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Lazennec JY, Pour AE. Sacroiliac pain after total hip arthroplasty: a combined analysis of clinical data and three-dimensional imaging in standing and sitting positions. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06270-w. [PMID: 39160383 DOI: 10.1007/s00264-024-06270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/02/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE Patients frequently complain of low back pain and sacroiliac joint pain (SIP) following total hip arthroplasty (THA). We hypothesized that patients with SIP would display different pelvic incidence (PI) values between standing and relaxed sitting positions, indicative of increased motion in the sacroiliac joints. METHODS In this retrospective case-control study, 94 patients who underwent unilateral THA and experienced SIP were compared with 94 control patients without SIP. SIP was confirmed through clinical tests and investigated using biplanar imaging in both standing and sitting positions. The key parameters analyzed included PI, sacral slope (SS), lumbar lordosis (LL), and limb length discrepancy (LLD). RESULTS Patients without SIP showed a mean difference in PI of -1.5° (-8°-5°) between standing-to-sitting positions, whereas those with SIP showed a difference of -3.3° (-12°-0°)(P < 0.0001), indicating more motion in the sacroiliac joint during daily activities in the latter group. Patients with SIP showed smaller change in LL between standing-to-sitting positions (mean:6.3°; range:-8°-27°) compared with those without SIP (mean:9.5°; range:-12°-28°)(P = 0.006). No significant differences were noted in functional leg length between patients with (mean:7 mm; range:0-12 mm) and without SIP (mean:7 mm; range:0-11 mm)(P = 0.973). CONCLUSIONS This study revealed significant sacroiliac joint motion in patients with SIP post-THA, as indicated by PI changes, increased posterior pelvic tilt, and reduced change in the LL. Contrary to common belief, SIP did not correlate with LLD.
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Affiliation(s)
- Jean Yves Lazennec
- Department of Orthopedic and Trauma Surgery, Pitié-Salpétrière Hospital Assistance Publique- Hopitaux de Paris, Sorbonne Universite Medecine, Paris, France
| | - Aidin Eslam Pour
- Department of Orthopedic Surgery, Yale University, New Haven, CT, USA.
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Khalifé M, Skalli W, Assi A, Guigui P, Attali V, Valentin R, Gille O, Lafage V, Kim HJ, Ferrero E, Vergari C. Sex-dependent evolution of whole-body postural alignment with age. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08323-5. [PMID: 38858268 DOI: 10.1007/s00586-024-08323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/17/2024] [Accepted: 05/21/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE The goal of this study was to explore sex-related variations of global alignment parameters and their distinct evolution patterns across age groups. METHODS This multicentric retrospective study included healthy volunteers with full-body biplanar radiographs in free-standing position. All radiographic data were collected from 3D reconstructions: global and lower limb parameters, pelvic incidence (PI) and sacral slope (SS). Lumbar lordosis (LL), thoracic kyphosis (TK) and cervical lordosis (CL) were also assessed as well as the lumbar and thoracic apex, and thoracolumbar inflexion point. The population was divided into five 5 age groups: Children, Adolescents, Young, Middle-Aged and Seniors. RESULTS This study included 861 subjects (53% females) with a mean age of 34 ± 17 years. Mean PI was 49.6 ± 11.1 and mean LL was - 57.1 ± 11.6°. Females demonstrated a PI increase between Young and Middle-Aged groups (49 ± 11° vs. 55 ± 12°, p < 0.001) while it remained stable in males. SS and LL increased with age in females while remaining constant in males between Children and Middle-aged and then significantly decreased for both sexes between Middle-Aged and Seniors. On average, lumbar apex, inflexion point, and thoracic apex were located one vertebra higher in females (p < 0.001). After skeletal maturity, males had greater TK than females (64 ± 11° vs. 60 ± 12°, p = 0.04), with significantly larger CL (-13 ± 10° vs. -8 ± 10°, p = 0.03). All global spinal parameters indicated more anterior alignment in males. CONCLUSION Males present more anteriorly tilted spine with age mainly explained by a PI increase in females between Young and Middle-Aged, which may be attributed to childbirth. Consequently, SS and LL increased before decreasing at senior age.
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Affiliation(s)
- Marc Khalifé
- Orthopaedic Surgery Department, Spine Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris, 75015, France.
- Université Paris-Cité, Paris, France.
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, Paris, 75013, France.
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, Paris, 75013, France
| | - Ayman Assi
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Pierre Guigui
- Orthopaedic Surgery Department, Spine Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris, 75015, France
- Université Paris-Cité, Paris, France
| | - Valérie Attali
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, Paris, 75013, France
- INSERM. UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
- Service des Pathologies du Sommeil (Département "R3S"), Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Rémi Valentin
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, Paris, 75013, France
- INSERM. UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
- Service des Pathologies du Sommeil (Département "R3S"), Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Olivier Gille
- Orthopaedic Surgery Department, Spine Unit, Pellegrin University Hospital, pl. Amélie Raba Léon, Bordeaux, 33000, France
| | - Virginie Lafage
- Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York City, NY, USA
| | - Han-Jo Kim
- Department of orthopaedics, Hospital for Special Surgery, New York City, NY, USA
| | - Emmanuelle Ferrero
- Orthopaedic Surgery Department, Spine Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris, 75015, France
- Université Paris-Cité, Paris, France
| | - Claudio Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, Paris, 75013, France
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Han MS, Hong JH, Jung JH, Lee JK. Normal Functional Local Alignment and Segmental Motion at the Thoracolumbar Junction: A Cross-Sectional Study of Healthy Subjects. World Neurosurg 2024; 186:e713-e720. [PMID: 38616027 DOI: 10.1016/j.wneu.2024.04.038] [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: 02/14/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Several studies have investigated the mechanical behavior of the thoracolumbar spine. However, finding an accurate reference for the normal functional local alignment and segmental motion (SM) at the thoracolumbar junction (TLJ) is challenging. Therefore, this study aimed to assess age- and sex-related changes and differences in local alignment and SM at the TLJ. METHODS The study recruited healthy subjects aged 20 to 79 without complaints of back pain. Healthy subjects (60 males and 60 females) with appropriate imaging results were enrolled in the study. The subjects were divided into age groups (20-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years); each group included 10 subjects of each sex. RESULTS The SM at the TLJ was small but noticeable, and the motion gradually increased toward the lower level of the TLJ, closer to the lumbar region. No significant differences were observed between male and female subjects in any SM measurements at the TLJ. The SM at the TLJ gradually decreased with age, while local kyphosis of TLJ progressed. The results also showed that the thoracolumbar slope value did not change with age and remained at a mean of -12.8 ± 7.2° (P = 0.893). CONCLUSIONS This study's results provide valuable guidance for appropriate surgical planning and rehabilitation of patients with spinal diseases or trauma. Furthermore, the results can be the basis for categorizing accurate criteria to evaluate the degree of disability after treatment.
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Affiliation(s)
- Moon-Soo Han
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea
| | - Jong-Hwan Hong
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea
| | - Ji-Ho Jung
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea
| | - Jung-Kil Lee
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea.
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Solla F, Ilharreborde B, Blondel B, Prost S, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Lamas V, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Kerckhove MV, Lebhar J, Giorgi H, Faure A, Sauleau EA, Pesenti S, Charles YP. Can Lumbopelvic Parameters Be Used to Predict Thoracic Kyphosis at all Ages? A National Cross-Sectional Study. Global Spine J 2024; 14:1116-1124. [PMID: 36282728 PMCID: PMC11289554 DOI: 10.1177/21925682221134039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN National cross-sectional study. OBJECTIVE Thoracic kyphosis (TK) is related to sagittal parameters as pelvic tilt (PT), lumbar lordosis (LL) and pelvic incidence (PI). The equation TK = 2 (PT+LL-PI) was validated for adolescents. The purpose of this study was to investigate if this equation correctly predicts TK regardless of age. METHODS Sagittal alignment parameters were assessed on full spine radiographs of 2599 individuals without spine pathology (1488 females, 1111 males). Calculated TK (CTK) = 2 (PT+LL-PI) and measured TK (MTK) were compared by calculating the gap and using a linear regression between both parameters. Subgroup analyses were performed for gender, age, TK groups (≤20°, 21°-40°, 41°-60°, >60°), and PI groups (<45°, 45°-60°, >60°). RESULTS Average values in the total population were: MTK 45.0°, CTK 36.9°. Average TK gap was 8.1°, 5.2° in females (intercept 11.7, slope .61) and 11.9° in males (intercept 7.1, slope .58). The mean gap was 3.6° for 15-34 years, 5.7° under 15 years and it increased progressively after 35 years with a maximum of 19.9° over 80 years. The gap also increased with the amount of MTK: -3.5° for TK<20° up to 17.3° for TK >60°. Differences in gaps were minor between PI groups. The intercept was smallest and slopes >.6 for PI <45° and TK ≤20°. CONCLUSION The formula TK=2 (PT+LL-PI) yielded moderate accuracy for adolescents and young adults, but did not fit for over 35 years and under 15. The amount and variance in TK increased in elderly subjects, which made the formula less accurate.
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Affiliation(s)
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Île-de-France, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Vincent Lamas
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, France
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Georges Naïm Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Vincent Fière
- Unité du Rachis, Centre Orthopédique Santy, Hôpital privé Jean Mermoz Ramsay Santé, Lyon, France
| | - Michiel Vande Kerckhove
- Unité du Rachis, Centre Orthopédique Santy, Hôpital privé Jean Mermoz Ramsay Santé, Lyon, France
| | - Jonathan Lebhar
- Institut Locomoteur de l’Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, France
| | | | | | - Erik A. Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, France
| | - Sébastien Pesenti
- Service d’Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - The French Spine Surgery Society (SFCR)
- Scoliosis Surgery Unit, Fondation Lenval, Nice, France
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Île-de-France, France
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
- Hôpital Privé de l’Est Lyonnais, Saint-Priest, France
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Hôpital Privé du Dos Francheville, Périgueux, France
- Clinique du Dos Jean Villar, Bruges, France
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, France
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
- Unité du Rachis, Centre Orthopédique Santy, Hôpital privé Jean Mermoz Ramsay Santé, Lyon, France
- Institut Locomoteur de l’Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, France
- Institut Méditerranéen du Dos, Marseille, France
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, France
- Service d’Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France
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Jacobi A, Schenk P, Aydin E, Klauke F, Mendel T, Ullrich BW. Relation between sagittal pelvic and thoracolumbar parameters in supine position - Pelvic parameters and their predictive value for spinal Cobb angles. BRAIN & SPINE 2024; 4:102779. [PMID: 38560042 PMCID: PMC10978473 DOI: 10.1016/j.bas.2024.102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/06/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
Introduction Predicting the pre-morbid sagittal profile of the spine or segmental angles could enhance the process of planning the extent of fracture reduction. There is evidence that spinopelvic parameters may be suitable for this purpose. Research question Is it possible to determine the inflection point and the mono- and bi-segmental endplate angles (EPA) in the thoracolumbar transition (from Th9 to L2) based on age, gender, spinopelvic parameters, and the adjacent EPA in the supine position? Material and methods Based on Polytrauma CT scans in the supine position, the following spinopelvic parameters were measured using non-fractured spines: pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and the apex of the LL. Results In this study, a total of 287 patients with a mean age of 42±16 years were included. Age-related changes were observed, where LL, thoracic kyphosis (TK), and PI increase with age. Gender-related comparisons showed that females had a more pronounced LL and reduced TK. Significant correlations between IP and spinopelvic parameters, with the apex of LL providing the best prediction, were found. However, the overall model quality remained low. Predicting mEPA and bEPA showed positive correlations. The prediction for mEPA L2/3 demonstrated the highest correlation. For bisegmental angles, the most caudal bEPA (L2) exhibited the highest correlation, albeit with some notable absolute differences in the values between measured and predicted values. Discussion and conclusion While this study highlights the complexity of the relationship between the pelvis and thoracolumbar parameters, finding a predictive tool for thoracolumbar reduction and stabilization was not possible.
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Affiliation(s)
- Arija Jacobi
- Department of Orthopedic and Trauma Surgery, DIAKO Ev. Diakonie-Krankenhaus gGmbH, 28239, Bremen, Germany
| | - Philipp Schenk
- Department of Science, Research and Education, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
| | - Esra Aydin
- Department of Cardiology, DRK Klinik Köpenick, 12559, Berlin, Germany
| | - Friederike Klauke
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
- Clinic for Trauma, Hand and Reconstructive Surgery, University Hospital Halle, Martin Luther University Halle-Wittenberg, Germany
| | - Thomas Mendel
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
- Clinic for Trauma, Hand and Reconstructive Surgery, University Hospital Halle, Martin Luther University Halle-Wittenberg, Germany
| | - Bernhard W. Ullrich
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
- Clinic for Trauma, Hand and Reconstructive Surgery, University Hospital Halle, Martin Luther University Halle-Wittenberg, Germany
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Solla F, Ilharreborde B, Clément JL, Rose EO, Monticone M, Bertoncelli CM, Rampal V. Patient-Specific Surgical Correction of Adolescent Idiopathic Scoliosis: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:106. [PMID: 38255419 PMCID: PMC10814112 DOI: 10.3390/children11010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
The restoration of sagittal alignment is fundamental to the surgical correction of adolescent idiopathic scoliosis (AIS). Despite established techniques, some patients present with inadequate postoperative thoracic kyphosis (TK), which may increase the risk of proximal junctional kyphosis (PJK) and imbalance. There is a lack of knowledge concerning the effectiveness of patient-specific rods (PSR) with measured sagittal curves in achieving a TK similar to that planned in AIS surgery, the factors influencing this congruence, and the incidence of PJK after PSR use. This is a systematic review of all types of studies reporting on the PSR surgical correction of AIS, including research articles, proceedings, and gray literature between 2013 and December 2023. From the 28,459 titles identified in the literature search, 81 were assessed for full-text reading, and 7 studies were selected. These included six cohort studies and a comparative study versus standard rods, six monocentric and one multicentric, three prospective and four retrospective studies, all with a scientific evidence level of 4 or 3. They reported a combined total of 355 AIS patients treated with PSR. The minimum follow-up was between 4 and 24 months. These studies all reported a good match between predicted and achieved TK, with the main difference ranging from 0 to 5 degrees, p > 0.05, despite the variability in surgical techniques and the rods' properties. There was no proximal junctional kyphosis, whereas the current rate from the literature is between 15 and 46% with standard rods. There are no specific complications related to PSR. The exact role of the type of implants is still unknown. The preliminary results are, therefore, encouraging and support the use of PSR in AIS surgery.
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Affiliation(s)
- Federico Solla
- Paediatric Orthopaedic Unit, Lenval Foundation, 57, Avenue de la Californie, 06200 Nice, France; (J.-L.C.); (C.M.B.); (V.R.)
| | - Brice Ilharreborde
- Paediatric Orthopaedic Unit, Hôpital Robert Debré, AP-HP, 75019 Paris, France;
| | - Jean-Luc Clément
- Paediatric Orthopaedic Unit, Lenval Foundation, 57, Avenue de la Californie, 06200 Nice, France; (J.-L.C.); (C.M.B.); (V.R.)
| | - Emma O. Rose
- Krieger School of Arts & Sciences, Homewood Campus, John Hopkins University, Baltimore, MD 21218, USA
| | - Marco Monticone
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy;
| | - Carlo M. Bertoncelli
- Paediatric Orthopaedic Unit, Lenval Foundation, 57, Avenue de la Californie, 06200 Nice, France; (J.-L.C.); (C.M.B.); (V.R.)
| | - Virginie Rampal
- Paediatric Orthopaedic Unit, Lenval Foundation, 57, Avenue de la Californie, 06200 Nice, France; (J.-L.C.); (C.M.B.); (V.R.)
