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Muraoka M, Hasegawa K, Sakai M, Hatsushikano S, Watanabe K. Quantitative assessment of muscle activity of back and lower extremities, whole body sagittal alignment, body sway, and health-related quality of life in adult spinal deformity patients before and after spinopelvic correction surgery: From the standpoint of the "cone of economy". J Orthop Sci 2024:S0949-2658(24)00045-9. [PMID: 38519379 DOI: 10.1016/j.jos.2024.02.006] [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: 10/17/2023] [Revised: 01/18/2024] [Accepted: 02/28/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND AND AIMS Pain and muscle fatigue in the low back and lower extremity associated with adult spinal deformity (ASD) markedly limit daily activities and affect quality of life. This study aimed to clarify if spinal correction surgery decreases the muscle activity requirements in relation to alignment and balance parameters. METHODS Integrated electromyogram (I-EMG) studies of the low back and lower extremity in addition to whole body alignment, body sway, and health-related quality of life (HRQOL) were evaluated in 16 patients with ASD before and after surgery. Sixteen healthy volunteers were included as control subjects. Muscle activities of the bilateral lumbar paravertebral, biceps femoris, rectus femoris, gastrocnemius, and tibialis anterior were measured using surface electromyogram in both resting and working standing positions. Surgical outcomes were based on improvements in muscle fatigue using the sum of the whole muscle I-EMGs and body sway. HRQOL was evaluated by SRS-22r, which measures 4 domains (function, pain, self-image, mental health) and subtotal scores. RESULTS In controls, the sum of the 10 whole I-EMGs (mVms; mean ± SD) was 3316 ± 1247 in the resting standing position and 5625 ± 2065 in the working standing position. The I-EMG values were higher in ASD patients than in healthy subjects; in the resting standing position, the sum of the whole 10 I-EMGs significantly decreased from baseline (9125 ± 3529) to 3 (6088 ± 1793) and 6 (6381 ± 1776) months postoperatively (p < 0.01). In the working standing position, the sum in ASD patients also significantly decreased from baseline (14,160 ± 5474) to 3 (8085 ± 2540) and 6 (8557 ± 3025) months postoperatively (p < 0.01). I-EMG values did not differ significantly between the 3- and 6-month time points in either condition. Body sway was also improved postoperatively at 3 months and maintained at 6 months along with the amelioration of whole-body sagittal alignment, and 4 domains and subtotal SRS-22r scores significantly increased postoperatively. CONCLUSION Following spinopelvic correction surgery, whole body sagittal alignment was improved, and muscle activity based on I-EMG and body sway were significantly decreased. The SRS-22r scores after surgery also indicated significant improvement, suggesting that muscle fatigue in the standing position was ameliorated, i.e., the "cone of economy" was normalized.
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Affiliation(s)
- Mikio Muraoka
- Kameda-Daiichi Hospital, Department of Rehabilitation, Niigata, Japan.
| | | | - Michiko Sakai
- Kameda-Daiichi Hospital, Division of Electrophysiology, Niigata, Japan
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Suzuki H, Funaba M, Fujimoto K, Ichihara Y, Nishida N, Sakai T. Current Concepts of Cervical Spine Alignment, Sagittal Deformity, and Cervical Spine Surgery. J Clin Med 2024; 13:1196. [PMID: 38592040 PMCID: PMC10932435 DOI: 10.3390/jcm13051196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
There are not many reports on cervical spine alignment, and only a few analyze ideal surgical approaches and optimal amounts of correction needed for the various types of deformity. We comprehensively reviewed the present literature on cervical spinal deformities (with or without myelopathy) and their surgical management to provide a framework for surgical planning. A general assessment of the parameters actually in use and correlations between cervical and thoracolumbar spine alignment are provided. We also analyzed posterior, anterior, and combined cervical surgical approaches and indications for the associated techniques of laminoplasty, laminectomy and fusion, and anterior cervical discectomy and fusion. Finally, on the basis of the NDI, SF-36, VAS, and mJOA questionnaires, we fully evaluated the outcomes and measures of postoperative health-related quality of life. We found the need for additional prospective studies to further enhance our understanding of the importance of cervical alignment when assessing and treating cervical deformities with or without myelopathy. Future studies need to focus on correlations between cervical alignment parameters, disability scores, and myelopathy outcomes. Through this comprehensive literature review, we offer guidance on practical and important points of surgical technique, cervical alignment, and goals surgeons can meet to improve symptoms in all patients.
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Affiliation(s)
- Hidenori Suzuki
- Department of Orthopedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan; (M.F.); (K.F.); (Y.I.); (N.N.); (T.S.)
