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Moreno-Mateo F, Maniega SS, Peris AL, Ramajo RH, González DCN. Spino-pelvic parameters and back pain in patients without coronal deformity or history of spinal surgery: A cross-sectional analysis. J Back Musculoskelet Rehabil 2024:BMR230242. [PMID: 38943379 DOI: 10.3233/bmr-230242] [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: 07/01/2024]
Abstract
BACKGROUND During the last two decades, there has been a growing interest in spinal sagittal alignment. Most published studies have focused on the role of spinopelvic parameters in patients with adult spinal deformity or in those with previous spinal fusion. OBJECTIVE The aim of this study was to explore possible association between disability related to back pain and spinopelvic parameters in the absence of coronal deformity or previous spinal surgery. METHODS In the setting of a larger study involving patients with low back pain (LBP), those without previous surgery or spinal deformity in the coronal plane were selected. A total of 52 patients (mean age 59 years, range 21-86, 23 men and 29 women) were found. The visual analogic scale (VAS) and Oswestry Disability Index questionnaire (ODI) were recorded. Surgimap software was used to measure the sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), and lumbar lordosis (LL). Statistical analysis was performed with SPSS Statistics software. Pearson or Spearman correlation were the test of choice depending on the specific variables. RESULTS A statistically significant association was found between SVA and ODI (r 0.59, p< 0.03). Increased pelvic tilt was also associated with more severe disability related to back pain (r 0.48, p< 0.03). PI-LL mismatch showed moderate association with disability and severity of back pain, although this association did not reach statistical significance (r 0.52, p< 0.08). CONCLUSION Our findings suggest that sagittal misalignment may be related with more severe disability and back pain in patients with minor or null deformity in the coronal plane.
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Putzier M, Koehli P, Khakzad T. [Surgical treatment of high-grade spondylolisthesis]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024; 36:43-55. [PMID: 37815580 DOI: 10.1007/s00064-023-00830-w] [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: 11/13/2022] [Revised: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Establishment of a physiological profile of the spine via reduction of the kyphotic slipped vertebra in the transverse and sagittal planes. Achieving solid fusion. Improvement of preoperative pain symptoms and prevention or elimination of neurological deficits. INDICATIONS High-grade spondylolisthesis (Meyerding grade 3 and 4) as well as spondyloptosis after conservative treatment and corresponding symptoms. Serious neurological deficits, hip-lumbar extensor stiffness, are emergency indications. CONTRAINDICATIONS (CI) Individual risk assessment must be made. Absolute CI are infections with the exception of serious neurological deficits. Multiple abdominal operations or interventions on the large vessels can be a relative contraindication for ventral intervention. SURGICAL TECHNIQUE For spondylolistheses of grade 3 according to Meyerding, we recommend a one-stage dorso-ventro-dorsal procedure with radicular decompression, correction and fusion in the index segment. From grade 4 according to Meyerding, reduction of the fifth lumbar vertebral body in the index segment L5/S1 is preceded by resection of the sacral dome. In cases of spondyloptosis, a two-stage procedure is often indicated. In this case, a screw-rod system spanning the index segment is implanted in the first step, which is used to distract the index segment for several days. Ventrodorsal reduction is performed in the second step. POSTOPERATIVE MANAGEMENT Axis-appropriate full mobilization from postoperative day 1. We recommend a light diet until the first defecation. Dorsal suture removal after 12 days if the wound is dry and free of irritation. Lifting and carrying heavy loads and also competitive or contact sports should be avoided for 12 weeks. RESULTS From January 2000 to December 2020, a total of 43 patients with high-grade spondylolisthesis were treated in our clinic in the manner described. The Numeric Rating Scale (NRS) and the Oswestry Disability Index (ODI) improved significantly during the observation period of 3 months and 1 year. The 1‑year radiological data in 28 of the 36 patients showed complete reduction of the slipped vertebra, in 6 grade 1, and in 2 patients grade 2 according to Meyerding. Also, the kyphosis of the index vertebra was significantly corrected from a mean of 15° (0-52°) preoperatively to a lordotic profile of a mean of 4° (0-11°). No complications requiring revision were observed. One patient with preoperative cauda equina syndrome was left with right radicular sensorimotor S1 syndrome.
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Affiliation(s)
- M Putzier
- Abteilung für Orthopädie und Unfallchirurgie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Luisenstr. 64, 10117, Berlin, Deutschland.
| | - P Koehli
- Abteilung für Orthopädie und Unfallchirurgie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Luisenstr. 64, 10117, Berlin, Deutschland
| | - T Khakzad
- Abteilung für Orthopädie und Unfallchirurgie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Luisenstr. 64, 10117, Berlin, Deutschland
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Chen SR, LeVasseur CM, Como CJ, Couch BK, Talentino SE, Klatt BA, O'Malley MJ, Donaldson WF, Lee JY, Shaw JD, Anderst WJ. Dynamic Changes in Lumbar Spine Kinematics During Gait May Explain Improvement in Back Pain and Disability in Patients With Hip-Spine Syndrome. Spine (Phila Pa 1976) 2023; 48:867-873. [PMID: 37052433 DOI: 10.1097/brs.0000000000004677] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/09/2022] [Indexed: 04/14/2023]
Abstract
STUDY DESIGN Prospective cohort. OBJECTIVE Determine if total hip arthroplasty (THA) changes lumbar spine kinematics during gait in a manner that explains the improvements in back pain seen in patients with hip-spine syndrome. SUMMARY OF BACKGROUND DATA For patients with hip-spine syndrome, improvements in both hip and back pain have been demonstrated after THA; however, the exact mechanism of improvement in back pain remains unknown, as no corresponding changes in lumbar spine static radiographic parameters have been identified. METHODS Thirteen patients with severe, unilateral hip osteoarthritis scheduled to undergo THA with concomitant back pain and disability were tested at baseline and 6 months after THA. Harris Hip Score (HHS) and Oswestry Disability Index questionnaires were completed; the static orientation of the spine and pelvis were measured on standing radiographs, and lumbar spine kinematics were measured during treadmill walking using a validated measurement system that matched subject-specific bone models created from CT scans to dynamic biplane radiographs. RESULTS After THA, both the Oswestry Disability Index (36.3-11.3, P <0.001) and Harris Hip Score (55.7-77.9, P <0.001) improved; however, there were no changes in static intervertebral or pelvis orientation. During gait after THA, the overall lumbar spine (L1 to L5) was less lordotic from heel strike to contralateral toe off ( P <0.001), the L4 and L5 vertebra were less anteriorly tilted by 3.9° ( P =0.038) from midstance to contralateral heel strike and by 3.9° ( P =0.001) during stance, respectively. CONCLUSION The decreased anterior tilt of the 2 lowest lumbar vertebrae and the corresponding loss of lumbar lordosis may reduce facet loading during the stance phase of gait after THA. This change in lumbar spine kinematics during gait is a potential mechanism to explain the observed improvements in back pain and disability after THA. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Stephen R Chen
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh PA
| | | | | | - Brandon K Couch
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh PA
| | | | - Brian A Klatt
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh PA
| | - Michael J O'Malley
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh PA
| | | | - Joon Y Lee
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh PA
| | - Jeremy D Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh PA
| | - William J Anderst
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh PA
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Tharu NS, Lee TTY, Lai KKL, Lau TE, Chan CY, Zheng YP. Sagittal Spinal Alignment in People with Chronic Spinal Cord Injury and Normal Individual: A Comparison Study Using 3D Ultrasound Imaging. J Clin Med 2023; 12:jcm12113854. [PMID: 37298049 DOI: 10.3390/jcm12113854] [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: 02/15/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of this study was to compare the sagittal spinal alignment of people with chronic spinal cord injury (SCI) with normal individuals and to determine whether transcutaneous electrical spinal cord stimulation (TSCS) could cause a change in the thoracic kyphosis (TK) and lumbar lordosis (LL) to re-establish normal sagittal spinal alignment. A case series study was conducted, wherein twelve individuals with SCI and ten neurologically intact subjects were scanned using 3D ultrasonography. In addition, three people with SCI having complete tetraplegia participated further to receive a 12-week treatment (TSCS with task-specific rehabilitation) after evaluation of sagittal spinal profile. Pre- and post-assessments were conducted to evaluate the differences in sagittal spinal alignment. The results showed that the TK and LL values for a person with SCI in a dependent seated posture were greater than those of normal subjects for: standing (by TK: 6.8° ± 1.6°; LL: 21.2° ± 1.9°), sitting straight (by TK: 10.0° ± 4.0°; LL: 1.7° ± 2.6°), and relaxed sitting (by TK: 3.9° ± 0.3°; LL: 7.7° ± 1.4°), respectively, indicating an increased risk for spinal deformity. In addition, TK decreased by 10.3° ± 2.3° after the TSCS treatment, showing a reversible change. These results suggest that the TSCS treatment could be used to restore normal sagittal spinal alignment for individuals with chronic SCI.