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Kouyoumdjian P, Mansour J, Haignère V, Demattei C, Maury E, George D, Coulomb R. Hip-Spine Relationship between Sagittal Balance of the Lumbo-Pelvi-Femoral Complex and Hip Extension Capacity: An EOS Evaluation in a Healthy Caucasian Population. Global Spine J 2024; 14:265-271. [PMID: 35604878 PMCID: PMC10676160 DOI: 10.1177/21925682221103831] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN A prospective study of healthy volunteers. OBJECTIVES The influence of the sagittal alignment of the spine and its influence on the extension reserve have been reported in the literature. However, specific analysis of the intrinsic coxofemoral and extrinsic pelvic component in subjects without any spinal or hip pathologies remains poorly reported. The aim of this study was to categorize the hip extension capacity, or extension reserve (ER), in relation to spinal sagittal alignment whilst standing, in a young healthy population. We hypothesized that the global extension reserve (GER) of the hip joint was influenced by the sagittal spinopelvic alignment. METHODS We evaluated the ER of 120 healthy Caucasian volunteers (56 females (46.7%), 74 males (53.3%); mean age 25.6 years), using low dose radiographs from an EOS® X-ray imaging system in 2 functional positions; neutral standing position and in a forward lunge position. The GER is defined as the sum of the intrinsic (hip) extension reserve (IER) and the extrinsic (pelvic) extension reserve (EER). Cases were grouped into 4 sagittal alignment subtypes according to the Roussouly classification, and analyzed. RESULTS Global extension reserve values were not significantly different between the 4 Roussouly subtypes (P = .094), nor between patients with a sacral slope (SS) <35° (types 1/2) and ≥ 35° (type 3/4) (P = .837). Statistically significant differences were seen between IER in each subtype (P = .015), and EER (P = .006). No difference in ER was seen between subtypes regarding pelvic incidence (PI). CONCLUSION An inverse relationship was found between IER and EER among Roussouly subtypes. The range of motion of the pelvis and the hip joint was higher in patients with a greater sacral slope.
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Affiliation(s)
- Pascal Kouyoumdjian
- Centre Hospitalo-universitaire de Nîmes, Montpellier, France
- Laboratoire de Mécanique et Génie Civile (LMGC), Montpellier, France
| | - Jad Mansour
- Laboratoire de Mécanique et Génie Civile (LMGC), Montpellier, France
| | | | - Christophe Demattei
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nimes, Univ Montpellier, Nimes, France
| | - Etienne Maury
- Centre Hospitalier Universitaire de Montpellier. Hôpital Lapeyronie
| | - David George
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Remy Coulomb
- Centre Hospitalo-universitaire de Nîmes, Montpellier, France
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Zhu C, Luo L, Li R, Guo J, Wang Q. Wearable Motion Analysis System for Thoracic Spine Mobility With Inertial Sensors. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1884-1895. [PMID: 38753470 DOI: 10.1109/tnsre.2024.3384926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
This study presents a wireless wearable portable system designed for the automatic quantitative spatio-temporal analysis of continuous thoracic spine motion across various planes and degrees of freedom (DOF). This includes automatic motion segmentation, computation of the range of motion (ROM) for six distinct thoracic spine movements across three planes, tracking of motion completion cycles, and visualization of both primary and coupled thoracic spine motions. To validate the system, this study employed an Inter-days experimental setting to conduct experiments involving a total of 957 thoracic spine movements, with participation from two representatives of varying age and gender. The reliability of the proposed system was assessed using the Intraclass Correlation Coefficient (ICC) and Standard Error of Measurement (SEM). The experimental results demonstrated strong ICC values for various thoracic spine movements across different planes, ranging from 0.774 to 0.918, with an average of 0.85. The SEM values ranged from 0.64° to 4.03°, with an average of 1.93°. Additionally, we successfully conducted an assessment of thoracic spine mobility in a stroke rehabilitation patient using the system. This illustrates the feasibility of the system for actively analyzing thoracic spine mobility, offering an effective technological means for non-invasive research on thoracic spine activity during continuous movement states.
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Jackson-Fowl B, Hockley A, Naessig S, Ahmad W, Pierce K, Smith JS, Ames C, Shaffrey C, Bennett-Caso C, Williamson TK, McFarland K, Passias PG. Adult cervical spine deformity: a state-of-the-art review. Spine Deform 2024; 12:3-23. [PMID: 37776420 DOI: 10.1007/s43390-023-00735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 07/01/2023] [Indexed: 10/02/2023]
Abstract
Adult cervical deformity is a structural malalignment of the cervical spine that may present with variety of significant symptomatology for patients. There are clear and substantial negative impacts of cervical spine deformity, including the increased burden of pain, limited mobility and functionality, and interference with patients' ability to work and perform everyday tasks. Primary cervical deformities develop as the result of a multitude of different etiologies, changing the normal mechanics and structure of the cervical region. In particular, degeneration of the cervical spine, inflammatory arthritides and neuromuscular changes are significant players in the development of disease. Additionally, cervical deformities, sometimes iatrogenically, may present secondary to malalignment or correction of the thoracic, lumbar or sacropelvic spine. Previously, classification systems were developed to help quantify disease burden and influence management of thoracic and lumbar spine deformities. Following up on these works and based on the relationship between the cervical and distal spine, Ames-ISSG developed a framework for a standardized tool for characterizing and quantifying cervical spine deformities. When surgical intervention is required to correct a cervical deformity, there are advantages and disadvantages to both anterior and posterior approaches. A stepwise approach may minimize the drawbacks of either an anterior or posterior approach alone, and patients should have a surgical plan tailored specifically to their cervical deformity based upon symptomatic and radiographic indications. This state-of-the-art review is based upon a comprehensive overview of literature seeking to highlight the normal cervical spine, etiologies of cervical deformity, current classification systems, and key surgical techniques.
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Affiliation(s)
- Brendan Jackson-Fowl
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Aaron Hockley
- Department of Neurosurgery, University of Alberta, Edmonton, AB, USA
| | - Sara Naessig
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Waleed Ahmad
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Katherine Pierce
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Claudia Bennett-Caso
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Tyler K Williamson
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Kimberly McFarland
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Peter G Passias
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
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10
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Fong AM, Duculan R, Endo Y, Carrino JA, Cammisa FP, Hughes AP, Lebl DR, Farmer JC, Huang RC, Sandhu HS, Mancuso CA, Girardi FP, Sama AA. Differences in imaging and clinical characteristics are associated with higher rates of decompression-fusion versus decompression-alone in women compared to men for lumbar degenerative spondylolisthesis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4184-4191. [PMID: 37796286 DOI: 10.1007/s00586-023-07958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/31/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE The goals were to ascertain if differences in imaging/clinical characteristics between women and men were associated with differences in fusion for lumbar degenerative spondylolisthesis. METHODS Patients had preoperative standing radiographs, CT scans, and intraoperative fluoroscopic images. Symptoms and comorbidity were obtained from patients; procedure (fusion-surgery or decompression-alone) was obtained from intraoperative records. With fusion surgery as the dependent variable, men and women were compared in multivariable logistic regression models with clinical/imaging characteristics as independent variables. The sample was dichotomized, and analyses were repeated with separate models for men and women. RESULTS For 380 patients (mean age 67, 61% women), women had greater translation, listhesis angle, lordosis, and pelvic incidence, and less diastasis and disc height (all p ≤ 0.03). The rate of fusion was higher for women (78% vs. 65%; OR 1.9, p = 0.008). Clinical/imaging variables were associated with fusion in separate models for men and women. Among women, in the final multivariable model, less comorbidity (OR 0.5, p = 0.05), greater diastasis (OR 1.6, p = 0.03), and less anterior disc height (OR 0.8, p = 0.0007) were associated with fusion. Among men, in the final multivariable model, opioid use (OR 4.1, p = 0.02), greater translation (OR 1.4, p = 0.0003), and greater diastasis (OR 2.4, p = 0.0002) were associated with fusion. CONCLUSIONS There were differences in imaging characteristics between men and women, and women were more likely to undergo fusion. Differences in fusion within groups indicate that decisions for fusion were based on composite assessments of clinical and imaging characteristics that varied between men and women.
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Affiliation(s)
- Alex M Fong
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Roland Duculan
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Yoshimi Endo
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - John A Carrino
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Frank P Cammisa
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | | | - Darren R Lebl
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - James C Farmer
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Russel C Huang
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | | | - Carol A Mancuso
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
- Weill Cornell Medical College, New York, NY, USA.
| | | | - Andrew A Sama
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
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11
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Lafage R, Song J, Diebo B, Daniels AH, Passias PG, Ames CP, Bess S, Eastlack R, Gupta MC, Hostin R, Kebaish K, Kim HJ, Klineberg E, Mundis GM, Smith JS, Shaffrey C, Schwab F, Lafage V, Burton D. Alterations in Magnitude and Shape of Thoracic Kyphosis Following Surgical Correction for Adult Spinal Deformity. Global Spine J 2023:21925682231218003. [PMID: 38031967 DOI: 10.1177/21925682231218003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
STUDY DESIGN Retrospective review of prospective multicenter data. OBJECTIVES This study aimed to investigate the shape of TK before and after fusion in ASD patients treated with long fusion. METHODS ASD patients undergoing posterior spinal fusions including at least T5 to L1 without prior fusion extending to the thoracic spine were included. Patients were categorized based on the preoperative T1-T12 kyphosis into: Hypo-TK (if < 30°), Normal-TK, and Hyper-TK (if > 70°). Regional kyphosis at T10-L1 (Distal), T5-T10 (Middle), and T1-T5 (Proximal) and their relative contributions to total kyphosis were compared between groups, and the pre-to postoperative changes were investigated using paired t test. RESULTS In total, 329 patients were included in this analysis (mean age: 57 ± 16 years, 79.6% female). Preoperative T1-T12 TK for the entire cohort was 40.9 ± 2° (32% Hypo-TK, 11% Hyper-TK, 57% Normal-TK). The Hypo-TK group had the smallest distal TK (5.9 vs 17.1 & 26.0), and middle TK (8.0 vs 25.3 & 45.4), but the percentage of contribution to total kyphosis was not significantly different (Distal: 24.1% vs 34.1% vs 32.8%; Middle: 46.6% vs 53.9% vs 56.8%, all P > .1). Postoperatively, T1-12 TK increased significantly (40.9 ± 2.0° vs 57.8 ± 17.6°). Each group had a decrease in distal kyphosis (Hypo-TK 2.6 ± 10.4°; Normal-TK 8.9 ± 11.5°; Hyper-TK 14.9 ± 12°, all P < .05). The middle kyphosis significantly decreased for Hyper-TK (11.8 ± 12.4) and increased for both Normal-TK and Hypo-TK (3.8 ± 11° and 14.2 ± 11°). Proximal TK increased significantly for all groups by 14-18°. Deterioration from Normal-TK to Hyper-TK postoperatively was associated with lower rate of patient satisfaction (59.6% vs 77.3%, P = .032). CONCLUSIONS Posterior spinal fusion for ASD alters the magnitude and shape of thoracic kyphosis. While 60% of patients had a normal TK at baseline, 30% of those patients developed iatrogenic hyperkyphosis postoperatively. Patients with baseline hypokyphosis were more likely to be corrected to normal TK than hyperkyphotic patients. Future research should investigate TK restoration in ASD and its impact on clinical outcomes and complications.
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Affiliation(s)
- Renaud Lafage
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Junho Song
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bassel Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Christopher P Ames
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Shay Bess
- Denver International Spine Center, Denver, CO, USA
| | | | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | | | - Khaled Kebaish
- Department of Orthopaedic Surgery, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Han Jo Kim
- Hospital for Special Surgery, New York, NY, USA
| | - Eric Klineberg
- Department of Orthopaedic surgery, University of Texas Health, Houston, TX
| | | | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | | | - Frank Schwab
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Douglas Burton
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas, KS, USA
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12
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Li H, Ma Z, Wang X, Yuan S, Tian Y, Wang L, Liu X. Comparative study of preoperative sagittal alignment between patients with multisegment cervical ossification of the posterior longitudinal ligament and cervical spondylotic myelopathy. Spine J 2023; 23:1667-1673. [PMID: 37355047 DOI: 10.1016/j.spinee.2023.06.390] [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: 11/25/2022] [Revised: 06/03/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND CONTEXT Preoperative sagittal alignment is of great significance in the development of spinal deformities, degenerative diseases, preoperative planning, postoperative clinical evaluation, and functional recovery. However, few reports have focused on the difference in preoperative sagittal alignment between patients with ossification of the posterior longitudinal ligament (OPLL) and patients with cervical spondylotic myelopathy (CSM). PURPOSE To compare preoperative sagittal alignment between patients with multisegment cervical OPLL and multilevel CSM. STUDY DESIGN Retrospective study. PATIENT SAMPLE A total of 243 patients were included in this study. OUTCOME MEASURES The outcome measures were the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, number of hand actions in 10 seconds, hand-grip strength, C2 to C7 Cobb angle, C2 to C5 Cobb angle, C5 to C7 Cobb angle, C2 to C7 sagittal vertical axis, C7 slope, T1 slope, K-line, K-line tilt, and range of motion (ROM). METHODS The outcome measures were calculated in the OPLL group and CSM group and the data were analyzed using the unpaired t-test, χ² test, and one-way analysis of variance. RESULTS A total of 243 patients (136 men, 107 women; mean age, 59.1±10.6 years) underwent surgical treatment from September 2013 to December 2021. In total, 123 patients were diagnosed with multisegment cervical OPLL, including continuous type (n=39), segmental type (n=38), and mixed type (n=46). The remaining 120 patients had multisegment CSM. The disease course in the OPLL group was significantly shorter than that in the CSM group (p<.05). Among the above preoperative measurements, the JOA score, number of hand actions in 10 seconds, hand-grip strength, and VAS score were not significantly different between the two groups (p>.05). The C2 to C7 Cobb angle was significantly larger in the OPLL than CSM group (17.7°±9.2° and 14.9°±9.3°, respectively; p< .05), as was the C5 to C7 Cobb angle (10.0°±6.3° and 7.5°±6.1°, respectively; p<.05). The ROM was significantly smaller in the OPLL than CSM group (33.1°±8.1° and 40.1°±10.9°, respectively; p<.001). Within the OPLL group, the ROM was significantly smaller in the continuous type than in the segmental type (p<.05). CONCLUSION Patients with multisegment cervical OPLL have greater lordotic preoperative sagittal alignment and smaller preoperative ROM than patients with CSM.
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Affiliation(s)
- Hao Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China
| | - Zhihao Ma
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China
| | - Xia Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China.