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Zhang Z, Song J, Jia S, Tian Z, Zhang Z, Zheng G, Meng C, Li N. How does the correction in lumbar lordosis affect the spinopelvic realignments in degenerative lumbar scoliosis underwent scoliosis surgery? Eur J Med Res 2023; 28:403. [PMID: 37798787 PMCID: PMC10552202 DOI: 10.1186/s40001-023-01339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 09/02/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND To evaluate the effects of correction in lumbar lordosis (LL) that have on full-body realignments in patients with degenerative lumbar scoliosis (DLS) who had undergone long sacroiliac fusion surgery. METHODS A multi-center retrospective study including 88 DLS patients underwent the surgical procedure of long sacroiliac fusion with instrumentations was performed. Comparisons of radiographic and quality-of-life (QoL) data among that at the pre-operation, the 3rd month and the final follow-up were performed. The correlations between the LL correction and the changes in other spinopelvic parameters were explored using Pearson-correlation linear analysis and linear regression analysis. The correlation coefficient (r) and the adjusted r2 were calculated subsequently. RESULTS All radiographic and QoL data improved significantly (P < 0.001) after the surgical treatments. The LL correction correlated (P < 0.001) with the changes in the sacral slope (SS, r = 0.698), pelvic tilt (PT, r = -0.635), sagittal vertical axis (SVA, r = -0.591), T1 pelvic angle (TPA, r = -0.782), and the mismatch of pelvic incidence minus lumbar lordosis (PI-LL, r = -0.936), respectively. Moreover, LL increased by 1° for each of the following spinopelvic parameter changes (P < 0.001): 2.62° for SS (r2 = 0.488), -4.01° for PT (r2 = 0.404), -4.86° for TPA (r2 = 0.612), -2.08° for the PI-LL (r2 = 0.876) and -15.74 mm for SVA (r2 = 0.349). Changes in the thoracic kyphosis (r = 0.259) and pelvic femur angle (r = 0.12) were independent of the LL correction, respectively. CONCLUSIONS LL correction correlated significantly to the changes in spinopelvic parameters; however, those independent variables including the thoracic spine and hip variables probably be remodeled themselves to maintain the full-body balance in DLS patients underwent the correction surgery.
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Affiliation(s)
- Zifang Zhang
- Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China
- Department of Orthopedics, Shandong University of Traditional Chinese Medicine, Jingshi Road 16369, Jinan, 250014, China
| | - Jianing Song
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Shu Jia
- Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China
| | - Zhikang Tian
- Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China
| | - Zhenyu Zhang
- Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China
| | - Guoquan Zheng
- The Spine Surgery, The first medical center of the Chinese PLA General Hospital, Beijing, China.
| | - Chunyang Meng
- Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China.
| | - Nianhu Li
- Department of Orthopedics, Shandong University of Traditional Chinese Medicine, Jingshi Road 16369, Jinan, 250014, China.
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Ouchida J, Nakashima H, Kanemura T, Okamoto M, Hatsushikano S, Imagama S, Le Huec JC, Hasegawa K. Racial differences in whole-body sagittal alignment between Asians and Caucasians based on international multicenter data. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3608-3615. [PMID: 37395781 DOI: 10.1007/s00586-023-07829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/05/2023] [Accepted: 06/17/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To examine inherent differences adjusted for age and clinical score in whole-body sagittal (WBS) alignment involving the lower extremities between Asians and Caucasians, and to determine the relationship between age and WBS parameters by race and sex. METHODS A total of 317 individuals consisting of 206 Asians and 111 Caucasians participated. WBS parameters including C2-7 lordotic angle, lower lumbar lordosis (lower LL, L4-S), pelvic incidence (PI), pelvic thickness, knee flexion (KF), sagittal vertical axis (SVA), and T1 pelvic angle (TPA) were evaluated radiologically. Propensity score-matching adjustments for age and the Oswestry Disability Index scores for comparative analysis between the two race cohorts and correlation analysis between age and WBS parameters for all subjects by race and sex were conducted. RESULTS The comparative analysis included 136 subjects (age: Asians 41.1 ± 13.5, Caucasians 42.3 ± 16.2 years, p = 0.936). Racial differences in WBS parameters were observed in C2-7 lordotic angle (-1.8 ± 12.3 vs. 6.3 ± 12.2 degrees, p = 0.001), and lower LL (34.0 ± 6.6 vs. 38.0 ± 6.1 degrees, p < .001). In correlation analysis with age, moderate or more significant correlations with age were found in KF for all groups, and in SVA and TPA for females of both racial groups. Age-related changes in pelvic parameters of PI and pelvic thickness were more significant in Caucasian females. CONCLUSION Analysis of the correlation between age and WBS parameters suggested that age-related WBS changes vary between races and should be considered during corrective spinal surgery.
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Affiliation(s)
- Jun Ouchida
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, Aichi, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, Aichi, 466-8550, Japan.
