonance imaging-based hip bone models for femoroacetabular impingement syndrome are equivalent to computed tomography-based models. J Orthop Res 2024; 42:2017-2025. [PMID: 38564320 DOI: 10.1002/jor.25845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 02/16/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
This study aimed to compare three-dimensional (3D) proximal femoral and acetabular surface models generated from 3.0T magnetic resonance imaging (MRI) to the clinical gold standard of computed tomography (CT). Ten intact fresh-frozen cadaveric hips underwent CT and 3.0T MRI scans. The CT- and MRI-based segmented models were superimposed using a validated 3D-3D registration volume-merge method to compare them. The least surface-to-surface distance between the models was calculated by a point-to-surface calculation algorithm using a custom-written program. The variables of interest were the signed and absolute surface-to-surface distance between the paired bone models. One-sample t-tests were performed using a signed and absolute test value of 0.16 mm and 0.37 mm, respectively, based on a previous study that validated 1.5T MRI bone models by comparison with CT bone models. For the femur, the average signed and absolute surface-to-surface distance was 0.18 ± 0.09 mm and 0.30 ± 0.06 mm, respectively. There was no difference in the signed surface-to-surface distance and the 0.16 mm test value (t = 0.650, p = 0.532). However, the absolute surface-to-surface difference was less than the 0.37 mm test value (t = -4.025, p = 0.003). For the acetabulum, the average signed and absolute surface-to-surface distance was -0.06 ± 0.06 mm and 0.26 ± 0.04 mm, respectively. The signed (t = -12.569, p < 0.001) and absolute (t = -8.688, p < 0.001) surface-to-surface difference were less than the 0.16 mm and 0.37 mm test values, respectively. Our data shows that 3.0T MRI bone models are more similar to CT bone models than previously validated 1.5T MRI bone models. This is likely due to the higher resolution of the 3T data.
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Affiliation(s)
- Alexander C Newhouse
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Thomas D Alter
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Lyla A Handoklow
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Department of Bioengineering, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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2
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Haughton DR, Barr EC, Gupta AK, Toohey WC, Kania AM. Investigating Fryette's mechanics in computed tomography scans: an analysis of vertebrae spinal physiology using open-sourced datasets and three-dimensional vertebral orientation. J Osteopath Med 2024; 0:jom-2023-0088. [PMID: 38837124 DOI: 10.1515/jom-2023-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/08/2024] [Indexed: 06/06/2024]
Abstract
CONTEXT Fryette's mechanics is taught as a simplistic model of coupled vertebral movement, fundamental in osteopathic practice. This study seeks to better understand the likelihood of Fryette's model by calculating vertebral orientation in computed tomography (CT) scans. Given previous findings of low angular coupled movements during overall spinal motion, static calculations provide a unique perspective on the likelihood of Fryette's mechanics. OBJECTIVES This analysis aims to evaluate the efficacy of Fryette's principles in predicting vertebral positioning in CT scans by comparing their 3-dimensional (3D) orientation to movements described by Fryette. METHODS 3D models of 953 thoracic and lumbar vertebrae were obtained from 82 CT scans within the VerSe`20 open-source dataset. A stepwise algorithm generated three unique symmetry planes for each vertebra, offering 3D angular orientation with respect to the vertebral level below. A total of 422 vertebrae were omitted from the analysis due to the presence of pathologies significant enough to affect their motion, inaccurate symmetry plane calculations, or absence of vertebral level below. The remaining 531 vertebra were analyzed to compare quantitative coupled positioning against expected coupled spinal movements in line with Fryette's mechanics. One-sample proportional z-scoring was implemented for all vertebral levels with an ∝=0.05 and a null hypothesis of Fryette's primed positioning occurring by chance of 50 %. Further analysis was performed with individual z-scoring for each individual level to see which levels were statistically significant. RESULTS Data from the VerSe`20 dataset revealed that 56.9 % of successfully analyzed vertebrae demonstrated positions compatible with Fryette's mechanics (p=0.0014, power=89 %). The 302 vertebral levels that did display coupled positioning consisted of Type I (166 vertebrae) and Type II (136 vertebrae) compatible with Fryette's mechanics. Levels that demonstrated statistical significance consisted of T5 (p=0, power=99 %), T6 (p=0.0023, power=77 %), T7 (p=0.041, power=46 %), and T10 (p=0.017, power=60 %). CONCLUSIONS Our analysis suggests that the static positions of vertebrae in CT scans may align with Fryette's descriptions, although not very often. Notably, vertebral levels T5-T7 and T10 exhibit strong evidence of their static positions aligning with expected movements, warranting further investigation into the Fryette phenomenon at these levels. Future studies should explore the dynamic implications of these findings to enhance our understanding of spinal biomechanics.
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Affiliation(s)
- Dillon R Haughton
- 448838 Burrell College of Osteopathic Medicine , Las Cruces, NM, USA
| | - Emily C Barr
- 448838 Burrell College of Osteopathic Medicine , Las Cruces, NM, USA
| | - Akhil K Gupta
- 448838 Burrell College of Osteopathic Medicine , Las Cruces, NM, USA
| | - Walker C Toohey
- 448838 Burrell College of Osteopathic Medicine , Las Cruces, NM, USA
| | - Adrienne M Kania
- Department of Clinical Medicine, 448838 Burrell College of Osteopathic Medicine , Las Cruces, NM, USA
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Nakanishi S, Watanabe K, Ouchi K, Hakozaki M, Oi N, Konno S. Reference values of lumbar spine range of motion by sex and age based on the assessment of supine trunk lateral bending-A preliminary study. Fukushima J Med Sci 2024; 70:25-33. [PMID: 38123298 PMCID: PMC10867432 DOI: 10.5387/fms.2023-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
[Purpose] The purpose of this study was to clarify the preliminary reference values for the lumbar spine range of motion associated with lateral bending exercises by gender and age group. [Methods] Subjects were 82 volunteers without low back pain, including five males and five females in each age group from 16-19 to 80-89 years. All subjects underwent radiographs of the lumbar spine with lateral flexion; the range of lateral flexion of the vertebrae from T12 to the sacrum (ROLB) was measured twice by three observers. [Results] The ROLB of the entire T12-S1 of all subjects showed a significant negative correlation with age in both sexes (p < 0.01). The ROLB of the lumbar spine tended to be greater in females, with a statistically significant difference between those aged 16-19 and 70-79 (p < 0.05). Lateral flexion angles for each intervertebral segment were largest at L3-L4 and smallest at L5-S1 (0.7°). [Conclusion] Lumbar ROLB reference values were examined by gender and age group; ROLB was greatest in L3-L4, and ROLB tended to be lower in older age groups.
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Affiliation(s)
- Shigetaka Nakanishi
- Department of Rehabilitation Medicine, Fukushima Medical University School of Medicine
| | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Kazuo Ouchi
- Department of Rehabilitation Medicine, Fukushima Medical University School of Medicine
| | - Michiyuki Hakozaki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Naoyuki Oi
- Department of Rehabilitation Medicine, Fukushima Medical University School of Medicine
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
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Kinoshita Y, Hirasaki E. Range of rotation of thoracolumbar vertebrae in Japanese macaques. Anat Rec (Hoboken) 2024; 307:223-232. [PMID: 37289013 DOI: 10.1002/ar.25273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023]
Abstract
In humans, the range of thoracic vertebral rotation is known to be greater than that of the lumbar vertebrae due to their zygapophyseal orientation and soft tissue structure. However, little is known regarding vertebral movements in non-human primate species, which are primarily quadrupedal walkers. To understand the evolutionary background of human vertebral movements, this study estimated the range of axial rotation of the thoracolumbar spine in macaque monkeys. First, computed tomography (CT) was performed while passively rotating the trunk of whole-body cadavers of Japanese macaques, after which the motion of each thoracolumbar vertebra was estimated. Second, to evaluate the influence of the shoulder girdle and surrounding soft tissues, specimens with only bones and ligaments were prepared, after which the rotation of each vertebra was estimated using an optical motion tracking system. In both conditions, the three-dimensional coordinates of each vertebra were digitized, and the axial rotational angles between adjacent vertebrae were calculated. In the whole-body condition, the lower thoracic vertebrae had a greater range of rotation than did the other regions, similar to that observed in humans. In addition, absolute values for the range of rotation were similar between humans and macaques. However, in the bone-ligament preparation condition, the upper thoracic vertebrae had a range of rotation similar to that of the lower thoracic vertebrae. Contrary to previous speculations, our results showed that the mechanical restrictions by the ribs were not as significant; rather, the shoulder girdle largely restricted the rotation of the upper thoracic vertebrae, at least, in macaques.
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Affiliation(s)
- Yuki Kinoshita
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, Inuyama, Aichi, Japan
| | - Eishi Hirasaki
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, Inuyama, Aichi, Japan
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McMullin P, Emmett D, Gibbons A, Clingo K, Higbee P, Sykes A, Fullwood DT, Mitchell UH, Bowden AE. Dynamic segmental kinematics of the lumbar spine during diagnostic movements. Front Bioeng Biotechnol 2023; 11:1209472. [PMID: 37840657 PMCID: PMC10568473 DOI: 10.3389/fbioe.2023.1209472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
Background: In vivo measurements of segmental-level kinematics are a promising avenue for better understanding the relationship between pain and its underlying, multi-factorial basis. To date, the bulk of the reported segmental-level motion has been restricted to single plane motions. Methods: The present work implemented a novel marker set used with an optical motion capture system to non-invasively measure dynamic, 3D in vivo segmental kinematics of the lower spine in a laboratory setting. Lumbar spinal kinematics were measured for 28 subjects during 17 diagnostic movements. Results: Overall regional range of motion data and lumbar angular velocity measurement were consistent with previously published studies. Key findings from the work included measurement of differences in ascending versus descending segmental velocities during functional movements and observations of motion coupling paradigms in the lumbar spinal segments. Conclusion: The work contributes to the task of establishing a baseline of segmental lumbar movement patterns in an asymptomatic cohort, which serves as a necessary pre-requisite for identifying pathological and symptomatic deviations from the baseline.