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Affiliation(s)
- Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Timothy Tin-Yan Lee
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kelly Ka-Lee Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ting-Er Lau
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Chui-Yi Chan
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Domokos B, Beer L, Reuther S, Raschka C, Spang C. Immediate Effects of Isolated Lumbar Extension Resistance Exercise (ILEX) on Spine Posture and Mobility Measured with the IDIAG Spinal Mouse System. J Funct Morphol Kinesiol 2023; 8:jfmk8020060. [PMID: 37218856 DOI: 10.3390/jfmk8020060] [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: 03/25/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
Posture and mobility are important aspects for spinal health. In the context of low back pain, strategies to alter postural anomalies (e.g., hyper/hypolordosis, hyper/hypokyphosis) and mobility deficits (e.g., bending restrictions) have been of interest to researchers and clinicians. Machine-based isolated lumbar extension resistance exercise (ILEX) has been used successfully for rehabilitation of patients suffering from low back pain. The aim of this study was to analyse the immediate effects of ILEX on spinal posture and mobility. In this interventional cohort study, the posture and mobility measures of 33 healthy individuals (m = 17, f = 16; mean age 30.0 years) were taken using the surface-based Spinal Mouse system (IDIAG M360©, Fehraltdorf, Switzerland). Individuals performed one exercise set to full exhaustion with an ILEX-device (Powerspine, Wuerzburg, Germany) in a standardized setup, including uniform range of motion and time under tension. Scans were made immediately before and after the exercise. There was an immediate significant decrease in standing lumbar lordosis and thoracic kyphosis. No change could be observed in standing pelvic tilt. Mobility measures showed a significant decrease in the lumbar spine and an increase in the sacrum. The results show that ILEX alters spine posture and mobility in the short-term, which may benefit certain patient groups.
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Affiliation(s)
- Bruno Domokos
- Institute for Sports Science, University of Wuerzburg, Judenbuehlweg 11, 97082 Wuerzburg, Germany
- Orthopedic Spine Centre Dr. Alfen, Schuererstraße 5, 97080 Wuerzburg, Germany
| | - Lisa Beer
- Institute for Sports Science, University of Wuerzburg, Judenbuehlweg 11, 97082 Wuerzburg, Germany
- Orthopedic Spine Centre Dr. Alfen, Schuererstraße 5, 97080 Wuerzburg, Germany
| | - Stefanie Reuther
- Orthopedic Spine Centre Dr. Alfen, Schuererstraße 5, 97080 Wuerzburg, Germany
| | - Christoph Raschka
- Institute for Sports Science, University of Wuerzburg, Judenbuehlweg 11, 97082 Wuerzburg, Germany
| | - Christoph Spang
- Institute for Sports Science, University of Wuerzburg, Judenbuehlweg 11, 97082 Wuerzburg, Germany
- Orthopedic Spine Centre Dr. Alfen, Schuererstraße 5, 97080 Wuerzburg, Germany
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Gupta S, Xiao R, Fainor M, Mauck RL, Smith HE, Gullbrand SE. Level dependent alterations in human facet cartilage mechanics and bone morphometry with spine degeneration. J Orthop Res 2023; 41:674-683. [PMID: 35770853 PMCID: PMC9800647 DOI: 10.1002/jor.25407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/10/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023]
Abstract
The zygapophyseal joints of the spine, also known as the facet joints, are paired diarthrodial joints posterior to the intervertebral disc and neural elements. The pathophysiology of facet osteoarthritis (OA), as well as crosstalk between the disc and facets, remains largely understudied compared to disc degeneration. The purpose of this study was to characterize alterations to human facet cartilage and subchondral bone across a spectrum of degeneration and to investigate correlations between disc and facet degeneration. Human lumbar facet articular surfaces from six independent donors were subject to creep indentation mechanical testing to quantify cartilage mechanical properties, followed by microcomputed tomography (µCT) analyses for subchondral bone morphometry. The degenerative state of each articular surface was assessed via macroscopic scoring and via Osteoarthritis Research Society International histopathology scoring. Our data suggest reduced facet cartilage compressive and tensile moduli and increased permeability with increasing degenerative grade, particularly at the lower levels of the spine. µCT analyses revealed spinal level-dependent alterations to the subchondral bone, with an increase in trabecular bone at the L4-L5 level, but a decrease at the upper levels of the lumbar spine with increasing degenerative grade. Cortical bone volume fraction was generally decreased with increasing degenerative grade across spinal levels. Correlation analysis revealed several associations between quantitative measures of disc degeneration and facet OA. This study showed that alterations in the mechanical properties of facet cartilage and in the structural properties of facet subchondral bone correlated with aspects of disc degeneration and were highly dependent on spinal level.
