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Lafage R, Mota F, Khalifé M, Protopsaltis T, Passias PG, Kim HJ, Line B, Elysée J, Mundis G, Shaffrey CI, Ames CP, Klineberg EO, Gupta MC, Burton DC, Lenke LG, Bess S, Smith JS, Schwab FJ, Lafage V. Mechanisms of lumbar spine "flattening" in adult spinal deformity: defining changes in shape that occur relative to a normative 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 2024:10.1007/s00586-024-08422-3. [PMID: 39068280 DOI: 10.1007/s00586-024-08422-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/08/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Previous work comparing ASD to a normative population demonstrated that a large proportion of lumbar lordosis is lost proximally (L1-L4). The current study expands on these findings by collectively investigating regional angles and spinal contours. METHODS 119 asymptomatic volunteers with full-body free-standing radiographs were used to identify age-and-PI models of each Vertebra Pelvic Angle (VPA) from L5 to T10. These formulas were then applied to a cohort of primary surgical ASD patients without coronal malalignment. Loss of lumbar lordosis (LL) was defined as the offset between age-and-PI normative value and pre-operative alignment. Spine shapes defined by VPAs were compared and analyzed using paired t-tests. RESULTS 362 ASD patients were identified (age = 64.4 ± 13, 57.1% females). Compared to their age-and-PI normative values, patients demonstrated a significant loss in LL of 17 ± 19° in the following distribution: 14.1% had "No loss" (mean = 0.1 ± 2.3), 22.9% with 10°-loss (mean = 9.9 ± 2.9), 22.1% with 20°-loss (mean = 20.0 ± 2.8), and 29.3% with 30°-loss (mean = 33.8 ± 6.0). "No loss" patients' spine was slightly posterior to the normative shape from L4 to T10 (VPA difference of 2°), while superimposed on the normative one from S1 to L2 and became anterior at L1 in the "10°-loss" group. As LL loss increased, ASD and normative shapes offset extended caudally to L3 for the "20°-loss" group and L4 for the "30°-loss" group. CONCLUSION As LL loss increases, the difference between ASD and normative shapes first occurs proximally and then progresses incrementally caudally. Understanding spinal contour and LL loss location may be key to achieving sustainable correction by identifying optimal and personalized postoperative shapes.
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Affiliation(s)
- Renaud Lafage
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Frank Mota
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Marc Khalifé
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA.
- Université Paris-Cité, Paris, France.
- Department of Orthopedic Surgery, Hôpital Européen Georges Pompidou, Paris, France.
| | | | - Peter G Passias
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
| | - Han-Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Breton Line
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Jonathan Elysée
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Gregory Mundis
- Division of Orthopedic Surgery, Scripps Clinic, La Jolla, San Diego, CA, USA
| | | | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Douglas C Burton
- Department of Orthopedic Surgery, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, The Och Spine Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Frank J Schwab
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
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Yuan S, Chen R, Liu X, Wang T, Wang A, Fan N, Du P, Xi Y, Gu Z, Zhang Y, Zang L. Artificial intelligence automatic measurement technology of lumbosacral radiographic parameters. Front Bioeng Biotechnol 2024; 12:1404058. [PMID: 39011157 PMCID: PMC11246908 DOI: 10.3389/fbioe.2024.1404058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/17/2024] [Indexed: 07/17/2024] Open
Abstract
Background Currently, manual measurement of lumbosacral radiological parameters is time-consuming and laborious, and inevitably produces considerable variability. This study aimed to develop and evaluate a deep learning-based model for automatically measuring lumbosacral radiographic parameters on lateral lumbar radiographs. Methods We retrospectively collected 1,240 lateral lumbar radiographs to train the model. The included images were randomly divided into training, validation, and test sets in a ratio of approximately 8:1:1 for model training, fine-tuning, and performance evaluation, respectively. The parameters measured in this study were lumbar lordosis (LL), sacral horizontal angle (SHA), intervertebral space angle (ISA) at L4-L5 and L5-S1 segments, and the percentage of lumbar spondylolisthesis (PLS) at L4-L5 and L5-S1 segments. The model identified key points using image segmentation results and calculated measurements. The average results of key points annotated by the three spine surgeons were used as the reference standard. The model's performance was evaluated using the percentage of correct key points (PCK), intra-class correlation coefficient (ICC), Pearson correlation coefficient (r), mean absolute error (MAE), root mean square error (RMSE), and box plots. Results The model's mean differences from the reference standard for LL, SHA, ISA (L4-L5), ISA (L5-S1), PLS (L4-L5), and PLS (L5-S1) were 1.69°, 1.36°, 1.55°, 1.90°, 1.60%, and 2.43%, respectively. When compared with the reference standard, the measurements of the model had better correlation and consistency (LL, SHA, and ISA: ICC = 0.91-0.97, r = 0.91-0.96, MAE = 1.89-2.47, RMSE = 2.32-3.12; PLS: ICC = 0.90-0.92, r = 0.90-0.91, MAE = 1.95-2.93, RMSE = 2.52-3.70), and the differences between them were not statistically significant (p > 0.05). Conclusion The model developed in this study could correctly identify key vertebral points on lateral lumbar radiographs and automatically calculate lumbosacral radiographic parameters. The measurement results of the model had good consistency and reliability compared to manual measurements. With additional training and optimization, this technology holds promise for future measurements in clinical practice and analysis of large datasets.
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Affiliation(s)
- Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ruiyuan Chen
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xingyu Liu
- School of Life Sciences, Tsinghua University, Beijing, China
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yu Xi
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhao Gu
- Longwood Valley Medical Technology Co., Ltd., Beijing, China
| | - Yiling Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
- Longwood Valley Medical Technology Co., Ltd., Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Athanasakis P, Nikodelis T, Panoutsakopoulos V, Mylonas V, Loizidis T, Koutlianos NA, Kollias IA. Acute effect of dry needling on trunk kinematics and balance of patients with non-specific low back pain. J Bodyw Mov Ther 2024; 39:24-31. [PMID: 38876633 DOI: 10.1016/j.jbmt.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/18/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Limited knowledge exists about the effectiveness of dry needling (DN) concerning the torso kinematics in patients with non-specific low back pain (NS-LBP). Acute effects of DN in NS-LBP patients from a functional perspective were investigated. METHODS Sixteen NS-LBP patients and 11 healthy individuals (HG) were examined. NS-LBP patients received a single session of DN at the lumbar region. Baseline and immediate post-treatment measurements during flexion-extension and lateral bending of the trunk were conducted for the NS-LBP patients. HG were measured only at baseline to be used as a reference of NS-LBP patients' initial condition. Algometry was applied in NS-LBP patients. Centre of pressure, range of motion of the trunk and its' derivatives were obtained. FINDINGS HG performed significantly faster, smoother and with greater mobility in the performed tasks compared to the pre intervention measurements of the NS-LBP patients. For the NS-LBP patients, significant greater angular velocity in frontal plane and significant lower jerk in the sagittal plane were demonstrated post intervention. DN alleviated pain tolerance significantly at the L5 level. Regarding the effectiveness of the DN upon spine kinematics, their derivatives were more sensitive. INTERPRETATION It appeared that the pathological type of torso movement was acutely affected by DN. NS-LBP patients showcased smoother movement immediately after the intervention and better control as imprinted in the higher derivative of motion although range of motion did not improve. This quantitative variable may not be subjected to acute effects of DN but rather need additional time and training to be improved.
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Affiliation(s)
- Petros Athanasakis
- Biomechanics Laboratory, School of Physical Education and Sport Science at Thessaloniki, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Thomas Nikodelis
- Biomechanics Laboratory, School of Physical Education and Sport Science at Thessaloniki, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Vassilios Panoutsakopoulos
- Biomechanics Laboratory, School of Physical Education and Sport Science at Thessaloniki, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Vasileios Mylonas
- Biomechanics Laboratory, School of Physical Education and Sport Science at Thessaloniki, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Theodoros Loizidis
- Department of Physical and Rehabilitation Medicine, Saint Loukes Hospital, 55236, Panorama, Thessaloniki, Greece.
| | - Nikolaos A Koutlianos
- Sports Medicine Laboratory, School of Physical Education and Sport Science at Thessaloniki, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Iraklis A Kollias
- Biomechanics Laboratory, School of Physical Education and Sport Science at Thessaloniki, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
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Sato K, Iwabuchi M, Endo T, Miura T, Ito T, Shirado O. Association between trunk extensor strength and gait-induced back pain in the elderly with adult spinal deformity: a cross-sectional study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2770-2776. [PMID: 38844588 DOI: 10.1007/s00586-024-08348-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: 08/20/2023] [Revised: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE The purpose of the present study was to investigate the association between quantitatively assessed trunk extensor strength and gait-induced back pain (GIBP) in patients with adult spinal deformity (ASD). METHODS Ninety-five patients with ASD aged ≥ 50 years who were admitted to our hospital between April 2018 and March 2023 were included in the study. GIBP was evaluated through a 6-minute walking test (6MWT), with GIBP being defined as the occurrence of back pain during the evaluation and inability to complete the test. The patients were divided into three groups: difficulty completing the 6MWT (Group 1), ability to complete the 6MWT with breaks (Group 2), and ability to complete the 6MWT without taking a break (Group 3). The main independent variable was trunk extensor strength, which was measured using a hand-held dynamometer. Ordered logistic regression analysis was conducted to assess the association between GIBP and trunk extensor strength while adjusting for basic characteristics and radiographic parameters as covariates. RESULTS The numbers of patients with ASD included in each group were; 27 in Group 1 (28.4%), 31 in Group 2 (32.6%), and 37 in Group 3 (39.0%). An ordered logistic regression analysis adjusted for basic characteristics and radiographic parameters, trunk extensor strength was significantly associated with GIBP (odds ratios, 1.128; 95% confidence intervals, 1.025-1.242). CONCLUSIONS The results of the present study strongly indicate that trunk extensor strength is a valuable factor associated with GIBP in patients with ASD.
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Affiliation(s)
- Keita Sato
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashi, Aizuwakamatsu, 969-3492, Fukushima, Japan.
| | - Masumi Iwabuchi
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashi, Aizuwakamatsu, 969-3492, Fukushima, Japan
| | - Tatsuya Endo
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashi, Aizuwakamatsu, 969-3492, Fukushima, Japan
| | - Takuya Miura
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashi, Aizuwakamatsu, 969-3492, Fukushima, Japan
| | - Toshikazu Ito
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashi, Aizuwakamatsu, 969-3492, Fukushima, Japan
- Hokkaido Chitose College of Rehabilitation, Chitose City, Hokkaido, Japan
| | - Osamu Shirado
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashi, Aizuwakamatsu, 969-3492, Fukushima, Japan
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Chen JH, Chen PJ, Kantha P, Tsai YC, Lai DM, Hsu WL. Examining the influence of body fat distribution on standing balance and functional performance in overweight female patients with degenerative lumbar disease. Front Bioeng Biotechnol 2024; 12:1375627. [PMID: 38974656 PMCID: PMC11224472 DOI: 10.3389/fbioe.2024.1375627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/23/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction: Degenerative lumbar disease (DLD) is a prevalent disorder that predominantly affects the elderly population, especially female. Extensive research has demonstrated that overweight individuals (categorized by body fat distribution) have a higher susceptibility to developing DLD and an increased risk of falling. However, there is limited research available on the standing balance and functional performance of overweight females with DLD. Aims: To determine the impact of body fat distribution on standing balance and functional performance in overweight females with DLD. Methods: This cross-sectional study evaluated thirty females with DLD were categorized into three types of body fat distribution based on body mass index (BMI) and waist-hip ratio, specifically as android-type, gynoid-type, and normal weight groups. In addition, a control group of ten age-matched females with normal weight was recruited. The Visual Analogue Scale, Roland Morris Disability Questionnaire, Cobb angle (Determined using x-ray), and body composition (Determined using the InBody S10), were conducted only on the DLD groups. All participants were assessed standing balance in the anteroposterior and mediolateral directions. The functional assessments included timed-up-and-go and 5-times-sit-to-stand tests. Results: There were 10 people in each group. Android-type (Age = 65.00 ± 6.34 years; BMI = 26.87 ± 2.05 kg/m2), Gynoid-type (Age = 65.60 ± 4.99 years; BMI = 26.60 ± 1.75 kg/m2), Normal weight (Age = 65.70 ± 5.92 years; BMI = 22.35 ± 1.26 kg/m2), and Control (Age = 65.00 ± 5.23 years; BMI = 22.60 ± 1.12 kg/m2). The android-type group had higher body fat, visceral fat, and lower muscle mass (p < 0.05), along with an increased Cobb angle (p < 0.05). They showed greater ellipse area, total excursion, and mean distance in the anteroposterior direction (p < 0.05). During the functional performance assessments, the android-type group had longer durations in both the 5-times-sit-to-stand and timed-up-and-go tasks (p < 0.05). Conclusion: Our study found that android-type overweight individuals showed postural instability, reduced functional performance, and insufficient lower limb muscle strength and mass. These findings might help physical therapists in planning interventions, as they imply that patients with DLD may require specific types of standing balance training and lower extremities muscle-strengthening based on their body fat distribution. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT05375201.