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Affiliation(s)
- Paul McMullin
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Darian Emmett
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Andrew Gibbons
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Kelly Clingo
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Preston Higbee
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Andrew Sykes
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - David T. Fullwood
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Ulrike H. Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Anton E. Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
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Yoshida Y, Matsumura N, Yamada Y, Yamada M, Yokoyama Y, Miyamoto A, Oki S, Nakamura M, Nagura T, Jinzaki M. Dynamic evaluation of the sternoclavicular and acromioclavicular joints using an upright four-dimensional computed tomography. J Biomech 2023; 157:111697. [PMID: 37406603 DOI: 10.1016/j.jbiomech.2023.111697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/27/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
In the analysis of the shoulder complex, the sequential changes occurring in the sternoclavicular and acromioclavicular joints during active shoulder motion are challenging to track. This study aimed to investigate the in vivo sternoclavicular and acromioclavicular joint motions during active elevation, including the sequential changes in these joint spaces using upright four-dimensional computed tomography (4DCT). Bilateral shoulders of 12 healthy volunteers upright 4DCT were obtained during active elevation similar to a "hands up" motion. The sternoclavicular and acromioclavicular rotation angles, joint distances, and closest points on the clavicle relative to the thorax and scapula were evaluated during 10°-140° of humerothoracic elevation. During humerothoracic elevation, the clavicle elevated, retracted, and rotated posteriorly relative to the thorax, whereas the scapula rotated upwardly, internally, and posteriorly relative to the clavicle. All the sternoclavicular and acromioclavicular joint rotation angles were significantly different at ≥ 30°-50° of humerothoracic elevation compared with 10° of humerothoracic elevation. The mean sternoclavicular and acromioclavicular joint distances were 2.2 ± 1.1 mm and 1.6 ± 0.9 mm, respectively. The closest points were located on the anteroinferior part of the medial and lateral clavicle in the sternoclavicular and acromioclavicular joints, respectively. Significant differences were observed in the acromioclavicular joint distance and anterior/posterior movements of the closest points in the sternoclavicular and acromioclavicular joints compared with 10° of humerothoracic elevation. Our sternoclavicular and acromioclavicular closest point results indicate that the impingement tends to occur at the anteroinferior part of the medial and lateral aspects of the clavicle and may be related to osteoarthritis.
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Affiliation(s)
- Yuki Yoshida
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Azusa Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Yoshida Y, Matsumura N, Miyamoto A, Oki S, Yokoyama Y, Yamada M, Yamada Y, Nakamura M, Nagura T, Jinzaki M. Three-dimensional shoulder kinematics: Upright four-dimensional computed tomography in comparison with an optical three-dimensional motion capture system. J Orthop Res 2023; 41:196-205. [PMID: 35430725 DOI: 10.1002/jor.25342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/16/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
Although shoulder kinematics have been analyzed by various methods, dynamic shoulder motion is difficult to track. This study aimed to validate the shoulder kinematic analysis using upright four-dimensional computed tomography (4DCT) and to compare the results with optical three-dimensional motion capture. During active elevation, bilateral shoulders of 10 healthy volunteers were tracked using 4DCT and motion capture. The scapulothoracic and glenohumeral rotations and the scapulohumeral rhythm (SHR) at each position were calculated, and the differences between 4DCT and motion capture were compared. During 10-140° of humerothoracic elevation, the scapulothoracic joint showed upward rotation, internal rotation, and posterior tilting, and the glenohumeral joint showed elevation, external rotation, and anterior plane of elevation in both analyses. In scapulothoracic rotations, the mean differences between the two analyses were -2.6° in upward rotation, 13.9° in internal rotation, and 6.4° in posterior tilting, and became significant with humerothoracic elevation ≥110° in upward rotation, ≥50° in internal rotation, and ≥100° in posterior tilting. In glenohumeral rotations, the mean differences were 3.7° in elevation, 9.1° in internal rotation, and -8.8° in anterior plane of elevation, and became significant with humerothoracic elevation ≥110° in elevation, ≥90° in internal rotation, and ≥100° in anterior plane of elevation. The mean overall SHRs were 1.8 in 4DCT and 2.4 in motion capture, and the differences became significant with humerothoracic elevation ≥100°. The 4DCT analysis of in vivo shoulder kinematics using upright computed tomography scanner is feasible, but the values were different from those by skin-based analysis at the elevated arm positions.
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Affiliation(s)
- Yuki Yoshida
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Azusa Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Cervical rotational osteotomy for correction of axial deformity in a patient with ankylosing spondylitis. 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; 31:3768-3775. [PMID: 36169729 DOI: 10.1007/s00586-022-07364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/05/2022] [Accepted: 08/20/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Severe cervical axial deformity associated with ankylosing spondylitis (AS) is rare in clinic, and there are little concerns about surgical treatment of axial deformity associated with AS. The case study aims to show the surgical technique to perform cervical rotational osteotomy. METHODS We present the case of a young AS patient whose neck was fixed in a left-rotational posture at 18°, requiring his trunk to be turned to the right to look forward visually. This made his gait appear to be limping, inconveniencing him with great difficulty. In order to correct this deformity, we performed a novel cervical rotational osteotomy through a one-stage posterior-anterior-posterior approach. Firstly, we performed laminectomies of C7 and T1, followed by a C7/T1 facetectomy with release of the bilateral C8 nerve roots. Next, we performed C7/T1 discectomy, bony resection of the lateral body and uncovertebral joints. The head of the patient was then rotated manually, so that both his face and torso were simultaneously facing frontward. Finally, rods spanning the screws from C6 to T2 were fixed. RESULTS Postoperatively, the patient's axial malalignment was significantly improved, and he was able to walk normally. Surgical outcomes were well maintained at a 3-year follow-up. CONCLUSION Through this case, we hope to draw the attention to spinal axial deformity and provide a reference point in the surgical treatment of spinal axial deformity.
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Xu F, Zhou S, Li Z, Jiang S, Chen Z, Sun Z, Li W. The 6 degrees-of-freedom range of motion of the L1-S1 vertebrae in young and middle-aged asymptomatic people. Front Surg 2022; 9:1002133. [PMID: 36386544 PMCID: PMC9643460 DOI: 10.3389/fsurg.2022.1002133] [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: 07/24/2022] [Accepted: 09/28/2022] [Indexed: 01/25/2023] Open
Abstract
STUDY DESIGN Controlled laboratory study. OBJECTIVE To determine the 6 degrees of freedom of lumbar vertebra in vivo during different functional activities in young and middle-aged asymptomatic subjects. METHODS A total of 26 asymptomatic subjects (M/F, 15/11; age, 20-55 years) were recruited in this study. They were divided into two groups: young group (number: 14; age: 20-30 years old) and middle-aged group (number: 12; age: 45-55 years old). The lumbar segment of each subject was scanned by computed tomography for the construction of three-dimensional (3D) models of the vertebra from L1 to S1. The lumbar spine was imaged by using a dual fluoroscopic system when the subjects performed different trunk postures. The 3D models of vertebrae were matched to two fluoroscopic images simultaneously in software. The range of motion (ROM) of vertebrae in the young and middle-aged groups was compared by using multiway analysis of variance, respectively. RESULTS During the supine to the upright posture, vertebral rotation of the L1-S1 occurred mainly around the mediolateral axis (mean: 3.9 ± 2.9°). Along the mediolateral axis, vertebral translation was significantly lower at L1-2 (7.7 ± 2.4 mm) and L2-3 (8.0 ± 3.5 mm) than at L3-4 (1.6 ± 1.2 mm), L4-5 (3.3 ± 2.6 mm), and L5-S1 (2.6 ± 1.9 mm). At the L4-5 level, the young group had a higher rotational ROM than the middle-aged group around all three axes during left-right bending. Along the anteroposterior axis, the young group had a lower translational ROM at L4-5 than the middle-aged group during left-right bending (4.6 ± 3.3 vs. 7.6 ± 4.8 mm; P < 0.05). At L5-S1, the young group had a lower translational ROM than the middle-aged group during flexion-extension, left-right bending, and left-right torsion. CONCLUSION This study explored the lumbar vertebral ROM at L1-S1 during different functional postures in both young and middle-aged volunteers. There were higher coupled translations at L3-4 and L4-5 than at the upper lumbar segments during supine to upright. The vertebral rotation decreased with age. In addition, the older subjects had a higher anteroposterior translation at the L4-5 segment and higher mediolateral translation at the L5-S1 segment than the young group. These data might provide basic data to be compared with spinal pathology.
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Affiliation(s)
- Fei Xu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Peking University Health Science Center, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Siyu Zhou
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuofu Li
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Peking University Health Science Center, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Shuai Jiang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Ze Chen
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Peking University Health Science Center, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuoran Sun
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Weishi Li
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China,Correspondence: Weishi Li
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10
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Guidetti M, Malloy P, Alter TD, Newhouse AC, Espinoza Orías AA, Inoue N, Nho SJ. MRI-- and CT--based metrics for the quantification of arthroscopic bone resections in femoroacetabular impingement syndrome. J Orthop Res 2022; 40:1174-1181. [PMID: 34192370 DOI: 10.1002/jor.25139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
The purpose of this in vitro study was to quantify the bone resected from the proximal femur during hip arthroscopy using metrics generated from magnetic resonance imaging (MRI) and computed tomography (CT) reconstructed three-dimensional (3D) bone models. Seven cadaveric hemi-pelvises underwent both a 1.5 T MRI and CT scan before and following an arthroscopic proximal femoral osteochondroplasty. The images from MRI and CT were segmented to generate 3D proximal femoral surface models. A validated 3D--3D registration method was used to compare surface--to--surface distances between the 3D models before and following surgery. The new metrics of maximum height, mean height, surface area and volume, were computed to quantify bone resected during osteochondroplasty. Stability of the metrics across imaging modalities was established through paired sample t--tests and bivariate correlation. Bivariate correlation analyses indicated strong correlations between all metrics (r = 0.728--0.878) computed from MRI and CT derived models. There were no differences in the MRI- and CT-based metrics used to quantify bone resected during femoral osteochondroplasty. Preoperative- and postoperative MRI and CT derived 3D bone models can be used to quantify bone resected during femoral osteochondroplasty, without significant differences between the imaging modalities.