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Affiliation(s)
- Sachin Gupta
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rui Xiao
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthew Fainor
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert L. Mauck
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - Harvey E. Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sarah E. Gullbrand
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Ludwig O, Dindorf C, Kelm J, Simon S, Nimmrichter F, Fröhlich M. Reference Values for Sagittal Clinical Posture Assessment in People Aged 10 to 69 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054131. [PMID: 36901144 PMCID: PMC10001505 DOI: 10.3390/ijerph20054131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/01/2023]
Abstract
Poor posture is a well-known problem in all age groups and can lead to back pain, which in turn can result in high socio-economic costs. Regular assessment of posture can therefore help to identify postural deficits at an early stage in order to take preventive measures and can therefore be an important tool for promoting public health. We measured the posture of 1127 symptom-free subjects aged 10 to 69 years using stereophotogrammetry and determined the sagittal posture parameters flèche cervicale (FC), flèche lombaire (FL), and kyphosis index (KI) as well as the values standardized to the trunk height (FC%, FL%, KI%). FC, FC%, KI, and KI% showed an increase with age in men but not in women, and a difference between the sexes. FL remained largely constant with age, although FL% had significantly greater values in women than men. Postural parameters correlated only moderately or weakly with body mass index. Reference values were determined for different age groups and for both sexes. Since the parameters analyzed can also be determined by simple and non-instrumental methods in medical office, they are suitable for performing preventive checks in daily medical or therapeutic practice.
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Affiliation(s)
- Oliver Ludwig
- Department of Sport Science, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau (RPTU), 67663 Kaiserslautern, Germany
| | - Carlo Dindorf
- Department of Sport Science, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau (RPTU), 67663 Kaiserslautern, Germany
| | - Jens Kelm
- Chirurgisch-Orthopädisches Zentrum, 66557 Illingen, Germany
| | - Steven Simon
- Department of Sport Science, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau (RPTU), 67663 Kaiserslautern, Germany
| | - Felix Nimmrichter
- Institute of Sport Science, Universität des Saarlandes, 66041 Saarbrücken, Germany
| | - Michael Fröhlich
- Department of Sport Science, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau (RPTU), 67663 Kaiserslautern, Germany
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Okuzu Y, Miyahara T, Goto K, Kuroda Y, Kawai T, Matsuda S. Investigating sagittal spinal alignment, low back pain, and clinical outcomes after total hip arthroplasty for lumbar hyperlordosis: a retrospective study. Arch Orthop Trauma Surg 2022; 142:4007-4013. [PMID: 34825248 DOI: 10.1007/s00402-021-04266-4] [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: 06/04/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hip-spine syndrome, wherein flexion deformity of the hip might exaggerate normal lumbar lordosis (LL), was first described in 1983. It could result in subluxation of the posterior facets and cause low back pain (LBP). However, the clinical outcomes of total hip arthroplasty (THA) and spinal alignment changes in patients with lumbar hyperlordosis (hyper LL) remain unknown. We aimed to clarify the proportion of patients with hyper LL before THA and compare pre- and post-operative sagittal spinal alignment, LBP, and clinical outcomes between patients with hyper LL and those with normal LL. MATERIALS AND METHODS We investigated 278 patients who underwent primary THA between December 2015 and December 2019. Spine radiographs in the standing position were examined preoperatively and 1 year postoperatively. Patients with hyper LL were defined as having a pelvic incidence (PI) minus LL of < - 9° preoperatively. The control group included age- and sex-matched patients with normal LL, defined by a PI minus LL of - 9° to 9°. Clinical outcomes were evaluated using the visual analogue scale (VAS) for LBP, Harris hip score (HHS), Oxford hip score (OHS), and University of California, Los Angeles (UCLA) activity score. RESULTS Thirty-eight patients (13.7%) had hyper LL, and they exhibited a lower pelvic tilt, lower sagittal vertical axis, and greater sigmoid curvature than did the controls. Evaluation of changes in the spinal alignment after surgery showed that the pelvis tilted more posteriorly, and LL decreased more in the hyper LL group than in the control group. Pre- and post-operative VAS for LBP, HHS, OHS, and UCLA activity scores were not significantly different between the two groups. CONCLUSION Hyper LL in patients with hip osteoarthritis had no adverse effects on LBP and the clinical outcomes of THA. Hyper LL may partially result from a flexible and adaptable lumbo-pelvic structure.
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Affiliation(s)
- Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Takuma Miyahara
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
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Quantitative evaluation of correlation between lumbosacral lordosis and pelvic incidence in standing position among asymptomatic Asian adults: a prospective study. Sci Rep 2022; 12:18965. [PMID: 36347920 PMCID: PMC9643535 DOI: 10.1038/s41598-022-21840-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
The determination of lumbopelvic alignment is essential for planning adult spinal deformity surgery and for ensuring favorable surgical outcomes. This prospective study investigated the correlation between the lumbar section of lumbar spine lordosis and increasing pelvic incidence in 324 Asian adults with a mean age of 55 ± 13 years (range: 20-80 years), comprising 115 male and 209 female volunteers. Participants were divided into three groups based on pelvic incidence (G1, G2, and G3 had pelvic incidence of < 45°, 45-55°, and ≥ 55°, respectively). We determined that distal and proximal lumbar lordosis contributed differentially to the increase in pelvic incidence, whereas the lordosis ratio of the L3-L4 and L4-L5 segments mostly remained constant. The mean contribution ratio of the segmental lordosis from L1 to S1 was as follows: L1-L2, 2.3%; L2-L3, 11.7%; L3-L4, 18.1%; L4-L5, 25.2%; and L5-S1, 42.7%. Pelvic incidence had a stronger correlation with proximal lumbar lordosis than did distal lumbar lordosis. The ratios of proximal lumbar lordosis to distal lumbar lordosis were 37.8% in G1, 45.8% in G2, and 55.9% in G3. These findings serve as a reference for future lumbar spine correction or fusion surgery for Asian adults.
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Spine abnormalities associated with bone edema on sacroiliac joints MRI in patients with non-inflammatory chronic back pain. Joint Bone Spine 2022; 89:105436. [PMID: 35777553 DOI: 10.1016/j.jbspin.2022.105436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/13/2022] [Accepted: 05/21/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate whether bone marrow edema (BME) fulfilling the ASAS definition of magnetic resonance imaging (MRI) sacroiliitis is associated with non-inflammatory spine abnormalities in patients with definite mechanical chronic back pain (CBP). METHODS Patients with definite mechanical CBP, according to the physician, started before the age of 45 and be lasting for more than 3months but less than 3years underwent a protocolized MRI and radiographs of sacroiliac joint (SIJ) and spine. BME and structural changes were scored, by three readers, for SIJ as well as non-inflammatory abnormalities for spine, including degenerative lesions and static disorders. Univariate analysis by Chi2 test was performed to search a statistical association between BME fulfilling the ASAS definition of MRI sacroiliitis and the presence of at least one non-inflammatory spine abnormality. RESULTS A total of 94 patients were analyzed, 27 (29%) patients had BME and 16 (17%) patients had BME fulfilling the ASAS definition of MRI sacroiliitis; 86 (91.5%) patients had at least one non-inflammatory spine abnormality which are associated into 3 distinct clusters. BME was slightly more frequent at the lower and posterior part of the SIJ. MRI sacroiliitis was associated with interspinous bursitis, facet joint effusion and lateral spinal deviation and was more likely in patients with at least one non-inflammatory spine abnormality (OR: 4.96, 95% CI [1.47; 16.72]). CONCLUSIONS BME fulfilling the ASAS definition of MRI sacroiliitis is significantly associated with non-inflammatory spine abnormalities in patients with mechanical CBP.