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Affiliation(s)
- Jung-Hsuan Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Jung Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Phunsuk Kantha
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Yi-Ching Tsai
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Dar-Ming Lai
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Physical Therapy Centre, National Taiwan University Hospital, Taipei, Taiwan
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Duvvuri P, Lafage R, Bannwarth M, Passias P, Bess S, Smith JS, Klineberg E, Kim HJ, Shaffrey C, Burton D, Gupta M, Protopsaltis T, Ames C, Schwab F, Lafage V. The Shape of the Fused Spine is Associated With Acute Proximal Junctional Kyphosis in Adult Spinal Deformity: An Assessment Based on Vertebral Pelvic Angles. Global Spine J 2024; 14:1563-1572. [PMID: 36625677 DOI: 10.1177/21925682221150770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
STUDY DESIGN Retrospective review of prospective database. OBJECTIVES Vertebral pelvic angles (VPAs) account for complexity in spine shape by assessing the relative position of each vertebra with regard to the pelvis. This study uses VPAs to investigate the shape of the fused spine after T10-pelvis fusion, in patients with adult spinal deformity (ASD), and then explores its association with proximal junctional kyphosis (PJK). METHODS Included patients had radiographic evidence of ASD and underwent T10-pelvis realignment. VPAs were used to construct a virtual shape of the post-operative spine. VPA-predicted and actual shapes were then compared between patients with and without PJK. Logistic regression was used to identify components of the VPA-based model that were independent predictors of PJK occurrence and post-operative shape. RESULTS 287 patients were included. VPA-predicted shape was representative of the true post-operative contour, with a mean point-to-point error of 1.6-2.9% of the T10-S1 spine length. At 6-weeks follow-up, 102 patients (35.5%) developed PJK. Comparison of the true post-operative shapes demonstrated that PJK patients had more posteriorly translated vertebrae from L3 to T7 (P < .001). Logistic regression demonstrated that L3PA (P = .047) and T11PA (P < .001) were the best independent predictors of PJK and were, in conjunction with pelvic incidence, sufficient to reproduce the actual spinal contour (error <3%). CONCLUSIONS VPAs are reliable in reproducing the true, post-operative spine shape in patients undergoing T10-pelvis fusion for ASD. Because VPAs are independent of patient position, L3PA, T11PA, and PI measurements can be used for both pre- and intra-operative planning to ensure optimal alignment.
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Affiliation(s)
- Priya Duvvuri
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Peter Passias
- Departments of Orthopaedic Surgery, NYU Langone, New York, NY, USA
| | - Shay Bess
- Denver International Spine Center, Presbyterian St Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Justin S Smith
- Department of Neurosurgery, University of VirginiaMedical Center, Charlottesville, VA, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Douglas Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University, St Louis, MO, USA
| | | | - Christopher Ames
- Department of Neurosurgery, University of California School of Medicine, San Francisco, CA, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
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Welling A, Patil A, Gunjal P, Naik P, Hubli R. Effectiveness of Three-Dimensional Myofascial Release on Lumbar Lordosis in Individuals with Asymptomatic Hyperlordosis: A Placebo Randomized Controlled Trial. Int J Ther Massage Bodywork 2024; 17:20-31. [PMID: 38873188 PMCID: PMC11131939 DOI: 10.3822/ijtmb.v17i2.957] [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] [Indexed: 06/15/2024] Open
Abstract
Background Lumbar hyperlordosis is the most prevalent musculoskeletal postural deformity. Maintenance of normal limits of lumbar lordosis is necessary for obtaining an ideal posture. Literature suggests that poor posture results in fascial restriction in which the fascia reorganizes in response to tension. Gross myofascial release (MFR) combined with posterior pelvic tilting exercises proved to be beneficial in improving the lumbar range of motion. Three-dimensional (3D) MFR is a novel approach toward reducing fascial restrictions. However, the literature determining the effects of 3D MFR is still emerging. Aim To determine the effect of 3D MFR on a lumbar lordosis angle and lumbar range of motion, in individuals with asymptomatic hyperlordosis. Method Participants (n = 30) with hyperlordosis were randomly assigned to either the experimental group receiving 3D MFR (n = 15) or the control group (n = 15) that received sham 3D MFR for six sessions (3 alternate days for 2 weeks). The outcomes were assessed at day 1 and day 6. Lumbar range of motion was assessed using modified-modified Schober's test and the lumbar lordosis angle was measured using x-ray and flexicurve. Results There was significant decrease (p = 0.0001) in the lumbar lordosis angle, increase in the lumbar flexion (p = 0.0001), and decrease in the extension (p = 0.0011) range of motion in the experimental group when compared to the control group. Conclusion Lumbar lordosis decreased and the lumbar range of motion increased in the experimental group only with 3D MFR and not with sham 3D MFR. Hence, 3D MFR is an effective method in the correction of lumbar hyperlordosis and improving the lumbar range.Clinical Trial Registry of India (CTRI) trial number CTRI/2023/03/050340.
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Affiliation(s)
- Aarti Welling
- Department of Orthopaedic Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi 590010, Karnataka, India
| | - Ashwin Patil
- Department of Radiology, J. N. Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Pragati Gunjal
- Department of Orthopaedic Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi 590010, Karnataka, India
| | - Priyanka Naik
- Department of Orthopaedic Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi 590010, Karnataka, India
| | - Rani Hubli
- Department of Orthopaedic Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi 590010, Karnataka, India
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Akgun MY, Ucar EA, Gedik CC, Gunerbuyuk C, Hekimoglu M, Cerezci O, Oktenoglu T, Sasani M, Ates O, Ozer AF. Use of Dynamic Spinal Instruments (Dynesys) in Adult Spinal Deformities According to Silva-Lenke and Berjano-Lamartina Classifications. Diagnostics (Basel) 2024; 14:549. [PMID: 38473021 DOI: 10.3390/diagnostics14050549] [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: 12/13/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Adult spinal deformities (ASD) present complex challenges in spine surgery. The diverse nature of these deformities requires a comprehensive understanding of their classification and treatment options. Traditional approaches, such as fusion and rigid stabilization are associated with complications, including screw loosening, breakage, proximal junctional kyphosis (PJK), and pseudoarthrosis. Dynamic stabilization techniques have emerged as promising alternatives, to reduce these complications and preserve spinal motion. OBJECTIVE This study investigated the effectiveness of dynamic stabilization using the Dynesys system in the surgical treatment of adult degenerative spinal deformities, with a particular emphasis on their classification. METHODS ASDs were classified according to the Berjano-Lamartina (BL) and Silva-Lenke (SL) classifications. We analyzed the efficacy of the Dynesys system in enhancing sagittal balance, radiological parameters, and clinical outcomes in this context. RESULTS Dynamic stabilization of patients with ASDs using the Dynesys system significantly improved the visual analog scale and Oswestry Disability Index scores and decreased the complication rates. Patients with BL types 2, 3, and 4 experienced a significant improvement in sagittal balance followed by sagittal vertical axis measurements (p = 0.045, p = 0.015, and p < 0.0001, respectively). CONCLUSION The SL and BL classifications, which were originally developed for rigid spinal stabilization, can be applied in dynamic stabilization. Furthermore, dynamic stabilization using the Dynesys system can be used as an alternative to rigid stabilization in SL levels 2 and 3, and BL types 1, 2, and 3, and in some patients with type 4 ASDs.
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Affiliation(s)
- Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
| | - Ege Anil Ucar
- Medical Faculty, Koc Univesity School of Medicine, 34010 Istanbul, Turkey
| | - Cemil Cihad Gedik
- Department of Orthopaedics and Traumatology, Koc University Hospital, 34010 Istanbul, Turkey
| | - Caner Gunerbuyuk
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
- Department of Orthopaedics and Traumatology, Koc University Hospital, 34010 Istanbul, Turkey
| | - Mehdi Hekimoglu
- Department of Neurosurgery, American Hospital, 34010 Istanbul, Turkey
| | - Onder Cerezci
- Department of Physical Medicine and Rehabilitation, American Hospital, 34010 Istanbul, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
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9
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Suzuki Y, Ohkoshi Y, Kawakami K, Shimizu K, Chida S, Ukishiro K, Onodera T, Iwasaki K, Maeda T, Suzuki S, Kondo E, Iwasaki N. Assessing knee joint biomechanics and trunk posture according to medial osteoarthritis severity. Sci Rep 2023; 13:19186. [PMID: 37932370 PMCID: PMC10628121 DOI: 10.1038/s41598-023-46486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023] Open
Abstract
During progression of knee osteoarthritis (OA), gait biomechanics changes three-dimensionally; however, its characteristics and trunk posture according to OA severity remain unknown. The present study investigated three-dimensional knee joint biomechanics and trunk posture according to knee OA severity. Overall, 75 patients (93 knees) with medial knee OA [Kellgren-Lawrence grade ≥ 2, grade 2: 20 patients with 24 knees (mean 60.0 years old); grade 3: 25 with 28 knees (mean 62.0 years old); grade 4: 30 with 41 knees (mean 67.9 years old)] and 14 healthy controls (23 knees, mean 63.6 years old) underwent gait analysis using an optical motion capture system and point cluster technique. In grade 2 knee OA, the relative contribution of the knee adduction moment (KAM) increased significantly (P < 0.05), and that of the knee flexion moment decreased (P < 0.05) prior to significant progression of varus knee deformity. Grade 3 knee OA showed significant exacerbation of varus knee deformity (P < 0.01) and KAM increase (P < 0.001). The maximum knee extension angle decreased (P < 0.05) and trunk flexion increased during gait in grade 4 knee OA (P < 0.001). Our study clarified the kinematics and kinetics of medial knee OA with trunk flexion according to severity. Kinetic conversion occurred in grade 2 knees prior to progression of varus deformities, knee flexion contractures, and sagittal imbalance during gait in patients with severe knee OA.