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13
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Prost S, Blondel B, Bauduin E, Pesenti S, Ilharreborde B, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Charles YP. Do Age-Related Variations Of Sagittal Alignment Rely On SpinoPelvic Organization? An Observational Study Of 1540 Subjects. Global Spine J 2023; 13:2144-2154. [PMID: 35191731 PMCID: PMC10538341 DOI: 10.1177/21925682221074660] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Descriptive radiographic analysis of a prospective multi-center database. OBJECTIVE This study aims to provide normative values of spinopelvic parameters and their correlations according to age and pelvic incidence (PI) of subjects without spinal deformity. METHODS After Institutional Review Board (IRB) approval, 1540 full spine radiographs were analyzed. Subjects were divided into 3 groups of PI: low PI < 45°, intermediate PI 45-60°, high PI > 60°, and then stratified by age (20-34, 35-49, 50-64, > 65 Y.O). Pelvic and spinal parameters were measured. Statistical analysis between parameters was performed using Bayesian inference and correlation. RESULTS Mean age was 53.5 years (845 females, 695 males, range 20-93 years).In low PI group, lumbar lordosis (LL) decrease was mainly observed in the 2 younger age groups.In medium and high PI groups, loss of lordosis was linear during aging and occurred mainly on the distal arch of lordosis. Moderate PI group had a stable lordosis apex and thoracolumbar inflection point. High PI group had a stable thoracolumbar inflection point and a more distal lordosis apex in elderly subjects.For all subjects, kyphosis and pelvic tilt (PT) increased with age.There was a constant chain of correlation between PI and age groups. Proximal lumbar lordosis (PLL) was correlated with kyphosis and sagittal vertical axis (SVA C7), while the distal lumbar lordosis (DLL) was correlated with PI and PT. CONCLUSION This study provides a detailed repository of sagittal spinopelvic parameters normative values with detailed analysis of segmental kyphosis and lordosis distribution according to gender, age, and PI.
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Affiliation(s)
- Solène Prost
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, France
| | - Benjamin Blondel
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, France
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, France
| | - Sébastien Pesenti
- Service d’Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, France
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, France
| | - Federico Solla
- Service d’Orthopédie Pédiatrique, Fondation Lenval, Nice, France
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, France
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Georges Naïm Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Vincent Fière
- Unité du Rachis, Centre Orthopédique Santy, Lyon, France
| | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, France
| | - Jonathan Lebhar
- Institut Locomoteur de l’Ouest Rachis,Centre Hospitalier Privé Saint-Grégoire, France
| | | | | | - Erik A. Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - The French Spine Surgery Society (SFCR)
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, France
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, France
- Service d’Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, France
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, France
- Hôpital Privé de l’Est Lyonnais, Saint-Priest, France
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Hôpital Privé du Dos Francheville, Périgueux, France
- Clinique du Dos Jean Villar, Bruges, France
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, France
- Service d’Orthopédie Pédiatrique, Fondation Lenval, Nice, France
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, France
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
- Unité du Rachis, Centre Orthopédique Santy, Lyon, France
- Institut Locomoteur de l’Ouest Rachis,Centre Hospitalier Privé Saint-Grégoire, France
- Institut Méditerranéen du Dos, Marseille, France
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, France
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
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14
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Fourman MS, Lafage R, Lovecchio F, Sheikh Alshabab B, Shah S, Punyala A, Ang B, Elysee J, Lenke LG, Kim HJ, Schwab F, Lafage V. How Does Gravity Influence the Distribution of Lordosis in Patients With Sagittal Malalignment? Global Spine J 2023; 13:2446-2453. [PMID: 35352585 PMCID: PMC10538318 DOI: 10.1177/21925682221087467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Compare the supine vs standing radiographs of patients with adult spinal deformity against ideals defined by healthy standing alignment. METHODS 56 patients with primary sagittal ASD (SRS-Schwab Type N) and 119 asymptomatic volunteers were included. Standing alignment of asymptomatic volunteers was used to calculate PI-based formulas for normative age-adjusted standing PI-LL, L4-S1, and L1-L4. These formulas were applied to the supine and standing alignment of ASD cohort. Analyses were repeated on a cohort of 25 patients with at least 5 degrees of lumbar flexibility (difference between supine and standing lordosis). RESULTS The asymptomatic cohort yielded the following PI-based formulas: PI-LL = -38.3 + .41*PI + .21*Age, L4-S1 = 45.3-.18*Age, L1-L4 = -3 + .48*PI). PI-LL improved with supine positioning (mean 8.9 ± 18.7°, P < .001), though not enough to correct to age-matched norms (mean offset 12.2 ± 16.9°). Compared with mean normative alignment at L1-L4 (22.1 ± 6.2°), L1-L4 was flatter on standing (7.2 ± 17.0°, P < .001) and supine imaging (8.5 ± 15.0°, P < .001). L4-S1 lordosis of subjects with L1-S1 flexibility >5° corrected on supine imaging (33.9 ± 11.1°, P = 1.000), but L1-L4 did not (23.0 ± 6.2° norm vs 2.2 ± 14.4° standing, P < .001; vs 7.3 ± 12.9° supine, P < .001). CONCLUSIONS When the effects of gravity are removed, the distal portion of the lumbar spine (i.e., below the apex of lordosis) corrects, suggesting that structural lumbar deformity is primarily proximal.
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Affiliation(s)
- Mitchell S. Fourman
- Spine Surgery Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Renaud Lafage
- Spine Surgery Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Francis Lovecchio
- Spine Surgery Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Basel Sheikh Alshabab
- Spine Surgery Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Sachiin Shah
- Spine Surgery Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Ananth Punyala
- Spine Surgery Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Bryan Ang
- Spine Surgery Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Jonathan Elysee
- Spine Surgery Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Lawrence G Lenke
- Spine Service, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, USA
| | - Han Jo Kim
- Spine Surgery Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, USA
| | - Virginie Lafage
- Spine Surgery Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, USA
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15
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Ouchida J, Nakashima H, Kanemura T, Okamoto M, Hatsushikano S, Imagama S, Le Huec JC, Hasegawa K. Racial differences in whole-body sagittal alignment between Asians and Caucasians based on international multicenter data. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3608-3615. [PMID: 37395781 DOI: 10.1007/s00586-023-07829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/05/2023] [Accepted: 06/17/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To examine inherent differences adjusted for age and clinical score in whole-body sagittal (WBS) alignment involving the lower extremities between Asians and Caucasians, and to determine the relationship between age and WBS parameters by race and sex. METHODS A total of 317 individuals consisting of 206 Asians and 111 Caucasians participated. WBS parameters including C2-7 lordotic angle, lower lumbar lordosis (lower LL, L4-S), pelvic incidence (PI), pelvic thickness, knee flexion (KF), sagittal vertical axis (SVA), and T1 pelvic angle (TPA) were evaluated radiologically. Propensity score-matching adjustments for age and the Oswestry Disability Index scores for comparative analysis between the two race cohorts and correlation analysis between age and WBS parameters for all subjects by race and sex were conducted. RESULTS The comparative analysis included 136 subjects (age: Asians 41.1 ± 13.5, Caucasians 42.3 ± 16.2 years, p = 0.936). Racial differences in WBS parameters were observed in C2-7 lordotic angle (-1.8 ± 12.3 vs. 6.3 ± 12.2 degrees, p = 0.001), and lower LL (34.0 ± 6.6 vs. 38.0 ± 6.1 degrees, p < .001). In correlation analysis with age, moderate or more significant correlations with age were found in KF for all groups, and in SVA and TPA for females of both racial groups. Age-related changes in pelvic parameters of PI and pelvic thickness were more significant in Caucasian females. CONCLUSION Analysis of the correlation between age and WBS parameters suggested that age-related WBS changes vary between races and should be considered during corrective spinal surgery.
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Affiliation(s)
- Jun Ouchida
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, Aichi, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, Aichi, 466-8550, Japan.
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | | | | | - Shiro Imagama
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, Aichi, 466-8550, Japan
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Lamas V, Chapon R, Prost S, Blondel B, Fuentes S, Sauleau EA, Charles YP. Variation of cervical sagittal alignment parameters according to age and pelvic incidence in degenerative spinal deformity patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3624-3633. [PMID: 37505278 DOI: 10.1007/s00586-023-07861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/05/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION In asymptomatic subjects, variations of cervical sagittal alignment parameters according to age and spinopelvic organization have been reported. A large range of compensation phenomena has been observed in degenerative spinal deformity in order to maintain horizontal gaze, but it remains unclear how age and spinopelvic morphology could additionally influence cervical alignment. The aim of this observational retrospective study was to describe the distribution of cervical sagittal alignment parameters according to age and pelvic incidence in subjects with and without degenerative spinal deformity in order to precisely evaluate cervical compensation phenomena in adult spinal deformity (ASD). MATERIAL AND METHODS Radiographs of 478 subjects (327 females and 151 males) were distributed into 235 asymptomatic and 243 deformed subjects. Occipito-cervical parameters were McGregor-C1, McGregor-C2, C1-C2 and occipito-C2 angles. The cervicothoracic inflection point (CTIP) was determined. Caudal cervical sagittal alignment parameters were: C2-C7 lordosis, C2-apex (superior arch), apex-CTIP (inferior arch), occipito-C3 and occipito-C4 angles, C7-slope and T1-slope. The distribution of parameters was analyzed using a Bayesian inference (significant when Pr > 0.975 or Pr < 0.025). Comparisons between asymptomatic and deformed subjects were done after matching on age (40-60 years; > 60 years) and on PI (< 45°; 45-60°; > 60°). RESULTS Among occipito-cervical parameters, there was no significant change in McGregor-C1 angle. However, McGregor-C2 angle was significantly higher in the ASD group (Pr = 0.0029), with influence of age (Pr = 0.023), but PI influence. C1-C2 lordosis was significantly higher in the ASD group compared to the asymptomatic group (Pr < 0.0007), without influence of age or PI noticed. C2-C7 lordosis was also higher in the ASD group (Pr < 0.025) with a role of age and PI (Pr < 0.025). Cervical lordosis in the superior arch was significantly higher in the ASD group (Pr > 0.999), without influence of age or PI. In the inferior arch, the lordosis angle was not modified according to the group, but there was an influence of age (Pr < 0.0007). C7-slope and T1-slope were higher according the age group (Pr < 0.0012), without influence of the group or PI. CONCLUSION This observational study highlights cervical sagittal alignment adaptations in degenerative spinal deformity, matched on age and pelvic incidence. The inferior cervical spine seemed to be modified with a higher lordosis, increasing with age responding to the age-related thoracic kyphosis increase. In addition to that, the superior cervical spine hyperextends more in adult degenerative deformity to maintain horizontal gaze. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vincent Lamas
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
| | - Renan Chapon
- Service de Neurochirurgie, Centre Hospitalier Universitaire Dijon-Bourgogne, Dijon, France
| | - Solène Prost
- Unité de Chirurgie Rachidienne, Centre Hospitalier Universitaire de La Timone, Aix-Marseille Université, Marseille, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, Centre Hospitalier Universitaire de La Timone, Aix-Marseille Université, Marseille, France
| | - Stéphane Fuentes
- Service de Neurochirurgie, Centre Hospitalier Universitaire de La Timone, Aix-Marseille Université, Marseille, France
| | - Erik André Sauleau
- Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
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17
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Wang Z, Hu X, Cui P, Liu X, Zhu W, Kong C, Wang W, Lu S. Description of age-related changes in cervical sagittal alignment based on pelvic incidence classification in asymptomatic Chinese population. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2402-2414. [PMID: 37193902 DOI: 10.1007/s00586-023-07769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/06/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To investigate the pelvic incidence (PI)- and age-related cervical alignment changes of Chinese healthy population. METHODS Six hundred and twenty-five asymptomatic adult subjects, who underwent the standing whole spinal radiograph, were recruited in this work. The sagittal parameters were measured, including Occipito-C2 angle (O-C2), C2-7 angle (C2-7), cranial arch, caudal arch, T1-slope (T1S), C2-7 sagittal vertical axis (C2-7 SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), PI, and sagittal vertical axis (SVA). All subjects were stratified into 5 age groups, namely 40-59 years, 60-64 years, 65-69 years, 70-74 years, and 75 years and above, with each age group further divided into 2 subgroups based on PI (deeming PI < 50° as low PI, and PI ≥ 50° as high PI). The correlations between PI or age, and other sagittal parameters were assessed. The age-related changes of sagittal parameters in each PI subgroup were also assessed, followed by one-way analysis of variance analysis for change comparison between age groups. RESULTS The average cervical sagittal parameters were as below: 18.2 ± 6.8° for O-C2, 10.4 ± 10.2° for C2-7, 3.9 ± 7.5° for cranial arch, 6.5 ± 7.1° for caudal arch, 23.6 ± 7.3° for T1S, and 21.0 ± 9.7 mm for C2-7 SVA. There was no obvious difference observed between PI and cervical sagittal parameters, excepting for caudal arch. While, C2-7, cranial arch, caudal arch, T1S, and C2-7 SVA increased remarkably with the age. Thereof, C2-7 exhibited great increases at the age of 60-64 years and 70-74 years, respectively, cranial arch increased notably at 60-64 years of age, and caudal arch developed obviously at 70-74 years of age, regardless of PI. CONCLUSION This study showed the PI- and age-related cervical alignment changes of Chinese healthy population. Based on the classification in our study, high or low PI apparently did not correlate with the occurrence of cervical degenerative disease.
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Affiliation(s)
- Zheng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Xinli Hu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Peng Cui
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Xu Liu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Weiguo Zhu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China.
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China.
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China.
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China.
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Li W, Zhou S, Zou D, Han G, Sun Z, Li W. Which Global Sagittal Parameter Could Most Effectively Predict the Surgical Outcome for Patients With Adult Degenerative Scoliosis? Global Spine J 2023; 13:1612-1621. [PMID: 34806441 PMCID: PMC10448095 DOI: 10.1177/21925682211043465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To evaluate the predictive effect of the 3 global sagittal parameters (Sagittal Vertical Axis [SVA], T1 Pelvic Angle [TPA], and relative TPA [rTPA]) in the surgical outcome of patients with adult degenerative scoliosis (ADS), then to define the optimum corrective goal based on the best of them. METHODS 117 ADS patients were included in this study and followed-up for an average of 3 years. Functional evaluation and radiographs were assessed preoperatively and postoperatively. The predictive accuracy of SVA, TPA, and relative TPA was analyzed through receiver operating characteristic (ROC) curve. The cutoff value of TPA was obtained at the maximal Youden index from ROC curve. RESULTS TPA most highly correlated with postoperative oswestry disability index (ODI). The best cutoff value of TPA was set at 19.3° (area under curve =0.701). TPA >19.3° was the highest risk factor in multivariate logistic regression analysis (OR = 7.124, P = 0.022). Patients with TPA <19.3° at 3 months after operation showed a better ODI than those with TPA >19.3°. Correcting TPA less than 19.3° for patients with preoperative TPA >19.3° attributed to a better health related quality of life (HRQOL) and sagittal balance at last follow-up. The formula "Postoperative TPA = 0.923 × PI - 0.241 × postoperative LL - 0.593 × postoperative SS - 2.471 (r = 0.914, r2 = 0.836, P < .001)" described the relation between SS, LL, PI, and TPA. CONCLUSION TPA was a useful global parameter for the prediction of postoperative HRQOL for patients with ADS. Keeping TPA <19.3° could improve the postoperative HRQOL for ADS patients with preoperative TPA >19.3°, and TPA <19.3° could be an optimum correction target for patients with ADS.
