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Duan Q, Liang G, Chen C, Ye Y, Zheng X, Liang C, Chang Y. Accuracy of Realigned K-line for Predicting Surgical Outcomes After Laminoplasty in Patients With Degenerative Cervical Myelopathy. Global Spine J 2024; 14:1573-1582. [PMID: 36626180 DOI: 10.1177/21925682221150908] [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: 01/11/2023] Open
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVES To report a new index, the realigned K-line, for predicting surgical outcomes after laminoplasty in patients with degenerative cervical myelopathy (DCM). METHODS One hundred twenty-eight patients with DCM undergoing laminoplasty were enrolled from January 2018 to April 2021 in our department. A realigned K-line was defined as the line connecting the midpoints of the spinal cord between C2 and C7 on realigned T1-weighted magnetic resonance imaging. The minimum interval between the anterior compression factors of the spinal cord and the realigned K-line (INTrea), and the modified K-line (INTmod) were measured. A logistic regression analysis was performed to identify factors associated with unsatisfactory surgical outcomes. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was applied to evaluate the reliability of the multivariate logistic regression model. RESULTS Univariate analysis showed that the score for the bladder function section of the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire, numeric rating scale scores for arm pain, and INTrea might be related to the Japanese Orthopaedic Association (JOA) recovery rate (RR) not achieving the minimal clinically important difference (MCID) (P < .05). Only INTrea (odds ratio = .744, P < .05) was an independent preoperative factor related to the JOA RR not achieving the MCID (area under the curve, .743). A cutoff of 5.0 mm for INTrea had an accuracy of 71.9% and specificity of 80.3% for predicting the JOA RR not achieving the MCID. CONCLUSIONS INTrea is an independent preoperative risk factor related to the JOA RR not achieving the MCID in patients with DCM. A cutoff point of 5.0 mm is most appropriate for alerting spine surgeons to a high likelihood of the JOA RR not achieving the MCID.
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Affiliation(s)
- Qifei Duan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guoyan Liang
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chong Chen
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yongyu Ye
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xiaoqing Zheng
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Changxiang Liang
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yunbing Chang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Comparison of MRI and bolster hyperextension radiography in determining the flexibility of thoracic curves in Scheuermann kyphosis: a retrospective cross-sectional study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Sugi A, Matsuki K, Fukushi R, Shimoto T, Hirose T, Shibayama Y, Nishinaka N, Iba K, Yamashita T, Banks SA. Comparing in vivo three-dimensional shoulder elevation kinematics between standing and supine postures. JSES Int 2021; 5:1001-1007. [PMID: 34766076 PMCID: PMC8568990 DOI: 10.1016/j.jseint.2021.07.005] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background It is often assumed that body posture, standing vs. supine, changes shoulder muscle activation and range of motion, but these altered shoulder mechanics have not been objectively assessed. We expected the supine posture might facilitate scapular rotation and change subacromial pressure. The purpose of this study is to evaluate the influence of body posture on shoulder kinematics during arm elevation. Methods Ten males and eight females with a mean age of 33 years participated in this study. Shoulder kinematics were assessed during scapular plane elevation in the standing and supine postures by using single-plane fluoroscopic images. Kinematics were measured using 3-dimensional to 2-dimensional model-image registration techniques: matching the 3-dimensional bone model derived from computed tomography onto each fluoroscopic image. Glenohumeral superior/inferior translation, acromiohumeral distance, and scapular rotations were compared between the postures. The effect of sex also was evaluated. Results With the arm at the side position, the humeral head in the supine posture was located 0.5 mm superior compared to the standing posture (P < .001). During humeral elevation, the humeral head significantly shifted more inferiorly in the supine posture than in standing; the biggest mean difference was 0.6 mm, P = .003. But acromiohumeral distance during elevation was not significantly affected by the body posture (P = .05). Scapular upward rotation and posterior tilt were significantly different between the postures (P < .001). Sex had statistically significant, but quantitatively small, effects on shoulder kinematics. Conclusions Body postures affect shoulder kinematics during humeral elevation. This knowledge will be useful to optimize rehabilitation exercises and for diagnostic insight.