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Tominaga R, Kurita N, Kokubun Y, Nikaido T, Sekiguchi M, Otani K, Iwabuchi M, Shirado O, Fukuhara S, Konno SI. Dose-response relationship between spino-pelvic alignment determined by sagittal modifiers and back pain-specific quality of life. 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; 30:3019-3027. [PMID: 34518920 DOI: 10.1007/s00586-021-06965-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/13/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether abnormalities of the sagittal modifiers (SMs) of the Scoliosis Research Society (SRS)-Schwab classification truly reflect back pain (BP)-specific quality of life (QOL), it is necessary to examine their dose-response relationships and to determine clinically impactful thresholds for declines in BP-specific QOL. This study aimed to analyse the continuous dose-response relationship between each SM and BP-specific QOL. METHODS This cross-sectional study, using data from a Japanese population-based cohort study, included 519 community-dwelling residents aged ≥ 50 years who participated in the annual health examination. The participants completed the Roland-Morris Disability Questionnaire (RDQ) on BP-specific QOL. Spino-pelvic alignment based on SMs was assessed by whole-spine X-ray examinations. We fitted general linear models with or without nonlinear terms to estimate the dose-response relationship between each SM and BP-specific QOL. RESULTS Pelvic tilt, pelvic incidence minus lumbar lordosis (PI-LL), and sagittal vertical axis showed dose-response relationships with BP-specific QOL measured as the RDQ score. PI-LL was most likely to predict a minimally clinically important RDQ score when its value exceeded the 90th percentile. A nonlinear relationship between PI-LL and the BP-specific QOL score was found. RDQ increased when PI-LL exceeded 10°. CONCLUSION PI-LL might be the most sensitive of the three modifiers of the SRS-Schwab classification for determining BP-specific QOL. Moreover, BP-specific QOL worsens rapidly when the compensatory mechanism against malalignment exceeds a critical value. Therefore, we suggest that traditional classifications and surgical strategies should be re-examined regarding the dose-dependent abnormalities of the SMs to develop a more reliable classification strategy.
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Affiliation(s)
- Ryoji Tominaga
- Department of Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashimahi, Aizuwakamatsu, Fukushima, 969-3492, Japan. .,Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan. .,Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan.
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan.,Department of Innovative Research and Education for Clinicians and Trainees, Fukushima Medical University Hospital, Fukushima, Japan.,Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | | | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan
| | - Masumi Iwabuchi
- Department of Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashimahi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Osamu Shirado
- Department of Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashimahi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Shunichi Fukuhara
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, Kyoto University School of Public Health, Kyoto, Japan
| | - Shin-Ichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan
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12
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Liang CL, Wang SW, Chen HJ, Tsai YD, Chen JS, Wang HK, Wang KW. Optimal Cut-Off Points of Sagittal Spinopelvic Parameters as a Morphological Parameter to Predict Efficiency in Nerve Block and Pulsed Radiofrequency for Lumbar Facet Joint Pain: A Retrospective Study. J Pain Res 2021; 14:1949-1957. [PMID: 34234541 PMCID: PMC8253931 DOI: 10.2147/jpr.s303979] [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: 02/03/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background After proper patient selection, anatomically correct pulsed radiofrequency of the lumbar facet joints provide long-term pain relief in a routine clinical setting. In the study, we performed an analysis of clinical and radiological predictive factors and provide the scientific basis for this promising modality. Methods The study included 198 patients with lower back pain due to lumbar facet joint disease who underwent medial branch block and pulsed radiofrequency during the period 2015–2019. According to the improvement in pain score, the patients were divided into good and poor outcome groups. Clinical and radiological data were collected and analyzed. Results The multivariable analysis revealed the predictive factors, including lumbar lordosis, lower lumbar lordosis, pelvic tilt, the number of facet joints, old compression fracture with/without vertebroplasty, and post lumbar fusion procedures. Conclusion With the results of this study, we demonstrated that the improved outcome after the surgery was related to lumbar lordosis, lower lumbar lordosis, pelvic tilt, the number of facet joints, old compression fracture with/without vertebroplasty, and the lumbar fusion procedures. Old compression fractures and lumbar fusion would change the radiological factors and cause refractory lumbar facet joint pain.
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Affiliation(s)
- Cheng-Loong Liang
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shih-Wei Wang
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,Department of Rheumatology, E-DA Hospital, Kaohsiung, Taiwan
| | - Han-Jung Chen
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Duan Tsai
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Jui-Sheng Chen
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hao-Kuang Wang
- Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Wei Wang
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Neurosurgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
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13
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Müller A, Rockenfeller R, Damm N, Kosterhon M, Kantelhardt SR, Aiyangar AK, Gruber K. Load Distribution in the Lumbar Spine During Modeled Compression Depends on Lordosis. Front Bioeng Biotechnol 2021; 9:661258. [PMID: 34178959 PMCID: PMC8222614 DOI: 10.3389/fbioe.2021.661258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Excessive or incorrect loading of lumbar spinal structures is commonly assumed as one of the factors to accelerate degenerative processes, which may lead to lower back pain. Accordingly, the mechanics of the spine under medical conditions, such as scoliosis or spondylolisthesis, is well-investigated. Treatments via both conventional therapy and surgical methods alike aim at restoring a "healthy" (or at least pain-free) load distribution. Yet, surprisingly little is known about the inter-subject variability of load bearings within a "healthy" lumbar spine. Hence, we utilized computer tomography data from 28 trauma-room patients, whose lumbar spines showed no visible sign of degeneration, to construct simplified multi-body simulation models. The subject-specific geometries, measured by the corresponding lumbar lordosis (LL) between the endplates of vertebra L1 and the sacrum, served as ceteris paribus condition in a standardized forward dynamic compression procedure. Further, the influence of stimulating muscles from the M. multifidus group was assessed. For the range of available LL from 28 to 66°, changes in compressive and shear forces, bending moments, as well as facet joint forces between adjacent vertebrae were calculated. While compressive forces tended to decrease with increasing LL, facet forces were tendentiously increasing. Shear forces decreased between more cranial vertebrae and increased between more caudal ones, while bending moments remained constant. Our results suggest that there exist significant, LL-dependent variations in the loading of "healthy" spinal structures, which should be considered when striving for individually appropriate therapeutic measures.