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Affiliation(s)
- Wei 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
| | - 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
| | - Da Zou
- 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
| | - Gengyu Han
- 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
| | - 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
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Lukas KJ, Verhaegen JCF, Livock H, Kowalski E, Phan P, Grammatopoulos G. The effect of ethnicity on the age-related changes of spinopelvic characteristics: a systematic review. Bone Joint Res 2023; 12:231-244. [PMID: 37051815 PMCID: PMC10065848 DOI: 10.1302/2046-3758.124.bjr-2022-0335.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Aims Spinopelvic characteristics influence the hip’s biomechanical behaviour. However, to date there is little knowledge defining what ‘normal’ spinopelvic characteristics are. This study aims to determine how static spinopelvic characteristics change with age and ethnicity among asymptomatic, healthy individuals. Methods This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify English studies, including ≥ 18-year-old participants, without evidence of hip or spine pathology or a history of previous surgery or interventional treatment, documenting lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). From a total of 2,543 articles retrieved after the initial database search, 61 articles were eventually selected for data extraction. Results When all ethnicities were combined the mean values for LL, SS, PT, and PI were: 47.4° (SD 11.0°), 35.8° (SD 7.8°), 14.0° (SD 7.2°), and 48.8° (SD 10°), respectively. LL, SS, and PT had statistically significant (p < 0.001) changes per decade at: −1.5° (SD 0.3°), −1.3° (SD 0.3°), and 1.4° (SD 0.1°). Asian populations had the largest age-dependent change in LL, SS, and PT compared to any other ethnicity per decade at: −1.3° (SD 0.3°) to −0.5° (SD 1.3°), –1.2° (SD 0.2°) to −0.3° (SD 0.3°), and 1.7° (SD 0.2°) versus 1.1° (SD 0.1°), respectively. Conclusion Ageing alters the orientation between the spine and pelvis, causing LL, SS, and PT to modify their orientations in a compensatory mechanism to maintain sagittal alignment for balance when standing. Asian populations have the largest degree of age-dependent change to their spinopelvic parameters compared to any other ethnicity, likely due to their lower PI. Cite this article: Bone Joint Res 2023;12(4):231–244.
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Affiliation(s)
- Kenneth J. Lukas
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Jeroen C. F. Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, Antwerp, Belgium
| | - Holly Livock
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Philippe Phan
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Correspondence should be sent to George Grammatopoulos. E-mail:
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20
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Odland K, Yson S, Polly DW. Wide anatomical variability of PI normative values within an asymptomatic population: a systematic review. Spine Deform 2023; 11:559-566. [PMID: 36735158 DOI: 10.1007/s43390-023-00649-2] [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: 10/15/2022] [Accepted: 01/14/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Studies on sagittal alignment parameters have solely focused on patients with preexisting spinal deformity. Limited data in the literature have analyzed pelvic incidence (PI) values in an asymptomatic patient population. The purpose of this study was to: (1) systematically review the literature to analyze normative PI values in asymptomatic patients; and (2) provide a more definitive geometric measurement guide for determining surgical interventions. METHODS A systematic review of retrospective studies was performed by searching PubMed to identify studies that analyzed PI measurements in asymptomatic subjects. The following search phrases were used: (pelvic incidence, pelvic tilt, sacral slope, sagittal alignment, radiograph, asymptomatic, normative values, and adults) using Boolean operators AND, OR and NOT. Patients with pathology involving the osseous pelvic anatomy (including fracture, infection, tumor, previous surgery, and lumbosacral fusion) that would prevent measurement of the selected parameters were not included. Pelvic incidence (PI) values were analyzed. RESULTS A total of 29 studies met inclusion criteria, including 3629 asymptomatic subjects who underwent standing lateral radiographs (mean age, 41.1 years; range, 24-69 years) for the purposes of analyzing pelvic incidence values. Overall, the mean PI value was 50.0° (range, 24-69) which is consistent with reported values in the literature. CONCLUSION Wide anatomical variability and broad clinical interpretation of PI normative values do little to guide surgical planning for successful outcomes. However, this systematic review has presented PI-stratified normative values in a large sample of asymptomatic subjects which can serve as a grounded geometric reference for spine surgeons when considering surgical intervention approaches.
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Affiliation(s)
- Kari Odland
- The Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA.
| | - Sharon Yson
- The Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - David W Polly
- The Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
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Ouchida J, Nakashima H, Kanemura T, Okamoto M, Hatsushikano S, Imagama S, Le Huec JC, Hasegawa K. The age-specific normative values of standing whole-body sagittal alignment parameters in healthy adults: based on international multicenter data. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:562-570. [PMID: 36380010 DOI: 10.1007/s00586-022-07445-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the age-specific normative values of whole-body sagittal alignment (WBSA) including global balance parameters in healthy adults and to clarify the correlations among parameters based on the data from three international multicenter. METHODS Three hundred and seventeen healthy subjects (range: 20-84 y.o., mean: 43.8 ± 14.7 y.o.) were included and underwent whole-body biplanar X-ray imaging system. Spinopelvic parameters and knee flexion (KF), the center of acoustic meatus (CAM)-hip axis (HA), and C2 dentiform apophyse (OD)-HA, the cranial center (Cr)-HA were evaluated radiologically. Sub-analysis for correlation analysis between age and parameters and among parameters was performed to investigate age-specific change and compensatory mechanisms. RESULTS For age-related change, C2-7 angle (r = .326 for male/.355 for female), KF (r = .427/.429), and SVA (r = .234/.507) increased with age in both male and female group. For global parameters related to the center of the gravity, correlations with age were not significant (r = .120/.161 for OD-HA, r = .163/.275 for Cr-HA, r = .149/.262 for CAM-HA). Knee flexion (KF) has correlation with global parameters (i.e., SVA, OD-HA, Cr-HA, CAM-HA) and does not have correlations with local spinopelvic alignment. CONCLUSION While several local alignment changes with age were found, changes in global parameters related to the center of gravity were kept relatively mild by the chain of compensation mechanisms including the lower limbs. We showed the normative values for a comprehensive WBSA in standing posture from large international healthy subjects' database.
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Affiliation(s)
- Jun Ouchida
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | | | | | - Shiro Imagama
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
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Kim N, Suk KS, Kwon JW, Seo J, Ju H, Lee BH, Moon SH, Kim HS, Lee HM. Clinical significance of the C2 slope after multilevel cervical spine fusion. J Neurosurg Spine 2023; 38:24-30. [PMID: 35986729 DOI: 10.3171/2022.6.spine22588] [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: 05/24/2022] [Accepted: 06/28/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The C2 slope (C2S) is one of the parameters that can determine cervical sagittal alignment, but its clinical significance is relatively unexplored. This study aimed to evaluate the clinical significance of the C2S after multilevel cervical spine fusion. METHODS A total of 111 patients who underwent multilevel cervical spine fusion were included in this study. The C2S, cervical sagittal vertical axis (cSVA), C2-7 lordosis, and T1 slope (T1S) were measured in standing lateral cervical spine radiographs preoperatively and 2 years after the surgery. Clinical outcome measures were visual analog scale (VAS) neck and arm pain scores, Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scale score, and patient-reported subjective improvement rate (IR) percentage. Statistical analysis was performed using a paired-samples t-test and Pearson's correlation, and a receiver operating characteristic (ROC) curve to determine the cutoff values of C2S. RESULTS C2S demonstrated a significant correlation with the cSVA, C2-7 lordosis, T1S, and T1S minus cervical lordosis. C2S revealed a significant correlation with the JOA, neck pain VAS, and NDI scores at 2 years after surgery. Change in the C2S correlated with postoperative neck pain and NDI scores. ROC curves demonstrated the cutoff values of C2S as 18.8°, 22.25°, and 25.35°, according to a cSVA of 40 mm, severe disability expressed by NDI, and severe myelopathy, respectively. CONCLUSIONS C2S can be an additional cervical sagittal alignment parameter that can be a useful prognostic factor after multilevel cervical spine fusion.
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Affiliation(s)
- Namhoo Kim
- 1Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and
- 2Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyung-Soo Suk
- 1Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and
| | - Ji-Won Kwon
- 1Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and
| | - Joonoh Seo
- 1Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and
| | - Hunjin Ju
- 1Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and
| | - Byung Ho Lee
- 1Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and
| | - Seong-Hwan Moon
- 1Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and
| | - Hak-Sun Kim
- 1Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and
| | - Hwan-Mo Lee
- 1Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and
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Quarto E, Zanirato A, Pellegrini M, Vaggi S, Vitali F, Bourret S, Le Huec JC, Formica M. GAP score potential in predicting post-operative spinal mechanical complications: a systematic review of the literature. 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; 31:3286-3295. [PMID: 36153789 DOI: 10.1007/s00586-022-07386-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/18/2022] [Accepted: 09/10/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE In 2017, the GAP score was proposed as a tool to reduce mechanical complications (MC) in adult spinal deformity (ASD) surgery: the reported MC rate for the GAP proportioned category was only 6%, which is clearly lower to the MC rate reported in the literature. The aim of this study is to analyse if the most recent literature confirms the promising results of the original article. MATERIALS AND METHODS Using the PRISMA flow chart, we reviewed the literature to analyse GAP score capacity in predicting MC occurrence. We included articles clearly reporting ASD surgery MC stratified by GAP categories and the score's overall capacity to predict MC using the area under the curve (AUC). The quality of the included studies was evaluated using GRADE and MINORS systems. RESULTS Eleven retrospective articles (1,517 patients in total) were included. The MC distribution per GAP category was as follows: GAP-P, 32.8%; GAP-MD, 42.3%; GAP-SD, 55.4%. No statistically significant difference was observed between the different categories using the Kruskal-Wallis test (p = 0.08) and the two-by-two Pearson-Chi square test (P Vs MD, p = 0.300; P Vs SD, p = 0.275; MD Vs SD, p = 0.137). The global AUC was 0.68 ± 0.2 (moderate accuracy). The included studies were of poor quality according to the GRADE system and had a high risk of bias based on the MINORS criteria. CONCLUSION The actual literature does not corroborate the excellent results reported by the original GAP score article. Further prospective studies, possibly stratified by type of MC and type of surgery, are necessary to validate this score.
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Affiliation(s)
- E Quarto
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
| | - A Zanirato
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - M Pellegrini
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - S Vaggi
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - F Vitali
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - S Bourret
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, 15 Rue Boucher, 33300, Bordeaux, France
| | - J C Le Huec
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, 15 Rue Boucher, 33300, Bordeaux, France
| | - M Formica
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
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Muellner M, Haffer H, Chiapparelli E, Dodo Y, Tan ET, Shue J, Zhu J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Differences in lumbar paraspinal muscle morphology in patients with sagittal malalignment undergoing posterior lumbar fusion surgery. 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; 31:3109-3118. [PMID: 36038784 PMCID: PMC10585706 DOI: 10.1007/s00586-022-07351-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/13/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To investigate whether (1) there is a difference between patients with normal or sagittal spinal and spinopelvic malalignment in terms of their paraspinal muscle composition and (2) if sagittal malalignment can be predicted using muscle parameters. METHODS A retrospective review of patients undergoing posterior lumbar fusion surgery was conducted. A MRI-based muscle measurement technique was used to assess the cross-sectional area, the functional cross-sectional area, the intramuscular fat and fat infiltration (FI) for the psoas and the posterior paraspinal muscles (PPM). Intervertebral disc degeneration was graded for levels L1 to S1. Sagittal vertical axis (SVA; ≥ 50 mm defined as spinal malalignment), pelvic incidence (PI) and lumbar lordosis (LL) were measured, and PI-LL mismatch (PI-LL; ≥ 10° defined as spinopelvic malalignment) was calculated. A receiver operating characteristic (ROC) analysis was conducted to determine the specificity and sensitivity of the FIPPM for predicting sagittal malalignment. RESULTS One hundred and fifty patients were analysed. The PI-LL and SVA malalignment groups were found to have a significantly higher FIPPM (PI-LL:47.0 vs. 42.1%; p = 0.019; SVA: 47.7 vs. 41.8%; p = 0.040). ROC analysis predicted sagittal spinal malalignment using FIPPM (cut-off value 42.69%) with a sensitivity of 73.4% and a specificity of 54.1% with an area under the curve of 0.662. CONCLUSION Significant differences in the muscle composition between normal and malalignment groups with respect to FIPPM in both sagittal spinal and spinopelvic alignment were found. This work underlines the imminent impact of the paraspinal musculature on the sagittal alignment.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA.
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Lafage R, Smith JS, Fong AM, Sheikh Alshabab B, Protopsaltis T, Klineberg EO, Mundis G, Passias PG, Gupta M, Shaffrey CI, Kim HJ, Bess S, Schwab F, Ames CP, Lafage V. Proximal and distal reciprocal changes following cervical deformity malalignment correction. J Neurosurg Spine 2022; 37:599-606. [PMID: 35523249 DOI: 10.3171/2022.2.spine211316] [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: 10/11/2021] [Accepted: 02/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hyperextension of C0-2 is a debilitating compensatory mechanism used to maintain horizontal gaze, analogous to high pelvic tilt in the lumbopelvic complex to maintain an upright posture. This study aims to investigate the impact of cervical deformity (CD) correction on this hyperextension. The authors hypothesize that correction of cervical sagittal malalignment allows for relaxation of C0-2 hyperextension and improved clinical outcomes. METHODS A retrospective review was conducted of a multicenter database of patients with CD undergoing spinal realignment and fusion caudal to C2 and cephalad to the pelvis. Range of motion (ROM) and reserve of extension (ROE) were calculated across C2-7 and C0-2. The association between C2-7 correction and change in C0-2 ROE was investigated while controlling for horizontal gaze, followed by stratification into ΔC2-7 percentiles. RESULTS Sixty-five patients were included (mean age 61.8 ± 9.6 years, 68% female). At baseline, patients had cervical kyphosis (C2-7, -11.7° ± 18.2°; T1 slope-cervical lordosis mismatch, 38.6° ± 18.6°), negative global alignment (sagittal vertical axis [SVA] -12.8 ± 71.2 mm), and hyperlordosis at C0-2 (mean 33.2° ± 11.8°). The mean ROM was 25.7° ± 17.7° and 21.3° ± 9.9° at C2-7 and C0-2, respectively, with an ROE of approximately 9° for each segment. Limited C0-2 ROM and ROE correlated with the Neck Disability Index (r = -0.371 and -0.394, p < 0.01). The mean number of levels fused was 7.0 ± 3.1 (24.6% anterior, 43.1% posterior), with 87.7% undergoing at least an osteotomy. At 1 year, mean C2-7 increased to 5.5° ± 13.4°, SVA became neutral (11.5 ± 54.8 mm), C0-2 hyperlordosis decreased to 27.8° ± 11.7°, and thoracic kyphosis (TK) increased to -49.4° ± 18.1° (all p < 0.001). Concurrently, mean C0-2 ROM increased to 27.6° ± 8.1° and C2-7 ROM decreased significantly to 9.0° ± 12.3° without a change in ROE. Controlling for horizontal gaze, change in C2-7 lordosis significantly correlated with increased TK (r = -0.617, p < 0.001), decreased C0-2 (r = -0.747, p < 0.001), and increased C0-2 ROE (r = 0.550, p = 0.002). CONCLUSIONS CD correction can significantly impact cephalad and caudal compensation in the upper cervical and thoracic spine. Restoration of cervical alignment resulted in increased C0-2 ROE and TK and was also associated with improved clinical outcome.