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Affiliation(s)
- Akira Sugi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
- Corresponding author: Akira Sugi, MD, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Keisuke Matsuki
- Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Ryunosuke Fukushi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Shimoto
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
- Department of Information and System Engineering, Fukuoka Institute of Technology, Fukuoka, Japan
| | | | - Yuji Shibayama
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Naoya Nishinaka
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Scott A. Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
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Boudreau C, Carrondo Cottin S, Ruel-Laliberté J, Mercier D, Gélinas-Phaneuf N, Paquet J. Correlation of supine MRI and standing radiographs for cervical sagittal balance in myelopathy patients: a cross-sectional study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1521-1528. [PMID: 33881642 DOI: 10.1007/s00586-021-06833-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/09/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Cervical sagittal alignment is correlated with myelopathy severity and used by spinal surgeons for surgical planification. Magnetic resonance imaging (MRI) is the gold standard for the evaluation of cervical myelopathy but may not be for the assessment of cervical sagittal balance compared to X-rays. The objective of this study was to assess the correlation of cervical alignment between supine MRI and standing radiographs in patients with cervical spondylotic myelopathy (CSM). METHODS Cobb, Jackson and Harrison methods were used to measure cervical sagittal alignment on supine MRI and standing radiographs of CSM adults. Cervical alignment was divided based on Cobb angle values on lordotic (> 4°), kyphotic (< - 4°) and rectitude (- 4° to 4°). Correlations between radiographic and MRI measurements were determined. Intra- and interobserver reliability were assessed and MRI and X-Ray-measured angles were compared. RESULTS One hundred and thirty patients with CSM were reviewed. Correlations of cervical lordosis measures between radiographs and MRI were strong using the Cobb (0.65) and Jackson (0.63) methods, and moderate using the Harrison (0.37) method. Mean cervical lordosis angle was significantly lower on supine MRI compared to standing radiographs for all methods (Cobb 11.6 Rx vs. 9.2 MRI, Jackson 14.6 vs. 11.6, Harrison 23.5 vs. 19.9). Eighteen patients (15.4%) without lordosis on supine MRI presented lordosis on standing radiographs. CONCLUSION A substantial proportion of patients has sagittal alignment discrepancies between supine MRI and standing radiographs. Therefore, standing radiographs of the cervical spine should always be included in surgical planning of CSM patients.
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Affiliation(s)
- Catherine Boudreau
- Department of Neurosciences, CHU de Québec - Université Laval Research center, Quebec, QC, Canada
| | - Sylvine Carrondo Cottin
- Department of Neurosciences, CHU de Québec - Université Laval Research center, Quebec, QC, Canada
| | - Jessica Ruel-Laliberté
- Department of Neurosciences, CHU de Québec - Université Laval Research center, Quebec, QC, Canada
| | - David Mercier
- Hôpital de L'Enfant-Jésus, Neurosurgery, CHU de Québec - Université Laval, 1401 18e rue, Quebec, QC, G1J1Z4, Canada
| | - Nicholas Gélinas-Phaneuf
- Hôpital de L'Enfant-Jésus, Neurosurgery, CHU de Québec - Université Laval, 1401 18e rue, Quebec, QC, G1J1Z4, Canada
| | - Jérôme Paquet
- Department of Neurosciences, CHU de Québec - Université Laval Research center, Quebec, QC, Canada. .,Hôpital de L'Enfant-Jésus, Neurosurgery, CHU de Québec - Université Laval, 1401 18e rue, Quebec, QC, G1J1Z4, Canada.
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Xia C, Xu L, Xue B, Sheng F, Qiu Y, Zhu Z. Grayscale Inversion View Can Improve the Reliability for Measuring Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis. World Neurosurg 2018; 119:e631-e637. [PMID: 30077754 DOI: 10.1016/j.wneu.2018.07.224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Proximal junctional kyphosis (PJK) is a common phenomenon after long segmental fusion surgery of adolescent idiopathic scoliosis. However, the inability to reliably identify vertebral endplates on lateral upright radiographs has made an accurate measurement of proximal junctional angle (PJA) technically impossible in many patients. The aim of this study was to determine whether a grayscale inversion view is more reliable to measure PJA and to assess PJK accurately. METHODS A total of 162 patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion surgeries were included in this study. PJA was measured on preoperative lateral standing films using 3 methods (upper-instrumented vertebrae [UIV] + 1, UIV + 2, and UIV to T2) on both standard view and grayscale inversion view. Two physicians independently measured the PJA twice at a 1-month interval. Intra- and interobserver reliabilities were compared between the 2 radiographic views. Forty patients with preoperative magnetic resonance imaging (MRI) scans were randomly selected. PJA was measured for these patients on both views of lateral standing films and MRI images. The correlation coefficients between PJA obtained on MRI and PJA obtained on radiographs with different views were calculated respectively. RESULTS The intraclass correlation coefficients were greater in a grayscale inversion view than in a standard view in all 3 methods for both observers, and the intraclass correlation coefficients of interobserver reliabilities also were greater in a grayscale inversion view. The correlation coefficient between PJA obtained on grayscale inversion view and preoperative MRI was greater in all methods compared with standard view. CONCLUSIONS Grayscale inversion view can be a more reliable tool for the evaluation of PJK as compared with the conventional measurement. We recommend the application of a grayscale inversion view to measure PJA and assess PJK in clinical practice, particularly for patients instrumented to the upper thoracic spine.