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | | | | | - Shiro Imagama
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, Aichi, 466-8550, Japan
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Liu Y, Yuan L, Zeng Y, Ni J, Yan S. The Difference in Paraspinal Muscle Parameters and the Correlation with Health-Related Quality of Life among Healthy Individuals, Patients with Degenerative Lumbar Scoliosis and Lumbar Spinal Stenosis. J Pers Med 2023; 13:1438. [PMID: 37888049 PMCID: PMC10608224 DOI: 10.3390/jpm13101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
(1) Background: Paraspinal muscle degeneration affects the quality of life in patients with degenerative lumbar scoliosis (DLS) and lumbar spinal stenosis (LSS). We aimed to describe the characteristics and differences in the paraspinal muscle parameters between patients with DLS and LSS and investigate their correlation with health-related quality of life (HRQOL). (2) Methods: There were forty-four participants in each group, namely the DLS, LSS, and healthy groups, who were matched at a ratio of 1:1 according to age, sex, and BMI. Differences in paraspinal muscle parameters among the three groups were compared using analysis of variance or the Mann-Whitney U test, and paraspinal muscle degeneration and HRQOL were analyzed using Spearman's correlation analysis. (3) Results: In the upper lumbar, the psoas (PS), quadratus lumborum (QL), and multifidus (MF) cross-sectional area (CSA) in the DLS group were smaller than those in the other groups. In the lower lumbar region, the CSA of the PS, QL, erector spinae (ES), and gross CSA (GCSA) of the MF in the DLS group were not significantly different from those in the LSS group. These values were lower than those observed in the healthy group. The lean muscle fat index (LMFI) of the MF and ES groups was higher than those of the other groups. Regarding HRQOL, we found that PS and MF CSA were strongly associated with HRQOL in healthy individuals; however, only MF was associated with HRQOL in the LSS group. (4): Conclusion: PS in the upper lumbar region and MF degeneration were more severe in patients with DLS than in those with LSS. ES degeneration was similar between the LSS and DLS groups. MF muscle atrophy in patients with LSS and asymmetric changes in the MF in DLS are associated with quality of life.
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Affiliation(s)
- Yinhao Liu
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China; (Y.L.); (L.Y.); (J.N.); (S.Y.)
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Peking University Third Clinical College, Peking University Health Science Center, Haidian District, No. 38 Xueyuan Road, Beijing 100191, China
| | - Lei Yuan
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China; (Y.L.); (L.Y.); (J.N.); (S.Y.)
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
| | - Yan Zeng
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China; (Y.L.); (L.Y.); (J.N.); (S.Y.)
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
| | - Jiajun Ni
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China; (Y.L.); (L.Y.); (J.N.); (S.Y.)
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Peking University Third Clinical College, Peking University Health Science Center, Haidian District, No. 38 Xueyuan Road, Beijing 100191, China
| | - Shi Yan
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China; (Y.L.); (L.Y.); (J.N.); (S.Y.)
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Peking University Third Clinical College, Peking University Health Science Center, Haidian District, No. 38 Xueyuan Road, Beijing 100191, China
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Chen C, Yang S, Tang Y, Yu X, Chen C, Zhang C, Luo F. Correlation between strength/endurance of paraspinal muscles and sagittal parameters in patients with degenerative spinal deformity. BMC Musculoskelet Disord 2023; 24:643. [PMID: 37563700 PMCID: PMC10413613 DOI: 10.1186/s12891-023-06747-6] [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: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Sagittal imbalance is a common cause of low back pain and dysfunction in patients with degenerative spinal deformity (DSD), which greatly affects their quality of life. Strength and endurance are important functional physical indexes for assessing muscle condition. However, the correlation between sagittal parameters and paraspinal muscle strength/endurance is not yet clear. The purpose of this study was to analyze the correlation between strength/endurance of paraspinal muscles and sagittal parameters in patients with DSD. METHODS There were 105 patients with DSD and 52 healthy volunteers (control group) enrolled. They were divided into the balance group [sagittal vertical axis (SVA) < 5 cm, n = 68] and imbalance group (SVA ≥ 5 cm, n = 37). The maximal voluntary exertion (MVE)/Endurance time (ET) of paravertebral muscles were assessed using the prone position test stand, and the sagittal parameters of the subjects were measured, namely, SVA, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Pearson coefficients were used to assess the correlation between paraspinal muscle MVE/ET and sagittal parameters. RESULTS MVE and ET of paravertebral muscles in the control group were significantly higher than those in the balance and imbalance groups (P < 0.05), whereas MVE in the balance group was significantly higher than that in the imbalance group (P < 0.05). SVA in the imbalance group was significantly higher than those in the control and balance groups (P < 0.05). SS and TK in the control group were significantly higher than those in the imbalance group (P < 0.05), and PT and PI in the control group were significantly lower than those in the balance and imbalance groups (P < 0.05). LL in the imbalance group was significantly lower than that in the balance and control groups (P < 0.05). MVE, MVE/BH, and MVE/BW of paraspinal muscles in the imbalance group were negatively correlated with SVA and PT. Moreover, they were positively correlated with LL. CONCLUSIONS Deformity may cause the decrease of MVE and ET of paraspinal muscles in the prone position in patients with DSD. Furthermore, the decline in MVE of paraspinal muscles may be a predisposing factor for the imbalance observed. The decrease of MVE/BW of paraspinal muscles may be involved in spinal compensation, and it is a sensitive indicator for sagittal imbalance and lumbar lordosis.