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Affiliation(s)
- Renaud Lafage
- 1Department of Orthopedics, Hospital for Special Surgery, New York, New York
| | - Justin S Smith
- 2Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Alex Moy Fong
- 1Department of Orthopedics, Hospital for Special Surgery, New York, New York
| | - Basel Sheikh Alshabab
- 3Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, New York
| | | | - Eric O Klineberg
- 5Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | | | - Peter G Passias
- 4Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York
| | - Munish Gupta
- 7Department of Orthopaedics, Washington University, St. Louis, Missouri
| | | | - Han Jo Kim
- 1Department of Orthopedics, Hospital for Special Surgery, New York, New York
| | - Shay Bess
- 9Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado; and
| | - Frank Schwab
- 3Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, New York
| | - Christopher P Ames
- 10Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Virginie Lafage
- 3Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, New York
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Zhou S, Sun Z, Li W, Zou D, Li W. The Pelvic Incidence Stratified Sagittal Spinopelvic Alignment in Asymptomatic Chinese Population With Different Age Groups. Global Spine J 2022; 12:1821-1826. [PMID: 33472426 PMCID: PMC9609520 DOI: 10.1177/2192568221989647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To provide the age- and pelvic incidence-related variations of sagittal alignment in asymptomatic Chinese population. METHODS This study recruited asymptomatic adult subjects. All subjects undertook the standing whole spinal radiograph and the sagittal parameters were measured: sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI) and pelvic tilt (PT). All subjects were divided into young, middle aged and elderly groups, then each age group was further divided into 5 subgroups (very low, low, average, high and very high) based on PI values. The relations between PI, age and other parameters were evaluated. The differences in sagittal parameters of each PI subgroup were compared. RESULTS 546 subjects were included with an average age of 38.6 years (18 to 81). The number of subjects over 70 years and with very low PI was relatively small. The average of PI, TPA, PT and LL were 45.9° ± 8.4°, 6.4° ± 6.2°, 11.9° ± 6.6° and 49.2° ± 10.1°, respectively. SVA, TPA, TK and PT increased with age (P < 0.05), while SVA, TPA, PT, PI-LL also increased with PI (P < 0.05). LL, PT, TPA, PI-LL and LL-TK were different among the 5 PI subgroups (P < 0.05). However, the values of LL in elderly subjects with high and very high PI were similar. CONCLUSION The age- and PI-related variations in sagittal alignment of Chinese population were provided. The sagittal parameters were significantly influenced by age and PI. The individual pelvic morphology should be carefully considered during the assessment and restoration of sagittal balance.
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Affiliation(s)
- Siyu Zhou
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China
| | - Zhuoran Sun
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China
| | - Wei Li
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China
| | - Da Zou
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China
| | - Weishi Li
- Orthopaedic Department, Peking
University Third Hospital, Haidian District, Beijing, China,Weishi Li, Department of Orthopaedic, Peking
University Third Hospital, Beijing 100191, China.
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Lin F, Zhou Z, Li Z, Shan B, Zhou Z, Sun Y, Zhou X. Utility of a fulcrum for positioning support during flexion-extension radiographs for assessment of lumbar instability in patients with degenerative lumbar spondylolisthesis. J Neurosurg Spine 2022; 37:535-540. [PMID: 35523252 DOI: 10.3171/2022.3.spine22192] [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: 02/10/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors investigated a new standardized technique for evaluating lumbar stability in lumbar lateral flexion-extension (LFE) radiographs. For patients with lumbar spondylolisthesis, a three-part fulcrum with a support platform that included a semiarc leaning tool with armrests, a lifting platform for height adjustment, and a base for stability were used. Standard functional radiographs were used for comparison to determine whether adequate flexion-extension was acquired through use of the fulcrum method. METHODS A total of 67 consecutive patients diagnosed with L4-5 degenerative lumbar spondylolisthesis were enrolled in the study. The authors analyzed LFE radiographs taken with the patient supported by a fulcrum (LFEF) and without a fulcrum. Sagittal translation (ST), segmental angulation (SA), posterior opening (PO), change in lumbar lordosis (CLL), and lumbar instability (LI) were measured for comparison using functional radiographs. RESULTS The average value of SA was 5.76° ± 3.72° in LFE and 9.96° ± 4.00° in LFEF radiographs, with a significant difference between them (p < 0.05). ST and PO were also significantly greater in LFEF than in LFE. The detection rate of instability was 10.4% in LFE and 31.3% in LFEF, and the difference was significant. The CLL was 27.31° ± 11.96° in LFE and 37.07° ± 12.963.16° in LFEF, with a significant difference between these values (p < 0.05). CONCLUSIONS Compared with traditional LFE radiographs, the LFEF radiographs significantly improved the detection rate of LI. In addition, this method may reduce patient discomfort during the process of obtaining radiographs.
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Affiliation(s)
| | | | - Zhiwei Li
- 2Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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The T4-L1-Hip Axis: Defining a Normal Sagittal Spinal Alignment. Spine (Phila Pa 1976) 2022; 47:1399-1406. [PMID: 35867583 DOI: 10.1097/brs.0000000000004414] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a cross-sectional cohort. OBJECTIVE The aim was to describe sagittal plane alignment and balance in a multinational cohort of nondegenerated, asymptomatic adults. SUMMARY OF BACKGROUND DATA Current sagittal alignment targets were developed using correlations between radiographic and quality-of-life measures in spinal deformity patients, rather than disease-free samples leading to relatively poor accounting for variance within a population. MATERIALS AND METHODS Sagittal balance was defined using vertebral body tilt and spinopelvic alignment was defined as the vertebral pelvic angles from C2 to L5 (vertebral pelvic angle=vertebral tilt+pelvic tilt). Associations with pelvic incidence (PI) were assessed using linear regression. Multivariable linear regression was used to estimate a normal L1-S1 lordosis, adjusting for PI and the L1 pelvic angle (L1PA). Correlation between the L1 and T4 pelvic angles was assessed to define a normal thoracic alignment conditioned on lumbar alignment. RESULTS Among 320 volunteers from 4 continents, median age was 37% and 60% were female. C2 tilt was independent of PI with minimal variation. PI was inadequate for estimating a normal lumbar lordosis (L1-S1, r2 =0.3), but was strongly associated with the lumbar pelvic angles (L1PA, r2 =0.58). Defining lumbar lordosis as a function of PI and L1PA resulted in high explained variance ( R2 =0.74) and the T4 pelvic angle had near perfect correlation with the L1PA ( r =0.9). CONCLUSIONS We defined normal sagittal balance and spinopelvic alignment in a disease-free international volunteer cohort. Four parameters are either fixed or directly modifiable in surgery and can define a normal thoracic and lumbar alignment: the L1-S1 lordosis defined as a function of PI and the L1PA; and the T4 pelvic angle is nearly equivalent to the L1PA, aligning the T4-L1-hip axis.
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Ma H, Hu Z, Shi B, Liu Z, Zhu Z, Chu WCW, Lam TP, Cheng JCY, Qiu Y. Global Alignment and Proportion (GAP) score in asymptomatic individuals: is it universal? Spine J 2022; 22:1566-1575. [PMID: 35447324 DOI: 10.1016/j.spinee.2022.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The global alignment and proportion (GAP) score was established based on American and European subjects, which might limit its applicability to the Chinese population due to ethnicity-related difference of sagittal alignment. PURPOSE To analyze the applicability of GAP score in the Chinese population and to investigate the age- and gender-associated differences of spinopelvic and GAP score parameters. STUDY DESIGN A prospective cross-sectional radiographic study. PATIENTS SAMPLE Of 692 asymptomatic Chinese volunteers aged between 20 and 79 prospectively recruited between January 2017 and June 2019, 490 subjects were eventually included in this study. OUTCOME MEASURES The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), L1-S1 lordosis, L4-S1 lordosis, sagittal vertical axis (SVA), T1 pelvic angle (TPA) and global tilt (GT) were measured on lateral X-rays. The GAP scores and its parameters including relative pelvic version (RPV), relative lumbar lordosis (RLL), lordosis distribution index (LDI) and relative spinopelvic alignment (RSA) were calculated for each subject. METHODS Subjects were divided into four groups: Group 1M: male subjects <60 years old; Group 1F: female subjects <60 years old; Group 2M: male subjects ≥60 years old and Group 2F: female subjects ≥60 years old. The GAP scores and categories were determined and compared between groups. The results of sagittal alignment were compared with the previous studies evaluating the normative sagittal alignment in other populations. Univariate linear regression analysis was carried out between pelvic incidence (PI) and sacral slope (SS), lumbar lordosis (LL) and global tilt (GT) in each group. RESULTS The distributions of GAP categories and the updated Roussouly classification were statistically different from other populations. Significantly different distribution of GAP categories was observed between Group 1M and Group 2M, Group 1F and Group 2F, and Group 1M and Group 1F. Radiographic measurements and GAP parameters were significantly different between Group 1M and Group 2M, and Group 1F and Group 2F. Gender-related difference of parameters was more prominent between Group 1M and Group 1F. Linear relationship of PI with SS, LL and GT were different from the regression models of "ideal" sagittal alignment in GAP score. CONCLUSIONS The GAP score might be inappropriate in Chinese population due to ethnicity-related alignment difference. Worse feasibility of GAP score was observed in female and old subjects.
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Affiliation(s)
- Hongru Ma
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Zongshan Hu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Benlong Shi
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China.
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; The Joint Scoliosis Research Center of the Chinese University of Hong Kong-Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China
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Gille O, Skalli W, Mathio P, Kouyoumdjian P, Boishardy A, Gajny L, Roscop C. Sagittal Balance Using Position and Orientation of Each Vertebra in an Asymptomatic Population. Spine (Phila Pa 1976) 2022; 47:E551-E559. [PMID: 35867624 DOI: 10.1097/brs.0000000000004366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 02/26/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A monocentric, retrospective radiographic study with 99 asymptomatic volunteers. OBJECTIVE The authors performed the postural analysis commonly scheduled when evaluating sagittal balance in a vertebra-by-vertebra manner by enrolling an asymptomatic population. They measured the position and angulation of each vertebra to reveal those for which the spatial positioning could be relevant during spinal surgeries. SUMMARY OF BACKGROUND DATA Several recent publications detailed the sagittal alignment parameters and focus on global analysis parameters. Some patients with identical commonly evaluated spinal parameters have exhibited very different profiles, with notable differences in vertebral positions and orientations. Therefore, a fine segmental analysis of position of each vertebra could be interest to gain understanding of spine alignment. MATERIALS AND METHODS The authors obtained full-spine EOS x-rays of 99 volunteers in the standard free-standing position. We used a validated three-dimensional reconstruction technique to extract current spinal parameters and the positions and angulations of all vertebrae and lumbar discs. Particular attention was paid to the positions and angulations of the apical and transitional vertebrae in the general population and in subgroups according to pelvic incidence (PI). RESULTS T1 was the most common transitional cervicothoracic vertebra (in 89.9% of subjects) and was oriented downwards by an average of 22.0° (SD=7.3°, minimum=2.3°, maximum=40.1°). The thoracic apex trio of T5 (22.2%), T6 (28.3%), and T7 (36.4%) were equally found. The transitional thoracolumbar vertebrae were L1 (39.4%) and T12 (33.3%). The lumbar apex was usually the L3-L4 disc (36.4%). T1 seemed to be the transitional vertebra (90%) irrespective of the PI. For the other relevant vertebrae, the greater the PI, the more cranial the vertebra. CONCLUSIONS We performed a detailed three-dimensional assessment of overall spinal balance using positional and rotational parameters. The positions and orientations of all vertebrae were specified, particularly the apical and transitional vertebrae. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Olivier Gille
- Spine Surgery Department, University Hospital, Bordeaux, France
| | - Wafa Skalli
- Biomechanical Laboratory, ENSAM-CNRS UMR 8005, Paris, France
| | - Paul Mathio
- Spine Surgery Department, University Hospital, Bordeaux, France
| | | | - Alice Boishardy
- Spine Surgery Department, University Hospital, Bordeaux, France
| | - Laurent Gajny
- Spine Surgery Department, University Hospital, Nîmes, France
| | - Cecile Roscop
- Spine Surgery Department, University Hospital, Bordeaux, France
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Charles YP, Bauduin E, Pesenti S, Ilharreborde B, Prost S, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Blondel B. Variation of Global Sagittal Alignment Parameters According to Gender, Pelvic Incidence, and Age. Clin Spine Surg 2022; 35:E610-E620. [PMID: 35383599 DOI: 10.1097/bsd.0000000000001321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE The aim was to describe existing global sagittal alignment parameters across ages and to analyze differences according to gender and pelvic incidence (PI). SUMMARY OF BACKGROUND DATA Variability with age has been reported. It remains unclear how gender and spinopelvic morphology could additionally influence global alignment parameters. MATERIALS AND METHODS Radiographs of 2599 individuals (5-93 y) were analyzed. Translation parameters were: Sagittal Vertical Axis (SVA)-C7, SVA-C2, SVA-Center Acoustic Meatus (CAM), C7/Sacrofemoral Distance (SFD) ratio. Inclination parameters were: C7-Vertical Tilt (VT), T1-VT and T9-VT, Odontoid-Hip Axis (OD-HA), OD-CAM. Pelvic compensation parameters were: T1-Pelvic Angle (TPA), Global Tilt (GT), Spino-Sacral Angle (SSA). Global sagittal alignment (GSA) was considered among formulae. The distribution of parameters was analyzed using a Bayesian inference. Correlations with spinopelvic parameters were investigated. RESULTS SVA-C7, SVA-C2, SVA-CAM were larger in males and high PI, and increased significantly after 50 years (Pr>0.9999). C7/SFD decreased during growth and was larger in low PI (Pr=0.951). There was no correlation with spinopelvic parameters. Age-related variations of inclination parameters were nonsignificant. T1-VT and T9-VT increased with PI and were significantly larger in high PI (Pr>0.95). C7-VT was significantly larger in low PI (Pr>0.9999). OD-HA and OD-CAM were constant and increased after 80 years. TPA and GT increased with PI (Pr>0.9999) and age after 35 years (Pr>0.9999). SSA decreased nonsignificantly after 50 years. TPA correlated with PI (ρ=0.6130) and pelvic tilt (PT) (ρ=0.8375). GT correlated with PI (ρ=0.5961) and PT (ρ=0.8996). SSA correlated with sacral slope (ρ=0.9026). GSA was larger in high PI (Pr>0.9999) and increased after 35 years (Pr>0.9999). GSA correlated with PT (ρ=0.7732). CONCLUSION Translation parameters increase with age, more prominently in males and high PI. Variations of inclination parameters are smaller. Pelvic compensation parameters and GSA increase with age and are closely related to PT and spinopelvic morphology. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yann P Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims
| | - Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris
| | - Federico Solla
- Service d'Orthopédie Pédiatrique, Fondation Lenval, Nice
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, Bordeaux
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris
| | - Georges N Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris
| | | | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris
| | - Jonathan Lebhar
- Institut Locomoteur de l'Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire
| | | | | | - Erik A Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille
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John J, Klug C, Kranjec M, Svenning E, Iraeus J. Hello, world! VIVA+: A human body model lineup to evaluate sex-differences in crash protection. Front Bioeng Biotechnol 2022; 10:918904. [PMID: 35928956 PMCID: PMC9343945 DOI: 10.3389/fbioe.2022.918904] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Finite element Human Body Models are increasingly becoming vital tools for injury assessment and are expected to play an important role in virtual vehicle safety testing. With the aim of realizing models to study sex-differences seen in the injury- and fatality-risks from epidemiology, we developed models that represent an average female and an average male. The models were developed with an objective to allow tissue-based skeletal injury assessment, and thus non-skeletal organs and joints were defined with simplified characterizations to enhance computational efficiency and robustness. The model lineup comprises female and male representations of (seated) vehicle occupants and (standing) vulnerable road users, enabling the safety assessment of broader segments of the road user population. In addition, a new workflow utilized in the model development is presented. In this workflow, one model (the seated female) served as the base model while all the other models were generated as closely-linked derivative models, differing only in terms of node coordinates and mass distribution. This approach opens new possibilities to develop and maintain further models as part of the model lineup, representing different types of road users to reflect the ongoing transitions in mobility patterns (like bicyclists and e-scooter users). In this paper, we evaluate the kinetic and kinematic responses of the occupant and standing models to blunt impacts, mainly on the torso, in different directions (front, lateral, and back). The front and lateral impacts to the thorax showed responses comparable to the experiments, while the back impact varied with the location of impact (T1 and T8). Abdomen bar impact showed a stiffer load-deflection response at higher intrusions beyond 40 mm, because of simplified representation of internal organs. The lateral shoulder impact responses were also slightly stiffer, presumably from the simplified shoulder joint definition. This paper is the first in a series describing the development and validation of the new Human Body Model lineup, VIVA+. With the inclusion of an average-sized female model as a standard model in the lineup, we seek to foster an equitable injury evaluation in future virtual safety assessments.