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Affiliation(s)
- Yuki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
- Department of Orthopedic Surgery, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan.
| | - Yasumitsu Ohkoshi
- Department of Orthopedic Surgery, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Kensaku Kawakami
- Department of Production Systems Eng., National Institute of Technology, Hakodate College, Tokura-cho 14-1, Hakodate, Hokkaido, 042-8501, Japan
| | - Kenta Shimizu
- Department of Rehabilitation, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Shuya Chida
- Department of Rehabilitation, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Kengo Ukishiro
- Department of Rehabilitation, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tatsunori Maeda
- Department of Orthopedic Surgery, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Sho'ji Suzuki
- Department of Complex and Intelligent Systems, Future University Hakodate, Kamedanakano-cho 116-2, Hakodate, Hokkaido, 041-8655, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Kita 14 jo Nishi 5 chome, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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10
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Muellner M, Haffer H, Chiapparelli E, Dodo Y, Shue J, Tan ET, Zhu J, Pumberger M, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: a potential compensatory mechanism in the lumbar spine. BMC Musculoskelet Disord 2023; 24:846. [PMID: 37891498 PMCID: PMC10604445 DOI: 10.1186/s12891-023-06967-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The function of the paraspinal muscles and especially the psoas muscle in maintaining an upright posture is not fully understood. While usually considered solely as a hip flexor, the psoas muscle and its complex anatomy suggest that the muscle has other functions involved in stabilizing the lumbar spine. The aim of this study is to determine how the psoas muscle and the posterior paraspinal muscles (PPM; erector spinae and multifidus) interact with each other. METHODS A retrospective review including patients undergoing posterior lumbar fusion surgery between 2014 and 2021 at a tertiary care center was conducted. Patients with a preoperative lumbar magnetic resonance imaging (MRI) scan performed within 12 months prior to surgery were considered eligible. Exclusion criteria included previous spinal surgery at any level, lumbar scoliosis with a Cobb Angle > 20° and patients with incompatible MRIs. MRI-based quantitative assessments of the cross-sectional area (CSA), the functional cross-sectional area (fCSA) and the fat area (FAT) at L4 was conducted. The degree of fat infiltration (FI) was further calculated. FI thresholds for FIPPM were defined according to literature and patients were divided into two groups (< or ≥ 50% FIPPM). RESULTS One hundred ninetypatients (57.9% female) with a median age of 64.7 years and median BMI of 28.3 kg/m2 met the inclusion criteria and were analyzed. Patients with a FIPPM ≥ 50% had a significantly lower FI in the psoas muscle in both sexes. Furthermore, a significant inverse correlation was evident between FIPPM and FIPsoas for both sexes. A significant positive correlation between FATPPM and fCSAPsoas was also found for both sexes. No significant differences were found for both sexes in both FIPPM groups. CONCLUSION As the FIPPM increases, the FIPsoas decreases. Increased FI is a surrogate marker for a decrease in muscular strength. Since the psoas and the PPM both segmentally stabilize the lumbar spine, these results may be indicative of a potential compensatory mechanism. Due to the weakened PPM, the psoas may compensate for a loss in strength in order to stabilize the spine segmentally.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA.
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany.
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
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11
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Joiner EF, Mummaneni PV, Shaffrey CI, Chan AK. Posterior-based Osteotomies for Deformity Correction. Neurosurg Clin N Am 2023; 34:555-566. [PMID: 37718102 DOI: 10.1016/j.nec.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Posterior-based osteotomies are crucial to the restoration of lordosis in adult spinal deformity. Posterior-column osteotomies are suited for patients with an unfused anterior column and non-focal sagittal deformity requiring modest correction in lordosis. When performed on multiple levels, posterior-column osteotomy may provide significant harmonious correction in patients who require more extensive correction. Pedicle subtraction osteotomy and vertebral column resection are appropriate for patients with a fused anterior column and more severe deformity, particularly focal and/or multiplanar deformity. The power of pedicle subtraction osteotomy and vertebral column resection to provide greater correction and to address multiplanar deformity comes at the cost of higher complication rates than posterior-column osteotomy.
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Affiliation(s)
- Evan F Joiner
- Department of Neurological Surgery, Columbia University-NewYork Presbyterian Hospital, 710 West 168th Street, 4th Floor, New York, NY 10032, USA. https://twitter.com/efjoiner
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Avenue M779, San Francisco, CA 94143, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Duke University, 40 Duke Medicine Circle Clinic 1B/1C, Durham, NC 27710, USA; Department of Orthopaedic Surgery, Duke University, 40 Duke Medicine Circle Clinic 1B/1C, Durham, NC 27710, USA
| | - Andrew K Chan
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Och Spine Hospital, 5141 Broadway, 3FW, New York, NY, USA.
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12
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Cho M, Han JS, Kang S, Ahn CH, Kim DH, Kim CH, Kim KT, Kim AR, Hwang JM. Biomechanical Effects of Different Sitting Postures and Physiologic Movements on the Lumbar Spine: A Finite Element Study. Bioengineering (Basel) 2023; 10:1051. [PMID: 37760153 PMCID: PMC10525568 DOI: 10.3390/bioengineering10091051] [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: 07/28/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
This study used the finite element method(FEM) to investigate how pressure on the lumbar spine changes during dynamic movements in different postures: standing, erect sitting on a chair, slumped sitting on a chair, and sitting on the floor. Three load modes (flexion, lateral bending, and axial rotation) were applied to the FEM, simulating movements of the lumbar spine. Results showed no significant difference in pressure distribution on the annulus fiber and nucleus pulposus, representing intradiscal pressure, as well as on the cortical bone during movements between standing and erect sitting postures. However, both slumped sitting on a chair and sitting on the floor postures significantly increased pressure on the nucleus pulposus, annulus fibrosus, and cortical bone in all three movements when compared to standing or erect sitting on a chair. Notably, sitting on the floor resulted in even higher pressure on the nucleus pulposus and annulus fibers compared to slumped sitting on a chair. The decreased lumbar lordosis while sitting on the floor led to the highest increase in pressure on the annulus fiber and nucleus pulposus in the lumbar spine. In conclusion, maintaining an erect sitting position with increased lumbar lordosis during seated activities can effectively reduce intradiscal pressure and cortical bone stress associated with degenerative disc diseases and spinal deformities.
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Affiliation(s)
- Mingoo Cho
- Precision Mechanical Process and Control R&D Group, Korea Institute of Industrial Technology, Jinju-si 52845, Republic of Korea; (M.C.); (S.K.)
| | - Jun-Sang Han
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (C.-H.A.); (C.-H.K.)
| | - Sungwook Kang
- Precision Mechanical Process and Control R&D Group, Korea Institute of Industrial Technology, Jinju-si 52845, Republic of Korea; (M.C.); (S.K.)
| | - Chang-Hwan Ahn
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (C.-H.A.); (C.-H.K.)
| | - Dong-Hee Kim
- Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine, Jinju-si 52727, Republic of Korea;
| | - Chul-Hyun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (C.-H.A.); (C.-H.K.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu 41944, Republic of Korea;
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Ae-Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (C.-H.A.); (C.-H.K.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jong-Moon Hwang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (C.-H.A.); (C.-H.K.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
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13
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Lambrechts MJ, Heard J, D'Antonio N, Bodnar J, Schneider G, Bloom E, Canseco J, Woods B, Kaye ID, Kurd M, Rihn J, Hilibrand A, Schroeder G, Vaccaro A, Kepler C. A Comparison of Radiographic Alignment between Bilateral and Unilateral Interbody Cages in Patients Undergoing Transforaminal Lumbar Interbody Fusion. Asian Spine J 2023; 17:666-675. [PMID: 37226381 PMCID: PMC10460650 DOI: 10.31616/asj.2022.0316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/17/2022] [Accepted: 10/17/2022] [Indexed: 05/26/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE To compare radiographic outcomes between unilateral and bilateral cage placement in transforaminal lumbar interbody fusions (TLIF) and to determine if the rate of fusion at the 1-year postoperative point was different in patients who received bilateral versus unilateral cages. OVERVIEW OF LITERATURE There is no clear evidence to dictate whether bilateral or unilateral cages promote superior radiographic or surgical outcomes in TLIF. METHODS Patients >18 years old who underwent primary one- or two-level TLIFs at our institution were identified and propensitymatched in a 3:1 fashion (unilateral:bilateral). Patient demographics, surgical characteristics, and radiographic outcomes, including vertebral endplate obliquity, segmental lordosis, subsidence, and fusion status, were compared between groups. RESULTS Of the 184 patients included, 46 received bilateral cages. Bilateral cage placement was associated with greater subsidence (1.06±1.25 mm vs. 0.59±1.16 mm, p=0.028) and enhanced restoration of segmental lordosis (5.74°±14.1° vs. -1.57°±10.9°, p=0.002) at the 1-year postoperative point, while unilateral cage placement was associated with an increased correction of endplate obliquity (-2.02°±4.42° vs. 0.24°±2.81°, p<0.001). Bilateral cage placement was significantly associated with radiographic fusion on bivariate analysis (89.1% vs. 70.3%, p=0.018) and significantly predicted radiographic fusion on multivariable regression analysis (estimate, 1.35; odds ratio, 3.87; 95% confidence interval, 1.51-12.05; p=0.010). CONCLUSIONS Bilateral interbody cage placement in TLIF procedures was associated with restoration of lumbar lordosis and increased fusion rates. However, endplate obliquity correction was significantly greater for patients who received a unilateral cage.
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Affiliation(s)
- Mark James Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jeremy Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nicholas D'Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John Bodnar
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory Schneider
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Evan Bloom
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jose Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Barrett Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mark Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jeffrey Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christopher Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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14
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Lodde MF, Fischer TM, Riesenbeck O, Roßlenbroich S, Katthagen JC, Rometsch D, Günes D, Schneider M, Raschke MJ, Liljenqvist U. Analysis of the Spinopelvic Parameters in Patients with Fragility Fractures of the Pelvis. J Clin Med 2023; 12:4445. [PMID: 37445480 DOI: 10.3390/jcm12134445] [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: 03/20/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND We investigated the spinopelvic parameters of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) in patients with fragility fractures of the pelvis (FFPs). We hypothesized that these parameters differ from asymptomatic patients. METHODS All patients treated for FFPs in a center of maximal care of the German Spine Society (DWG) between 2017 and 2021 were included. The inclusion criteria were age ≥ 60 years and the availability of a standing lateral radiograph of the spine and pelvis in which the spine from T12 to S1 and both femoral heads were visible. The baseline characteristics and study parameters were calculated and compared with databases of asymptomatic patients. The two-sample t-Test was performed with p < 0.05. RESULTS The study population (n = 57) consisted of 49 female patients. The mean age was 81.0 years. The mean LL was 47.9°, the mean PT was 29.4°, the mean SS was 34.2° and the mean PI was 64.4°. The mean value of LLI was 0.7. LL, LLI and SS were significantly reduced, and PI and PT were significantly increased compared to asymptomatic patients. CONCLUSIONS The spinopelvic parameters in patients with FFPs differ significantly from asymptomatic patients. In patients with FFPs, LL, LLI and SS are significantly reduced, and PI and PT are significantly increased. The sagittal spinopelvic balance is abnormal in patients with FFPs.