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Affiliation(s)
- Can Chen
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), No 30, Gaotanyan Street, 400038 Shapingba, Chongqing, China
- Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University (Third Military Medical University), 400038 Chongqing, China
| | - Sen Yang
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), No 30, Gaotanyan Street, 400038 Shapingba, Chongqing, China
- Department of Orthopaedics, The Hospital of Eighty-third Army, Xinxiang Medical College, 210 Wenhua Street, Hongqi District, 453000 Xinxiang, Henan province China
| | - Yong Tang
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), No 30, Gaotanyan Street, 400038 Shapingba, Chongqing, China
| | - Xueke Yu
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), No 30, Gaotanyan Street, 400038 Shapingba, Chongqing, China
| | - Chunhua Chen
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), No 30, Gaotanyan Street, 400038 Shapingba, Chongqing, China
| | - Chengmin Zhang
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), No 30, Gaotanyan Street, 400038 Shapingba, Chongqing, China
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), No 30, Gaotanyan Street, 400038 Shapingba, Chongqing, China
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Ouchida J, Nakashima H, Kanemura T, Ito K, Tsushima M, Machino M, Ito S, Segi N, Ode Y, Imagama S. Differences in Involvement of Whole-Body Compensatory Alignment for Decompensated Spinopelvic Sagittal Balance. J Clin Med 2023; 12:4690. [PMID: 37510804 PMCID: PMC10381014 DOI: 10.3390/jcm12144690] [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: 05/23/2023] [Revised: 06/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the differences in the involvement of whole-body compensatory alignment in different conditions of spinopelvic sagittal balance (compensated/decompensated). METHODS We enrolled 330 individuals who underwent medical checkups and divided them according to sagittal vertical axis (SVA): for the compensated group, this was <4 cm, (group C) and for the decompensated group, it was ≥4 cm, (group D). The correlation between the lack of ideal lumbar lordosis (iLL), which was calculated by using the Schwab formula, and the compensatory radiographic parameters in each group was analyzed. The threshold value of knee flexion (KF) angle, which indicated spinopelvic sagittal imbalance (SVA ≥ 4), was determined by a ROC-curve analysis. RESULTS The correlation analysis of the lack of iLL and each compensatory parameter showed a strong correlation for pelvic tilt (PT) (r = -0.723), and a weak correlation for thoracic kyphosis (TK) (r = 275) in Group C. In Group D, the correlations were strong for PT (r = -0.796), and moderate for TK (r = 0.462) and KF (r = -0.415). The optimal cutoff value for the KF angle was determined to be 8.4 degrees (sensitivity 89%, specificity 46%). CONCLUSIONS The present study shows differences between compensated/decompensated spinopelvic sagittal balance in the correlation strength between lack of iLL and whole-body compensatory parameters.
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Affiliation(s)
- Jun Ouchida
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, Nagoya 464-8601, Japan
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan 483-8704, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, Nagoya 464-8601, Japan
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan 483-8704, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan 483-8704, Japan
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan 483-8704, Japan
| | - Masaaki Machino
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, Nagoya 464-8601, Japan
| | - Sadayuki Ito
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, Nagoya 464-8601, Japan
| | - Naoki Segi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, Nagoya 464-8601, Japan
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan 483-8704, Japan
| | - Yukihito Ode
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan 483-8704, Japan
| | - Shiro Imagama
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, Nagoya 464-8601, Japan
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Lukas KJ, Verhaegen JCF, Livock H, Kowalski E, Phan P, Grammatopoulos G. The effect of ethnicity on the age-related changes of spinopelvic characteristics: a systematic review. Bone Joint Res 2023; 12:231-244. [PMID: 37051815 PMCID: PMC10065848 DOI: 10.1302/2046-3758.124.bjr-2022-0335.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Aims Spinopelvic characteristics influence the hip’s biomechanical behaviour. However, to date there is little knowledge defining what ‘normal’ spinopelvic characteristics are. This study aims to determine how static spinopelvic characteristics change with age and ethnicity among asymptomatic, healthy individuals. Methods This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify English studies, including ≥ 18-year-old participants, without evidence of hip or spine pathology or a history of previous surgery or interventional treatment, documenting lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). From a total of 2,543 articles retrieved after the initial database search, 61 articles were eventually selected for data extraction. Results When all ethnicities were combined the mean values for LL, SS, PT, and PI were: 47.4° (SD 11.0°), 35.8° (SD 7.8°), 14.0° (SD 7.2°), and 48.8° (SD 10°), respectively. LL, SS, and PT had statistically significant (p < 0.001) changes per decade at: −1.5° (SD 0.3°), −1.3° (SD 0.3°), and 1.4° (SD 0.1°). Asian populations had the largest age-dependent change in LL, SS, and PT compared to any other ethnicity per decade at: −1.3° (SD 0.3°) to −0.5° (SD 1.3°), –1.2° (SD 0.2°) to −0.3° (SD 0.3°), and 1.7° (SD 0.2°) versus 1.1° (SD 0.1°), respectively. Conclusion Ageing alters the orientation between the spine and pelvis, causing LL, SS, and PT to modify their orientations in a compensatory mechanism to maintain sagittal alignment for balance when standing. Asian populations have the largest degree of age-dependent change to their spinopelvic parameters compared to any other ethnicity, likely due to their lower PI. Cite this article: Bone Joint Res 2023;12(4):231–244.