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Affiliation(s)
- Jobin John
- Division of Vehicle Safety, Department of Mechanics and Maritime Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Corina Klug
- Vehicle Safety Institute, Graz University of Technology, Graz, Austria
| | - Matej Kranjec
- Chair of Modeling in Engineering Sciences and Medicine, Faculty of Mechanical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | | | - Johan Iraeus
- Division of Vehicle Safety, Department of Mechanics and Maritime Sciences, Chalmers University of Technology, Gothenburg, Sweden
- *Correspondence: Johan Iraeus,
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Khalifé M, Vergari C, Ferrero E, Attali V, Heidsieck C, Assi A, Skalli W. The rib cage: a new element in the spinopelvic chain. 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; 31:1457-1467. [PMID: 35501578 DOI: 10.1007/s00586-022-07216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 03/03/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION This study analyzes anatomical variations of the thoracic cage (TC) according to spinopelvic alignment, age and gender using stereoradiography in erect position. METHODS This retrospective multicentric study analyzed computed parameters collected from free-standing position bi-planar radiographs, among healthy subjects. Collected data were: age, gender, pelvic parameters (Pelvic Incidence, Pelvic Tilt (PT) and Sacral Slope), T1-T12 Kyphosis (TK), L1-S1 Lordosis (LL), curvilinear spinal length, global TC parameters (maximum thickness and width, rib cage volume, mean Spinal Penetration Index (SPI)), 1st-10th rib parameters (absolute and relative (to the corresponding vertebra) sagittal angles). RESULTS Totally, 256 subjects were included (140 females). Mean age was 34 (range: 8-83). Significant correlations were found between TK and TC thickness (0.3, p < 0.001) and with TC Volume (0.3, p = 0.04), as well as rib absolute sagittal angle for upper and middle ribs (0.2, p = 0.02). Conversely, a -0.3 correlation has been exhibited between SPI and TK. Similar correlations were found with LL. PT significantly correlated with TC thickness (0.4, p = 0.003), SPI (-0.3, p = 0.03), and all rib relative sagittal angles. Among global TC parameters, only thickness and SPI significantly changed after 20 years (respectively, 0.39 and -0.52, p < 0.001). Ribs relative sagittal angle showed negative correlation with age in skeletally mature subjects (p < 0.001). CONCLUSION This study demonstrates the correlation between TC anatomy and spinopelvic parameters, confirming its part of the spinopelvic chain of balance. Indeed, higher spinal curvatures were associated with lower SPI and higher TC thickness, TC volume and rib absolute sagittal angles.
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Affiliation(s)
- Marc Khalifé
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015, Paris, France. .,Université Paris Cité, Paris, France. .,Arts Et Métiers Institute of Technology, Université Sorbonne Paris Nord, Villetaneuse, France. .,IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France.
| | - Claudio Vergari
- Arts Et Métiers Institute of Technology, Université Sorbonne Paris Nord, Villetaneuse, France.,IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France
| | - Emmanuelle Ferrero
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015, Paris, France.,Université Paris Cité, Paris, France
| | - Valérie Attali
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Université, Paris, France.,Service Des Pathologies du Sommeil (Département "R3S"), Assistance Publique Hôpitaux de Paris (APHP), Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Cécile Heidsieck
- Arts Et Métiers Institute of Technology, Université Sorbonne Paris Nord, Villetaneuse, France.,IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France
| | - Ayman Assi
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Wafa Skalli
- Arts Et Métiers Institute of Technology, Université Sorbonne Paris Nord, Villetaneuse, France.,IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France
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Li QD, Yang JS, He BR, Liu TJ, Gao L, Chai X, Tian X, Hao DJ. Risk factors for proximal junctional kyphosis after posterior long-segment internal fixation for chronic symptomatic osteoporotic thoracolumbar fractures with kyphosis. BMC Surg 2022; 22:189. [PMID: 35568832 PMCID: PMC9107743 DOI: 10.1186/s12893-022-01598-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to analyze the risk factors for proximal junctional kyphosis (PJK) for patients with chronic symptomatic osteoporotic thoracolumbar fractures (CSOTLF) and kyphosis who underwent long-segment internal fixation.
Methods We retrospectively reviewed the records of patients with CSOTLF complicated with kyphosis who underwent posterior multilevel internal fixation in our hospital between January 2013 and January 2020. The patients’ age, sex, body mass index (BMI), bone mineral density (BMD), smoking status, cause of injury, comorbidities, injury segments, and American Spinal Injury Association (ASIA) grading non-surgical data; posterior ligament complex (PLC) injury, upper and lower instrumented vertebral position (UIV and LIV, respectively), number of fixed segments surgical data, proximal junctional angle (PJA), sagittal vertebral axis (SVA), pelvic incidence (PI), lumbar lordosis (LL), pelvic incidence-lumbar lordosis mismatch (PI-LL), pelvic tilt (PT), and sacral slope (SS) surgical indicators were collected. Patients were divided into postoperative PJK and non-PJK groups. Results This study included 90 patients; among them, 30 (31.58%) developed PJK postoperatively. All patients were followed up for > 24 months (mean 32.5 months). Univariate analysis showed significant differences in age, BMI, BMD, PLC injury, UIV, and LIV fixation position, number of fixation stages, and preoperative PJA, SVA, PI-LL, and SS between the two groups (P < 0.05). Additionally, no significant differences were observed in sex, smoking, cause of injury, complications, injury segment ASIA grade, and preoperative PT between the two groups (P > 0.05). Multifactorial logistic regression analysis showed that age > 70 years (OR = 32.279, P < 0.05), BMI > 28 kg/m2 (OR = 7.876, P < 0.05), BMD T value < − 3.5 SD (OR = 20.836, P < 0.05), PLC injury (OR = 13.981, P < 0.05), and preoperative PI-LL > 20° (OR = 13.301, P < 0.05) were risk factors for PJK after posterior long-segment internal fixation in elderly patients with CSOTLF complicated with kyphosis. Conclusion CSOTLF patients undergoing posterior long segment internal fixation are prone to PJK, and age > 70 years, BMI > 28 kg/m2, BMD T value < − 3.5 SD, preoperative PI-LL > 20° and PLC injury may increase their risk.
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Affiliation(s)
- Qing-Da Li
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Jun-Song Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Bao-Rong He
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Tuan-Jiang Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Lin Gao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Xin Chai
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Xin Tian
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China.
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Charles YP, Prost S, Pesenti S, Ilharreborde B, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Blondel B. Variation of cervical sagittal alignment parameters according to gender, pelvic incidence and age. 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; 31:1228-1240. [PMID: 34989876 DOI: 10.1007/s00586-021-07102-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/03/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim was to describe radiographic cervical sagittal alignment variations according to age, gender and pelvic incidence (PI) and to investigate relationships with thoracic alignment. METHODS A total of 2599 individuals (5-93 years) without spinal deformity were studied. Cranial cervical parameters were: McGregor slope, occipita-C2 angle, McGregor-C2 lordosis and C1-C2 lordosis. Caudal cervical parameters were: C2-C7, cranial arch and caudal arch lordosis and C7- and T1-slope. A Bayesian inference compared parameter distributions. Correlations with spinopelvic and global alignment parameters were investigated. RESULTS Among cranial cervical parameters, variations of McGregor slope were non-significant. McGregor-C2 lordosis and C1-C2 lordosis were smaller in males and increased significantly during growth, whereas the occipito-C2 angle decreased (Pr > 0.95). The occipito-C2 angle was larger and McGregor-C2 lordosis was smaller in low PI (Pr > 0.95). Among caudal cervical parameters, C2-C7 lordosis and C7- and T1-slope were larger in males and increased after 50 years (Pr > 0.95). Lordosis changes were non-significant in the cranial arch, whereas values increased in the caudal arch after 35 years (Pr > 0.95). Caudal parameter differences were non-significant between PI groups. Strong correlations existed between C2-C7, caudal arch lordosis, C7-slope, T1-slope and thoracic kyphosis. The sagittal vertical axis C2 correlated with caudal arch lordosis and T1-slope (ρ > 0.5; Pr > 0.95). CONCLUSION Cervical alignment parameters vary according to age, gender and PI. In the cranial cervical spine, changes occur mainly during growth. In the caudal cervical spine, lordosis increases in the caudal arch, which is related to thoracic kyphosis increase with age. The caudal cervical arch acts as a compensatory segment by progressive extension, allowing horizontal gaze.
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Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Federico Solla
- Service d'Orthopédie Pédiatrique, Fondation Lenval, Nice, France
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, Bordeaux, France
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Georges Naïm Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Vincent Fière
- Centre Orthopédique Santy, Unité du Rachis, Lyon, France
| | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France
| | - Jonathan Lebhar
- Institut Locomoteur de L'Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire, France
| | | | | | - Erik André Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
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Zhai M, Huang Y, Zhou S, Feng J, Pei C, Wen L. Effects of a postural cueing for head and neck posture on lumbar lordosis angles in healthy young and older adults: a preliminary study. J Orthop Surg Res 2022; 17:199. [PMID: 35379258 PMCID: PMC8981642 DOI: 10.1186/s13018-022-03090-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background Postural rehabilitation plays an important role in the treatment of non-specific low back pain. Although pelvic inclination has been widely used to improve lumbar lordosis, the effect of cervical anterior inclination on lumbar lordosis in young and older adults in sitting and standing posture is still unclear. This preliminary study was designed to examine the influence of changing the cervical anterior angle on the lumbar lordosis angle, through alterations of the head position under the natural sitting and standing conditions, aiming to provide a basis for establishing a new postural rehabilitation strategy. Methods Thirty-six young (24.0 ± 2.2 years, 14 females and 22 males) and 38 older (68.4 ± 5.9 years, 36 females and 2 males) healthy adults participated in this study. The four spinal regional angles—cervical anterior angle, thoracic kyphosis angle, lumbar lordosis angle, and pelvic forward inclination angle, were measured in standing and relaxed sitting postures to determine the effects of a postural cueing for the head and neck posture, “inclining head backward and performing chin tuck,” on lumbar lordosis angle. Results In the standing posture, the pelvic forward inclination angle in the older adult group was significantly smaller (P < 0.001, by ANOVA) than that in the young adult group and increased significantly (P < 0.001) in response to the postural cueing. In addition, the thoracic kyphosis angle in the standing (P = 0.001) and sitting (P = 0.003) positions was significantly reduced in response to the postural cueing. However, the lumbar lordosis angle in response to the postural cueing increased significantly in both the standing position (P < 0.001) and sitting position (P < 0.001). Conclusion The results suggest that increasing the cervical anterior angle can increase the lumbar lordosis angle, and the cervical anterior inclination can be used as an alternative to pelvic forward inclination to improve the lumbar lordosis angle. Furthermore, the change in head and neck posture can reduce the thoracic kyphosis angle, making it possible to establish a new noninvasive body posture rehabilitation strategy. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03090-9.
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Affiliation(s)
- Meiling Zhai
- School of Sports and Health, Nanjing Sport Institute, No.8 Linggusi road, Nanjing, 210014, Jiangsu, China.,Institute of Exercise and Health, Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Yongchao Huang
- School of Sports and Health, Nanjing Sport Institute, No.8 Linggusi road, Nanjing, 210014, Jiangsu, China.,Institute of Exercise and Health, Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Shi Zhou
- Sport and Exercise Science, Faculty of Health, Southern Cross University, P Block, Military Road, East Lismore, NSW, 2480, Australia
| | - Jiayun Feng
- Institute of Sports Training, Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Chaolei Pei
- Institute of Sports Training, Shanxi Normal University, No.339 Taiyu Road, Xiaodian District, Taiyuan City, 030000, China
| | - Li Wen
- School of Sports and Health, Nanjing Sport Institute, No.8 Linggusi road, Nanjing, 210014, Jiangsu, China.
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Associations between potentially modifiable clinical factors and sagittal balance of the spine in older adults from the general population. Spine Deform 2022; 10:433-441. [PMID: 34741754 DOI: 10.1007/s43390-021-00435-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/23/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Spinal sagittal balance is associated with back pain and quality of life. Enhancing understanding of the clinical factors associated with sagittal balance is essential for guiding the development of effective non-operative treatment. We aimed to evaluate the associations between spinal sagittal balance and potentially modifiable clinical factors and interactions between current back pain and the evaluated clinical factors. METHODS We conducted a cross-sectional study where sagittal alignment, measured radiographically by EOS, was defined by sagittal vertical axis (SVA). The clinical factors included non-radiographic (NR) lumbar lordosis angle, balance (Berg balance scale), hip and back extension range of motion (ROM) and extensor strength, and back pain. Pearson's correlation coefficients and multivariable regression analyses were conducted in 63 adult participants (70% female, mean age 73 (SD 8.6) years) from the general population. RESULTS We identified correlations between SVA and age (r = 0.4, p < 0.001), body mass index (BMI) (r = 0.3, p = 0.008), balance (r = - 0.5, p < 0.001) and NR lumbar lordosis angle (r = - 0.5, p < 0.001). The final model (R2 = 58%) identified that, after controlling for age and BMI, larger SVA was associated with lower NR lumbar lordosis (R2 = 15%, p < 0.001), poorer balance (R2 = 7%, p = 0.02), greater hip extensor strength (R2 = 4%, p = 0.053), and among people with back pain, NR lumbar extension ROM (R2 = 3%, p = 0.034). Hip ROM and lumbar strength were not significant. CONCLUSION Reduced NR lumbar lordosis magnitude and ROM, balance and hip strength are associated with SVA; however, it is unclear if these factors are compensatory, contributing, or modifiable. Hence, future longitudinal studies are needed.