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Affiliation(s)
- Martina Guidetti
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA.,Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander C Newhouse
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Alejandro A Espinoza Orías
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Nozomu Inoue
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
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Kaneda K, Harato K, Oki S, Yamada Y, Nakamura M, Nagura T, Jinzaki M. Increase in tibial internal rotation due to weight-bearing is a key feature to diagnose early-stage knee osteoarthritis: a study with upright computed tomography. BMC Musculoskelet Disord 2022; 23:253. [PMID: 35291984 PMCID: PMC8925230 DOI: 10.1186/s12891-022-05190-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background The classification of knee osteoarthritis is an essential clinical issue, particularly in terms of diagnosing early knee osteoarthritis. However, the evaluation of three-dimensional limb alignment on two-dimensional radiographs is limited. This study evaluated the three-dimensional changes induced by weight-bearing in the alignments of lower limbs at various stages of knee osteoarthritis. Methods Forty five knees of 25 patients (69.9 ± 8.9 years) with knee OA were examined in the study. CT images of the entire leg were obtained in the supine and standing positions using conventional CT and 320-row detector upright CT, respectively. Next, the differences in the three-dimensional alignment of the entire leg in the supine and standing positions were obtained using 3D-3D surface registration technique, and those were compared for each Kellgren–Lawrence grade. Results Greater flexion, adduction, and tibial internal rotation were observed in the standing position, as opposed to the supine position. Kellgren–Lawrence grades 1 and 4 showed significant differences in flexion, adduction, and tibial internal rotation between two postures. Grades 2 and 4 showed significant differences in adduction, while grades 1 and 2, and 1 and 3 showed significant differences in tibial internal rotation between standing and supine positions. Conclusions Weight-bearing makes greater the three-dimensional deformities in knees with osteoarthritis. Particularly, greater tibial internal rotation was observed in patients with grades 2 and 3 compared to those with grade 1. The greater tibial internal rotation due to weight-bearing is a key pathologic feature to detect early osteoarthritic change in knees undergoing osteoarthritis.
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Affiliation(s)
- Kazuya Kaneda
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kengo Harato
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
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12
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Four-dimensional computed tomography evaluation of shoulder joint motion in collegiate baseball pitchers. Sci Rep 2022; 12:3231. [PMID: 35217693 PMCID: PMC8881615 DOI: 10.1038/s41598-022-06464-5] [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: 06/22/2021] [Accepted: 01/24/2022] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study is to evaluate the glenohumeral contact area, center of glenohumeral contact area, and center of humeral head during simulated pitching motion in collegiate baseball pitchers using four-dimensional computed tomography (4D CT). We obtained 4D CT data from the dominant and non-dominant shoulders of eight collegiate baseball pitchers during the cocking motion. CT image data of each joint were reconstructed using a 3D reconstruction software package. The glenohumeral contact area, center of glenohumeral contact area, center of humeral head, and oblateness of humeral head were calculated from 3D bone models using customized software. The center of glenohumeral contact area translated from anterior to posterior during maximum external rotation to maximum internal rotation (0.58 ± 0.63 mm on the dominant side and 0.99 ± 0.82 mm on the non-dominant side). The center of humeral head translated from posterior to anterior during maximum external rotation to maximum internal rotation (0.76 ± 0.75 mm on the dominant side and 1.21 ± 0.78 mm on the non-dominant side). The increase in anterior translation of the center of glenohumeral contact area was associated with the increase in posterior translation of the center of humeral head. Also, the increase in translation of the center of humeral head and glenohumeral contact area were associated with the increase in oblateness of the humeral head. 4D CT analyses demonstrated that the center of humeral head translated in the opposite direction to that of the center of glenohumeral contact area during external rotation to internal rotation in abduction in the dominant and non-dominant shoulders. The oblateness of the humeral head may cause this diametric translation. 4D CT scanning and the software for bone surface modeling of the glenohumeral joint enabled quantitative assessment of glenohumeral micromotion and be used for kinematic evaluation of throwing athletes.
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13
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Lindenmann S, Tsagkaris C, Farshad M, Widmer J. Kinematics of the Cervical Spine Under Healthy and Degenerative Conditions: A Systematic Review. Ann Biomed Eng 2022; 50:1705-1733. [PMID: 36496482 PMCID: PMC9794546 DOI: 10.1007/s10439-022-03088-8] [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: 06/15/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
Knowledge of spinal kinematics is essential for the diagnosis and management of spinal diseases. Distinguishing between physiological and pathological motion patterns can help diagnose these diseases, plan surgical interventions and improve relevant tools and software. During the last decades, numerous studies based on diverse methodologies attempted to elucidate spinal mobility in different planes of motion. The authors aimed to summarize and compare the evidence about cervical spine kinematics under healthy and degenerative conditions. This includes an illustrated description of the spectrum of physiological cervical spine kinematics, followed by a comparable presentation of kinematics of the degenerative cervical spine. Data was obtained through a systematic MEDLINE search including studies on angular/translational segmental motion contribution, range of motion, coupling and center of rotation. As far as the degenerative conditions are concerned, kinematic data regarding disc degeneration and spondylolisthesis were available. Although the majority of the studies identified repeating motion patterns for most motion planes, discrepancies associated with limited sample sizes and different imaging techniques and/or spine configurations, were noted. Among healthy/asymptomatic individuals, flexion extension (FE) and lateral bending (LB) are mainly facilitated by the subaxial cervical spine. C4-C5 and C5-C6 were the major FE contributors in the reported studies, exceeding the motion contribution of sub-adjacent segments. Axial rotation (AR) greatly depends on C1-C2. FE range of motion (ROM) is distributed between the atlantoaxial and subaxial segments, while AR ROM stems mainly from the former and LB ROM from the latter. In coupled motion rotation is quantitatively predominant over translation. Motion migrates caudally from C1-C2 and the center of rotation (COR) translocates anteriorly and superiorly for each successive subaxial segment. In degenerative settings, concurrent or subsequent lesions render the association between diseases and mobility alterations challenging. The affected segments seem to maintain translational and angular motion in early and moderate degeneration. However, the progression of degeneration restrains mobility, which seems to be maintained or compensated by adjacent non-affected segments. While the kinematics of the healthy cervical spine have been addressed by multiple studies, the entire nosological and kinematic spectrum of cervical spine degeneration is partially addressed. Large-scale in vivo studies can complement the existing evidence, cover the gaps and pave the way to technological and clinical breakthroughs.
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Affiliation(s)
- Sara Lindenmann
- Spine Biomechanics, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Christos Tsagkaris
- Spine Biomechanics, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland ,Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Mazda Farshad
- Spine Biomechanics, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Jonas Widmer
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
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14
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Zehr JD, Callaghan JP. Reaction Forces and Flexion-Extension Moments Imposed On Functional Spinal Units with Constrained and Unconstrained in Vitro Testing Systems. J Biomech Eng 2021; 144:1129241. [PMID: 34897374 DOI: 10.1115/1.4053208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 11/08/2022]
Abstract
A mechanical goal of in vitro testing systems is to minimize differences between applied and actual forces and moments experienced by spinal units. This study quantified the joint reaction forces and reaction flexion-extension moments during dynamic compression loading imposed throughout the physiological flexion-extension range-of-motion. Constrained (fixed base) and unconstrained (floating base) testing systems were compared. Sixteen porcine spinal units were assigned to both testing groups. Following conditioning tests, specimens were dynamically loaded for 1 cycle with a 1 Hz compression waveform to a peak load of 1 kN and 2 kN while positioned in five different postures (neutral, 100% and 300% of the flexion and extension neutral zone), totalling ten trials per FSU. A six degree-of-freedom force and torque sensor was used to measure peak reaction forces and moments for each trial. Shear reaction forces were significantly greater (25.5 N - 85.7 N) when the testing system was constrained compared to unconstrained (p < 0.029). The reaction moment was influenced by posture (p = 0.037), particularly in C5C6 spinal units. In 300% extension (C5C6), the reaction moment was, on average, 9.9 Nm greater than the applied moment in both testing systems and differed from all other postures (p < 0.001). The reaction moment error was, on average, 0.45 Nm at all other postures. In conclusion, these findings demonstrate that comparable reaction moments can be achieved with unconstrained systems, but without inducing appreciable shear reaction forces.
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Affiliation(s)
- Jackie D Zehr
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Jack P Callaghan
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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15
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Alter TD, Malloy P, Newhouse AC, Suppauksorn S, Orias AE, Chahla J, Inoue N, Nho SJ. Three-Dimensional Measures of Bony Resection During Femoral Osteochondroplasty Are Related to Alpha Angle Measures: A Cadaveric Study. Arthrosc Sports Med Rehabil 2021; 3:e1857-e1863. [PMID: 34977641 PMCID: PMC8689252 DOI: 10.1016/j.asmr.2021.08.016] [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: 03/22/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Methods Results Conclusions Clinical Relevance
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Affiliation(s)
- Thomas D. Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
- Address correspondence to Thomas Alter, 1611 W Harrison St, Chicago, IL 60612.
| | - Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
- Department of Physical Therapy, Arcadia University, Pennsylvania, U.S.A
| | - Alex C. Newhouse
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Sunikom Suppauksorn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Alejandro Espinzoa Orias
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Nozomu Inoue
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Shane J. Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
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Dugailly PM, Dethier C, Salem W. Immediate alteration of the lumbar intervertebral foramen during the so-called osteopathic locking technique: A preliminary analysis on healthy subjects. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Keylock L, Felton P, Alway P, Brooke-Wavell K, Peirce N, King M. Lumbar Bone Mineral Adaptation: The Effect of Fast Bowling Technique in Adolescent Cricketers. Med Sci Sports Exerc 2021; 54:438-446. [PMID: 34711706 DOI: 10.1249/mss.0000000000002820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Localised bone mineral density (BMD) adaptation of the lumbar spine, particularly on the contralateral side to the bowling arm, has been observed in elite male cricket fast bowlers. No study has investigated this in adolescents, or the role of fast bowling technique on lumbar BMD adaptation. This study aims to investigate lumbar BMD adaptation in adolescent cricket fast bowlers, and its relationship with fast bowling technique. METHODS 39 adolescent fast bowlers underwent antero-posterior DXA scan of their lumbar spine. Hip, lumbopelvic and thoracolumbar joint kinematics, and vertical ground reaction kinetics were determined using 3D motion capture and force plates. Significant partial (covariate: fat free mass) and bivariate correlations of the technique parameters with whole lumbar (L1-L4) BMD and BMD asymmetry (L3 and L4) were advanced as candidate variables for multiple stepwise linear regression. RESULTS Adolescent fast bowlers demonstrated high lumbar Z-Scores (+1.0; 95%CI: 0.7 - 1.4) and significantly greater BMD on the contralateral side of L3 (9.0%; 95%CI: 5.8 - 12.1%) and L4 (8.2%; 95%CI: 4.9 - 11.5%). Maximum contralateral thoracolumbar rotation and maximum ipsilateral lumbopelvic rotation in the period between back foot contact (BFC) and ball release (BR), as well as contralateral pelvic drop at front foot contact (FFC), were identified as predictors of L1-L4 BMD, explaining 65% of the variation. Maximum ipsilateral lumbopelvic rotation between BFC and BR, as well as ipsilateral lumbopelvic rotation and contralateral thoracolumbar side flexion at BR, were predictors of lumbar asymmetry within L3 and L4. CONCLUSION Thoracolumbar and lumbopelvic motion are implicated in the aetiology of the unique lumbar bone adaptation observed in fast bowlers whereas vertical ground reaction force, independent of body mass, was not. This may further implicate the osteogenic potential of torsional rather than impact loading in exercise-induced adaptation.