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Affiliation(s)
- Kenneth J. Lukas
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Jeroen C. F. Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, Antwerp, Belgium
| | - Holly Livock
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Philippe Phan
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Correspondence should be sent to George Grammatopoulos. E-mail:
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Ouchida J, Nakashima H, Kanemura T, Okamoto M, Hatsushikano S, Imagama S, Le Huec JC, Hasegawa K. The age-specific normative values of standing whole-body sagittal alignment parameters in healthy adults: based on international multicenter data. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:562-570. [PMID: 36380010 DOI: 10.1007/s00586-022-07445-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the age-specific normative values of whole-body sagittal alignment (WBSA) including global balance parameters in healthy adults and to clarify the correlations among parameters based on the data from three international multicenter. METHODS Three hundred and seventeen healthy subjects (range: 20-84 y.o., mean: 43.8 ± 14.7 y.o.) were included and underwent whole-body biplanar X-ray imaging system. Spinopelvic parameters and knee flexion (KF), the center of acoustic meatus (CAM)-hip axis (HA), and C2 dentiform apophyse (OD)-HA, the cranial center (Cr)-HA were evaluated radiologically. Sub-analysis for correlation analysis between age and parameters and among parameters was performed to investigate age-specific change and compensatory mechanisms. RESULTS For age-related change, C2-7 angle (r = .326 for male/.355 for female), KF (r = .427/.429), and SVA (r = .234/.507) increased with age in both male and female group. For global parameters related to the center of the gravity, correlations with age were not significant (r = .120/.161 for OD-HA, r = .163/.275 for Cr-HA, r = .149/.262 for CAM-HA). Knee flexion (KF) has correlation with global parameters (i.e., SVA, OD-HA, Cr-HA, CAM-HA) and does not have correlations with local spinopelvic alignment. CONCLUSION While several local alignment changes with age were found, changes in global parameters related to the center of gravity were kept relatively mild by the chain of compensation mechanisms including the lower limbs. We showed the normative values for a comprehensive WBSA in standing posture from large international healthy subjects' database.
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Affiliation(s)
- Jun Ouchida
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | | | | | - Shiro Imagama
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
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Hasegawa K, Hatsushikano S, Watanabe K, Ohashi M, Dubousset J. Scoliosis Research Society-22r score is affected by standing whole body sagittal alignment, age, and sex, but not by standing balance or skeletal muscle mass in healthy volunteers. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3000-3012. [PMID: 36053322 DOI: 10.1007/s00586-022-07360-2] [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: 11/01/2021] [Revised: 08/01/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Aging and spinal disease impair standing whole body sagittal alignment (WBS alignment), which leads to stooping. When WBS alignment deteriorates, compensatory mechanisms are activated to maintain standing posture. Increase of the compensation impairs health-related quality of life (HRQOL). The purpose of this research was to determine whether postural factors, age, and sex affect HRQOL. METHODS This cross-sectional study evaluated the influence of WBS alignment, standing body sway (balance), skeletal muscle mass (SMM), aging, and sex on HRQOL in healthy volunteers (n = 150; mean age 40.9 years [20-76], 96 women). Age, sex, weight, height, and body mass index (BMI) were obtained. HRQOL was assessed with Scoliosis Research Society-22 (SRS-22r). WBS alignment and balance were measured by EOS imaging with simultaneous force plate measurement. SMM was measured using a medical body composition analyzer. Based on the bivariate analysis between the SRS-22r subtotal and all parameters, selected ten parameters were used for multivariate logistic regression analysis to identify affecting factors to SRS-22r. RESULTS Men had significantly higher weight, height, BMI, and SRS-22r score in all domains. The L4-S1 lumbar lordosis angle was greater in men, and pelvic tilt and knee hyperextension were greater in women. Women had a more stable standing posture, whereas men had significantly higher SMM values. Multivariate logistic regression analysis revealed that age, sex, and TPA were identified as significant factors affecting SRS-22r. CONCLUSIONS In healthy volunteers, SRS-22r is affected by aging, sex (woman had a lower score), and sagittal malalignment. Neither Standing balance nor SMM, however, affect SRS-22r.4.
