Sacral orientation and Scheuermann's kyphosis

Scheuermann Kyphosis: Current Concepts and Management

PURPOSE OF REVIEW

Scheuermann's kyphosis (SK) is a developmental deformity of the spine that affects up to 8% of children in the US. Although, the natural progression of SK is noted to be gradual over years, severe deformity can be associated with significant morbidity. Thorough clinical examination and interpretation of relevant imaging help differentiate and confirm this diagnosis. Treatment includes both operative and nonoperative approaches. The purpose of this article is to provide an updated overview of the current theories of its pathogenesis, as well as the principles of diagnosis and treatment of SK.

RECENT FINDINGS

Although a definitive, unified theory continues to be elusive, numerous reports in the past decade provide insight into the pathophysiology of SK. These include alterations in mechanical stress and/or hormonal disturbances. Candidate genes have also been identified to be linked to the inheritance of SK. Updates to nonoperative treatment include the effectiveness of dedicated exercise programs, as well as the types and duration of orthotic treatment. Advances in surgical technique can be observed with a trend toward a posterior-only approach, with supporting evidence for careful evaluation of both the sagittal and coronal planes to determine fusion levels in order to avoid postoperative junctional pathologies. SK is an important cause of structural or rigid kyphosis. It can lead to significant morbidity in severe cases. Treatment is based on curve magnitude and symptoms. Nonoperative treatment consists of physical therapy in symptomatic patients, and bracing can be added for skeletally mature patients. Operative management can be considered in patients with large, progressive, and symptomatic deformity. Future studies can benefit from a focused investigation into patient-reported outcomes after undergoing appropriate treatment.

Sacral Anatomical Orientation in the Lebanese Population

INTRODUCTION

PI is currently used as the gold standard measurement in spinopelvic anatomy. There is a need for a reliable method to calculate sacral anatomic orientation (SAO) independent of posture and to establish its association with PI, which was previously established in a single study (Peleg et al., 2007). Therefore, the aim of our study is the application and verification of this association on a Lebanese sample.

METHODS

Methods for measuring SAO and PI on living individuals are described. The study was carried out on 200 adult individuals using CT 3D images (volume-rendering method). Reliability (intratester and intertester) was evaluated using the intraclass correlation test. A regression analysis was carried out to evaluate the association between the two measurements.

RESULTS

There were 103 females (51%) and 97 males (49%) with a mean age of 58.68 ± 19.6 years (min = 20; max = 93). The mean SAO and PI in our population were found to be 52.65° (SD = 8.16°) and 59.08° (SD = 12.53°), respectively. SAO and PI measurements were highly correlated (Pearson correlation test; r = -0.296, P < 0.0001 for our general population). PI can be predicted via SAO, i.e., SAO = (-0.193 × PI) + 64.057.

CONCLUSIONS

SAO may be an important tool, alongside PI, in defining the sagittal shape of the spine and useful for understanding its association with spinal diseases as they are not affected by postural changes.

Scheuermann's Disease: Radiographic Pathomorphology and Association with Clinical Features

STUDY DESIGN

Cross-sectional analytical study.

PURPOSE

To evaluate the spinal radiological features in patients with Scheuermann's disease and the association between the thoracic kyphosis angle and clinical presentation. Overview of the Literature: Scheuermann's disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine in adolescents; however, literature is limited in this area.

METHODS

Data regarding 150 successive X-ray images of 95 males and 55 females diagnosed with Scheuermann's disease were retrieved from the digital archives of the Maccabi Healthcare Services in Tel Aviv. Data included thoracic kyphosis angle (T3-T12), cervical lordosis (C2-C7), lumbar lordosis (L1-S1), sacral slope (SS), number and location of the anterior wedged vertebrae (AWV, minimum 5°), and C7 plumb line. Other data included age, sex, height, family history, Risser sign, self-perceived body image (rated by the Numeric Rating Scale [NRS]), and back pain during the previous week (rated by the Numeric Pain Rating Scale [NPRS]).

RESULTS

Significant positive associations were observed between the Cobb angle of thoracic kyphosis and age (r =0.186, p =0.023), cervical lordosis (r =0.263, p <0.001), lumbar lordosis (r =0.576, p <0.001), SS (r =0.236, p <0.004), T10-T12 Cobb angle (r =0.319, p <0.001), and number of AWV (r =0.519, p <0.001). The highest frequency of vertebral wedging was noted in T7 (68%), followed by T8 (65%) and T9 (44%). The NPRS showed a significant association only with SS (r =0.219, p =0.014). Significant positive associations were observed between the NRS for self-perceived body image, the thoracic kyphosis (r =0.494, p <0.001), and the number of AWV (r =0.361, p <0.001).

CONCLUSIONS

Thoracic kyphosis was significantly associated with cervical and lumbar lordosis, SS, T10-T12 Cobb angle, and AWV number. Pain was not substantial; however, self-perceived body image, the most common complaint of patients with Scheuermann's disease, was high and significantly associated with thoracic kyphosis and the number of AWV.

Pelvic incidence variation among individuals: functional influence versus genetic determinism

Pelvic incidence has become one of the most important sagittal parameters in spinal surgery. Despite its great importance, pelvic incidence can vary from 33° to 85° in the normal population. The reasons for this great variability in pelvic incidence remain unexplored. The objective of this article is to present some possible interpretations for the great variability in pelvic incidence under both normal and pathological conditions and to further understand the determinants of pelvic incidence from the perspective of the functional requirements for bipedalism and genetic backgrounds via a literature review. We postulate that both pelvic incidence and pelvic morphology may be genetically predetermined, and a great variability in pelvic incidence may already exist even before birth. This great variability may also serve as a further reminder that the sagittal profile, bipedal locomotion mode, and genetic background of every individual are unique and specific, and clinicians should avoid making universally applying broad generalizations of pelvic incidence. Although PI is an important parameter and there are many theories behind its variability, we still do not have clear mechanistic answers.