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Affiliation(s)
- Laura Keylock
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom Department of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom National Cricket Performance Centre, England and Wales Cricket Board, Loughborough, United Kingdom
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18
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Zhang YJ, Long X, Du JY, Liu T, Lin XJ. Effect of soft inflatable orthosis on the medial longitudinal arch in patients with flexible flatfoot deformity. Clin Biomech (Bristol, Avon) 2021; 88:105418. [PMID: 34216988 DOI: 10.1016/j.clinbiomech.2021.105418] [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: 02/22/2021] [Revised: 05/21/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Orthoses can stabilize the foot and restore the medial longitudinal arch for symptomatic flexible flatfoot. However, the effectiveness of orthoses remains controversial. The purpose of this study was to evaluate effectiveness of a customized soft inflatable orthosis on the medial longitudinal arch of flexible flatfoot patients under load. METHODS We obtained CT scans of the feet of 14 healthy volunteers and 14 patients with flexible flatfoot under non- and simulated weight-bearing conditions. Then CT scans under the same conditions were taken for patients with flexible flatfoot equipped with soft inflatable orthosis. Three-dimensional models of the medial longitudinal arch and hindfoot were constructed from CT images. The three-dimensional mobility of the medial longitudinal arch joints under load was compared between patients with flexible flatfoot equipped with soft inflatable orthosis or not. FINDINGS From non- to simulated weight-bearing condition, the eversion and dorsiflexion of the talocalcaneal joint, the eversion of the talonavicular joint, the abduction and dorsiflexion of the cuneonavicular joint, and the dorsiflexion of the first tarsometatarsal joint were significantly larger in patients with flexible flatfoot than healthy volunteers. The customized soft inflatable orthosis could reduce the eversion of the talonavicular joint and the eversion and dorsiflexion of the talocalcaneal joint. INTERPRETATION The soft inflatable orthosis is effective to improve medial longitudinal arch height and reduce excessive mobility of joints for flexible flatfoot deformity. The results of this study could provide evidence for the optimal orthosis design to treat flexible flatfoot in the future.
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Affiliation(s)
- Yi-Jun Zhang
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, PR China.
| | - Xiao Long
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, PR China
| | - Jing-Yu Du
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, PR China
| | - Tao Liu
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University School of Mechanical Engineering, Hangzhou 310027, PR China.
| | - Xiang-Jin Lin
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, PR China
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19
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The relationship between external thoracopelvic angle and lumbar segmental axial twist angle using an ultrasound imaging technique. Hum Mov Sci 2021; 78:102824. [PMID: 34062363 DOI: 10.1016/j.humov.2021.102824] [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: 03/25/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/21/2022]
Abstract
The relationship between externally measured and internal spine axial twist motion (rotation about a vertical axis) is not well understood. Ultrasound is a validated technique for measurement of vertebral axial twist motion and has the potential for measuring segmental vertebral axial twist in vivo. The objective of this study was to evaluate lumbar segmental axial twist in relation to external thoracopelvic twist from optical motion capture using an ultrasound imaging technique. Sixteen participants were tested in a custom-built axial twist jig, which isolated motion to the lumbar spine. Participants were moved from neutral to 75% of maximum axial twist range of motion in an upright kneeling posture. Thoracopelvic motion was recorded with a motion capture system and L1 to S1 vertebral axial twist was recorded using ultrasound. From motion capture, maximum thoracopelvic axial twist motion was 41.1 degrees. From ultrasound, the majority of axial twist motion occurred at the L2-L3 (46.8% of lumbar axial twist motion) and L5-S1 (33.5%) intervertebral joints. Linear regression linking axial twist at each vertebral level to thoracopelvic axial twist ranged from 0.43 to 0.79. These findings demonstrate a mathematical relationship between internal and external axial twist motion and the distribution of motion across the lumbar spine suggests that classic use of L4-L5 to represent lumbar spine motion may not be appropriate for axial twist modelling approaches.
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20
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Fusini F, Pizones J, Moreno-Manzanaro L, Sánchez Márquez JM, Talavera G, Fernández-Baíllo N, Sánchez Pérez-Grueso FJ. How to Select the Lower Instrumented Vertebra in Traditional Growing Rods Index Surgery. Int J Spine Surg 2021; 15:577-584. [PMID: 33963029 DOI: 10.14444/8078] [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] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There are still no consensus criteria on how to select the lower instrumented vertebra (LIV) for traditional growing rods (TGRs) at index surgery. The aim was to evaluate whether the criteria used for adolescent idiopathic scoliosis fusion adapts to early onset scoliosis (EOS). METHODS Retrospective analysis of prospectively longitudinal collected data in a consecutive cohort of patients with EOS treated with TGR, expanding from index surgery to 2 years after graduation. The LIV was analyzed regarding its relation to the stable vertebra (SV), substantially touched vertebra (STV), and not STV (NSTV). Failure of LIV selection was considered when revision surgery with distal extension was needed during follow up, due to adding on (ΔLIV tilt > 10°). RESULTS A total of 25 patients met inclusion criteria. Mean age was 8.6 ± 3 (at index surgery), 15.1 ± 1.8 (at graduation), and 17.8 ± 1.6 (at final follow up). The most frequent LIV at index surgery was L3 (13/25); in 13 cases, STV was selected as LIV; in 7, it was NSTV; and in 5, SV on the standard postero-anterior radiographs. During follow up, a significant increase in the mean LIV tilt (P = .049) and distal junctional angle (P = .017) was found. Nine of the 25 patients (36%) developed adding on: 20% (1/5) of those with LIV at SV, 38.5% (5/13) at STV, and 42.8% (3/7) at NSTV. Of those 9 cases of adding on, only four needed distal extension (mean LIV tilt = 17.6°): 2 STV patients (15.4%), and 2 NSTV patients (28.6%). None of the patients with the LIV chosen at SV needed distal extension due to adding on. CONCLUSIONS The more cranial the selection of the LIV above the SV, the higher the risk of adding on and of revision surgery with distal extension during follow up. Saving motion segments could be justified by choosing STV as LIV because the need for distal extension is not high, and it can be scheduled during lengthening procedures or at graduation surgery. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE Choosing the correct LIV in TGR index surgery is crucial to have a secure distal foundation, control and correct the deformity during growth, and save distal segments to allow growth and mobility.
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Affiliation(s)
- Federico Fusini
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | - Gloria Talavera
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
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21
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Lenz AL, Strobel MA, Anderson AM, Fial AV, MacWilliams BA, Krzak JJ, Kruger KM. Assignment of local coordinate systems and methods to calculate tibiotalar and subtalar kinematics: A systematic review. J Biomech 2021; 120:110344. [PMID: 33744722 DOI: 10.1016/j.jbiomech.2021.110344] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022]
Abstract
The introduction of biplane fluoroscopy has created the ability to evaluate in vivo motion, enabling six degree-of-freedom measurement of the tibiotalar and subtalar joints. Although the International Society of Biomechanics defines a standard method of assigning local coordinate systems for the ankle joint complex, standards for the tibiotalar and subtalar joints are lacking. The objective of this systematic review was to summarize and appraise the existing literature that (1) defined coordinate systems for the tibia, talus, and/or calcaneus or (2) assigned kinematic definitions for the tibiotalar and/or subtalar joints. A systematic literature search was developed with search results limited to English Language from 2006 through 2020. Articles were screened by two independent reviewers based on title and abstract. Methodological quality was evaluated using a modified assessment tool. Following screening, 52 articles were identified as having met inclusion criteria. Methodological assessment of these articles varied in quality from 61 to 97. Included articles adopted primary methods for defining coordinate systems that included: (1) anatomical coordinate system (ACS) based on individual bone landmarks and/or geometric shapes, (2) orthogonal principal axes, and (3) interactive closest point (ICP) registration. Common methods for calculating kinematics included: (1) joint coordinate system (JCS) to calculate rotation and translation, (2) Cardan/Euler sequences, and (3) inclination and deviation angles for helical angles. The methods each have strengths and weaknesses. This summarized knowledge should provide the basis for the foot and ankle biomechanics community to create an accepted standard for calculating and reporting tibiotalar and subtalar kinematics.
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Affiliation(s)
- Amy L Lenz
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, United States
| | - Marisa A Strobel
- Department of Biomedical Engineering, Marquette University, 1515 W Wisconsin Ave, Milwaukee, WI 53233, United States
| | - Abigail M Anderson
- Department of Biomedical Engineering, Marquette University, 1515 W Wisconsin Ave, Milwaukee, WI 53233, United States
| | - Alissa V Fial
- Research & Instruction Services, Marquette University, 1355 W. Wisconsin Ave, Milwaukee, WI 53201, United States
| | - Bruce A MacWilliams
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, United States; Motion Analysis Center, Shriners Hospitals for Children-Salt Lake City, 1275 Fairfax Rd., Salt Lake City, UT 84103, United States
| | - Joseph J Krzak
- Physical Therapy Program, Midwestern University, 555 31st St., Downers Grove, IL 60515, United States; Motion Analysis Center, Shriners Hospitals for Children-Chicago, 2211 N Oak Park Ave, Chicago, IL 60707, United States
| | - Karen M Kruger
- Department of Biomedical Engineering, Marquette University, 1515 W Wisconsin Ave, Milwaukee, WI 53233, United States; Motion Analysis Center, Shriners Hospitals for Children-Chicago, 2211 N Oak Park Ave, Chicago, IL 60707, United States.