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Ohyama S, Aoki Y, Inoue M, Nakajima T, Sato Y, Watanabe A, Takahashi H, Kubota G, Nakajima A, Saito J, Eguchi Y, Orita S, Nakagawa K, Ohtori S. Predictors of Spontaneous Restoration of Lumbar Lordosis after Single-Level Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Diseases. Spine Surg Relat Res 2021; 5:397-404. [PMID: 34966866 PMCID: PMC8668222 DOI: 10.22603/ssrr.2020-0195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Preoperative factors that predict postoperative restoration of lumbar lordosis (LL) are not well understood. To investigate whether preoperative postural correction of LL, sagittal malalignment, or lumbar flexibility are associated with the postoperative restoration of LL in patients treated with a single-level transforaminal lumbar interbody fusion (TLIF), a retrospective cohort study was conducted. Methods We enrolled 104 patients (mean age: 67.5±10.7 years old; 47 men and 57 women) with lumbar degenerative diseases treated with a single-level TLIF. The pre- and postoperative LL were examined using lateral radiographs in the standing position and computed tomography (CT) images in the supine position. The correlation between postoperative LL restoration and preoperative postural correction of LL (difference in LL between the standing and supine positions: D-LL), sagittal imbalance (pelvic incidence minus LL: PI-LL), and lumbar flexibility (difference in LL between the flexion and extension postures) were analyzed. Patients were divided into two groups according to the D-LL (D-LL≥0° and D-LL<0°). The rates of postoperative LL restoration (postoperative LL-preoperative LL in standing) were compared between the two groups. Results Multiple regression analysis performed after adjustment for age, gender, body mass index, and cage angle revealed that postoperative LL restoration was significantly correlated with D-LL (p<0.001), but not with PI-LL, and lumbar flexibility. Patients with a preoperative D-LL≥0° showed a significantly greater increase of LL after TLIF (7.1°±11.2°) than those with D-LL<0° (1.4°±6.6°) (p=0.003). Conclusions A preoperative evaluation of a lateral radiograph or CT taken in the supine position is useful in predicting postoperative improvement of sagittal alignment. Postoperative improvement of sagittal spinopelvic alignment would be expected when LL is corrected in the supine position preoperatively. Surgeons should pay attention to the postural correction of LL when performing short-segment fusion surgery for lumbar degenerative disease with sagittal malalignment.
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Affiliation(s)
- Shuhei Ohyama
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Go Kubota
- Department of Orthopaedic Surgery, Sawara Prefectural Hospital, Katori, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
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Lafage R, Smith JS, Sheikh Alshabab B, Ames C, Passias PG, Shaffrey CI, Mundis G, Protopsaltis T, Gupta M, Klineberg E, Kim HJ, Bess S, Schwab F, Lafage V. When can we expect global sagittal alignment to reach a stable value following cervical deformity surgery? J Neurosurg Spine 2021; 36:616-623. [PMID: 34740177 DOI: 10.3171/2021.7.spine21306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical deformity (CD) is a complex condition with a clear impact on patient quality of life, which can be improved with surgical treatment. Previous study following thoracolumbar surgery demonstrated a spontaneous and maintained improvement in cervical alignment following lumbar pedicle subtraction osteotomy (PSO). In this study the authors aimed to investigate the complementary questions of whether cervical alignment induces a change in global alignment and whether this change stabilizes over time. METHODS To analyze spontaneous changes, this study included only patients with at least 5 levels remaining unfused following surgery. After data were obtained for the entire cohort, repeated-measures analyses were conducted between preoperative baseline and 3-month and 1-year follow-ups with a post hoc analysis and Bonferroni correction. A subanalysis of patients with 2-year follow-up was performed. RESULTS One-year follow-up data were available for 121 of 168 patients (72%), and 89 patients had at least 5 levels remaining unfused following surgery. Preoperatively there was a moderate anterior cervical alignment (C2-7, -7.7° [kyphosis]; T1 slope minus cervical lordosis, 37.1°; cervical sagittal vertebral axis [cSVA], 37 mm) combined with a posterior global alignment (SVA, -8 mm) with lumbar hyperextension (pelvic incidence [PI] minus lumbar lordosis [LL] mismatch [PI-LL], -0.6°). Patients underwent a significant correction of the cervical alignment (median ΔC2-7, 13.6°). Simultaneously, PI-LL, T1 pelvic angle (TPA), and SVA increased significantly (all p < 0.05) between baseline and 3-month and 1-year follow-ups. Post hoc analysis demonstrated that all of the changes occurred between baseline and 3 months. Subanalysis of patients with complete 2-year follow-up demonstrated similar results, with stable postoperative thoracolumbar alignment achieved at 3 months. CONCLUSIONS Correction of cervical malalignment can have a significant impact on thoracolumbar regional and global alignment. Peak relaxation of compensatory mechanisms is achieved by the 3-month follow-up and tends to remain stable. Subanalysis with 2-year data further supports this finding. These findings can help to identify when the results of cervical surgery on global alignment can be best evaluated.
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Quek CX, Goh GS, Soh RCC. Does Cervical Alignment Matter? The Effect of 2-level Anterior Cervical Discectomy and Fusion on Sagittal Alignment and Patient-reported Outcomes. Clin Spine Surg 2021; 34:E545-E551. [PMID: 34183546 DOI: 10.1097/bsd.0000000000001223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE This study aimed to determine the change in cervical sagittal balance following 2-level anterior cervical discectomy and fusion (ACDF) and whether the degree of change was associated with improvement in patient-reported outcomes (PROs). SUMMARY OF BACKGROUND DATA Sagittal balance in cervical spine surgery has been recognized as an important surgical goal. However, its influence on clinical outcomes following anterior decompressive procedures remains debatable. MATERIALS AND METHODS Patients who underwent primary 2-level ACDF for cervical spondylotic radiculopathy and/or myelopathy were identified from an institutional spine registry. Radiographic measurements were done preoperatively, postoperatively, and at minimum 24 months follow-up. Measurements comprised segmental lordosis (SL), C2-C7 cervical lordosis (CL), C2-C7 sagittal vertical axis, C7 slope (C7S), T1 slope (T1S) and C7 slope minus cervical lordosis (C7S-CL). Disk heights were measured preoperatively and postoperatively. PROs including the Neck Disability Index, Short Form-36, and Visual Analog Scale for neck pain and arm pain were collected preoperatively and at 24 months postoperatively. RESULTS In total, 90 patients were included. Mean follow-up was 58.6±22.9 months. Significant improvement in all PROs was achieved at 24 months (P<0.05). SL was -1.2±8.2 degrees preoperatively, increased to 5.2±5.9 degrees postoperatively (P<0.001), and decreased to 1.2±6.2 degrees at follow-up (P=0.005). CL was 8.5±12.5 degrees preoperatively, increased to 10.8±12.4 degrees postoperatively (P=0.018), and maintained at 10.9±11.2 degrees at follow-up (P=0.030). Sagittal vertical axis, C7S, T1S, and C7S-CL did not change significantly. Significant increases in disk heights were achieved postoperatively (P<0.001). Fusion rate was 98.9% at follow-up. PROs were not related to radiologic measurements. Maintaining or increasing CL or SL was not related to a greater degree of improvement in PROs. CONCLUSIONS Two-level ACDF restored segmental and global CL, but changes in cervical sagittal alignment did not correlate with the magnitude of improvement in PROs. Adequate decompression with solid fusion remains fundamental to achieving good clinical outcomes in patients with degenerative cervical disease.
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Affiliation(s)
- Clara X Quek
- Singapore General Hospital, Singapore, Singapore
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Zhang ZF, Qi DB, Wang TH, Wang CG, Wang Z, Wang Y, Zheng GQ. Association of Sagittal Spinopelvic Realignment with Correction in Lower Lumbar Lordosis after Surgical Treatment in Degenerative Lumbar Scoliosis. Orthop Surg 2021; 13:2034-2042. [PMID: 34559468 PMCID: PMC8528994 DOI: 10.1111/os.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/09/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the effect that correction of lower lumbar lordosis (3L) has on global spine realignment due to the key role of 3L for scoliosis surgery in patients with degenerative lumbar scoliosis (DLS). Methods This study is a retrospective review performed between June 2018 and January 2020, including consecutive patients with DLS. Only patients age ≥ 45 years who had already undergone a selective root block operation and had the procedure of long‐fusion extending to pelvis and posterior lumbar interbody fusion (PLIF) at lower lumbar spine (L4‐S1) were retained for analysis. Spinopelvic parameters measured included thoracic kyphosis (TK), lumbar lordosis (LL), 3L, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), T1 pelvic angle (TPA), and sagittal vertical axis (SVA) at pre‐operation and the third month follow‐up. The mismatch (PI‐LL) was calculated subsequently. Pearson correlation and linear regression analysis were performed to explore the association of the changes in global spinopelvic parameters with 3L correction. Results Thirty‐nine patients (five males, 34 females) with the average age of 63.84 years (SD 7.53; range, 45–75 years) at the time of surgery were identified. All patients had the surgical procedure of long‐fusion (≥4 vertebras) with PLIF at lower lumbar spine between L4 and S1 spine. Lower instrumented vertebras (LIV) fused to pelvis (S1, 14; S2, 18; ilium, 7) were operated in all patients. Seventeen patients were with upper instrumented vertebras (UIV) at thoracolumbar spine (L2‐T11), and 22 patients at thoracic spine (T10 and above). The median of instrumented segments was 10 (5–14). 3L significantly increased (P = 0.02) after surgical treatment by mean change of 4.21° (range, −19.7° to +22.2°). Perioperatively, all spinopelvic parameters regarding to TK, LL, SS, PT, TPA, SVA, and mismatch (PI‐LL) had significant changes (P < 0.001). The change in 3L correlated significantly with the changes in spinopelvic parameters (r = 0.772 for LL, −0.589 for SVA, −0.439 for TPA, and −0.428 for PI‐LL). After linear regression analysis, the formulas were obtained: d‐LL = 14.977 + 0.636 × d‐3L, (R2 = 0.596); d‐(PI‐LL) = 16.575 + 0.62 × d‐3L, (R2 = 0.183); d‐TPA = −7.284 to 0.358 × d‐3L, (R2 = 0.193); d‐SVA = −30.556–2.639 × d‐3L (R2 = 0.347). Conclusions Correction in lower lumbar lordosis, following the surgical procedure of long‐fusion with PLIF at lower lumbar spine, could result in significant changes in full‐spine parameters. The significant association of changes in each of global spine parameter with the correction of 3L perioperatively could provide important information for surgeons to make a surgical plan for spinal correction.
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Affiliation(s)
- Zi-Fang Zhang
- The Medical College of Nankai University, Tianjin, China.,The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Deng-Bin Qi
- The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Tian-Hao Wang
- The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Chun-Guo Wang
- The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Zheng Wang
- The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Yan Wang
- The Medical College of Nankai University, Tianjin, China.,The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Guo-Quan Zheng
- The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
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42
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Song J, Pan F, Zhu W, Kong C, Lu S. Characteristics of the sagittal spinal balance in the asymptomatic elderly Chinese population. 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; 31:233-240. [PMID: 34463863 DOI: 10.1007/s00586-021-06979-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/05/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the normal values of the sagittal spinal parameters and analyze the distribution of the global spinal profiles in a Chinese population with age over 75. METHODS Two hundred and twelve sets of the whole spine lateral radiographs were obtained from a database of an asymptomatic elderly population. Global and regional spinal parameters were measured. Sagittal profiles were determined according to the Roussouly classification compared with previous studies involving different populations. RESULTS A total of 102 elderly subjects (≥ 75 years) were enrolled with an average age of 79.24 ± 3.53 years. The mean values of the spinopelvic parameters were 42.89 ± 11.64° for TK, 13.84 ± 10.78° for TLK, 44.48 ± 12.88° for LL, 44.76 ± 9.84° for PI, 17.19 ± 8.08° for PT, 28.35 ± 7.94° for SS, 3.47 ± 3.56 cm for SVA, 14.75 ± 7.85° for TPA, -0.27 ± 11.95° for PI-LL, respectively. Subjects ≥ 75 years were found to have significantly smaller LL and SS, but greater TLK, PT, SVA, TPA, and PI-LL than those 60-74 years (p < 0.05). Significant age- and sex-dependent differences were found in the Roussouly classification's distribution between the two subgroups. CONCLUSIONS The normal values of the sagittal parameters were presented in the elderly Chinese asymptomatic population (≥ 75 years). Ethnic, age, and sex displayed significant effects on the behaviors of the sagittal spinal balance and profiles. These results could be served as physiological references for the planning of surgical strategies in elderly Chinese patients over 75 years.
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Affiliation(s)
- Jipeng Song
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fumin Pan
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weiguo Zhu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Aoki Y, Inoue M, Takahashi H, Kubota G, Watanabe A, Nakajima T, Sato Y, Nakajima A, Saito J, Eguchi Y, Orita S, Fukuchi H, Sakai T, Ochi S, Yanagawa N, Nakagawa K, Ohtori S. Computed Tomographic Assessment of Age- and Gender-Specific Sagittal Lumbopelvic Alignment in a Japanese Population. Spine Surg Relat Res 2021; 5:278-283. [PMID: 34435152 PMCID: PMC8356231 DOI: 10.22603/ssrr.2020-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/29/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Previous studies have reported differences in lumbopelvic alignment between standing and supine positions. Computed tomography (CT) images taken in the supine position are often used for clinical studies in addition to standing radiographs, although not frequently. Our study aims to clarify normative values of CT-evaluated lumbopelvic parameters and the characteristics of age- and gender-related lumbopelvic alignment in the supine position. Methods Patients undergoing CT scans of abdominal or lumbar regions for reasons other than low back disorders were included (n=581). Sagittal multiplanar reconstruction CT images were obtained, and lumbar lordosis (LL), L5-S1 angle, and sacral slope (SS) were measured. Mean values of the parameters in patients aged 59 years and under, 60-69, 70-79, and 80 and over, and in males and females, were calculated. Age- and gender-related differences in these parameters were statistically analyzed. Results Among the four age groups, patients 80 years and over showed significantly lower LL and SS than patients aged 70-79. Females 80 years and over showed significantly lower LL and SS than all other age groups, but those in males did not. The comparison between males and females showed no significant differences in LL and SS; however, the L5-S1 angle was significantly higher in males than in females. In patients 80 years and over, females showed significantly lower LL and SS than in males. Conclusions This study provides normative CT-evaluated lumbopelvic parameters, such as LL, L5-S1 angle, and SS, which will be utilized for comparisons in future studies. The present study first revealed that pelvic retroversion and lumbar kyphosis occur in elderly females in the supine position, which raised a possibility that age-related decrease of LL and SS in females occurs at an older age in the supine position than in the standing position.