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Affiliation(s)
- Moritz F Lodde
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Thies M Fischer
- Department for Spine Surgery and Scoliosis, St. Franziskus-Hospital GmbH Münster, Hohenzollernring 70, 48145 Münster, Germany
| | - Oliver Riesenbeck
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Steffen Roßlenbroich
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - J Christoph Katthagen
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Daria Rometsch
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, Kardinal-von-Galen-Ring 10, 48149 Münster, Germany
| | - Dennis Günes
- Department for Spine Surgery and Scoliosis, St. Franziskus-Hospital GmbH Münster, Hohenzollernring 70, 48145 Münster, Germany
| | - Marc Schneider
- Department for Spine Surgery and Scoliosis, St. Franziskus-Hospital GmbH Münster, Hohenzollernring 70, 48145 Münster, Germany
| | - Michael J Raschke
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Ulf Liljenqvist
- Department for Spine Surgery and Scoliosis, St. Franziskus-Hospital GmbH Münster, Hohenzollernring 70, 48145 Münster, Germany
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15
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Xu D, Gan K, Zhao X, Lian L, Hu X, Luo N, Ma W. Comparison of staged lateral lumbar interbody fusion combined two-stage posterior screw fixation and two osteotomy strategies for adult degeneration scoliosis: a retrospective comparative study. BMC Musculoskelet Disord 2023; 24:387. [PMID: 37189086 DOI: 10.1186/s12891-023-06449-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023] Open
Abstract
AIMS The commonly used treatments of adult degeneration scoliosis (ADS) were posterior long segment screw fixation with osteotomies. Recently, lateral lumbar intervertebral fusion combined two-stage posterior screw fixation (LLIF + PSF) as a new strategy without osteotomy. Herein, this study aimed to compare the clinical and radiological outcomes among LLIF + PSF and pedicle subtraction osteotomy (PSO), posterior column osteotomies (PCO). METHODS Totals of 139 ADS patients underwent operation with 2 years longer follow-up visit between January 2013 and January 2018 in Ningbo No.6 Hospital were enrolled into this study. 58 patients were included in PSO group, 45 in PCO group and 36 in LLIF + PSF group, The clinical and radiological data were reviewed from medical records. Baseline characteristic, perioperative radiological data (sagittal vertical axis (SVA), coronal balance (CB), Cobb angle of Mian curve (MC), Lumbar lordosis (LL), pelvic tilt (PT) and pelvic incidence-lumbar lordosis mismatch (PI-LL)), clinical outcomes (VAS of back and leg, Oswestry disability index (ODI) and Scoliosis Research Society 22-question Questionnaire (SRS-22)) and complications were evaluated and compared. RESULT There were no significantly difference in baseline characteristics, preoperative radiological parameters and clinical outcomes among three groups. LLIF + PSF group was significantly shorter in operation time than other two groups (P < 0.05), whereas significant longer hospital stay was observed in LLIF + PSF group (P < 0.05). As for radiological parameters, LLIF + PSF group had significantly improvement in SVA, CB, MC, LL and PI-LL (P < 0.05). Moreover, LLIF + PSF group achieved significantly less correction loss in SVA, CB and PT than PSO and PCO group (1.5 ± 0.7 VS 2.0 ± 0.9 VS 2.2 ± 0.8, P < 0.05; 1.0 ± 0.4 VS 1.3 ± 0.5 VS 1.1 ± 0.7, P < 0.05 and 4.2 ± 2.8 VS 7.2 ± 3.1 VS 6.0 ± 2.8, P < 0.05). Significantly recovery in VAS of back and leg, ODI score and SRS-22 were found among all groups, however, LLIF + PSF shown significant better clinical therapy maintain at follow-up visit than other two groups (P < 0.05). There were no significantly difference in complications among groups (P = 0.66). CONCLUSION Lateral lumbar interbody fusion combined two-stage posterior screw fixation (LLIF + PSF) can achieve comparable clinical therapy for adult degeneration scoliosis as osteotomy strategies. However, furthermore more studies need be taken for verifying the effect of LLIF + PSF in the future.
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Grants
- LQ21H060002 the Natural Science Foundation of Zhejiang, China
- LQ21H060002 the Natural Science Foundation of Zhejiang, China
- LQ21H060002 the Natural Science Foundation of Zhejiang, China
- LQ21H060002 the Natural Science Foundation of Zhejiang, China
- 2021S105 Social Welfare Research Key Project of Ningbo, China
- 2021S105 Social Welfare Research Key Project of Ningbo, China
- 2021S105 Social Welfare Research Key Project of Ningbo, China
- 2021S105 Social Welfare Research Key Project of Ningbo, China
- 2022J251 the Natural Science Foundation of Ningbo, China
- 2022J251 the Natural Science Foundation of Ningbo, China
- 2022J251 the Natural Science Foundation of Ningbo, China
- 2022YPT10 the Natural Science Foundation of Yuyao, China
- 2022YPT10 the Natural Science Foundation of Yuyao, China
- 2021AS0068 Yinzhou District the second batch of agricultural and social science and technology projects
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Affiliation(s)
- Dingli Xu
- Health Science Center, Ningbo University Zhejiang, Ningbo, China
| | - Kaifeng Gan
- Orthopedic Department, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China.
| | - Xuchen Zhao
- Health Science Center, Ningbo University Zhejiang, Ningbo, China
| | - Leidong Lian
- Health Science Center, Ningbo University Zhejiang, Ningbo, China
| | - Xudong Hu
- Orthopedic Department, Ningbo No.6 Hospital, Zhejiang, Ningbo, China
| | - Ni Luo
- Orthopedic Department, Ningbo No.6 Hospital, Zhejiang, Ningbo, China
| | - Weihu Ma
- Orthopedic Department, Ningbo No.6 Hospital, Zhejiang, Ningbo, China.
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16
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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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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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Risk factors of early complications after thoracic and lumbar spinal deformity surgery: a systematic review and meta-analysis. 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; 32:899-913. [PMID: 36611078 DOI: 10.1007/s00586-022-07486-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/07/2022] [Accepted: 12/04/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To determine risk factors increasing susceptibility to early complications (intraoperative and postoperative within 6 weeks) associated with surgery to correct thoracic and lumbar spinal deformity. METHODS We systematically searched the PubMed and EMBASE databases for studies published between January 1990 and September 2021. Observational studies evaluating predictors of early complications of thoracic and lumbar spinal deformity surgery were included. Pooled odds ratio (OR) or standardized mean difference (SMD) with 95% confidence intervals (CI) was calculated via the random effects model. RESULTS Fifty-two studies representing 102,432 patients met the inclusion criteria. Statistically significant patient-related risk factors for early complications included neurological comorbidity (OR = 3.45, 95% CI 1.83-6.50), non-ambulatory status (OR = 3.37, 95% CI 1.96-5.77), kidney disease (OR = 2.80, 95% CI 1.80-4.36), American Society of Anesthesiologists score > 2 (OR = 2.23, 95% CI 1.76-2.84), previous spine surgery (OR = 1.98, 95% CI 1.41-2.77), pulmonary comorbidity (OR = 1.94, 95% CI 1.21-3.09), osteoporosis (OR = 1.60, 95% CI 1.17-2.20), cardiovascular diseases (OR = 1.46, 95% CI 1.20-1.78), hypertension (OR = 1.37, 95% CI 1.23-1.52), diabetes mellitus (OR = 1.84, 95% CI 1.30-2.60), preoperative Cobb angle (SMD = 0.43, 95% CI 0.29, 0.57), number of comorbidities (SMD = 0.41, 95% CI 0.12, 0.70), and preoperative lumbar lordotic angle (SMD = - 0.20, 95% CI - 0.35, - 0.06). Statistically significant procedure-related factors were fusion extending to the sacrum or pelvis (OR = 2.53, 95% CI 1.53-4.16), use of osteotomy (OR = 1.60, 95% CI 1.12-2.29), longer operation duration (SMD = 0.72, 95% CI 0.05, 1.40), estimated blood loss (SMD = 0.46, 95% CI 0.07, 0.85), and number of levels fused (SMD = 0.37, 95% CI 0.03, 0.70). CONCLUSION These data may contribute to development of a systematic approach aimed at improving quality-of-life and reducing complications in high-risk patients.
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Miura T, Hongo M, Kasukawa Y, Kijima H, Kudo D, Saito K, Kimura R, Iwami T, Miyakoshi N. Relationship between Intervertebral Disc Compression Force and Sagittal Spinopelvic Lower Limb Alignment in Elderly Women in Standing Position with Patient-Specific Whole Body Musculoskeletal Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16452. [PMID: 36554333 PMCID: PMC9779485 DOI: 10.3390/ijerph192416452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
The intervertebral disc loading based on compensated standing posture in patients with adult spinal deformity remains unclear. We analyzed the relationship between sagittal alignment and disc compression force (Fm). In 14 elderly women, the alignment of the sagittal spinopelvic and lower extremities was measured. Fm was calculated using the Anybody Modeling System. Patients were divided into low sagittal vertical axis (SVA) and high SVA groups. Comparisons between the two groups were performed and the relationship between the Fm and each parameter was examined using Spearman's correlation coefficient (r). The mean lumbar Fm in the high SVA group was 67.6%; significantly higher than that in the low SVA group (p = 0.046). There was a negative correlation between cervical Fm with T1 slope (r = -0.589, p = 0.034) and lumbar Fm with lumbar lordosis (r = -0.566, p = 0.035). Lumbar Fm was positively correlated with center of gravity-SVA (r = 0.615, p = 0.029), T1 slope (r = 0.613, p = 0.026), and SVA (r = 0.612, p = 0.020). The results suggested sagittal malalignment increased the load on the thoracolumbar and lower lumbar discs and was associated with cervical disc loading.
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Affiliation(s)
- Takanori Miura
- Department of Orthopedic Surgery, Tazawako Hospital, Akita 014-1201, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Akita 010-8543, Japan
| | - Yuji Kasukawa
- Department of Rehabilitation Medicine, Akita University Hospital, Akita 010-8543, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Akita 010-8543, Japan
| | - Daisuke Kudo
- Department of Rehabilitation Medicine, Akita University Hospital, Akita 010-8543, Japan
| | - Kimio Saito
- Department of Rehabilitation Medicine, Akita University Hospital, Akita 010-8543, Japan
| | - Ryota Kimura
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Akita 010-8543, Japan
| | - Takehiro Iwami
- Department of Mechanical Engineering, Faculty of Engineering Science, Akita University, Akita 010-8502, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Akita 010-8543, Japan
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20
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Qiu H, Chu TW, Niu XJ, Zhang Y, Yang SZ, Chen WG. Multisegment transforaminal lumbar interbody fusion (TLIF) combined with Ponte osteotomy in degenerative lumbar scoliosis (DLS) surgery: a minimum of five years' follow-up. INTERNATIONAL ORTHOPAEDICS 2022; 46:2897-2906. [PMID: 36153365 PMCID: PMC9674761 DOI: 10.1007/s00264-022-05572-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/31/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the long-term clinical outcomes of degenerative lumbar scoliosis (DLS) with the administration of multisegment transforaminal lumbar interbody fusion (TLIF) combined with Ponte osteotomy long-level fixation fusion, as well as to identify the factors affecting health-related quality of life (HRQOL). METHODS This was a retrospective single-centre study involving comprehensive clinical data. The Oswestry Disability Index (ODI), visual analog scale (VAS) outcomes, and Scoliosis Research Society (SRS-22) questionnaire were recorded to assess HRQOL. A correlation analysis was performed to determine the association between HRQOL and radiographic parameters. RESULTS A total of 41 consecutive patients (15 males and 26 females) met the inclusion criteria with a follow-up of 8.62 ± 1.20 years. Factors associated with HRQOL were significantly improved post-operation. Global sagittal parameters, including the sagittal vertebral axis (SVA) and T1 pelvic angle (TPA), and local parameters, including apical vertebral translation (AVT) and apical vertebral rotation (AVR), were significantly improved at the last follow-up. Significantly strong correlations between each clinical and radiographic parameter were demonstrated. Moreover, a multiple linear regression analysis demonstrated that the differences in AVT and AVR were significantly correlated with the difference in lumbar lordosis (LL), which was significantly correlated with the differences in SVA and TPA. CONCLUSION The surgical treatment of DLS with multisegment TLIF accompanied by Ponte osteotomy and long-level fixations improved the quality of life of patients with a long-term effect. AVR correction is an important factor for LL restoration that significantly correlates with improvements in the sagittal balance parameters SVA and TPA, which are key factors for guaranteeing good HRQOL.