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22
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Akeda K, Cheng K, Abarado E, Takegami N, Yamada J, Inoue N, Masuda K, Sudo A. Three-dimensional computed tomographic evaluation of lateral lumbar interbody fusion: morphometric change of intervertebral structure. 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 2021; 30:1355-1364. [PMID: 33651180 DOI: 10.1007/s00586-021-06776-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Two-dimensional (2D) analyses of intervertebral disc (IVD) height and foramen measurements following lateral lumbar interbody fusion (LLIF) have been reported. However, three-dimensional (3D) morphometric analysis of intervertebral structure using 3D computed tomography (3D CT) provides increased precision for measuring morphological changes. The purpose of this study was to evaluate 3D changes of lumbar IVD height and foramen diameter in degenerative lumbar disease patients following LLIF. METHODS Subject-based 3D CT lumbar models were created for 26 patients before and following LLIF. IVD height (whole and five anatomical zones) and foramen diameter (minimum and maximum) were measured based on the model using custom software. The sagittal placement of cages (SPC) and cross-sectional area of the thecal sac (CSA) were measured. Changes in these parameters by LLIF were quantified and statistically analysed. RESULTS Following LLIF, disc height increased by an average of 2.9 mm (P < 0.01). Post-operative measurements of both minimum and maximum diameters of the foramen were significantly increased by 1.0 mm and 1.9 mm, respectively (P < 0.01). Change in maximum foramen diameter was significantly correlated with change in disc height (P < 0.05). The SPC was significantly correlated with the changes in disc height and foraminal diameters (P < 0.05, respectively). No significant change between the change in disc height and CSA was found. CONCLUSION This preliminary study quantifies disc height and foramen diameter changes in 3D following LLIF. The presented data provide baseline intervertebral changes for future comparisons with follow-up studies and clinical outcomes. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
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Affiliation(s)
- Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan.
| | - Kevin Cheng
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Edward Abarado
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Junichi Yamada
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush Medical College, Chicago, IL, USA
| | - Koichi Masuda
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
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Quantitative analysis of metacarpophalangeal joints during active flexion using four-dimensional computed tomography. Clin Biomech (Bristol, Avon) 2020; 80:105188. [PMID: 33080527 DOI: 10.1016/j.clinbiomech.2020.105188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/27/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The metacarpophalangeal joint has a unique morphology with a high degree of freedom. However, few studies have analyzed the kinematics of fingers owing to the rapid movement of the small bones involved. The in-vivo kinematics of metacarpophalangeal joints were analyzed by four-dimensional computed tomography (4DCT) and associated with its morphology. METHODS The flexion motion of the fingers of bilateral hands in 10 volunteers were examined using 4DCT. Iterative surfaces were registered to trace the surface of the proximal phalanges with respect to metacarpals. Rotation angles were calculated using Euler/Cardan angles. FINDINGS In the index finger, the proximal phalange supinated to a maximum flexion of 40° and then pronated, and its range of rotation was larger than the previous reports. In the other fingers, the proximal phalanges continued to supinate during flexion. The helical axis of the proximal phalange passed a point extremely close to the center point of bilateral condyles, and it moved toward the proximal and palmar directions until the middle stage of flexion and toward the proximal and dorsal directions during the late stage of flexion. The translation of the rotation axis was larger in the ring and little fingers. INTERPRETATION The rotation in the index finger was larger than previously reported. The helical axes moved in the dorsal direction and proximally during the latter phase of the flexion. These results can be employed to better understand the causes of implant failure of the metacarpophalangeal joints.
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Malloy P, Gasienica J, Dawe R, Espinoza Orías AA, Nwachukwu BU, Inoue N, Yanke AB, Nho SJ. 1.5 T magnetic resonance imaging generates accurate 3D proximal femoral models: Surgical planning implications for femoroacetabular impingement. J Orthop Res 2020; 38:2050-2056. [PMID: 31976569 DOI: 10.1002/jor.24596] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/10/2019] [Accepted: 01/13/2020] [Indexed: 02/04/2023]
Abstract
The objective of this study was to validate three-dimensional (3D) proximal femoral surface models generated from a 1.5 T magnetic resonance imaging (MRI) by comparing these 3D models to those derived from the clinical "gold standard" of computed tomography (CT) scan and to ground-truth surface models obtained by laser scans (LSs) of the excised femurs. Four intact bilateral cadaveric pelvis specimens underwent CT and MRI scans and 3D surface models were generated. Six femurs were extracted from these specimens, and the overlying soft tissues were removed. The extracted femurs were then laser scanned to produce a ground-truth surface model. A 3D-3D registration method was used to compare the signed and absolute surface-to-surface distances between the 3D models. Absolute agreement was evaluated using a 95% confidence interval (CI) derived from the precision of the LS ground-truth. Paired samples t tests and Kolmogrov-Smirnov tests were performed to compare the differences between the signed and absolute surface-to-surface distances between the models. The average signed surface-to-surface distances for the MRI vs LS and MRI vs CT models were 0.07 and 0.16 mm, respectively. These differences fell within the 95% CI of ±0.20 mm indicating absolute agreement between the surface models generated from these modalities. The signed surface-to-surface distance was significantly smaller for MRI vs LS ground truth model as compared with the CT vs LS model. Femoral models derived from a 1.5 T MRI scan demonstrated absolute agreement with the clinical gold standard of CT-derived models and were most like LS ground truth models of the excised femurs.
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Affiliation(s)
- Philip Malloy
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.,Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania
| | - Jacob Gasienica
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Robert Dawe
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | | | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Adam B Yanke
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Yin J, Liu Z, Li C, Luo S, Lai Q, Wang S, Zhang B, Wan Z. Effect of facet-joint degeneration on the in vivo motion of the lower lumbar spine. J Orthop Surg Res 2020; 15:340. [PMID: 32819395 PMCID: PMC7439653 DOI: 10.1186/s13018-020-01826-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
Objective This research studied the in vivo motion characteristics of the L3–S1 lumbar spine with facet-joint degeneration during functional activities. Methods Thirteen male and 21 female patients with facet-joint degeneration at the L3–S1 spinal region were included in the study. The L3–S1 lumbar segments of all the patients were divided into 3 groups according to the degree of facet-joints degeneration (mild, moderate, or severe). The ranges of motion (ROM) of the vertebrae were analyzed using a combination of computed tomography and dual fluoroscopic imaging techniques. During functional postures, the ROMs were compared between the 3 groups at each spinal level (L3–L4, L4–L5, and L5–S1). Results At L3–L4 level, the primary rotations between the mild and moderate groups during left-right twisting activity were significantly different. At L4–L5 level, the primary rotation of the moderate group was significantly higher than the other groups during flexion-extension. During left-right bending activities, a significant difference was observed only between the moderate and severe groups. At L5–S1 level, the rotation of the moderate group was significantly higher than the mild group during left-right bending activity. Conclusions Degeneration of the facet joint alters the ROMs of the lumbar spine. As the degree of facet-joint degeneration increased, the ROMs of the lumbar vertebra that had initially increased declined. However, when there was severe facet-joint degeneration, the ROMs of the lumbar spine declined to levels comparative to the moderate group. The relationship between the stability of the lumbar vertebra and the degree of facet-joint degeneration requires further study.
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Affiliation(s)
- Jun Yin
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, Jiangxi, 330006, PR China
| | - Zhang Liu
- Science and Technology Office, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Chao Li
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, Jiangxi, 330006, PR China
| | - Shiwei Luo
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, Jiangxi, 330006, PR China
| | - Qi Lai
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, Jiangxi, 330006, PR China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Bin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, Jiangxi, 330006, PR China
| | - Zongmiao Wan
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, Jiangxi, 330006, PR China.
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Dang L, Zhu J, Liu Z, Liu X, Jiang L, Wei F, Song C. A new approach to the treatment of spinal instability: Fusion or structural reinforcement without surgery? Med Hypotheses 2020; 144:109900. [PMID: 32562916 DOI: 10.1016/j.mehy.2020.109900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023]
Abstract
Spinal instability related low back pain is a common condition resulting from degeneration and loss of stiffness of the intervertebral joint. In order to restore stability, highly invasive surgical fusion is needed for patients who are not responding to conservative treatment. Given the risk and complications of surgery, there has been the urge for improvement with a less invasive solution. Formation of vertebral body osteophytes is a common observation that has been treated as a degenerative condition. However, recent studies have associated it with reduced motion of spinal segments. Unlike the traditional view, we regard it as adaptive reactions aiming to repair and hypothesize that the spinal segments could be stabilized or fused by intentionally induced osteophytes growth at the mobile parts of the intervertebral joint. This could be achieved by injecting Bone Morphogenetic Proteins to the anterior ends of the vertebral bodies and/or the facet joints on both sides of two consecutive vertebrae percutaneously. If verified, it would be the first time that fusion could be achieved without surgery. Hence it would provide a valuable alternative to current treatments of spinal instability. Preliminary test in favor of this hypothesis is presented and we recommend that a formal study with sufficient number of samples is needed for verification.
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Affiliation(s)
- Lei Dang
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Jinglin Zhu
- Department of Orthopedics, Beijing Shijitan Hospital, No. 10 Tieyi Rd., Yangfangdian Subdistrict, Haidian District, Beijing, PR China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Liang Jiang
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Feng Wei
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Chunli Song
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China.
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New classification of facet joint synovial cysts. Acta Neurochir (Wien) 2020; 162:929-936. [PMID: 32086604 DOI: 10.1007/s00701-020-04264-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/10/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE Facet cysts develop due to degeneration of the zygapophyseal joints and can lead to radiculopathy and neurogenic claudication. Various surgical options are available for facet cyst excision. The aim was to facilitate surgical treatment of lumbar facet cysts based on a new classification. METHODS We retrospectively analyzed all patients of the last 10 years in whom a facet cyst was surgically removed (ipsilateral laminotomy, contralateral laminotomy, and segmental fusion). Several radiological parameters were analyzed and correlated with the patients' outcome (residual symptoms, perioperative complications, need for re-operation, need for secondary fusion, facet cyst recurrence). RESULTS One hundred eleven patients (55 women; median age 64 years) could be identified. Thirty-three (48%) of 69 cases, for which MRI data were available, were classified as medial facet cyst (compressing the spinal canal), 6 facet cysts were localized intraforaminal (9%) and 30 cases (43%) mediolateral (combination of both). The contralateral approach had the lowest rate for revision surgery (7.5%, p = .038) and the lowest prevalence of residual complaints (7.5%, p = .109). A spondylolisthesis and a higher/steeper angle of the facet joints were associated with poorer patient outcome. CONCLUSIONS Lateral facet joint cysts are best resected by a contralateral approach offering the best outcome while medial cysts are suitable for removal by an ipsilateral laminotomy. The approach of mediolateral cysts can be determined by the width of the lamina and the angle of the joint. Segmental fusion should be considered in cases with detected spondylolisthesis and/or steep facet joints.