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Affiliation(s)
- Andreas Müller
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz-Landau, Koblenz, Germany
- Mechanical Systems Engineering, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Duebendorf, Switzerland
- Department of Mathematics and Natural Sciences, Institute of Sports Science, University Koblenz-Landau, Koblenz, Germany
| | - Robert Rockenfeller
- Department of Mathematics and Natural Sciences, Mathematical Institute, UniversityKoblenz-Landau, Koblenz, Germany
| | - Nicolas Damm
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz-Landau, Koblenz, Germany
| | - Michael Kosterhon
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sven R. Kantelhardt
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ameet K. Aiyangar
- Mechanical Systems Engineering, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Duebendorf, Switzerland
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Karin Gruber
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz-Landau, Koblenz, Germany
- Department of Mathematics and Natural Sciences, Institute of Sports Science, University Koblenz-Landau, Koblenz, Germany
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14
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Kho J, Thaker S, Azzopardi C, James SL, Botchu R. Exploring the correlation between increased femoral anteversion and pars interarticularis defects in the lumbar spine: A single center experience. Indian J Radiol Imaging 2020; 30:263-265. [PMID: 33273758 PMCID: PMC7694724 DOI: 10.4103/ijri.ijri_364_20] [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: 05/13/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Altered femoral version can result in lumbar hyperlordosis and hip spine syndrome. We conducted a retrosepctive study to evalute if there is correlation between altered femoral version and pars defect. Materal and Methods A cohort of pateints with CT rotational profile and MR of lumbar spine over a 12 year period were included in the sutdy. The femoral version was calculated and the MR was evaluated for pars defect. Results 130 patients had CT rotational profile and MR of lumbar spine with a female predomiannce (94 female and 36 males) and average age of 24.3 years. There were 6 patients with bilateral pars defects involving L5 (3 with increased femoral version, 2 with decreased version and one had normal version). Conclusion Increased femoral anterversion is not associated with increased prevalence of pars defects.
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Affiliation(s)
- James Kho
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - Siddharth Thaker
- Department of Radiology, Kettering General Hospital, Kettering, UK
| | - Christine Azzopardi
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - Steven L James
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
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15
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Imagama S, Ando K, Kobayashi K, Machino M, Tanaka S, Morozumi M, Kanbara S, Ito S, Inoue T, Seki T, Ishizuka S, Nakashima H, Ishiguro N, Hasegawa Y. Impact of pelvic incidence on lumbar osteophyte formation and disc degeneration in middle-aged and elderly people in a prospective cross-sectional cohort. 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 2020; 29:2262-2271. [PMID: 32130527 DOI: 10.1007/s00586-019-06204-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/29/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Pelvic incidence (PI) is unique to each individual and does not change throughout life. High PI is related to lumbar spondylolisthesis, but associations of PI with lumbar osteophyte formation and disc degeneration are unclear. The objective was to evaluate relationships of PI with lumbar osteophyte formation and disc degeneration, as well as spinal sagittal alignment and geriatric diseases, in middle-aged and elderly people. METHODS A total of 1002 volunteers (male: 434, female: 568, average age: 63.5) were prospectively examined for lumbar osteophyte formation (Nathan class ≥ 2) and disc degeneration (disc score ≥ 3). High (PI > 51, n = 501) and low (PI ≤ 51, n = 501) PI groups were defined. Clinical factors, frailty, sarcopenia, and physical quality of life (QOL) were compared between these groups, and risk factors for lumbar osteophyte formation and disc degeneration were identified in multivariate logistic regression analysis. RESULTS Physical QOL was poorer in people with lumbar osteophyte formation (54.8%) and disc degeneration (33.6%). Age, male gender, spinal parameters including PI, bone mineral density, back muscle strength, and gait ability differed significantly between the groups, whereas frailty and sarcopenia were not significantly different. Low PI, low lumbar lordosis, elder age, male gender, high BMI, and weak back muscle strength were significant risk factors for lumbar osteophyte formation and disc degeneration. CONCLUSIONS Low PI was identified as a risk factor for lumbar osteophyte formation and disc degeneration, both of which reduce physical QOL in middle-aged and elderly people. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Satoshi Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masayoshi Morozumi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shunsuke Kanbara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Taro Inoue
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Sciences, 3-11-1, Asahigaoka, Kashiwara, Osaka, 582-0026, Japan
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16
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Fereydounnia S, Shadmehr A. Efficacy of whole body vibration on neurocognitive parameters in women with and without lumbar hyper-lordosis. J Bodyw Mov Ther 2020; 24:182-189. [PMID: 31987541 DOI: 10.1016/j.jbmt.2019.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The prevalence of lumbar hyper-lordosis is high in young women. Considering the previous studies into the effects of the whole body vibration (WBV) on the physiological parameters, the present study aimed to evaluate the immediate effects of WBV on the neurocognitive parameters in women with and without lumbar hyper-lordosis. METHOD A total of 15 women with normal lumbar lordosis and 15 women with lumbar hyper-lordosis participated in the study. The effects of the WBV (30 Hz, 5 mm, and 5 min) on the visual and auditory reaction time and anticipatory skills were assessed using the Speed Anticipation Reaction Time (SART) Test. RESULTS The results indicated that the auditory complex choice reaction time decreased, and the anticipation skill with high speed increased after the WBV in women with normal lumbar lordosis (P = 0.01, P = 0.01, respectively). Additionally, the visual choice reaction time in women with lumbar hyperlordosis significantly decreased after WBV intervention. Although other variables in the two groups decreased after vibration, these changes were not statistically significant. CONCLUSION The present study demonstrated that WBV had positive immediate effects on the reaction time in both groups, however, it had negative effects on anticipatory skill with high speed in women with normal lumbar lordosis; these negative effects appeared to be due to mental fatigue in the participants. This finding indicated WBV had the potential to enhance neuro-cognition. Therefore, further evaluations with different study settings and populations should be conducted.
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Affiliation(s)
- Sara Fereydounnia
- Physiotherapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Azadeh Shadmehr
- Physiotherapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
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17
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Okano I, Carlson BB, Chiapparelli E, Salzmann SN, Winter F, Shirahata T, Miller CO, Rentenberge C, Shue J, Carrino JA, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Local Mechanical Environment and Spinal Trabecular Volumetric Bone Mineral Density Measured by Quantitative Computed Tomography: A Study on Lumbar Lordosis. World Neurosurg 2019; 135:e286-e292. [PMID: 31790845 DOI: 10.1016/j.wneu.2019.11.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE There have been some reports on the association between spinal balance parameters and regional bone mineral density (BMD), but the results are controversial. The purpose of this study is to evaluate the relationship between spinopelvic parameters and regional volumetric BMDs (vBMDs) measured by quantitative computed tomography (QCT) in the lumbosacral region of patients undergoing lumbar fusion surgery. METHODS The data of consecutive patients undergoing posterior lumbar spinal fusion with preoperative computed tomography was reviewed. QCT measurements were conducted in L1-S1 vertebral trabecular bone. The associations between spinopelvic sagittal parameters and vBMDs were evaluated. Multivariate analyses adjusted with age, gender, race, and body mass index were conducted with vBMD as the response variable. RESULTS A total of 144 patients were included in the final analyses. Mean age (± standard deviation) was 65.4 ± 11.8 years. Mean vBMD in L1 (± standard deviation) was 118.3 ± 37.4 mg/cm3. After adjusting by cofactors, lumbar lordosis was negatively associated with vBMDs in all levels from L1 to L5 (% regression coefficients and adjusted R2 values: L1, -0.438, 0.268; L2, -0.556, 0.296; L3, -0.608, 0.362; L4, -0.554, 0.228; L5, -0.424, 0.194), but not in S1. Sacral slope was negatively associated with vBMD only at L4 (% coefficient, -0.588; R2, 0.208). Other parameters were not significantly associated with vBMDs at any levels. CONCLUSIONS Higher lumbar lordosis was associated with lower vBMDs in all lumbar spine levels. Our results suggest that BMD is affected not only by metabolic factors but also by the mechanical environment. Further longitudinal studies are needed to elucidate this effect of vBMD on clinical outcomes.