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Affiliation(s)
- Hao Qiu
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Tong-wei Chu
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Xiao-Jian Niu
- Department of Orthopedics, 907 Hospital of The Joint Logistics Team, Nanping, Fujian Province People’s Republic of China 353000
| | - Ying Zhang
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Si-Zhen Yang
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Wu-Gui Chen
- Department of Spinal Surgery, Mindong Hospital, Ningde, Fujian Province People’s Republic of China 355000
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21
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D’Antona G, Burtscher M. Muscle endurance: Is bipedalism the cause? Front Ecol Evol 2022. [DOI: 10.3389/fevo.2022.1067396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
One may ask if the transition to bipedalism from the condition of quadrupedalism, which occurred about 7 million years ago, has been the cause or consequence of a series of fundamental physiological muscular aspects including the cost of locomotion, a crucial determinant of endurance, which has been found to be significantly lower in humans than in apes. This issue strictly links to unsolved issues regarding the significance of several muscular structural and functional adaptations, classically attributed to bipedalism and its associated locomotions, which we cannot simply attribute to the acquisition of the upright position and which may directly or indirectly contribute to the observed changes in muscle energetics that make the modern human an exceptional endurance walker and runner compared to quadrupedals.
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22
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Postoperative spinal alignment comparison of lateral versus supine patient position L5-S1 anterior lumbar interbody fusion. 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; 31:2248-2254. [PMID: 35610486 DOI: 10.1007/s00586-022-07252-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 04/18/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Over the past decade, alternative patient positions for the treatment of the anterior lumbar spine have been explored in an effort to maximize the benefits of direct anterior column access while minimizing the inefficiencies of single or multiple intraoperative patient repositionings. The lateral technique allows for access from L1 to L5 through a retroperitoneal, muscle-splitting, transpsoas approach with placement of a large intervertebral spacer than can reliably improve segmental lordosis, though its inability to be used at L5-S1 limits its overall adoption, as L5-S1 is one of the most common levels treated and where high levels of lordosis are optimal. Recent developments in instrumentation and techniques for lateral-position treatment of the L5-S1 level with a modified anterior lumbar interbody fusion (ALIF) approach have expanded the lateral position to L5-S1, though the positional effect on L5-S1 lordosis is heretofore unreported. The purpose of this study was to compare local and regional alignment differences between ALIFs performed with the patient in the lateral (L-ALIF) versus supine position (S-ALIF). METHODS Retrospective, multi-center data and radiographs were collected from 476 consecutive patients who underwent L5-S1 L-ALIF (n = 316) or S-ALIF (n = 160) for degenerative lumbar conditions. Patients treated at L4-5 and above with other single-position interbody fusion and posterior fixation techniques were included in the analysis. Baseline patient characteristics were similar between the groups, though L-ALIF patients were slightly older (58 vs. 54 years), with a greater preoperative mean L5-S1 disk height (7.8 vs. 5.8 mm), and with less preoperative slip (6.6 vs. 8.5 mm), respectively. 262 patients were treated with only L-ALIF or S-ALIF at L5-S1 while the remaining 214 patients were treated with either L-ALIF or S-ALIF at L5-S1 along with fusions at other thoracolumbar levels. Lumbar lordosis (LL), L5-S1 segmental lordosis, L5-S1 disk space height, and slip reduction in L5-S1 spondylolisthesis were measured on preoperative and postoperative lateral X-ray images. LL was only compared between single-level ALIFs, given the variability of other procedures performed at the levels above L5-S1. RESULTS Mean pre- to postoperative L5-S1 segmental lordosis improved 39% (6.6°) and 31% (4.9°) in the L-ALIF and S-ALIF groups, respectively (p = 0.063). Mean L5-S1 disk height increased by 6.5 mm (89%) in the L-ALIF and 6.4 mm (110%) in the S-ALIF cohorts, (p = 0.650). Spondylolisthesis, in those patients with a preoperative slip, average reduction in the L-ALIF group was 1.5 mm and 2.2 mm in the S-ALIF group (p = 0.175). In patients treated only at L5-S1 with ALIF, mean segmental alignment improved significantly more in the L-ALIF compared to the S-ALIF cohort (7.8 vs. 5.4°, p = 0.035), while lumbar lordosis increased 4.1° and 3.6° in the respective groups (p = 0.648). CONCLUSION Use of the lateral patient position for L5-S1 ALIF, compared to traditional supine L5-S1 ALIF, resulted in at least equivalent alignment and radiographic outcomes, with significantly greater improvement in segmental lordosis in patients treated only at L5-S1. These data, from the largest lateral ALIF dataset reported to date, suggest that-radiographically-the lateral patient position can be considered as an alternative to traditional ALIF positional techniques.
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Kitab SA, Wakefield AE, Benzel EC. Postlaminectomy lumbopelvic sagittal changes in patients with developmental lumbar spinal stenosis grouped into Roussouly lumbopelvic sagittal profiles: 2- to 10-year prospective follow-up. J Neurosurg Spine 2022; 36:695-703. [PMID: 34826807 DOI: 10.3171/2021.8.spine21797] [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: 06/09/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Roussouly lumbopelvic sagittal profiles are associated with distinct pathologies or distinct natural histories and prognoses. The associations between developmental lumbar spinal stenosis (DLSS) and native lumbopelvic sagittal profiles are unknown. Moreover, the relative effects of multilevel decompression on lumbar sagittal alignment, geometrical parameters of the pelvis, and compensatory mechanisms for each of the Roussouly subtypes are unknown. This study aimed to explore the association between DLSS and native lumbar lordosis (LL) subtypes. It also attempts to understand the natural history of postlaminectomy lumbopelvic sagittal changes and compensatory mechanisms for each of the Roussouly subtypes and to define the critical lumbar segment or specific lordosis arc that is recruited after relief of the stenosis effect. METHODS A total of 418 patients with multilevel DLSS were grouped into various Roussouly subtypes, and lumbopelvic sagittal parameters were prospectively compared at follow-up intervals of preoperative to < 2 years, 2 to < 5 years, and 5 to ≥ 10 years after laminectomy. The variables analyzed included LL, upper lordosis arc from L1 to L4, lower lordosis arc from L4 to S1, and segmental lordosis from L1 to S1. Pelvic parameters included pelvic incidence, sacral slope, pelvic tilt, and pelvic incidence minus LL values. RESULTS Of the 329 patients who were followed up throughout this study, 33.7% had Roussouly type 1 native lordosis, whereas the incidence rates of types 2, 3, and 4 were 33.4%, 21.9%, and 10.9%, respectively. LL was not reduced in any of the Roussouly subtypes after multilevel decompressions. Instead, LL increased by 4.5° (SD 11.9°-from 27.3° [SD 11.5°] to 31.8° [SD 9.8°]) in Roussouly type 1 and by 3.1° (SD 11.6°-from 41.3° [SD 9.5°] to 44.4° [SD = 9.7°]) in Roussouly type 2. The other Roussouly types showed no significant changes. Pelvic tilt decreased significantly-by 2.8°, whereas sacral slope increased significantly-by 2.9° in Roussouly type 1 and by 1.7° in Roussouly type 2. The critical lumbar segment that recruits LL differs between Roussouly subtypes. Increments and changes were sustained until the final follow-up. CONCLUSIONS The study findings are important in predicting patient prognosis, LL evolution, and the need for prophylactic or corrective deformity surgery. Multilevel involvement in DLSS and the high prevalence of Roussouly types 1 and 2 suggest that spinal canal dimensions are closely linked to the developmental evolution of LL.
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Affiliation(s)
| | - Andrew E Wakefield
- 2Connecticut Neurosurgery and Spine Associates, Windsor, Connecticut; and
| | - Edward C Benzel
- 3Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
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Hodges PW, van den Hoorn W. A vision for the future of wearable sensors in spine care and its challenges: narrative review. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:103-116. [PMID: 35441093 PMCID: PMC8990399 DOI: 10.21037/jss-21-112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This review aimed to: (I) provide a brief overview of some topical areas of current literature regarding applications of wearable sensors in the management of low back pain (LBP); (II) present a vision for a future comprehensive system that integrates wearable sensors to measure multiple parameters in the real world that contributes data to guide treatment selection (aided by artificial intelligence), uses wearables to aid treatment support, adherence and outcome monitoring, and interrogates the response of the individual patient to the prescribed treatment to guide future decision support for other individuals who present with LBP; and (III) consider the challenges that will need to be overcome to make such a system a reality. BACKGROUND Advances in wearable sensor technologies are opening new opportunities for the assessment and management of spinal conditions. Although evidence of improvements in outcomes for individuals with LBP from the use of sensors is limited, there is enormous future potential. METHODS Narrative review and literature synthesis. CONCLUSIONS Substantial research is underway by groups internationally to develop and test elements of this system, to design innovative new sensors that enable recording of new data in new ways, and to fuse data from multiple sources to provide rich information about an individual's experience of LBP. Together this system, incorporating data from wearable sensors has potential to personalise care in ways that were hitherto thought impossible. The potential is high but will require concerted effort to develop and ultimately will need to be feasible and more effective than existing management.
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Affiliation(s)
- Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Wolbert van den Hoorn
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Identification of the Visually Prominent Gait Parameters for Forensic Gait Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042467. [PMID: 35206652 PMCID: PMC8872625 DOI: 10.3390/ijerph19042467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 02/05/2023]
Abstract
Walking patterns can be used as a key parameter in identifying individuals, as it varies visually depending on one’s body size as well as their habits, gender, and age group. In this study, we measure the gait characteristics of a large number of subjects using 34 visual parameters to identify significant parameters that can be used to distinguish individual walking features. We recorded 291 subjects’ walking on a constructed footpath using four video cameras, and data on parameters was calculated at the points of double support, toe-off, and heel-strike. K-means Clustering Analysis and ANOVA were conducted to determine the difference between age, gender, and BMI. As a result, we confirm that parameters related to the spine, neck, and feet are useful for identifying individuals. In the comparative analysis between age groups, the older the age, the more significant variables appeared in the upper body. The difference between genders showed significant parameters in both the upper and lower bodies of males. Similarly, among the large BMI groups, we also derived significant results in the upper and lower bodies. The key parameters derived from this study can be used more effectively in the real-world visual analysis of gait, as the walking characteristics of a large number of subjects have been measured with a similar view as real-world CCTV. This study will be effectively utilized as a foundation for future research attempting to identify people through their gait by distinguishing major gait characteristic differences.
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Spinopelvic alignment and lumbar vertebral shape in children: associations with structural spinal abnormalities and body composition in the generation R study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:248-257. [PMID: 34799780 DOI: 10.1007/s00586-021-07054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 06/28/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the spinopelvic alignment and vertebral shape in children, and associations with body composition and structural spinal abnormalities on magnetic resonance imaging (MRI). METHODS We performed a cross-sectional study embedded in the Generation R Study, a prospective population-based birth cohort. Pelvic incidence and vertebral concavity ratios for each lumbar level were determined on sagittal MRI images in 9-year-old children, and structural spinal abnormalities were scored semi-quantitatively. The BMI-SD score was calculated, and body composition was assessed using DXA scans. Associations of pelvic incidence and vertebral concavity ratios with structural abnormalities and body composition measures were assessed using (multilevel) regression analyses. RESULTS This study included 522 participants (47.7% boys), aged 9.9 years (IQR 9.7-10.0). The mean pelvic incidence was 36.6° (SD 8.0). Vertebral concavity ratios ranged from 0.87 to 0.90, with significantly lower ratios for boys compared to girls. Associations were found for a larger pelvic incidence with decreased disc height [OR 1.03 (95% CI 1.02-1.05)], and a pelvic incidence in the lowest tertile with less disc bulging [OR 0.73 (95% CI 0.56-0.95)]. Increased vertebral concavity ratio was associated with decreased disc height [OR 14.16 (95% CI 1.28-157.13)]. Finally, increased fat-free mass index was associated with a smaller pelvic incidence [adjusted OR 0.85 (95% CI 0.07-1.63)]. CONCLUSION The mean pelvic incidence of 9-year-old children is 36.6° on supine MRI images, and a slightly concave shape of the lumbar vertebrae is seen. Spinopelvic alignment is associated with structural spinal abnormalities, and might itself be influenced by the children's body composition.