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Cvetanovich GL, Beck EC, Chalmers PN, Espinoza Orías AA, Stover MD, Inoue N, Nho SJ. Assessment of Hip Translation In Vivo in Patients With Femoracetabular Impingement Syndrome Using 3-Dimensional Computed Tomography. Arthrosc Sports Med Rehabil 2020; 2:e113-e120. [PMID: 32368747 PMCID: PMC7190544 DOI: 10.1016/j.asmr.2019.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/12/2019] [Indexed: 11/04/2022] Open
Abstract
Purpose To determine the 3-dimensional (3D) in vivo hip translation in patients with symptomatic femoroacetabular impingement syndrome (FAIS) using 3D computed tomography (CT) models with the hip in neutral and FABER (flexion, abduction, and the external rotation) positions and to identify patient predictors associated with the degree of hip translation. Methods Seventy-eight patients with FAIS and cam lesions underwent CT scans in neutral and FABER positions. Demographics including age, sex, and body mass index (BMI) were recorded for each patient. The cam deformity was characterized both in plain x-ray film and 3D. Translation between both positions was calculated using a validated high-precision 3D-3D registration technique. Univariate and multivariate regression analyses sought factors correlated with translation. Results The mean age of the patients included in the analysis was 36.3 ± 9.2 years, with 51% of the study group being female. The mean 3D femoral head center translation was 0.84 ± 0.37 mm, decomposed into vectors on standard anatomical directions as 0.13 ± 0.58 mm medial, 0.10 ± 0.54 mm posterior, and 0.08 ± 0.46 mm inferior. Multivariate analysis demonstrated that total translation was associated with larger alpha angles (β = 0.014; 95% confidence interval [CI] 0.003-0.024; P = .013), and greater BMI (β = 0.033; 95% CI 0.001-0.065; P = .042). Furthermore, posterior–inferior translation was associated with BMI (β = 0.032; 95% CI 0.003-0.061; P = .031), whereas medial–lateral translation is associated with the female sex (β = 0.388; 95% CI 0.124-0.634; P = .002), and smaller head radius (β = –0.068; 95% CI –0.128 to –0.007; P = .029). Conclusions As a provocative maneuver, FABER positioning in patients with FAIS resulted in an average measurable translation of the femoral head center in the posterior, medial, and inferior direction. Factors including sex, BMI, and alpha angle predicted the degree of translation. Clinical Relevance The current study demonstrates that there is measurable hip translation between the neutral and FABER positions in patients with symptomatic FAIS, which may cause hip microinstability. Furthermore, the study found an association between hip translation and both modifiable and nonmodifiable factors. This may indicate the need for more comprehensive preoperative surgical planning, intraoperative dynamic examination of the hip, and consideration of capsular plication in certain patients.
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Affiliation(s)
- Gregory L Cvetanovich
- Department of Orthopedic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Edward C Beck
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Peter N Chalmers
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | | | - Michael D Stover
- Department of Orthopedic Surgery, Northwestern University Medical Center, Chicago, Illinois, U.S.A
| | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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McKinnon CD, Callaghan JP. The effect of axial twist angle on in vitro cumulative injury load tolerance: a magnitude-weighting approach for axial twist exposures. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2019. [DOI: 10.1080/1463922x.2019.1696422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Jack P. Callaghan
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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Zhang YJ, Du JY, Chen B, Jin RL, Hu JG, Lin XJ. Correlation between three-dimensional medial longitudinal arch joint complex mobility and medial arch angle in stage II posterior tibial tendon dysfunction. Foot Ankle Surg 2019; 25:721-726. [PMID: 30321919 DOI: 10.1016/j.fas.2018.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/26/2018] [Accepted: 08/22/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate correlation between three-dimensional medial longitudinal arch joint complex mobility and medial arch angle in stage II posterior tibial tendon dysfunction flatfoot under loading. METHODS CT scans of 15 healthy feet and 15 feet with stage II posterior tibial tendon dysfunction flatfoot were taken both in non- and simulated weight-bearing condition. The CT images of the hindfoot and medial longitudinal arch bones were reconstructed into three-dimensional models with Mimics and Geomagic reverse engineering software. The three-dimensional complex mobility of each joint in the medial longitudinal arch and their correlation with the medial arch angle change were calculated. RESULTS From non- to simulated weight-bearing condition, the medial arch angle change and the medial longitudinal arch joints mobility were significant larger in stage II posterior tibial tendon dysfunction flatfoot (p<0.05). The eversion of the talocalcaneal joint, the proximal translation of the calcaneus relative to the talus, the dorsiflexion of the talonavicular joint, the dorsiflexion and abduction of the medial cuneonavicular joint, and the lateral translation of the medial cuneiform relative to the navicular, and the dorsiflexion of the first tarsometatarsal joint were all significantly correlated to the medial arch angle change in stage II posterior tibial tendon dysfunction flatfoot (all r>0.5, p<0.05). CONCLUSIONS There is increased mobility in the medial longitudinal arch joints in stage II posterior tibial tendon dysfunction flatfoot and the medial arch angle change under loading causes displacement not only at hindfoot joints but also involve midfoot and forefoot joint.
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Affiliation(s)
- Yi-Jun Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
| | - Jing-Yu Du
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
| | - Bin Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
| | - Ri-Long Jin
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
| | - Jin-Gen Hu
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
| | - Xiang-Jin Lin
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
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Three-dimensional kinematic change of hindfoot during full weightbearing in standing: an analysis using upright computed tomography and 3D-3D surface registration. J Orthop Surg Res 2019; 14:355. [PMID: 31711523 PMCID: PMC6849314 DOI: 10.1186/s13018-019-1443-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023] Open
Abstract
Background Weightbearing of the hindfoot affects positional changes of the ankle joint and subtalar joint (ankle-joint complex [AJC]). However, it is difficult to assess the kinematic changes in the hindfoot in a natural full weightbearing condition using conventional CT or cone beam computed tomography (CT) due to limitations of acquiring foot images under a physiological weightbearing condition using those imaging modalities. Analysis of AJC kinematics using fluoroscopy and 2D-3D registration technique requires data on the number of steps and amount of time to build and match the bones. This study aimed to analyze the effect of full weightbearing on hindfoot motion when standing using upright CT and 3D-3D surface registration. Methods Forty-eight AJCs of 24 asymptomatic volunteers (13 women, 11 men) were examined under no weightbearing, 50% weightbearing, and single leg full weightbearing conditions while standing. The CT images were acquired from the distal femur to the whole foot using a 320-row upright CT scanner. The condition of each weightbearing stance was measured using a pressure mat. Bone-to-bone rotations of the talus relative to the tibia and calcaneus relative to the talus were evaluated using the surface registration technique. Image quality of the CT and intra- and interobserver reliabilities of the rotation angle were also evaluated. Results All CT images were excellent or good quality and the intra- and interobserver correlation coefficients for the angle were 0.996 and 0.995, respectively. The motion of the ankle joint and subtalar joint under 50% and 100% weightbearing were as follows (in degrees); the talus plantarflexed (5.1 ± 4.5 and 6.8 ± 4.8), inverted (1.3 ± 1.4 and 2.0 ± 1.6), and internally rotated (2.4 ± 4.2 and 4.3 ± 4.6) relative to the tibia, and the calcaneus dorsiflexed (2.8 ± 1.4 and 3.8 ± 1.7), everted (5.3 ± 2.6 and 8.0 ± 3.6), and externally rotated (3.0 ± 2.0 and 4.1 ± 2.4) relative to the talus, respectively. Conclusions The effect of weightbearing was clearly identified using an upright CT and the 3D-3D registration technique. Three-dimensional kinematics under static full weightbearing were opposite between the ankle and subtalar joints on their respective axes.
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Claassen L, Luedtke P, Yao D, Ettinger S, Daniilidis K, Nowakowski AM, Mueller-Gerbl M, Stukenborg-Colsman C, Plaass C. The geometrical axis of the talocrural joint-Suggestions for a new measurement of the talocrural joint axis. Foot Ankle Surg 2019; 25:371-377. [PMID: 30306891 DOI: 10.1016/j.fas.2018.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/04/2018] [Accepted: 02/02/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite intensive research there is no consensus about the talocrural joint axis. The aim of the present study is a new method to determinate the geometric rotational axis of the talocrural joint. METHODS We analyzed 98 CT-scans of full cadaver Caucasian legs. We generated three-dimensional reconstruction models of the talus. A best fitting cone was orientated to the talar articular surface. The geometric rotational axis was defined to be the axis of this cone. RESULTS The geometric rotational axis of the talocrural joint is orientated from lateral-distal to medial-proximal (85.6°±10 compared to anatomical tibial axis in torsional plane), from posterior-distal to anterior-proximal (81.43°±44.35 compared to anatomical tibial axis in sagittal plane) and from posterior-medial to anterior-lateral (169.2°±5.91 compared to intermalleolar axis in axial plane). CONCLUSIONS The consideration of our results might be helpful for better understanding of ankle biomechanics.
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Affiliation(s)
- Leif Claassen
- Orthopedic Department of the Hannover Medical School at DIAKOVERE Annastift, Germany.
| | - Philipp Luedtke
- Orthopedic Department of the Hannover Medical School at DIAKOVERE Annastift, Germany.
| | - Daiwei Yao
- Orthopedic Department of the Hannover Medical School at DIAKOVERE Annastift, Germany.
| | - Sarah Ettinger
- Orthopedic Department of the Hannover Medical School at DIAKOVERE Annastift, Germany.
| | | | | | | | | | - Christian Plaass
- Orthopedic Department of the Hannover Medical School at DIAKOVERE Annastift, Germany.