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Affiliation(s)
- Ichiro Okano
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Brandon B Carlson
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA; Marc A. Asher, MD, Comprehensive Spine Center, University of Kansas, Kansas City, Kansas, USA
| | - Erika Chiapparelli
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Stephan N Salzmann
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Fabian Winter
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Toshiyuki Shirahata
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA; Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | | | | | - Jennifer Shue
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Andrew A Sama
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Frank P Cammisa
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Federico P Girardi
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Alexander P Hughes
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA.
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18
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Oakley PA, Ehsani NN, Harrison DE. Non-surgical reduction of lumbar hyperlordosis, forward sagittal balance and sacral tilt to relieve low back pain by Chiropractic BioPhysics ® methods: a case report. J Phys Ther Sci 2019; 31:860-864. [PMID: 31645820 PMCID: PMC6801353 DOI: 10.1589/jpts.31.860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/27/2019] [Indexed: 12/19/2022] Open
Abstract
[Purpose] To present the reduction of both lumbar spine hyperlordosis and anterior sagittal balance in a symptomatic patient as treated by Chiropractic BioPhysics® technique. [Participant and Methods] A 46 year old reported with low back and hip pains for six years. Oswestry disability index scored 28%. Radiographic assessment revealed pronounced anterior sagittal balance with lumbar hyperlordosis. The patient was treated by Chiropractic BioPhysics technique to reverse the spinal deformity subluxation via mirror image corrective exercises and spinal traction, as well as spinal manipulative therapy. [Results] Assessments after 36 and 74 treatments corresponding to the 4-month and 13-month check-ups demonstrated a continuous structural improvement in lumbar spine biomechanical parameters. There was a near complete resolution in low back and hip pains with an Oswestry score of 4%. [Conclusion] This case documents the reduction of lumbar spine hyperlordosis and forward sagittal balance by contemporary spine rehabilitation methods. It is essential to screen spinal subluxation patterns via standing radiography which obviously, as demonstrated in this case determines treatment approach as most low back pain patients present with lumbar hypolordosis. Routine initial and repeat radiography is safe in the screening and monitoring of treatment efficacy and is the standard for evidence-based, patient-centred structural rehabilitation.
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19
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Ludwig O, Berger J, Becker S, Kemmler W, Fröhlich M. The Impact of Whole-Body Electromyostimulation on Body Posture and Trunk Muscle Strength in Untrained Persons. Front Physiol 2019; 10:1020. [PMID: 31481895 PMCID: PMC6710354 DOI: 10.3389/fphys.2019.01020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/24/2019] [Indexed: 01/06/2023] Open
Abstract
Muscular imbalances of the trunk muscles are held responsible for changes in body posture. At the same time, whole-body electromyostimulation (WB-EMS) has been established as a new training method that enables simultaneous stimulation of many muscle groups. This study was aiming to analyze if a 10 weeks WB-EMS training changes posture-relevant parameters and/or improves isometric strength of the trunk extensors and flexors, and if there are differences based on stimulation at 20 Hz and 85 Hz. Fifty eight untrained adult test persons were divided into three groups (control, CON; training with 20 Hz stimulation, TR20; training with 85 Hz, TR85). Anthropometric parameters, trunk extension and flexion forces and torques, and posture parameters were determined before (n = 58) and after (n = 53: CON: n = 15, TR20: n = 19, TR85: n = 19) a 10 weeks WB-EMS training program (15 applications, 9 exercises). Differences between the groups were calculated for pre- and post-tests using univariate ANOVA and between the test times using repeated (2 × 3) ANOVA. Comparisons of pairs were calculated post hoc based on Fisher (LSD). No differences between the groups were found for the posture parameters. The post hoc analysis of both trunk flexion and trunk extension forces and torques showed a significant difference between the groups TR85 and CON but no difference between the other group pairs. A 10 weeks whole-body electrostimulation training with a stimulation frequency of 85 Hz in contrast to training with a stimulation frequency of 20 Hz improves the trunk muscle strength of an untrained group but does not significantly change posture parameters.
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Affiliation(s)
- Oliver Ludwig
- Department of Sports Science, Faculty of Social Sciences, University of Kaiserslautern, Kaiserslautern, Germany
| | - Joshua Berger
- Department of Sports Science, Faculty of Social Sciences, University of Kaiserslautern, Kaiserslautern, Germany
| | - Stephan Becker
- Department of Sports Science, Faculty of Social Sciences, University of Kaiserslautern, Kaiserslautern, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Fröhlich
- Department of Sports Science, Faculty of Social Sciences, University of Kaiserslautern, Kaiserslautern, Germany
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20
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Lois Zlolniski S, Torres‐Tamayo N, García‐Martínez D, Blanco‐Pérez E, Mata‐Escolano F, Barash A, Nalla S, Martelli S, Sanchis‐Gimeno JA, Bastir M. 3D geometric morphometric analysis of variation in the human lumbar spine. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 170:361-372. [DOI: 10.1002/ajpa.23918] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/01/2019] [Accepted: 07/29/2019] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Federico Mata‐Escolano
- CT and MRI Unit, ERESA, Department of RadiologyGeneral University Hospital Valencia Spain
| | - Alon Barash
- Faculty of Medicine in the GalileeBar Ilan University Ramat Gan Israel
| | - Shahed Nalla
- Department of Human Anatomy and Physiology, Faculty of Health SciencesUniversity of Johannesburg Johannesburg South Africa
- Evolutionary Studies Institute and Centre for Excellence in PalaeoSciencesUniversity of the Witwatersrand Johannesburg South Africa
| | - Sandra Martelli
- Centre for Integrative Anatomy (CIA), Department of Cell and Developmental BiologyFaculty of Life Sciences, University College London London UK
| | - Juan A. Sanchis‐Gimeno
- Giaval Research Group, Department of Anatomy and Human Embryology, Faculty of MedicineUniversity of Valencia Valencia Spain
| | - Markus Bastir
- Paleoanthropology GroupMuseo Nacional de Ciencias Naturales (CSIC) Madrid Spain
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Okuzu Y, Goto K, Okutani Y, Kuroda Y, Kawai T, Matsuda S. Hip-Spine Syndrome: Acetabular Anteversion Angle Is Associated with Anterior Pelvic Tilt and Lumbar Hyperlordosis in Patients with Acetabular Dysplasia: A Retrospective Study. JB JS Open Access 2019; 4:e0025. [PMID: 31161147 PMCID: PMC6510466 DOI: 10.2106/jbjs.oa.18.00025] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Hip-spine syndrome was originally described by Offierski and MacNab, who argued that the flexion deformity of the hip rotated the pelvis forward, causing the spine symptoms. We additionally hypothesized that in patients who have osteoarthritis (OA) of the hip, the pelvis is tilted anteriorly to compensate for the anterior acetabular coverage defect. We investigated the hip factors associated with anterior pelvic tilt (PT) in patients who had OA of the hip due to acetabular dysplasia. Methods: We retrospectively reviewed the medical records of patients who had undergone total hip arthroplasty between January 2009 and December 2017 to identify those who had unilateral secondary OA due to acetabular dysplasia. Patients who had spinal imbalance, a history of spinal or lower limb fracture or surgery, bilateral OA of the hip, or a severely subluxated hip were excluded, leaving 100 eligible patients. We defined the indicators of an anterior acetabular coverage defect, flexion deformity of the hip, and anterior PT as the acetabular anteversion angle (AAA), extension range of motion (ROM), and anterior tilt of the pelvis, respectively. We measured hip factors and spinal parameters on radiographs and the standardized axial and coronal planes on 3-dimensional computed tomography with reference to the anterior pelvic plane. Hip factors associated with PT were investigated. Results: Univariate analysis showed a significant correlation between PT and both AAA (r = –0.389, p < 0.001) and combined anteversion angle (r = –0.272, p = 0.03). Multivariate regression analysis identified AAA (β = –0.385, p < 0.001) and extension ROM (β = 0.212, p = 0.0496) as independent factors associated with PT. Lumbar lordosis and pelvic incidence minus lumbar lordosis were significantly correlated with AAA, but sagittal vertical axis was not. Conclusions: When treating patients who have acetabular dysplasia, surgeons should recognize the relationship between the anterior acetabular coverage and anterior PT. Correcting hyperlordosis of the lumbar spine can induce progression of hip OA because it may decrease the acetabular anterior coverage.