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Chung NS. Etiology, diagnosis, and treatment of iatrogenic spinal deformity. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.11.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Spinal fusion is a common procedure that provides spinal stability by connecting vertebral segments using a bone graft. Because the spinal alignment is fixed permanently after spinal fusion, a mal-aligned fusion can produce iatrogenic spinal deformity and imbalance with significant disability.Current Concepts: Failure to restore adequate segmental lordosis in lumbar spinal fusion is a common cause of iatrogenic spine deformity. Local and regional spinal deformities can affect the global alignment; accordingly, spinal imbalance can occur when the compensation mechanisms fail. Diagnosis and surgical planning should be made on a thorough analysis of global and spinopelvic parameters on the standing whole-spine radiographs. Surgical treatment includes neural decompression, spinal fusion, and deformity correction. Spinal osteotomy provides a favorable surgical outcome, although the complication rate is high.Discussion and Conclusion: Iatrogenic spine deformity is increasing due to the increased occurrence of spinal fusion surgery. To prevent iatrogenic spine deformity, the index fusion surgery should be performed based on a comprehensive analysis of spinopelvic alignment and balance.
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de Andrada Pereira B, Sawa AGU, Godzik J, Lehrman JN, Uribe JS, Turner JD, Kelly BP. Influence of Lumbar Lordosis on Posterior Rod Strain in Long-Segment Construct During Biomechanical Loading: A Cadaveric Study. Neurospine 2021; 18:635-643. [PMID: 34610695 PMCID: PMC8497261 DOI: 10.14245/ns.2142368.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
Objective The lordotic shape of the lumbar spine differs substantially between individuals. Measuring and recording strain during spinal biomechanical tests is an effective method to infer stresses on spinal implants and predict failure mechanisms. The geometry of the spine may have a significant effect on the resultant force distribution, thereby directly affecting rod strain.
Methods Seven fresh-frozen cadaveric specimens (T12-sacrum) underwent standard (7.5 Nm) nondestructive sagittal plane tests: flexion and extension. The conditions tested were intact and pedicle screws and rods (PSR) at L1-sacrum. The posterior right rod was instrumented with strain gauges between L3–4 (index level) and the L5–S1 pedicle screw. All specimens underwent lateral radiographs before testing. Lordotic angles encompassing different levels (L5–S1, L4–S1, L3–S1, L2–S1, and L1–S1) were measured and compared with rod strain. Data were analyzed using Pearson correlation analyses.
Results Strong positive correlations were observed between lordosis and posterior rod strain across different conditions. The L3–S1 lordotic angle in the unloaded intact condition correlated with peak rod strain at L3–4 with PSR during flexion (R=0.76, p=0.04). The same angle in the unloaded PSR condition correlated with peak strain in the PSR condition during extension (R=-0.79, p=0.04). The unloaded intact L2–S1 lordotic angle was significantly correlated with rod strain at L3–4 in the PSR condition during flexion (R=0.85, p=0.02) and extension (R=-0.85, p=0.02) and with rod strain at L5–S1 in the PSR condition during flexion (R=0.84, p=0.04).
Conclusion Lordosis measured on intact and instrumented conditions has strong positive correlations with posterior rod strain in cadaveric testing.
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Affiliation(s)
- Bernardo de Andrada Pereira
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Anna G U Sawa
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jennifer N Lehrman
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Brian P Kelly
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Zhang ZF, Qi DB, Wang TH, Wang CG, Wang Z, Wang Y, Zheng GQ. Association of Sagittal Spinopelvic Realignment with Correction in Lower Lumbar Lordosis after Surgical Treatment in Degenerative Lumbar Scoliosis. Orthop Surg 2021; 13:2034-2042. [PMID: 34559468 PMCID: PMC8528994 DOI: 10.1111/os.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/09/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the effect that correction of lower lumbar lordosis (3L) has on global spine realignment due to the key role of 3L for scoliosis surgery in patients with degenerative lumbar scoliosis (DLS). Methods This study is a retrospective review performed between June 2018 and January 2020, including consecutive patients with DLS. Only patients age ≥ 45 years who had already undergone a selective root block operation and had the procedure of long‐fusion extending to pelvis and posterior lumbar interbody fusion (PLIF) at lower lumbar spine (L4‐S1) were retained for analysis. Spinopelvic parameters measured included thoracic kyphosis (TK), lumbar lordosis (LL), 3L, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), T1 pelvic angle (TPA), and sagittal vertical axis (SVA) at pre‐operation and the third month follow‐up. The mismatch (PI‐LL) was calculated subsequently. Pearson correlation and linear regression analysis were performed to explore the association of the changes in global spinopelvic parameters with 3L correction. Results Thirty‐nine patients (five males, 34 females) with the average age of 63.84 years (SD 7.53; range, 45–75 years) at the time of surgery were identified. All patients had the surgical procedure of long‐fusion (≥4 vertebras) with PLIF at lower lumbar spine between L4 and S1 spine. Lower instrumented vertebras (LIV) fused to pelvis (S1, 14; S2, 18; ilium, 7) were operated in all patients. Seventeen patients were with upper instrumented vertebras (UIV) at thoracolumbar spine (L2‐T11), and 22 patients at thoracic spine (T10 and above). The median of instrumented segments was 10 (5–14). 3L significantly increased (P = 0.02) after surgical treatment by mean change of 4.21° (range, −19.7° to +22.2°). Perioperatively, all spinopelvic parameters regarding to TK, LL, SS, PT, TPA, SVA, and mismatch (PI‐LL) had significant changes (P < 0.001). The change in 3L correlated significantly with the changes in spinopelvic parameters (r = 0.772 for LL, −0.589 for SVA, −0.439 for TPA, and −0.428 for PI‐LL). After linear regression analysis, the formulas were obtained: d‐LL = 14.977 + 0.636 × d‐3L, (R2 = 0.596); d‐(PI‐LL) = 16.575 + 0.62 × d‐3L, (R2 = 0.183); d‐TPA = −7.284 to 0.358 × d‐3L, (R2 = 0.193); d‐SVA = −30.556–2.639 × d‐3L (R2 = 0.347). Conclusions Correction in lower lumbar lordosis, following the surgical procedure of long‐fusion with PLIF at lower lumbar spine, could result in significant changes in full‐spine parameters. The significant association of changes in each of global spine parameter with the correction of 3L perioperatively could provide important information for surgeons to make a surgical plan for spinal correction.
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Affiliation(s)
- Zi-Fang Zhang
- The Medical College of Nankai University, Tianjin, China.,The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Deng-Bin Qi
- The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Tian-Hao Wang
- The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Chun-Guo Wang
- The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Zheng Wang
- The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Yan Wang
- The Medical College of Nankai University, Tianjin, China.,The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Guo-Quan Zheng
- The Spine Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
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Sielatycki JA, Metcalf T, Koscielski M, Devin CJ, Hodges S. Seated Lateral X-ray Is a Better Stress Radiograph of the Lumbar Spine Compared to Standing Flexion. Global Spine J 2021; 11:1099-1103. [PMID: 32748641 PMCID: PMC8351069 DOI: 10.1177/2192568220939527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
STUDY DESIGN Prospective lumbar radiograph analysis. OBJECTIVE To compare changes in lumbar lordosis in standing flexion versus seated lateral radiographs. METHODS Standing lateral, standing flexion, and seated lateral X-rays of the lumbar spine were obtained in patients presenting with low back pain. Trauma, tumor, and revision cases were excluded. Changes in global lumbar as well as segmental lordosis were measured in each position. RESULTS Seventy adult patients were reviewed. Overall, the greatest changes in lordosis were seen at L4-S1 in both the seated and flexion X-rays (12.5° and 6.3°, respectively). Greater kyphosis was seen in seated versus flexion X-rays (21.6° vs 15.8°); changes in lordosis from L1-L3 were similar in both positions, with little change seen at these levels (approximately 5° to 7°). On subgroup analysis, these differences were magnified in analyzing only patients that moved at least 20° globally, and there were no significant differences between sitting and flexion in "stiff" patients that moved less than 20° globally. CONCLUSION Greater lumbar kyphosis was seen in the seated position compared to standing flexion, especially from L4-S1. Given these results we suggest the use of seated lateral X-rays to dynamically assess the lumbar spine. These findings may also guide future research into the mechanism and clinical relevance of a stiff versus mobile lumbar spine, as well as into the sensitivity of seated X-rays in detecting instability.
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Affiliation(s)
- J. Alex Sielatycki
- Center for Sports Medicine and Orthopedics, Chattanooga Orthopedic Group, Chattanooga, TN, USA,J. Alex Sielatycki, Center for Sports Medicine and Orthopedics, Chattanooga Orthopedic Group, Chattanooga, TN 37404-3322, USA.
| | | | | | - Clinton J. Devin
- Vanderbilt University Medical Center, Nashville, TN, USA,Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO, USA
| | - Scott Hodges
- Center for Sports Medicine and Orthopedics, Chattanooga Orthopedic Group, Chattanooga, TN, USA
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Use of a Spinal Traction Device during Work Shift in Assembly Line Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147708. [PMID: 34300157 PMCID: PMC8305420 DOI: 10.3390/ijerph18147708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022]
Abstract
Increasing back discomfort and spinal shrinkage during the workday is a problem that affects assembly line workers. The aim of this research was to analyze the effect of a spinal traction system on discomfort, spinal shrinkage, and spinal sagittal alignment in assembly line workers, who are in prolonged standing conditions during a workday. A total of 16 asymptomatic males were recruited to assess spinal shrinkage, spinal sagittal alignment, and back discomfort during the workday. The measurement was carried out in two days of work, a normal day, and the other using a spinal traction device utilized in two breaks during the workday. Assembly line workers lost height significantly on both control and intervention days. No differences were found between days. No changes were found in spinal sagittal alignment on the control day. Lumbar lordosis angle increased significantly at the end of the intervention day. The use of a spinal traction device during the workday in two breaks time did not significantly reduce the spinal shrinkage of healthy workers. Lumbar lordosis angle increased significantly at the end of the spinal traction intervention day. Prospective studies would be necessary to clarify the possible benefits of the traction device.