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Kinematics of the Spine Under Healthy and Degenerative Conditions: A Systematic Review. Ann Biomed Eng 2019; 47:1491-1522. [DOI: 10.1007/s10439-019-02252-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/21/2019] [Indexed: 01/05/2023]
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McKinnon CD, Callaghan JP. Validation of an Ultrasound Protocol to Measure Intervertebral Axial Twist during Functional Twisting Movements in Isolated Functional Spinal Units. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:642-649. [PMID: 30545788 DOI: 10.1016/j.ultrasmedbio.2018.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 07/13/2018] [Accepted: 10/19/2018] [Indexed: 06/09/2023]
Abstract
Ultrasound has potential for use in evaluation of bone and joint movement during axial twist of the lumbar spine both in vivo and in vitro. Such segmental rotations could then be measured under controlled external thoracic axial twist conditions and in response to mechanical loading. The purpose of this study was to measure vertebral segmental rotations in a porcine model of the human lumbar spine using an ultrasound imaging protocol and to validate use of this imaging technique with an optical motion capture system. In part 1, ultrasound transducer angle was confirmed to have no effect on sonogram point digitization. In part 2, 12 porcine functional spinal units were fixed to a mechanical testing system, and compression (15% of compressive tolerance), flexion-extension and axial twist (0°, 2°, 4° or 6°) were applied. Axial twist motion was tracked using an optical motion capture system and posterior surface ultrasound. Correlation between the two measurement systems was >0.903, and absolute system error was 0.01° across all flexion-extension postures. These findings indicate that ultrasound can be used to track axial twist motion in an in vitro spine motion segment and has the potential for use in vivo to evaluate absolute intervertebral axial twist motion.
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Affiliation(s)
- Colin D McKinnon
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Jack P Callaghan
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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Eskandari A, Arjmand N, Shirazi-Adl A, Farahmand F. Hypersensitivity of trunk biomechanical model predictions to errors in image-based kinematics when using fully displacement-control techniques. J Biomech 2019; 84:161-171. [DOI: 10.1016/j.jbiomech.2018.12.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/16/2018] [Accepted: 12/28/2018] [Indexed: 12/24/2022]
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Abstract
STUDY DESIGN This is a retrospective clinical case series (case-control study). OBJECTIVE To clarify the influence of facet joint osteoarthritis (FJOA) on the pathology of degenerative spondylolisthesis (DS) using in vivo 3-dimensional image analysis. SUMMARY OF BACKGROUND DATA There are no radical treatments to prevent progression of DS in patients with lumbar spinal canal stenosis associated with DS. Therefore, an effective treatment method based on the pathology of DS should be developed. PATIENTS AND METHODS In total, 50 patients with lumbar spinal canal stenosis involving L4/5 who underwent dynamic computed tomography were divided into 2 groups: with DS [spondylolisthesis (Sp) group; 12 male, 14 female; mean age, 74 y]; and without DS (non-Sp group; 15 male, 9 female; mean age, 70 y). Degeneration of the intervertebral disk and FJOA at L4/5 were evaluated using magnetic resonance imaging. Disk and intervertebral foramen heights, the distance between the craniocaudal edges of the facet joint, and the interspinous distance were measured on dynamic computed tomographic images. Also, in vivo 3-dimensional segmental motion was evaluated using the volume merge method. RESULTS There were no significant differences in degenerative findings for the intervertebral disk; however, progressive FJOA was detected in the Sp group. Dynamic changes in the distance between the craniocaudal edges of the facet joints were significantly larger in the Sp group. CONCLUSIONS In this study, progressive FJOA and larger segmental motion in the distance between the craniocaudal edges of the facet joints were found in the Sp group. We clarified for the first time that DS involves ligament laxity due to FJOA that affects spinal segmental motion in vivo. We consider that a treatment method based on FJOA would be useful for treating patients with DS. LEVEL OF EVIDENCE Level IV.
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Coupled motions in human and porcine thoracic and lumbar spines. J Biomech 2018; 70:51-58. [DOI: 10.1016/j.jbiomech.2017.11.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/01/2017] [Accepted: 11/26/2017] [Indexed: 11/17/2022]
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A model-based approach for estimation of changes in lumbar segmental kinematics associated with alterations in trunk muscle forces. J Biomech 2017; 70:82-87. [PMID: 29029957 DOI: 10.1016/j.jbiomech.2017.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/15/2017] [Accepted: 09/25/2017] [Indexed: 11/20/2022]
Abstract
The kinematics information from imaging, if combined with optimization-based biomechanical models, may provide a unique platform for personalized assessment of trunk muscle forces (TMFs). Such a method, however, is feasible only if differences in lumbar spine kinematics due to differences in TMFs can be captured by the current imaging techniques. A finite element model of the spine within an optimization procedure was used to estimate segmental kinematics of lumbar spine associated with five different sets of TMFs. Each set of TMFs was associated with a hypothetical trunk neuromuscular strategy that optimized one aspect of lower back biomechanics. For each set of TMFs, the segmental kinematics of lumbar spine was estimated for a single static trunk flexed posture involving, respectively, 40° and 10° of thoracic and pelvic rotations. Minimum changes in the angular and translational deformations of a motion segment with alterations in TMFs ranged from 0° to 0.7° and 0 mm to 0.04 mm, respectively. Maximum changes in the angular and translational deformations of a motion segment with alterations in TMFs ranged from 2.4° to 7.6° and 0.11 mm to 0.39 mm, respectively. The differences in kinematics of lumbar segments between each combination of two sets of TMFs in 97% of cases for angular deformation and 55% of cases for translational deformation were within the reported accuracy of current imaging techniques. Therefore, it might be possible to use image-based kinematics of lumbar segments along with computational modeling for personalized assessment of TMFs.
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Basques BA, Espinoza Orías AA, Shifflett GD, Fice MP, Andersson GB, An HS, Inoue N. The Kinematics and Spondylosis of the Lumbar Spine Vary Depending on the Levels of Motion Segments in Individuals With Low Back Pain. Spine (Phila Pa 1976) 2017; 42:E767-E774. [PMID: 27831966 PMCID: PMC5423857 DOI: 10.1097/brs.0000000000001967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE The aim of this study was to identify associations of spondylotic and kinematic changes with low back pain (LBP). SUMMARY OF BACKGROUND DATA The ability to characterize and differentiate the biomechanics of both the symptomatic and asymptomatic lumbar spine is crucial to alleviate the sparse literature on the association of lumbar spine biomechanics and LBP. METHODS Lumbar dynamic plain radiographs (flexion-extension), dynamic computed tomography (CT) scanning (axial rotation, disc height), and magnetic resonance imaging (MRI, disc and facet degeneration grades) were obtained for each subject. These parameters were compared between symptomatic and control groups using Student t test and multivariate logistic regression, which controlled for patient age and sex and identified spinal parameters that were independently associated with symptomatic LBP. Disc grade and mean segmental motion by level were tested by one-way analysis of variance (ANOVA). RESULTS Ninety-nine volunteers (64 asymptomatic/35 LBP) were prospectively recruited. Mean age was 37.3 ± 10.1 years and 55% were male. LBP showed association with increased L5/S1 translation [odds ratio (OR) 1.63 per mm, P = 0.005], decreased flexion-extension motion at L1/L2 (OR 0.87 per degree, P = 0.036), L2/L3 (OR 0.88 per degree, P = 0.036), and L4/L5 (OR 0.87 per degree, P = 0.020), increased axial rotation at L4/L5 (OR 2.11 per degree, P = 0.032), decreased disc height at L3/L4 (OR 0.52 per mm, P = 0.008) and L4/L5 (OR 0.37 per mm, p < 0.001), increased disc grade at all levels (ORs 2.01-12.33 per grade, P = 0.001-0.026), and increased facet grade at L4/L5 (OR 4.99 per grade, P = 0.001) and L5/S1 (OR 3.52 per grade, P = 0.004). Significant associations were found between disc grade and kinematic parameters (flexion-extension motion, axial rotation, and translation) at L4/L5 (P = 0.001) and L5/S1 (P < 0.001), but not at other levels (P > 0.05). CONCLUSION In symptomatic individuals, L4/L5 and L5/S1 levels were affected by spondylosis and kinematic changes. This study clarifies the relationships between kinematic alterations and LBP, mostly observed at the above-mentioned segments. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Bryce A Basques
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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Abstract
Adjacent segment disease (ASD) is disappointing long-term outcome for both the patient and clinician. In contrast to adjacent segment degeneration, which is a common radiographic finding, ASD is less common. The incidence of ASD in both the cervical and lumbar spine is between 2% and 4% per year, and ASD is a significant contributor to reoperation rates after spinal arthrodesis. The etiology of ASD is multifactorial, stemming from existing spondylosis at adjacent levels, predisposed risk to degenerative changes, and altered biomechanical forces near a previous fusion site. Numerous studies have sought to identify both patient and surgical risk factors for ASD, but a consistent, sole predictor has yet to be found. Spinal arthroplasty techniques seek to preserve physiological biomechanics, thereby minimizing the risk of ASD, and long-term clinical outcome studies will help quantify its efficacy. Treatment strategies for ASD are initially nonoperative, provided a progressive neurological deficit is not present. The spine surgeon is afforded many surgical strategies once operative treatment is elected. The goal of this manuscript is to consider the etiologies of ASD, review its manifestations, and offer an approach to treatment.
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Tamai K, Kato M, Konishi S, Matsumura A, Hayashi K, Nakamura H. Facet Effusion without Radiographic Instability Has No Effect on the Outcome of Minimally Invasive Decompression Surgery. Global Spine J 2017; 7:21-27. [PMID: 28451505 PMCID: PMC5400161 DOI: 10.1055/s-0036-1583173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 03/08/2016] [Indexed: 11/12/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Lumbar segmental instability is a key factor determining whether decompression alone or decompression and fusion surgery is required to treat lumbar spinal stenosis (LSS). Some recent reports have suggested that facet joint effusion is correlated with spinal segmental instability. The aim of this study is to report the effect of facet effusion without radiographic segmental instability on the outcome of less-invasive decompression surgery for LSS. METHODS Seventy-nine patients with LSS (32 women, mean age: 69.1 ± 9.1 years) who had no segmental instability on dynamic radiographs before undergoing L4-L5 microsurgical decompression and who were followed for at least 2 years postoperatively were analyzed. They were divided into three groups on the basis of the existence and size of L4-L5 facet effusion using preoperative magnetic resonance imaging: grade 0 had no effusion (n = 31), grade 1 had measurable effusion (n = 35), and grade 2 had large effusion (n = 13). Japanese Orthopedics Association (JOA) score, visual analog scale (VAS), and the Short-Form (SF)-36 scores were recorded preoperatively and 12 and 24 months postoperatively. RESULTS JOA score; VAS of low back pain, leg pain, and numbness; and SF-36 (physical component summary and mental component summary) scores did not differ significantly between the three groups in every terms (p = 0.921, 0.996, 0.950, 0.693, 0.374, 0.304, and 0.624, respectively, at final follow-up). CONCLUSION In the absence of radiographic instability, facet joint effusion has no effect on the outcome of less-invasive decompression surgery.