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Affiliation(s)
- Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Go Kubota
- Department of Orthopaedic Surgery, Sawara Prefectural Hospital, Katori, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroyuki Fukuchi
- Department of Radiology, Eastern Chiba Medical Center, Togane, Japan
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, Togane, Japan
| | - Shigehiro Ochi
- Department of Radiology, Eastern Chiba Medical Center, Togane, Japan
| | - Noriyuki Yanagawa
- Department of Radiology, Eastern Chiba Medical Center, Togane, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Ochtman AEA, Kruyt MC, Jacobs WCH, Kersten RFMR, le Huec JC, Öner FC, van Gaalen SM. Surgical Restoration of Sagittal Alignment of the Spine: Correlation with Improved Patient-Reported Outcomes: A Systematic Review and Meta-Analysis. JBJS Rev 2021; 8:e1900100. [PMID: 32796194 DOI: 10.2106/jbjs.rvw.19.00100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The sagittal-plane curvatures of the human spine are the consequence of evolution from quadrupedalism to bipedalism and are needed to maintain the center of mass of the body within the base of support in the bipedal position. Lumbar degenerative disorders can lead to a decrease in lumbar lordosis and thereby affect overall alignment of the spine. However, there is not yet enough direct evidence that surgical restoration of spinal malalignment would lead to a better clinical outcome. Therefore, the aim of this study was to assess the correlation between patient-reported outcomes and actual obtained spinal sagittal alignment in adult patients with lumbar degenerative disorders who underwent surgical treatment. METHODS A comprehensive literature search was conducted through databases (PubMed, Cochrane, Web of Science, and Embase). The last search was in November 2018. Risk of bias was assessed with the Newcastle-Ottawa quality assessment scale. A meta-regression analysis was performed. RESULTS Of 2,024 unique articles in the original search, 34 articles with 973 patients were included. All studies were either retrospective or prospective cohort studies; no randomized controlled trials were available. A total of 54 relations between preoperative-to-postoperative improvement in patient-reported outcome measures (PROMs) and radiographic spinopelvic parameters were found, of which 20 were eligible for meta-regression analysis. Of these, 2 correlations were significant: pelvic tilt (PT) versus Oswestry Disability Index (ODI) (p = 0.009) and PT versus visual analog scale (VAS) pain (p = 0.008). CONCLUSIONS On the basis of the current literature, lower PT was significantly correlated with improved ODI and VAS pain in patients with sagittal malalignment caused by lumbar degenerative disorders that were treated with surgical correction of the sagittal balance. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- A E A Ochtman
- Department of Orthopedics, Clinical Orthopedic Research Center midden-Nederland (CORC-mN), Utrecht, the Netherlands
| | - M C Kruyt
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - W C H Jacobs
- The Health Scientist, The Hague, the Netherlands
| | - R F M R Kersten
- Department of Orthopedics, Clinical Orthopedic Research Center midden-Nederland (CORC-mN), Utrecht, the Netherlands
| | - J C le Huec
- Orthospine Unit, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - F C Öner
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - S M van Gaalen
- Acibadem International Medical Center, Amsterdam, the Netherlands
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Hey HWD, Tay HW, Wong GC, Tan KA, Lau ETC, Wong SJ, Liu KPG, Wong HK. Fulcrum to Generate Maximum Extension of the Spine and Hip-Proposing A New Strategy using EOS Imaging for Patient-specific Assessment of Degenerated Lumbar Spines. Spine (Phila Pa 1976) 2021; 46:E832-E839. [PMID: 33660680 DOI: 10.1097/brs.0000000000004025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective, radiographic comparative study conducted in a single academic institution. OBJECTIVE This study aims to compare fulcrum extension with conventional extension imaging to determine maximum "hip lordosis" (HL), an important novel patient-specific parameter in spinal realignment surgery, as well as understand the extension capabilities of the lower lumbar spine, which together, are key contributors to whole-body balancing. SUMMARY OF BACKGROUND DATA Recent literature recognizes the hip as an important contributor to whole-body lordosis beyond a compensator for spinal imbalance. METHODS Patients >45 years' old with mechanical low back pain due to degenerative spinal conditions were included and grouped based on the imaging performed-fulcrum or conventional extension. All imaging was performed using EOS under standardized instructions and visual aids. Radiographic parameters include global lumbar angle (GLA), inflexion-S1 (Inf-S1) angle, segmental lumbar angles, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), femoral alignment angle (FAA), HL and spinocoxa angle (SCA). Unpaired t test was used to compare between radiographic parameters. RESULTS One hundred patients (40 males and 60 females, mean age 63.0 years) underwent either fulcrum or conventional extension EOS® imaging. Both groups had comparable baseline radiographic parameters. Fulcrum extension gave a larger mean GLA (-60.7° vs. -48.5°, P = 0.001), Inf-S1 angle (-58.8° vs. -48.8°, P = 0.003), SCA (-36.5° vs. -24.8°, P < 0.001), L4/5 and L5/S1 lordosis (-20.7° vs. -17.7°, P = 0.041, and -22.3° vs. -17.1°, P = 0.018, respectively), compared to conventional extension. PI, SS, PT, FAA, and HL were similar between both extension postures. CONCLUSION Fulcrum extension, compared to conventional extension, is better at generating lordosis in the lower lumbar spine, thus improving preoperative assessment of stiffness or instability of the lumbar spine. Both extension methods were equally effective at determining the patient-specific maximum HL to assess the flexibility and compensation occurring at the hip, potentially guiding surgical management of patients with degenerative spines.Level of Evidence: 3.
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Affiliation(s)
- Hwee Weng Dennis Hey
- University Orthopedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui Wen Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gordon Chengyuan Wong
- University Orthopedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore
| | - Kimberly-Anne Tan
- University Orthopedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore
| | - Eugene Tze-Chun Lau
- University Orthopedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore
| | - Seng Juong Wong
- University Orthopedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore
| | - Ka-Po Gabriel Liu
- University Orthopedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore
| | - Hee-Kit Wong
- University Orthopedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Azimi P, Yazdanian T, Benzel EC, Montazeri A. Global Sagittal Balance of Spine in Asymptomatic Controls: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 154:93-108. [PMID: 34314909 DOI: 10.1016/j.wneu.2021.07.036] [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: 03/16/2021] [Revised: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the global sagittal balance of spine (GSBS) in asymptomatic controls. METHODS PubMed, Scopus, Cochrane library, and Web of Science searched up to July 2020. Studies were screened for the GSB parameters including T1 pelvic angle (TPA), spinosacral angle (SSA), sagittal vertical axis (SVA), C7/sacrofemoral distance ratio (Barrey index), odontoid hip axis (OD-HA), and Full Balance Index (FBI) as measured in asymptomatic participants. A meta-analysis was performed to synthesize pooled estimates. Heterogeneity and publication bias were assessed. RESULTS Overall, 76 studies were identified including 12,169 participants (54.7% female) with mean age ranges from 12.0 to 72.9 years old. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the mean (standard deviation) normative values were: 1) age ˃18 years, SSA (°), 127.6 (0.89); SVA absolute value (millimeters), 13.1 (1.13); TPA (°), 9.8 (1.13); T1SPI (°), -4.3 (0.57); and Barrey index absolute value, 0.51 (0.3). The mean value of the OD-HA (°) was reported 2.9 (1.6), and the FBI average value was less than 5°. 2) Age ≤18 years, SSA (°), 132.1 (8.3); SVA absolute value (millimeters), 11.9 (2.0); and Barrey index, -0.7 (8.3). A significant difference was observed between the 2 age groups based on SVA and SSA. CONCLUSIONS This paper presents normative data on TPA, SSA, SVA, Barrey index, OD-HA, and FBI as a reference for evaluating/measuring a GSB of spine in asymptomatic controls.
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Affiliation(s)
- Parisa Azimi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Edward C Benzel
- Cleveland Clinic Foundation, Department of Neurosurgery, Cleveland, Ohio, USA
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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Zappalá M, Lightbourne S, Heneghan NR. The relationship between thoracic kyphosis and age, and normative values across age groups: a systematic review of healthy adults. J Orthop Surg Res 2021; 16:447. [PMID: 34243795 PMCID: PMC8268398 DOI: 10.1186/s13018-021-02592-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/28/2021] [Indexed: 01/22/2023] Open
Abstract
Background Thoracic kyphosis is reported to increase with ageing. However, this relationship has not been systematically investigated. Peoples’ kyphosis often exceeds 40°, but 40° is the widely accepted cut-off and threshold for normality. Consequently, patients may be misclassified. Accurate restoration of kyphosis is important to avoid complications following spinal surgery. Therefore, specific reference values are needed. The objective of the review is to explore the relationship between thoracic kyphosis and age, provide normative values of kyphosis for different age groups and investigate the influence of gender and ethnicity. Methods Two reviewers independently conducted a literature search, including seven databases and the Spine Journal, from inception to April 2020. Quantitative observational studies on healthy adults (18 years of age or older) with no known pathologies, and measuring kyphosis with Cobb’s method, a flexicurve, or a kyphometer, were included. Study selection, data extraction, and study quality assessment (AQUA tool) were performed independently by two reviewers. The authors were contacted if clarifications were necessary. Correlation analysis and inferential statistics were performed (Microsoft Excel). The results are presented narratively. A modified GRADE was used for evidence quality assessment. Results Thirty-four studies (24 moderate-quality, 10 high-quality) were included (n = 7633). A positive moderate correlation between kyphosis and age was found (Spearman 0.52, p < 0.05, T5-T12). Peoples’ kyphosis resulted greater than 40° in 65% of the cases, and it was significantly smaller in individuals younger than 40 years old (x < 40) than in those older than 60 years old (x > 60) 75% of the time (p < 0.05). No differences between genders were found, although a greater kyphosis angle was observed in North Americans and Europeans. Conclusion Kyphosis increases with ageing, varying significantly between x < 40 and x > 60. Furthermore, kyphosis appears to be influenced by ethnicity, but not gender. Peoples’ thoracic sagittal curvature frequently exceeds 40°. Trial registration The review protocol was devised following the PRISMA-P Guidelines, and it was registered on PROSPERO (CRD42020175058) before study commencement. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02592-2.
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Affiliation(s)
- Mattia Zappalá
- Physiotherapy Department, St John & St Elizabeth Hospital, 60 Grove End Rd., St John's Wood, London, UK. .,Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK.
| | - Stephen Lightbourne
- Bermuda Hospitals Board, King Edward Memorial Hospital, 7 Point Finger Road, Paget, DV 04, Bermuda
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Liu H, Li X, Wang J, Li Z, Li Z, Chen S, Wang H, Zheng Z. Comparison study of clinical outcomes and sagittal alignment improvement between anterior and posterior fusion techniques for multilevel cervical spondylotic myelopathy. J Orthop Surg (Hong Kong) 2021; 29:2309499020988177. [PMID: 33626976 DOI: 10.1177/2309499020988177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare the sagittal alignment of different surgical approaches in patients with multiple levels cervical spondylotic myelopathy and explore the relationship between the cervical sagittal alignment and patient's health relative quality of life. METHOD A total of 97 multiple levels cervical spondylotic myelopathy patients who underwent surgery from January 2013 to January 2019 were collected in this study. Patients were divided into three groups: anterior cervical discectomy with fusion, anterior cervical corpectomy with fusion and laminectomy with fusion groups. Clinical outcomes and sagittal alignment parameters were compared preoperative and postoperative. RESULTS There were no significant differences in the average age and sex ratio among the groups. Sagittal parameters correlated to health relative quality of life were C7 slope, occipito-C2 angle, external auditory meatus tilt and cervical sagittal vertical axis. Both anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion groups exhibited better sagittal alignment and clinical outcomes improvement postoperatively. Anterior cervical discectomy with fusion provided better clinical outcomes and the better improvement of cervical lordosis, C7 slope, occipito-C2 angle and cervical sagittal vertical axis compared with patients with Laminectomy with fusion. CONCLUSION C7 slope, occipito-C2 angle, external auditory meatus tilt and cervical sagittal vertical axis are the most important cervical sagittal parameters correlated to clinical outcomes in patients with multilevels cervical spondylotic myelopathy; anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion provides more efficient to restoration of cervical sagittal alignment.
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Affiliation(s)
- Hui Liu
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiang Li
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianru Wang
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zemin Li
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zihao Li
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Siwen Chen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hua Wang
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhaomin Zheng
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Ang B, Lafage R, Elysée JC, Pannu TS, Bannwarth M, Carlson BB, Schwab FJ, Kim HJ, Lafage V. In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which? Global Spine J 2021; 11:541-548. [PMID: 32875889 PMCID: PMC8119914 DOI: 10.1177/2192568220914882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective single-center study. OBJECTIVE Investigate the effect of posterior instrumentation on the relationship between lordosis and kyphosis. METHODS Surgically treated patients with a minimum of 6 months of follow-up were analyzed. Asymptomatic volunteers served to show the normal anatomical relationship between thoracic and lumbar curves. Patients were stratified based on postoperative instrumentation: "Thoracic Fusion" = complete fusion of thoracic spine; "Lumbar Fusion" = complete fusion of lumbar spine; and "Complete Fusion" = fusion from sacrum to at least T5. Bivariate correlations and regression analysis were used to evaluate the relationship between change in thoracic kyphosis (ΔTK) and change in spinopelvic mismatch (ΔPI-LL; pelvic incidence-lumbar lordosis) before and after fusion. Analyses were repeated in "Lumbar Fusion" patients with flexible preoperative thoracic spines. RESULTS For asymptomatic volunteers, the natural anatomical relationship between TK and LL was found to be TK = 41% of LL (r = 0.425, P < .001). A total of 153 of 167 adult spinal deformity patients were included (62 years old, 26.7 kg/m2, 78% female). Mean follow-up was 11.5 ± 6.8 months. "Thoracic Fusion" group showed no alteration in the natural relationship between TK and LL (ΔTK = 39% ΔPI-LL), whereas "Lumbar Fusion" group had a reduction in reciprocal change (ΔTK = 34% ΔPI-LL) although a subanalysis of patients in the "Lumbar Fusion" group with flexible thoracic spines showed a marked compensation in reciprocal change with (ΔTK = 58% ΔPI-LL). CONCLUSION The relationship between ΔTK and ΔPI-LL is dependent on level instrumented. "Thoracic Fusion" drives change in LL while this relationship is affected by TK's natural stiffness in "Lumbar Fusion" patients.
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Affiliation(s)
- Bryan Ang
- Hospital for Special
Surgery, New York, NY, USA,Weill Cornell Medicine Medical School, New York, NY, USA
| | - Renaud Lafage
- Hospital for Special
Surgery, New York, NY, USA,Renaud Lafage, 525 E 71st St, Belaire 4E,
New York, NY 10021, USA.
| | | | | | - Mathieu Bannwarth
- Hospital for Special
Surgery, New York, NY, USA,CHU de Reims, Reims, France
| | - Brandon B. Carlson
- Hospital for Special
Surgery, New York, NY, USA,University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Han Jo Kim
- Hospital for Special
Surgery, New York, NY, USA
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Han HS, Yun KR, Cho K, Kim TW, Kang SB. Relationships between the changes in flexion contracture and standing flexion angle of the knee and sagittal spinal alignment after total knee arthroplasty. Knee 2021; 29:374-380. [PMID: 33706029 DOI: 10.1016/j.knee.2021.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/02/2020] [Accepted: 02/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The sagittal spinal alignment interacts with the lower extremity in patients with combined degenerative disease of the spine and lower extremity. This study aimed to clarify the relationships between the reciprocal changes in sagittal alignment of the knee, pelvis, and spine after total knee arthroplasty (TKA) in osteoarthritis patients. METHODS Prospectively, 36 patients who underwent primary TKA for severe knee osteoarthritis were enrolled. Their clinical and radiological evaluation included assessments of the knee flexion contracture (KFC) and standing knee flexion angle (KFA), as well as spinopelvic parameters and the global sagittal spinal alignment from standing whole-lower-extremity and whole-spine radiographs preoperatively and at postoperative 2 weeks, 6 weeks, 6 months, 1 year, and 2 years. Linear mixed models were used to assess the relationships between KFC/KFA and between spinopelvic/global sagittal spinal alignments. RESULTS The KFC decreased abruptly immediately after TKA, and the correction was maintained for 2 years postoperatively. The KFA decreased gradually and approached the value of the KFC after 2 years. Of the spinopelvic parameters, sacral slope and pelvic incidence decreased significantly, in ways related to changes in KFA. There was no significant relationship between sagittal spinal alignment and postoperative changes in KFC. CONCLUSION Although the flexion contracture was corrected immediately after TKA, the standing KFA improved gradually over 2 years. The pelvic parameters showed compensatory changes according to the KFA. The decompensated sagittal spinal malalignment was not related to a relapse in flexion contracture.
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Affiliation(s)
- Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Kuk-Ro Yun
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Kwanjae Cho
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea.
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