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Katzman WB, Parimi N, Gladin A, Wong S, Lane NE. Long-Term Efficacy of Treatment Effects After a Kyphosis Exercise and Posture Training Intervention in Older Community-Dwelling Adults: A Cohort Study. J Geriatr Phys Ther 2021; 44:127-138. [PMID: 32796410 PMCID: PMC7876164 DOI: 10.1519/jpt.0000000000000262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Treatments that prevent worsening kyphosis are important due to the progressive nature of kyphosis with aging. We assessed long-term efficacy of treatment effects after a short-term kyphosis exercise and posture training intervention in a cohort study among older adults with hyperkyphosis, and investigated whether long-term treatment effects differ among males and females. METHODS In the original kyphosis intervention, 112 older adults enrolled in a waitlist design randomized controlled trial. One hundred three participants, mean age 70.0 (5.7) years and kyphosis 52.0° (7.4°), completed a twice weekly, 3-month, group exercise and posture training intervention, and were eligible to enroll in the follow-up study. We compared (1) change in outcomes pre-/postintervention to change postintervention over the follow-up period, (2) change in outcomes pre-/postintervention and postintervention to follow-up, stratified by sex, and (3) long-term change postintervention to follow-up in males and females. Primary outcome was change in kyphometer-measured thoracic kyphosis. Secondary outcomes were change in lumbar lordosis, objective measures of physical function, self-reported measures of physical activity, and health-related quality of life (HRQoL). RESULTS AND DISCUSSION Forty-three participants, 42% of the eligible cohort, returned for follow-up, a mean 3.0 (0.7) years after completing the original intervention. Participants (27 females and 16 males) were 73.8 (6.1) years old, with mean kyphosis 48.9° (11.9°) at follow-up. Kyphosis declined -1.5° (95% confidence interval [CI]: -3.9° to 1.0°) postintervention to follow-up and this was no different than change pre-/postintervention, P = .173. Lordosis improved 8.9° (95% CI: 6.2° to 11.6°), more than change pre-/postintervention, P < .001. Gait speed measure of physical function increased 0.08 (95% CI: 0.02 to 0.14) m/s, Physical Activity Scale for the Elderly (PASE) measure of physical activity increased 4 (95% CI: -16 to 24) points, and Patient-Reported Outcomes Measurement Information System (PROMIS) mental health T-score measure of HRQoL increased 1.1 (95% CI: -1.0 to 3.1) points, but these improvements were not significantly more than change pre-/postintervention, P > .050. Other measures of physical function (modified Physical Performance Test [PPT], Timed Up and Go, and 6-minute walk) and HRQoL (Scoliosis Research Society [SRS-30] self-image and PROMIS physical function and physical health) declined at follow-up, significantly more than change pre/postintervention, P ≤ .050. Comparing change in outcomes pre-/postintervention and postintervention to follow-up, stratified by sex, both males and females increased lordosis, and decreased modified PPT and 6-minute walk measures of physical function, P < .050. Males and females differed in long-term change postintervention to follow-up. Time loaded standing and PASE improved in females compared with males, P = .008 and P = .092, respectively, and PROMIS mental health, physical health, and physical function declined in females compared with males, P = .073, P = .025, and P = .005, respectively. CONCLUSIONS In our follow-up study, a mean of 3.0 (0.07) years after a 3-month kyphosis exercise and posture training intervention, kyphosis maintained and did not progress as expected with age. There was long-term improvement in lordosis. Compared with treatment effects from the short-term intervention, gait speed maintained equally well in males and females, while trunk endurance improved in females. Further investigation of long-term benefits of a short-term kyphosis exercise and posture training intervention is warranted.
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Affiliation(s)
- Wendy B Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco
| | - Neeta Parimi
- Department of Biostatistics and Epidemiology, University of California, San Francisco
| | - Amy Gladin
- Rehabilitation Services, Kaiser Permanente San Francisco Medical Center, California
| | - Shirley Wong
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco
| | - Nancy E Lane
- Department of Medicine, University of California, Davis
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Kasai Y, Mizuno T, Paholpak P, Sirichativapee W, Fukui M. The new imaging findings: "Passing spine" without kissing. Medicine (Baltimore) 2021; 100:e26191. [PMID: 34087886 PMCID: PMC8183755 DOI: 10.1097/md.0000000000026191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/14/2021] [Indexed: 01/04/2023] Open
Abstract
Case-control studies by examining the lumbar spine computed tomography (CT) findings focusing on the spinous processes."Passing spine" was defined as a lumbar degenerative change observed on CT images. In contrast, kissing spine, which is also an image finding, has been acknowledged as an established clinical condition. Therefore, we compared the passing spine group and the kissing spine group to investigate whether the 2 groups belong to a similar disease group; this would help explain the clinical and imaging characteristics of patients with passing spine.Previous studies have described the gradual increase in the height and thickness of the lumbar vertebral spinous processes that can occur in individuals aged >40 years, and reported that this progressive degeneration can lead to a condition termed "kissing spine."We examined the CT imaging of 373 patients with lumbar spinal disease and divided patients into 2 groups, the kissing spine (K) group and the passing spine (P) group, and compared the clinical (age, sex, presence/absence of lower extremity pain) and imaging data (localization of kissing or passing spine, intervertebral disc height at the level of kissing or passing spine, lumbar lordosis (LL) angle, presence/absence of vacuum phenomenon (VP) in the intervertebral discs and spondylolisthesis at the level of kissing or passing spine between the 2 groups.Compared with patients with kissing spine, patients with passing spine had an increased incidence of lower extremity pain, lower intervertebral disc height at the level of passing spine, relatively static LL, and VP commonly observed in the intervertebral discs at the level of passing spine.Because the clinical and imaging characteristics of patients with passing spine are different from those of patients with kissing spine, passing spine might be a pathological condition distinct from kissing spine.
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Affiliation(s)
- Yuichi Kasai
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Tetsutaro Mizuno
- Department of Orthopaedic Surgery, Seirei Hamamatsu General Hospital, Hamamatsu
- Tetsutaro MIzunob : Seirei Hamamatsu General Hospital, Hamamatsu
| | - Permsak Paholpak
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Winai Sirichativapee
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Mitsuru Fukui
- Laboratory of Statistics, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Prost S, Pesenti S, Fuentes S, Tropiano P, Blondel B. Treatment of osteoporotic vertebral fractures. Orthop Traumatol Surg Res 2021; 107:102779. [PMID: 33321233 DOI: 10.1016/j.otsr.2020.102779] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/17/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023]
Abstract
Osteoporosis is a public health problem that is contributing to an increasing number of osteoporotic vertebral fractures. The aim of this lecture is to summarize the current state of knowledge about osteoporotic fractures by answering five questions. 1/How does the spine typically age and how is osteoporosis diagnosed? Various normal aging processes will gradually modify the vertebral column (static, dynamic, bone quality). Osteoporosis is diagnosed through a DEXA scan. 2/How is an osteoporotic fracture evaluated clinically and radiologically? Magnetic resonance imaging is the preferred modality for making the diagnosis and selecting the most appropriate treatment. 3/What are the treatment options for an osteoporotic fracture? The options are conservative treatment, conventional surgery, and minimally invasive techniques (cementoplasty, percutaneous instrumentation). 4/Which fractures should be treated, and which technique should be used? The choice is clear when neurological deficits are present, although the indications are less firm when there is no deficit. The treatment can be conservative (back brace) if the fracture is non-displaced and minimally painful, vertebroplasty if the fracture is painful and shows hyperintensity on T2-STIR sequences, vertebral expansion if the radiological deformity worsens along with symptoms. 5/What are the technical challenges and complications related to the presence of osteoporosis when treating vertebral fractures surgically? The reduced bone stock increases the risk of poor implant hold and postoperative mechanical complications (adjacent fracture, junctional kyphosis). Technical solutions have been developed (augmented screw fixation, transitional zone) to limit their impact. It is essential to know and master these techniques, and their indications. Treatment of the osteoporosis itself is crucial. Level of evidence V; Expert opinion.
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Affiliation(s)
- Solène Prost
- Unité de chirurgie rachidienne, Aix-Marseille université, AP-HM, CNRS, ISM, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Sébastien Pesenti
- Unité de chirurgie rachidienne, Aix-Marseille université, AP-HM, CNRS, ISM, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Stéphane Fuentes
- Unité de chirurgie rachidienne, Aix-Marseille université, AP-HM, CNRS, ISM, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Patrick Tropiano
- Unité de chirurgie rachidienne, Aix-Marseille université, AP-HM, CNRS, ISM, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Benjamin Blondel
- Unité de chirurgie rachidienne, Aix-Marseille université, AP-HM, CNRS, ISM, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
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Kim HJ, Yang JH, Chang DG, Suk SI, Suh SW, Song KS, Park JB, Cho W. Adult Spinal Deformity: Current Concepts and Decision-Making Strategies for Management. Asian Spine J 2020; 14:886-897. [PMID: 33254357 PMCID: PMC7788366 DOI: 10.31616/asj.2020.0568] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 01/05/2023] Open
Abstract
Adult spinal deformity (ASD) is characterized by three-dimensional abnormalities of the thoracic or thoracolumbar spine that exerts significant impacts on the health-related quality of life (HRQoL). With the important effects that deformity of the sagittal plane exerts on the HRQoL, there have been paradigm shifts in ASD evaluation and management. Loss of lumbar lordosis is recognized as a key driver of ASD followed by reducing kyphosis, pelvic retroversion, and knee flexion. The Scoliosis Research Society (SRS)– Schwab classification reflects the sagittal spinopelvic parameters that correlate pain and disability in ASD patients. Although the SRS–Schwab classification provides a realignment target framework for surgeons, a structured patient-specific systemic approach is crucial for the process of decision-making. ASD management should be focused on restoring age-specific harmonious alignment and should consider the comorbidities and risk factors of each patient to prevent catastrophic complications and enhance the HRQoL.
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Affiliation(s)
- Hong Jin Kim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Hyuk Yang
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Se-Il Suk
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Seung Woo Suh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kwang-Sup Song
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woojin Cho
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Pan F, Zhu R, Zander T, Lu S, Schmidt H. The sagittal sways of back lordosis and sacral orientation during still standing at different arm positions. J Biomech 2020; 114:110149. [PMID: 33271471 DOI: 10.1016/j.jbiomech.2020.110149] [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: 08/29/2020] [Revised: 10/29/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
Lumbo-pelvic parameters in the sagittal plane are normally measured from lateral radiographs obtained at a single time point during upright standing with arms held forward to expose anatomical bony structures. However, the human trunk naturally sways during still standing, which potentially alters the targeted parameters. We therefore aimed to investigate the effect of postural sway on lumbo-pelvic parameters during still standing at different arm positions. A non-radiological back measurement device was used to determine the absolute changes of back lordosis and sacral orientation during one-minute still standing while participants (10 males and 10 females without low back pain) held their arms at eight different positions. When the arms were freely hanging down at both sides, males displayed median values of 25.2° (range: 15.6-45.0°) and 7.4° (range: 2.0-26.7°) for back lordosis and sacral orientation, which were smaller than those of 33.1° (range: 11.9-41.9°) and 16.1° (range: 0.8-22.8°) for females, respectively (P < 0.05). At the same arm position, the median values were 2.7° (range: 1.3-5.2°) and 2.9° (range: 1.6-4.5°) for change of back lordosis and change of sacral orientation, respectively. Sex displayed no significant influence for both measures. Different arm positions non-significantly affected the change of back lordosis. When hands rested on horizontal bars, the change of sacral orientation was significantly less than during other arm positions (P < 0.05). Hence, back lordosis and sacral orientation inherently change during still standing, independently of sex and arm position, which could compromise the reliability of measurements at a single time point. When categorizing subjects into groups with normal or abnormal lumbo-pelvic balance, this variability should be taken into consideration.
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Affiliation(s)
- Fumin Pan
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 389 Xincun Road, 200065 Shanghai, China; Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Rui Zhu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 389 Xincun Road, 200065 Shanghai, China
| | - Thomas Zander
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hendrik Schmidt
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.
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Zhu W, Wang W, Kong C, Wang Y, Pan F, Lu S. Lumbar Muscle Fat Content Has More Correlations with Living Quality than Sagittal Vertical Axis in Elderly Patients with Degenerative Lumbar Disorders. Clin Interv Aging 2020; 15:1717-1726. [PMID: 33061324 PMCID: PMC7519808 DOI: 10.2147/cia.s265826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose As the most poorly tolerated and debilitating form of spinal malalignment, sagittal imbalance is becoming an increasingly recognized cause of pain and disability in adults. However, there is evidence showing that sagittal imbalance has a weak or no correlation with health-related quality-of-life (HRQoL) outcomes. The objective of this study was to describe the direct factor associated with HRQoL in terms of Oswestry Disability Index (ODI) assessment. Patients and Methods This study retrospectively evaluated the clinical and radiographic information of 179 elderly patients with degenerative lumbar disorders and suboptimal sagittal standing posture (sagittal vertical axis>50 mm). Patient-reported outcomes were assessed using ODI. Patients with ODI≥40% were assigned to Group D (disability), while those with ODI<40% were assigned to Group ND (non-disability). Results Compared with Group ND (n=104), patients in Group D (n=75) had greater thoracolumbar kyphosis, pelvic incidence-lumbar lordosis (PI-LL), sagittal vertical axis (SVA), T1 pelvic angle, and fat infiltration, and smaller LL and muscle mass ratio. Pearson analysis revealed a high correlation between the percentage of fat infiltrated and ODI (r=768, P<0.01) and moderate correlation between SVA and ODI (r=0.408, P<0.001). Linear regression results indicated that fat infiltration was an independent factor associated with ODI. ODI significantly correlated with SVA in patients with major fat infiltration (r=0.328, P=0.001), while having no correlation with SVA in those with moderate or minor fat infiltration (r=0.083, P=0.464). Conclusion Lumbar muscle fat infiltration is an independent factor associated with the living quality in terms of ODI assessment in the elderly population with degenerative lumbar disorders, which has more correlations with ODI scores than the sagittal imbalance. The relationship between HRQoL outcomes and sagittal imbalance depends on the quality of lumbar muscle.