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Affiliation(s)
- Koji Tamai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan,Address for correspondence Koji Tamai, MD Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine 1-5-7, Asahimachi, Abenoku, Osaka, 545-8585 Japan (e-mail: )
| | - Minori Kato
- Department of Orthopedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Sadahiko Konishi
- Department of Orthopedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Akira Matsumura
- Department of Orthopedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Kazunori Hayashi
- Department of Orthopedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Aiyangar A, Zheng L, Anderst W, Zhang X. Instantaneous centers of rotation for lumbar segmental extension in vivo. J Biomech 2017; 52:113-121. [DOI: 10.1016/j.jbiomech.2016.12.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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Ren Z, Liu A, Yang K, Wang D, Buser Z, Wang JC. Evaluation of changes in lumbar neuroforaminal dimensions in symptomatic young adults using positional MRI. 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; 26:1999-2006. [DOI: 10.1007/s00586-017-4953-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/02/2017] [Accepted: 01/12/2017] [Indexed: 02/07/2023]
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A non-ionizing technique for three-dimensional measurement of the lumbar spine. J Biomech 2016; 49:4073-4079. [DOI: 10.1016/j.jbiomech.2016.10.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
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Utilizing the "Stable-to-be Vertebra" Saves Motion Segments in Growing Rods Treatment for Early-Onset Scoliosis. J Pediatr Orthop 2016; 36:336-42. [PMID: 25851684 DOI: 10.1097/bpo.0000000000000467] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is no consensus on the selection of distal instrumentation levels in growing rod surgery. Many surgeons utilize the stable zone of Harrington, but there is not overwhelming evidence to support this preference. The aim of this study was to determine the value of bending/traction radiographs in selection of distal instrumentation levels of a growing rod construct in children with idiopathic or idiopathic-like early-onset scoliosis (EOS). METHODS Twenty-three consecutive patients with idiopathic or idiopathic-like EOS who underwent growing rod surgery at 2 separate institutions between 2006 and 2011 were included. Lengthening procedures were performed periodically at 6-month intervals. Analyses were performed retrospectively for age at index surgery, follow-up period, and radiographic measurements. Lower instrumented levels, neutral vertebra, stable vertebrae (SV), and stable-to-be vertebrae (StbV) were identified on the preoperative radiographs. Coronal Cobb angles, tilt of lower instrumented vertebra (LIV) and LIV+1, and disk wedging under the LIV and LIV+1 were measured on the early postoperative and latest follow-up radiographs. RESULTS Average age at index surgery was 83.6 months. Mean follow-up period was 68.1 months. Initial analysis showed that the relationship of LIV to the StbV was a better predictive of LIV+1 tilt than the SV at the final follow-up. Therefore, the patients were grouped according to the relationship of the LIV to the StbV. LIV was the StbV in 9 patients, proximal to the StbV in 8 patients, and distal to the StbV in 6 patients. At the latest follow-up, tilt of LIV+1 exceeded 10 degrees in 7 of the 8 patients where LIV was proximal to the StbV, whereas only in 1 of 9 patients where LIV was StbV, and in none of the 6 patients where LIV was distal to the StbV. The data indicate that selection of the StbV as the LIV could spare an average of 1.8 vertebral segments when compared with the SV, as StbV is never distal but almost always proximal to the SV. CONCLUSIONS Choosing the StbV as the LIV saves motion segments and prevents distal adding on, while providing satisfactory deformity correction in idiopathic and idiopathic-like EOS. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Espinoza Orías AA, Mammoser NM, Triano JJ, An HS, Andersson GBJ, Inoue N. Effects of Axial Torsion on Disc Height Distribution: An In Vivo Study. J Manipulative Physiol Ther 2016; 39:294-303. [PMID: 27059249 DOI: 10.1016/j.jmpt.2016.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Axial rotation of the torso is commonly used during manipulation treatment of low back pain. Little is known about the effect of these positions on disc morphology. Rotation is a three-dimensional event that is inadequately represented with planar images in the clinic. True quantification of the intervertebral gap can be achieved with a disc height distribution. The objective of this study was to analyze disc height distribution patterns during torsion relevant to manipulation in vivo. METHODS Eighty-one volunteers were computed tomography-scanned both in supine and in right 50° rotation positions. Virtual models of each intervertebral gap representing the disc were created with the inferior endplate of each "disc" set as the reference surface and separated into 5 anatomical zones: 4 peripheral and 1 central, corresponding to the footprint of the annulus fibrosus and nucleus pulposus, respectively. Whole-disc and individual anatomical zone disc height distributions were calculated in both positions and were compared against each other with analysis of variance, with significance set at P < .05. RESULTS Mean neutral disc height was 7.32 mm (1.59 mm). With 50° rotation, a small but significant increase to 7.44 mm (1.52 mm) (P < .0002) was observed. The right side showed larger separation in most levels, except at L5/S1. The posterior and right zones increased in height upon axial rotation of the spine (P < .0001), whereas the left, anterior, and central decreased. CONCLUSIONS This study quantified important tensile/compressive changes disc height during torsion. The implications of these mutually opposing changes on spinal manipulation are still unknown.
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Affiliation(s)
| | - Nicole M Mammoser
- Research Assistant, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - John J Triano
- Professor, Research Graduate Education and Research Program & Director, Partnerships and Research Commercialization, Canadian Memorial Chiropractic College, North York, ON, Canada
| | - Howard S An
- The Morton International Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL; Director of Spine Surgery and Spine Fellowship, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Gunnar B J Andersson
- The Ronald L. DeWald, M.D. Professor, Chairman Emeritus, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Nozomu Inoue
- Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
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Hierarchical CT to Ultrasound Registration of the Lumbar Spine: A Comparison with Other Registration Methods. Ann Biomed Eng 2016; 44:2887-2900. [DOI: 10.1007/s10439-016-1599-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
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Yoshioka N, Ikoma K, Kido M, Imai K, Maki M, Arai Y, Fujiwara H, Tokunaga D, Inoue N, Kubo T. Weight-bearing three-dimensional computed tomography analysis of the forefoot in patients with flatfoot deformity. J Orthop Sci 2016; 21:154-8. [PMID: 26786344 DOI: 10.1016/j.jos.2015.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 10/06/2015] [Accepted: 11/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The recent classifications for posterior tibial tendon dysfunction (PTTD) stage II are based on forefoot deformity, but there is still no consensus regarding a detailed explanation of the clinical condition. The purposes of this study were to clarify the clinical condition of flatfoot deformity using three-dimensional (3D) computed tomography (CT) imaging under loading on both healthy and flat feet and to compare 3D movement of the forefoot in response to load. METHODS Ten volunteers and 10 PTTD stage II patients with symptomatic flatfoot deformity were examined. CT scans of 20 healthy and 20 flat feet were performed under non-loading and full weight-bearing conditions. Images of the tibia and foot arch bones (talus, calcaneus, navicular, and first and fifth metatarsal bones) were reconstructed into 3D models. Rotations of individual tarsal bone or metatarsal bone were described by the Eulerian angles. RESULTS Compared with healthy feet, flat feet experienced plantarflexion of the fifth metatarsal bone relative to the first metatarsal bone under loading conditions. We defined this phenomenon as synonymous with forefoot varus on the coronal plane. CONCLUSIONS The results of this study have clarified part of the clinical condition of the forefoot in flatfoot deformity and may have applications in basic research of the staging advancement and substage classification of PTTD.
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Affiliation(s)
- Naoki Yoshioka
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.
| | - Masamitsu Kido
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Kan Imai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Masahiro Maki
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yuji Arai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Daisaku Tokunaga
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, United States
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
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Biomechanical Evaluation of Capsulotomy, Capsulectomy, and Capsular Repair on Hip Rotation. Arthroscopy 2015; 31:1511-7. [PMID: 25882176 DOI: 10.1016/j.arthro.2015.02.031] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 02/02/2015] [Accepted: 02/17/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine the effect of different types of capsulotomies on hip rotational biomechanical characteristics. METHODS Seven fresh-frozen cadaveric hip specimens were thawed and dissected, leaving the hip capsule and labrum intact. The femur was transected and potted, and each specimen was placed in a custom loading apparatus that allowed for adjustment of flexion, extension, and axial rotation of the femur. Six reflective infrared markers were attached to the specimens to track the motion of the femoral head with respect to the acetabulum in real time, and external rotation was produced by applying a torque of 10 Nm to the hip specimens. Data analysis was performed using the 3-dimensional position of the markers in space. The specimens were tested in neutral flexion and 40° of flexion in the following capsular states: intact, interportal capsulotomy, T-capsulotomy, repaired capsulotomy, and capsulectomy. Paired t tests and analysis of variance were used with an α value of .05 set as significant. RESULTS With the hip in neutral flexion, there was increased external rotation with a T-capsulotomy (91.1° ± 20.3°, P = .029) and capsulectomy (91.9° ± 19.6°, P = .015) compared with the intact hip (83.2° ± 20.5°). After complete repair of the T-capsulotomy (87.4° ± 20.6°), there was no significant difference in external rotation compared with the intact hip. No significant differences were seen between groups at 40° of hip flexion. CONCLUSIONS A T-capsulotomy showed significantly increased external rotation versus the intact and interportal capsulotomy states. The repaired T-capsulotomy restored the rotational profile back to the native state. CLINICAL RELEVANCE Many methods of capsular treatment during hip arthroscopy exist. Capsulotomy and capsulectomy do not restore the external rotation restraint of the hip back to its native state.
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Do in vivo kinematic studies provide insight into adjacent segment degeneration? A qualitative systematic literature review. 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 2015; 24:1865-81. [DOI: 10.1007/s00586-015-3992-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 05/02/2015] [Accepted: 05/03/2015] [Indexed: 02/07/2023]
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