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Affiliation(s)
- Kazuhiro Hasegawa
- Niigata Spine Surgery Center, 2-5-22 Nishi-machi, Niigata City, 950-0165, Japan.
| | - Shun Hatsushikano
- Niigata Spine Surgery Center, 2-5-22 Nishi-machi, Niigata City, 950-0165, Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Masayuki Ohashi
- Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Jean Dubousset
- Académie Nationale de Médecine, 16 Rue Bonaparte, 75006, Paris, France
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11
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Kim HJ, Yang JH, Chang DG, Lenke LG, Suh SW, Nam Y, Park SC, Suk SI. Adult Spinal Deformity: A Comprehensive Review of Current Advances and Future Directions. Asian Spine J 2022; 16:776-788. [PMID: 36274246 PMCID: PMC9633249 DOI: 10.31616/asj.2022.0376] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Owing to rapidly changing global demographics, adult spinal deformity (ASD) now accounts for a significant proportion of the Global Burden of Disease. Sagittal imbalance caused by age-related degenerative changes leads to back pain, neurological deficits, and deformity, which negatively affect the health-related quality of life (HRQoL) of patients. Along with the recognized regional, global, and sagittal spinopelvic parameters, poor paraspinal muscle quality has recently been acknowledged as a key determinant of the clinical outcomes of ASD. Although the Scoliosis Research Society-Schwab ASD classification system incorporates the radiological factors related to HRQoL, it cannot accurately predict the mechanical complications. With the rapid advances in surgical techniques, many surgical options for ASD have been developed, ranging from minimally invasive surgery to osteotomies. Therefore, structured patient-specific management is important in surgical decision-making, selecting the proper surgical technique, and to prevent serious complications in patients with ASD. Moreover, utilizing the latest technologies such as robotic-assisted surgery and machine learning, should help in minimizing the surgical risks and complications in the future.
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Affiliation(s)
- Hong Jin Kim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jae Hyuk Yang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
- Corresponding author: Dong-Gune Chang Spine Center and Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: +82-2-950-1284, Fax: +82-2-950-1287, E-mail:
| | - Lawrence G. Lenke
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, Columbia University, New York, NY, USA
| | - Seung Woo Suh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yunjin Nam
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Cheol Park
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Se-Il Suk
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
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12
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Hasegawa K, Amabile C, Nesme M, Dubousset J. Gravity center estimation for evaluation of standing whole body compensation using virtual barycentremetry based on biplanar slot-scanning stereoradiography - validation by simultaneous force plate measurement. BMC Musculoskelet Disord 2022; 23:22. [PMID: 34980054 PMCID: PMC8725375 DOI: 10.1186/s12891-021-04948-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/08/2021] [Indexed: 02/08/2023] Open
Abstract
Background Whole body standing alignment (WBSA) in terms of biomechanics can be evaluated accurately only by referring the gravity line (GL) which lies on the gravity center (GC). Here, we introduce a method for estimating GL and simultaneous WBSA measurement using the EOS® imaging system and report on the reproducibility and reliability of the method. Methods A 3-dimensional (3D) avatar to estimate GC was created following three steps: 3D reconstruction of the bone based on EOS images; deformation into a generic morphotype (MakeHuman statistical model) before density integration with 3D rasterization of the full body into 1-mm3 voxels (the content of each voxel is considered homogeneous); computation of the density of all the voxels provides the center of mass, which can be projected onto the floor as the GC of the full body, providing the GL in relation to the WBSA. The repeatability, reproducibility, and accuracy of the estimated GC and body weight of the avatar were compared with clinical estimation using a force plate in healthy volunteers and patients with degenerative and deformative diseases. Results Statistical analyses of the data revealed that the repeatability and reproducibility of the estimation was high with intra-rater and inter-rater intraclass correlation coefficient. ≥0.999. The coordinate values of the GC and body weight estimation did not differ significantly between the avatar and force plate measurements, demonstrating the high accuracy of the method. Conclusion This new method of estimating GC and WBSA is reliable and accurate. Application of this method could allow clinicians to quickly and qualitatively evaluate WBSA with GL with various spinal malalignment pathologies.
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Affiliation(s)
- Kazuhiro Hasegawa
- Niigata Spine Surgery Center, 2-5-22 Nishi-machi, Niigata City, 950-0165, Japan.