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Affiliation(s)
- Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Okutani
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Schmid S, Stauffer M, Jäger J, List R, Lorenzetti S. Sling-based infant carrying affects lumbar and thoracic spine neuromechanics during standing and walking. Gait Posture 2019; 67:172-180. [PMID: 30343249 DOI: 10.1016/j.gaitpost.2018.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/13/2018] [Accepted: 10/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Regular infant carrying might be a contributing factor for the development and progression of low back and pelvic girdle pain in mothers after childbirth. However, the neuromechanical adaptations of the spine due to different sling-based carrying techniques are not sufficiently well understood in order to provide evidence-based carrying recommendations. RESEARCH QUESTION What are the immediate effects of different sling-based infant carrying techniques on trunk neuromechanics? METHODS Using a Vicon motion capture and a wireless surface electromyography system, three-dimensional pelvis and spinal kinematics as well as activation patterns of eight trunk muscles were derived from fifteen healthy young women during upright standing and level walking without carrying a load and while carrying a 6 kg-dummy with a sling in front and on either side. Data were analyzed using Statistical Parametric Mapping, allowing group comparisons of discrete parameters (standing) as well as continuous data (walking). To distinguish between clinically relevant and clinically not relevant kinematic findings, statistically significant differences were only considered in case of ≥5°. RESULTS Compared to unloaded walking, carrying the dummy in front was mainly associated with increased lumbar lordosis (standing: (Δ8.8°, p = 0.006; walking: (Δ ≥ 8.2°, 1-100% of gait cycle [%GC], p < 0.001). When carrying the dummy on the preferred side, increased thoracic kyphosis (standing: ≥6.4°, p ≤ 0.003; walking: Δ ≥ 5.6°, 1-100%GC, p < 0.001) and axial rotation towards the ipsilateral side (standing: Δ5.3°, p = 0.003; walking: Δ ≥ 5.0°, 46-58%GC, p = 0.002) were observed. All three conditions entailed increased paraspinal muscle activity during walking, although only unilaterally in side carrying (lumbar, preferred condition: Δ ≥ 13.2%maxMVIC, 49-57%GC, p < 0.001; thoracic, non-preferred condition: Δ ≥ 5.3%maxMVIC, 47-58%GC, p < 0.001). SIGNIFICANCE Carrying an infant alternating on both sides using a sling could be advantageous for preventing musculoskeletal pain resulting from excessive lumbar hyperextension and paraspinal muscle hyperactivation in women after childbirth.
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Affiliation(s)
- Stefan Schmid
- Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland; ETH Zurich, Institute for Biomechanics, Zurich, Switzerland.
| | - Michèle Stauffer
- Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland; Fios - Praxis für Physio- und Ergotherapie, Herzogenbuchsee, Switzerland
| | - Judit Jäger
- ETH Zurich, Institute for Biomechanics, Zurich, Switzerland
| | - Renate List
- ETH Zurich, Institute for Biomechanics, Zurich, Switzerland; Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
| | - Silvio Lorenzetti
- ETH Zurich, Institute for Biomechanics, Zurich, Switzerland; Swiss Federal Institute of Sport Magglingen SFISM, Magglingen, Switzerland
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Abstract
STUDY DESIGN Radiologic analysis using computed tomography. OBJECTIVES To analyze the degenerative changes of the facet joints in patients with spondylolysis in comparison with control subjects. SUMMARY OF BACKGROUND DATA Defects of the pars interarticularis are thought to result in a reduction of biomechanical stress on adjacent facet joints. Therefore, degenerative changes of the facet joints in patients with spondylolysis are expected to be less than those in patients without spondylolysis. METHODS Abdominal and pelvic multidetector computed tomography scans of 2000 subjects, performed for conditions unrelated to low back pain, were reviewed. A total of 107 patients (37 women and 70 men) with L5 spondylolysis were identified [spondylolysis (+) group]. Sex-matched and age-matched controls without spondylolysis were chosen randomly [spondylolysis (-) group]. Subjects in the spondylolysis group were subdivided into either bilateral spondylolysis or unilateral spondylolysis groups for comparison with the control group. Four radiologic findings (narrowing, sclerosis, osteophyte, and bone cyst) indicative of degenerative change of the facet joints adjacent to the L5 pars defects were evaluated and the degree of degenerative change was graded by summing the number of degenerative changes (score range, 0-4). The χ test and Mann-Whitney U test were used for statistical analysis. RESULTS Significantly more degenerative changes in both L4/L5 and L5/S facet joints were found in the spondylolysis (+) group than in the spondylolysis (-) group (χ test, P <0.05). Degenerative changes of the facet joints at both L4/L5 and L5/S were more severe in the bilateral spondylolysis (+) group than in the spondylolysis (-) group. Degenerative changes of the facet joints at both L4/L5 and L5/S were more severe in the unilateral spondylolysis (+) group than in the spondylolysis (-) group. CONCLUSIONS Degenerative changes of the facet joints in patients with lumbar spondylolysis were more severe than those without spondylolysis.