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Affiliation(s)
- Chao Xia
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Leilei Xu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Bingchuan Xue
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Fei Sheng
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
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Inglez de Souza MCCM, Ryan R, ter Haar G, Packer RMA, Volk HA, De Decker S. Evaluation of the influence of kyphosis and scoliosis on intervertebral disc extrusion in French bulldogs. BMC Vet Res 2018; 14:5. [PMID: 29304802 PMCID: PMC5756331 DOI: 10.1186/s12917-017-1316-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 12/08/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Although thoracic vertebral malformations with kyphosis and scoliosis are often considered incidental findings on diagnostic imaging studies of screw-tailed brachycephalic breeds, they have been suggested to interfere with spinal biomechanics and intervertebral disc degeneration. It is however unknown if an abnormal spinal curvature also predisposes dogs to develop clinically relevant intervertebral disc herniations. The aim of this study was to evaluate if the occurrence of thoracic vertebral malformations, kyphosis or scoliosis would be associated with a higher prevalence of cervical or thoracolumbar intervertebral disc extrusion in French bulldogs. RESULTS French bulldogs that underwent computed tomography for reasons unrelated to spinal disease (n = 101), and French bulldogs with thoracolumbar (n = 47) or cervical intervertebral disc extrusion (n = 30) that underwent magnetic resonance imaging were included. There was a significant association between the presence of kyphosis and the occurrence of intervertebral disc extrusion, particularly in the thoracolumbar region. Dogs with kyphosis were at nearly a two times increased odds of being affected by intervertebral disc extrusion than those without kyphosis [(OR = 1.98 (95% CI: 1.04-3.78)]. There was also an association between the presence of scoliosis and the anatomical distribution of intervertebral disc extrusions, with dogs with scoliosis more likely to have more caudal lumbar intervertebral disc extrusions. Presence of scoliosis was not associated with an increased odds of being affected by intervertebral disc extrusion. CONCLUSIONS Although thoracic vertebral malformations with kyphosis only rarely cause spinal cord dysfunction in itself, French bulldogs with kyphosis appear to be at higher risk to develop thoracolumbar intervertebral disc extrusion.
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Affiliation(s)
- Maria Claudia C. M. Inglez de Souza
- Department of Surgery, University of São Paulo-School of Veterinary Medicine and Animal Science, Av. Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, Cidade Universitária Brazil
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hawkshead lane, AL9 7TA North Mymms, Hatfield, UK
| | - Richard Ryan
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hawkshead lane, AL9 7TA North Mymms, Hatfield, UK
| | - Gert ter Haar
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hawkshead lane, AL9 7TA North Mymms, Hatfield, UK
| | - Rowena M. A. Packer
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hawkshead lane, AL9 7TA North Mymms, Hatfield, UK
| | - Holger A. Volk
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hawkshead lane, AL9 7TA North Mymms, Hatfield, UK
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hawkshead lane, AL9 7TA North Mymms, Hatfield, UK
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Abstract
STUDY DESIGN Retrospective, blinded analysis of imaging studies. OBJECTIVE The aim of this study is compare the use of magnetic resonance imaging (MRI) to lateral radiograph using bolster in the evaluation of Scheuermann kyphosis (SK) curve flexibility measurement. SUMMARY AND BACKGROUND DATA The flexibility of the thoracic curve [thoracic kyphosis (TK)] in SK is of primary importance in its preoperative planning. Several methods have been described for SK curve flexibility measurement. The most commonly used method is lateral hyperextension radiography on hard bolster [hyperextension radiograph (HE)]. No current methods use MRI for flexibility assessment. MATERIALS AND METHODS Flexibility of TK in SK patients was measured as a difference between standing radiograph and bolster-assisted lateral HE or supine MRI. The sagittal Cobb angle of the TK was measured between the superior endplate of T4 and the inferior endplate of T12 vertebral body. Flexibilities measured by these 2 methods were compared and analyzed using the generalized estimating equation analysis and the correlation analysis. RESULTS We assessed 18 SK patients (14 males and 4 females) with mean age of 20.06±6.03 years. The standing TK x-rays showed 83.8±6.1 degrees. On HE, TK curve reduced by 39.3 degrees (95% confidence interval, 35.8-42.9) to 44.5±6.2 degrees (P<0.001). Preoperative MRI images showed TK of 53.8±5.9 degrees which means reduction by 30 degrees (95% confidence interval, 26.6-33.4) from the standing radiographs (P<0.001). Linear dependency between HE and MRI flexibility with a mean difference of 9.3 degrees was found (R=0.61, P<0.001). CONCLUSIONS Our study shows that preoperative MRI can be used for SK flexibility assessment with similar predictive value as routinely used bolster-assisted hyperextension lateral radiograph. Consequently, patient exposure to preoperative hyperextension ionizing radiation may be reduced.
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