| | | | - Matthieu Nesme
- AnatoScope, Montpellier Headquarter, Cap-Omega Rond-Point Benjamin ranklin, 34960, Montpellier, France
| | - Jean Dubousset
- Académie Nationale de Médecine, 16 Rue Bonaparte, 75006, Paris, France
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Hasegawa K, Dubousset JF. <i>Cone of Economy with the Chain of Balance</i> -Historical Perspective and Proof of Concept. Spine Surg Relat Res 2022; 6:337-349. [PMID: 36051675 PMCID: PMC9381078 DOI: 10.22603/ssrr.2022-0038] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/15/2022] [Indexed: 11/05/2022] Open
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Optoelectronic Study of Gait Kinematics in Sagittal Spinopelvic Imbalance. World Neurosurg 2021; 158:e956-e963. [PMID: 34863937 DOI: 10.1016/j.wneu.2021.11.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Degenerative processes induce loss of lumbar lordosis and anterior sagittal imbalance (ASI). Optoelectronic study provides kinematic analysis of movement and can also detect ASI. The aim of the present study was to assess gait kinematic modifications induced by ASI. METHODS Thirty-five healthy male volunteers were subjected to reversible ASI induced by wearing a kyphotic thermoformed thoracolumbar corset. The deformation was assessed by C7 tilt on EOS (EOS Imaging, Paris, France) full-spine views. Ten optoelectronic gait recordings were made with corset and 10 without. Gait kinematic parameters (stride length, walking speed, rhythm), gait balance parameters (center of mass braking index, stride width, double support time) and spinal sagittal balance parameters (C7T10S1, C7´S1' and spinal angles) were averaged. Adjusted analysis distinguished direct ASI impact from locomotor factors. RESULTS The corset-induced ASI produced +15° change in C7 tilt (P < 0.0001), -7.4° in C7T10S1 (P < 0.0001), +66.2 mm in C7´S1' (P < 0.0001), and +13.1° in spinal angle (P < 0.0001). Radiographic and optoelectronic data correlated significantly. Stride length (P < 0.0001) and rhythm (P = 0.0003) were significantly reduced, contributing to a reduction in walking speed (P < 0.0001), and strongly influencing double support time (β = -0.38; 95% confidence interval [CI]: -0.69; -0.06). Center of mass braking index was significantly reduced (P < 0.0001) and significantly influenced by ASI (β = -0.51; 95% CI: -0.78; -0.28). Stride width was significantly increased by ASI (P < 0.0001), independently of rhythm and stride length. CONCLUSIONS ASI induced by a kyphotic corset was detectable on the optoelectronic system, leading to significant changes in gait kinematics. Locomotor parameters were significantly reduced. Balance parameters were significantly and directly altered by ASI.
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Song J, Pan F, Zhu W, Kong C, Lu S. Characteristics of the sagittal spinal balance in the asymptomatic elderly Chinese population. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:233-240. [PMID: 34463863 DOI: 10.1007/s00586-021-06979-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/05/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the normal values of the sagittal spinal parameters and analyze the distribution of the global spinal profiles in a Chinese population with age over 75. METHODS Two hundred and twelve sets of the whole spine lateral radiographs were obtained from a database of an asymptomatic elderly population. Global and regional spinal parameters were measured. Sagittal profiles were determined according to the Roussouly classification compared with previous studies involving different populations. RESULTS A total of 102 elderly subjects (≥ 75 years) were enrolled with an average age of 79.24 ± 3.53 years. The mean values of the spinopelvic parameters were 42.89 ± 11.64° for TK, 13.84 ± 10.78° for TLK, 44.48 ± 12.88° for LL, 44.76 ± 9.84° for PI, 17.19 ± 8.08° for PT, 28.35 ± 7.94° for SS, 3.47 ± 3.56 cm for SVA, 14.75 ± 7.85° for TPA, -0.27 ± 11.95° for PI-LL, respectively. Subjects ≥ 75 years were found to have significantly smaller LL and SS, but greater TLK, PT, SVA, TPA, and PI-LL than those 60-74 years (p < 0.05). Significant age- and sex-dependent differences were found in the Roussouly classification's distribution between the two subgroups. CONCLUSIONS The normal values of the sagittal parameters were presented in the elderly Chinese asymptomatic population (≥ 75 years). Ethnic, age, and sex displayed significant effects on the behaviors of the sagittal spinal balance and profiles. These results could be served as physiological references for the planning of surgical strategies in elderly Chinese patients over 75 years.