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Diebo BG, Oren JH, Challier V, Lafage R, Ferrero E, Liu S, Vira S, Spiegel MA, Harris BY, Liabaud B, Henry JK, Errico TJ, Schwab FJ, Lafage V. Global sagittal axis: a step toward full-body assessment of sagittal plane deformity in the human body. J Neurosurg Spine 2016; 25:494-499. [DOI: 10.3171/2016.2.spine151311] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Sagittal malalignment requires higher energy expenditure to maintain an erect posture. Because the clinical impact of sagittal alignment is affected by both the severity of the deformity and recruitment of compensatory mechanisms, it is important to investigate new parameters that reflect both disability level and compensatory mechanisms for all patients. This study investigated the clinical relevance of the global sagittal axis (GSA), a novel measure to evaluate the standing axis of the human body.
METHODS
This is a retrospective review of patients who underwent full-body radiographs and completed health-related quality of life (HRQOL) questionnaires: Oswestry Disability Index (ODI), Scoliosis Research Society–22, EuroQol-5D (EQ-5D), and the visual analog scale for back and leg pain. The GSA was defined as the angle formed by a line from the midpoint of the femoral condyles to the center of C-7, and a line from the midpoint between the femoral condyles to the posterior superior corner of the S-1 sacral endplate. After evaluating the correlation of GSA/HRQOL with sagittal parameters, linear regression models were generated to investigate how ODI and GSA related to radiographic parameters (T-1 pelvic angle, pelvic retroversion, knee flexion, and pelvic posterior translation).
RESULTS
One hundred forty-three patients (mean age 44 years) were included. The GSA correlated significantly with all HRQOL (up to r = 0.6 with EQ-5D) and radiographic parameters (up to r = 0.962 with sagittal vertical axis). Regression between ODI and sagittal radiographic parameters identified the GSA as an independent predictor (r = 0.517, r2 = 0.267; p < 0.001). Analysis of standardized coefficients revealed that when controlling for deformity, the GSA increased with a concurrent decrease in pelvic retroversion (−0.837) and increases in knee flexion (+0.287) and pelvic posterior translation (+0.193).
CONCLUSIONS
The GSA is a simple, novel measure to assess the standing axis of the human body in the sagittal plane. The GSA correlated highly with spinopelvic and lower-extremities sagittal parameters and exhibited remarkable correlations with HRQOL, which exceeded other commonly used parameters.
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Lv X, Liu Y, Zhou S, Wang Q, Gu H, Fu X, Ding Y, Zhang B, Dai M. Correlations between the feature of sagittal spinopelvic alignment and facet joint degeneration: a retrospective study. BMC Musculoskelet Disord 2016; 17:341. [PMID: 27528107 PMCID: PMC4986370 DOI: 10.1186/s12891-016-1193-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sagittal spinopelvic alignment changes associated with degenerative facet joint arthritis have been assessed in a few studies. It has been documented that patients with facet joint degeneration have higher pelvic incidence, but the relationship between facet joint degeneration and other sagittal spinopelvic alignment parameters is still disputed. Our purpose was to evaluate the correlation between the features of sagittal spinopelvic alignment and facet joint degeneration. METHODS Imaging data of 140 individuals were retrospectively analysed. Lumbar lordosis, pelvic tilt (PT), pelvic incidence (PI), sacral slope, and height of the lumbar intervertebral disc were measured on lumbar X-ray plates. Grades of facet joint degeneration were evaluated from the L2 to S1 on CT scans. Spearman's rank correlation coefficient and Student's t-test were used for statistical analyses, and a P-value <0.05 was considered statistically significant. RESULTS PI was positively associated with degeneration of the facet joint at lower lumbar levels (p < 0.001 r = 0.50 at L5/S1 and P = 0.002 r = 0.25 at L4/5). A significant increase of PT was found in the severe degeneration group compared with the mild degeneration group: 22.0° vs 15.7°, P = 0.034 at L2/3;21.4°vs 15.1°, P = 0.006 at L3/4; 21.0° vs 13.5°, P = 0.000 at L4/5; 20.8° vs 12.1°, P = 0.000 at L5/S1. CONCLUSION Our results indicate that a high PI is a predisposing factor for facet joint degeneration at the lower lumbar spine, and that severe facet joint degeneration may accompany with greater PT at lumbar spine.
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Affiliation(s)
- Xin Lv
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China
| | - Yuan Liu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China
| | - Song Zhou
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China
| | - Qiang Wang
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi, 330006, China
| | - Houyun Gu
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi, 330006, China
| | - Xiaoxing Fu
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi, 330006, China
| | - Yi Ding
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi, 330006, China
| | - Bin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China.
| | - Min Dai
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China.
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Diebo BG, Varghese JJ, Lafage R, Schwab FJ, Lafage V. Sagittal alignment of the spine: What do you need to know? Clin Neurol Neurosurg 2015; 139:295-301. [DOI: 10.1016/j.clineuro.2015.10.024] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
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Lumbar juxta-facet joint cysts in association with facet joint orientation, -tropism and -arthritis: A case–control study. Clin Neurol Neurosurg 2015; 139:278-81. [DOI: 10.1016/j.clineuro.2015.10.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/26/2015] [Accepted: 10/22/2015] [Indexed: 11/19/2022]
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Jentzsch T, Gomes de Lima V, Seifert B, Sprengel K, Werner CML. The benefits of elective spinal implant removal: a retrospective study of 137 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 2015; 25:856-64. [PMID: 26337927 DOI: 10.1007/s00586-015-4211-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/22/2015] [Accepted: 08/22/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE While spinal instrumentations are becoming more common, the advantages of elective spinal implant removal remain ambiguous. We hypothesized that elective implant removal of the posterior spine is beneficial. METHODS A retrospective study evaluated 137 consecutive trauma patients with elective implant removal of the posterior spine. If additional cages were present, they were not removed. Primary outcomes were the change in pre- and post-operative pain, fingertip-floor distance (FFD), and Cobb angles. Some secondary outcomes consisted of complications, work disability, and pelvic incidence (PI). Different stabilization approaches and cage sizes were compared. RESULTS The presence and amount of pain as well as the FFD showed significant improvement. There was no loss of reduction. Delayed wound healing was observed in 9%, but only 3% needed revision. Thoracic fascial dehiscences were seen only in patients (9%) that had stand-alone posterior surgery. Larger cages were associated with increased work disability. An increased PI was associated with less post-operative pain and decreased FFD. CONCLUSIONS In this study, trauma patients benefited from elective implant removal of the posterior spine due to lower presence and level of pain, improved function and low revision rates; irrespective of an initial combined or stand-alone posterior approach or varying cage sizes. However, stand-alone posterior instrumentation may be accompanied by increased rates of fascial dehiscence surgeries and larger cages may lead to increased work disability. Increased PI may be associated with less pain after spinal implant removal.
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Affiliation(s)
- Thorsten Jentzsch
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Vinicius Gomes de Lima
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kai Sprengel
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Clément M L Werner
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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