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Affiliation(s)
- Jipeng Song
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fumin Pan
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weiguo Zhu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Glennie RA, Bailey CS, Abraham E, Manson N, Casha S, Thomas K, Paquet J, McIntosh G, Hall H, Fisher CG, Rampersaud YR. Variation in surgical treatment of degenerative spondylolisthesis in Canada: surgeon assessment of stability and impact on treatment. 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; 30:3709-3719. [PMID: 34327542 DOI: 10.1007/s00586-021-06928-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Controversy exists regarding the optimal surgical treatment of degenerative lumbar spondylolisthesis (DS). Not all DS patients are the same, and the degree to which inherent stability may dictate treatment is unknown. The purpose of this study was to determine the variability in surgical approach relative to surgeon classified stability. The secondary objective was to compare patient-reported outcomes (PROs) across different surgical techniques and grades of stability. METHODS Patients prospectively enrolled from eleven tertiary care institutions and followed from 2015 to 2019. The surgical technique was at the surgeon's discretion. Surgeons were asked to grade the degree of instability based on the degenerative spondylolisthesis instability classification system (DSIC). DSIC categorizes three different types (I-stable, II-potentially unstable, and III-unstable). One-year changes in PROs were compared between each group. Multivariable regression was used to identify any characteristics that explained variability in treatment. RESULTS There were 323 patients enrolled in this study. Surgeons' stability classification versus procedure [decompression alone (D)/decompression and posterolateral fusion (D-PL)/and decompression with posterior/transforaminal lumbar interbody fusion (D-PLIF/TLIF)] were as follows: type I (n = 91): D-41%/D-PL-13%/D-PLIF/TLIF-46%; type II (n = 175): D-23%/D-PL-17%/D-PLIF/TLIF-60%; and type III (n = 57):(D-0%/D-PL-14%/D-PLIF/TLIF-86%). Type I patients undergoing D-PL had some improvements in EQ-5D and NRS versus those undergoing D-PLIF/TLIF but otherwise there were no other significant differences between groups. Regression analysis demonstrated advanced age (OR = 1.06, CI 1.02-10.12) and type I (OR = 2.61, CI 1.17-5.81) were associated with receiving decompression surgery alone. CONCLUSIONS There exists considerable variation in surgical management of DS in Canada. Given similar PROs in two of the three groups, there is potential to tailor surgical intervention and improve resource utilization.
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Affiliation(s)
- R Andrew Glennie
- Department of Surgery, Dalhousie University, Halifax, NS, Canada.
| | | | | | - Neil Manson
- Canada East Spine Center, Saint John, NB, Canada
| | - Steve Casha
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Kenneth Thomas
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Jerome Paquet
- CHU Laval: Centre Hospitalier de l'Universite Laval, Quebec, Canada
| | - Greg McIntosh
- The University of British Columbia, Vancouver, BC, Canada
| | - Hamiton Hall
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
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Sugiura K, Morimoto M, Higashino K, Takeuchi M, Manabe A, Takao S, Maeda T, Sairyo K. Transitional vertebrae and numerical variants of the spine : prevalence and relationship to low back pain or degenerative spondylolisthesis. Bone Joint J 2021; 103-B:1301-1308. [PMID: 34192932 DOI: 10.1302/0301-620x.103b7.bjj-2020-1760.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Although lumbosacral transitional vertebrae (LSTV) are well-documented, few large-scale studies have investigated thoracolumbar transitional vertebrae (TLTV) and spinal numerical variants. This study sought to establish the prevalence of numerical variants and to evaluate their relationship with clinical problems. METHODS A total of 1,179 patients who had undergone thoracic, abdominal, and pelvic CT scanning were divided into groups according to the number of thoracic and lumbar vertebrae, and the presence or absence of TLTV or LSTV. The prevalence of spinal anomalies was noted. The relationship of spinal anomalies to clinical symptoms (low back pain, Japanese Orthopaedic Association score, Roland-Morris Disability Questionnaire) and degenerative spondylolisthesis (DS) was also investigated. RESULTS Normal vertebral morphology (12 thoracic and five lumbar vertebrae without TLTV and LSTV) was present in 531 male (76.7%) and 369 female patients (75.8%). Thoracolumbar transitional vertebrae were present in 15.8% of males and 16.0% of females. LSTV were present in 7.1% of males and 9.0% of females. The prevalence of the anomaly of 16 presacral mobile vertebrae (total number of thoracolumbar vertebrae and TLTV) without LSTV was 1.0% in males and 4.1% in females, and that of the anomaly of 18 vertebrae without LSTV was 5.3% in males and 1.2% in females. The prevalence of DS was significantly higher in females with a total of 16 vertebrae than in those with normal morphology. There was no significant correlation between a spinal anomaly and clinical symptoms. CONCLUSION Overall, 24% of subjects had anomalies in the thoracolumbar region: the type of anomaly differed between males and females, which could have significant implications for spinal surgery. A decreased number of vertebrae was associated with DS: numerical variants may potentially be a clinical problem. Cite this article: Bone Joint J 2021;103-B(7):1301-1308.
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Affiliation(s)
- Kosuke Sugiura
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, Tokushima, Japan
| | - Masatoshi Morimoto
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, Tokushima, Japan
| | - Kosaku Higashino
- Department of Orthopedics, Shikoku Medical Center for Children and Adults, Tokushima, Japan
| | - Makoto Takeuchi
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, Tokushima, Japan
| | - Akihiro Manabe
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, Tokushima, Japan
| | - Shoichiro Takao
- Department of Diagnostic Radiology, Tokushima University Graduate School, Institute of Health Sciences, Tokushima, Japan
| | - Toru Maeda
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, Tokushima, Japan
| | - Koichi Sairyo
- Department of Diagnostic Orthopedics, Tokushima University Graduate School, Institute of Health Sciences, Tokushima, Japan
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