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Affiliation(s)
- Weiguo Zhu
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
| | - Wei Wang
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
| | - Chao Kong
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
| | - Yu Wang
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
| | - Fumin Pan
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
| | - Shibao Lu
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
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Cho BH, Kaji D, Cheung ZB, Ye IB, Tang R, Ahn A, Carrillo O, Schwartz JT, Valliani AA, Oermann EK, Arvind V, Ranti D, Sun L, Kim JS, Cho SK. Automated Measurement of Lumbar Lordosis on Radiographs Using Machine Learning and Computer Vision. Global Spine J 2020; 10:611-618. [PMID: 32677567 PMCID: PMC7359685 DOI: 10.1177/2192568219868190] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
STUDY DESIGN Cross sectional database study. OBJECTIVE To develop a fully automated artificial intelligence and computer vision pipeline for assisted evaluation of lumbar lordosis. METHODS Lateral lumbar radiographs were used to develop a segmentation neural network (n = 629). After synthetic augmentation, 70% of these radiographs were used for network training, while the remaining 30% were used for hyperparameter optimization. A computer vision algorithm was deployed on the segmented radiographs to calculate lumbar lordosis angles. A test set of radiographs was used to evaluate the validity of the entire pipeline (n = 151). RESULTS The U-Net segmentation achieved a test dataset dice score of 0.821, an area under the receiver operating curve of 0.914, and an accuracy of 0.862. The computer vision algorithm identified the L1 and S1 vertebrae on 84.1% of the test set with an average speed of 0.14 seconds/radiograph. From the 151 test set radiographs, 50 were randomly chosen for surgeon measurement. When compared with those measurements, our algorithm achieved a mean absolute error of 8.055° and a median absolute error of 6.965° (not statistically significant, P > .05). CONCLUSION This study is the first to use artificial intelligence and computer vision in a combined pipeline to rapidly measure a sagittal spinopelvic parameter without prior manual surgeon input. The pipeline measures angles with no statistically significant differences from manual measurements by surgeons. This pipeline offers clinical utility in an assistive capacity, and future work should focus on improving segmentation network performance.
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Affiliation(s)
- Brian H. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Brian H. Cho and Deepak Kaji contributed equally to this work
| | - Deepak Kaji
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Brian H. Cho and Deepak Kaji contributed equally to this work
| | - Zoe B. Cheung
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ivan B. Ye
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ray Tang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amy Ahn
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Oscar Carrillo
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Varun Arvind
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Ranti
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Li Sun
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun S. Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Samuel K. Cho, Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, 5th Floor, New York, NY 10019, USA.
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Buckland AJ, Burapachaisri A, Stekas N, Vasquez-Montes D, Protopsaltis T, Vigdorchik J. Obesity Alters Spinopelvic Alignment Changes From Standing to Relaxed Sitting: the Influence of the Soft-tissue Envelope. Arthroplast Today 2020; 6:590-595.e1. [PMID: 32995406 PMCID: PMC7502584 DOI: 10.1016/j.artd.2020.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/26/2020] [Accepted: 02/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background Changes in spinopelvic and lower extremity alignment between standing and relaxed sitting have important clinical implications with regard to stability of total hip arthroplasty. This study aimed to analyze the effect of body mass index (BMI) on lumbopelvic alignment and motion at the hip joint. Methods A retrospective review of patients who underwent full-body stereoradiographs in standing and relaxed sitting for total hip arthroplasty planning was conducted. Spinopelvic parameters measured included spinopelvic tilt (SPT), pelvic incidence (PI), lumbar lordosis (LL), PI minus LL (PI-LL), proximal femoral shaft angle (PFSA), and standing-to-sitting hip range of motion. Propensity score matching controlled for age, gender, PI, and hip ostoarthritis grade. Patients were stratified into normal (NORMAL; BMI, 18.5-24.9), overweight (OW; 25.0-29.9), and obese (OB; 30.0-34.9) groups. Alignment parameters were compared using one-way analysis of variance. Results There were 84 patients in each group after propensity score matching. Standing alignment between BMI groups was similar for all parameters (P > .05) except for PFSA (P < .001). Significant differences were noted for sitting alignment between patients who are NORMAL, OW, and OB in: SPT (P = .007), PI-LL (P = .018), and LL (P = .029). PFSA between groups was not significantly different (P > .05). Significant differences were found for sitting-to-standing alignment across groups in PFSA change (P < .001), SPT change (P = .006), PI-LL change (P = .005), LL change (P = .037), and hip flexion (P < .001). Conclusions Significant differences in sitting and standing-to-sitting change in lumbopelvic alignment based on BMI suggest obese patients recruit more posterior spinopelvic tilt when sitting to compensate for soft-tissue impingement that occurs anterior to the hip joint and limiting hip flexion.
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Affiliation(s)
- Aaron J Buckland
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Aonnicha Burapachaisri
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Nicholas Stekas
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Dennis Vasquez-Montes
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Themistocles Protopsaltis
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jonathan Vigdorchik
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Clifton W, Damon A, Valero-Moreno F, Nottmeier E, Pichelmann M. The SpineBox: A Freely Available, Open-access, 3D-printed Simulator Design for Lumbar Pedicle Screw Placement. Cureus 2020; 12:e7738. [PMID: 32455058 PMCID: PMC7241219 DOI: 10.7759/cureus.7738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The recent COVID-19 pandemic has demonstrated the need for innovation in cost-effective and easily produced surgical simulations for trainee education that are not limited by physical confines of location. This can be accomplished with the use of desktop three-dimensional (3D) printing technology. This study describes the creation of a low-cost and open-access simulation for anatomical learning and pedicle screw placement in the lumbar spine, which is termed the SpineBox. Materials and methods An anonymized CT scan of the lumbar spine was obtained and converted into 3D software files of the L1-L5 vertebral bodies. A computer-assisted design (CAD) software was used to assemble the vertebral models into a simulator unit in anatomical order to produce an easily prototyped simulator. The printed simulator was layered with foam in order to replicate soft tissue structures. The models were instrumented with pedicle screws using standard operative technique and examined under fluoroscopy. Results Ten SpineBoxes were created using a single desktop 3D printer, with accurate replication of the cortico-cancellous interface using previously validated techniques. The models were able to be instrumented with pedicle screws successfully and demonstrated quality representation of bony structures under fluoroscopy. The total cost of model production was under $10. Conclusion The SpineBox represents the first open-access simulator for the instruction of spinal anatomy and pedicle screw placement. This study aims to provide institutions across the world with an economical and feasible means of spine surgical simulation for neurosurgical trainees and to encourage other rapid prototyping laboratories to investigate innovative means of creating educational surgical platforms in the modern era.
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Affiliation(s)
| | - Aaron Damon
- Neurological Surgery, Mayo Clinic, Jacksonville, USA
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Patient-Reported Outcome Measures After Multilevel Lumbar Total Disc Arthroplasty for the Treatment of Multilevel Degenerative Disc Disease. Spine (Phila Pa 1976) 2020; 45:18-25. [PMID: 31425431 DOI: 10.1097/brs.0000000000003201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case series OBJECTIVE.: The aim of this study was to assess the patient-reported outcome measures (PROMs) and patient satisfaction of multilevel lumbar total disc arthroplasty (TDA) for symptomatic multilevel degenerative disc disease (MLDDD). SUMMARY OF BACKGROUND DATA TDA has been shown to be safe and effective for the treatment of symptomatic single level degenerative disc disease. There is minimal PROMs data on the mid- to long-term outcomes of multilevel TDA constructs. METHODS Prospectively collected PROMs were analyzed from patients receiving multilevel TDA for symptomatic MLDDD. Data were collected preoperatively and postoperatively at 3, 6, and 12 months, then yearly. PROMs included patient satisfaction, Visual Analog Score back and leg, Oswestry Disability Index, and Roland-Morris Disability Questionnaire. RESULTS One hundred twenty-two patients (77 men, 45 women) who had preoperative and at least 24-month follow-up data were included. The average age was 42 ± 8.2 years (range 21-61) and mean follow-up 7.8 years (range 2-10). The majority received two-level TDA, except two patients (1.6%) who received three-level TDA. The two- to three-level TDA's were at the levels L3-4, L4-5, and L5-S1, whereas most two levels (n = 110, 90.2%) were at L4-5 and L5-S1; the remainder (n = 10, 8.2%) being at L3-4 and L4-5. Implants used were Charité (DePuy Spine, Raynham, MA) in 119 patients (240 levels) and InMotion (DePuy Spine) in 3 patients (6 levels). Improvement in pain and disability scores were both clinically and statistically significant (P < 0.001), and this improvement was sustained in those patients over the course of their follow-up. Ninety-two percent of patients reported good or excellent satisfaction with treatment at final review. CONCLUSION Multilevel TDA constructs for MLDDD demonstrate favorable and sustained clinical outcomes at mid- to long-term follow-up. LEVEL OF EVIDENCE 4.
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Plomp KA, Dobney K, Weston DA, Strand Viðarsdóttir U, Collard M. 3D shape analyses of extant primate and fossil hominin vertebrae support the ancestral shape hypothesis for intervertebral disc herniation. BMC Evol Biol 2019; 19:226. [PMID: 31842740 PMCID: PMC6916256 DOI: 10.1186/s12862-019-1550-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 11/29/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Recently we proposed an evolutionary explanation for a spinal pathology that afflicts many people, intervertebral disc herniation (Plomp et al. [2015] BMC Evolutionary Biology 15, 68). Using 2D data, we found that the bodies and pedicles of lower vertebrae of pathological humans were more similar in shape to those of chimpanzees than were those of healthy humans. Based on this, we hypothesized that some individuals are more prone to intervertebral disc herniation because their vertebrae exhibit ancestral traits and therefore are less well adapted for the stresses associated with bipedalism. Here, we report a study in which we tested this "Ancestral Shape Hypothesis" with 3D data from the last two thoracic and first lumbar vertebrae of pathological Homo sapiens, healthy H. sapiens, Pan troglodytes, and several extinct hominins. RESULTS We found that the pathological and healthy H. sapiens vertebrae differed significantly in shape, and that the pathological H. sapiens vertebrae were closer in shape to the P. troglodytes vertebrae than were the healthy H. sapiens vertebrae. Additionally, we found that the pathological human vertebrae were generally more similar in shape to the vertebrae of the extinct hominins than were the healthy H. sapiens vertebrae. These results are consistent with the predictions of the Ancestral Shape Hypothesis. Several vertebral traits were associated with disc herniation, including a vertebral body that is both more circular and more ventrally wedged, relatively short pedicles and laminae, relatively long, more cranio-laterally projecting transverse processes, and relatively long, cranially-oriented spinous processes. We found that there are biomechanical and comparative anatomical reasons for suspecting that all of these traits are capable of predisposing individuals to intervertebral disc herniation. CONCLUSIONS The results of the present study add weight to the hypothesis that intervertebral disc herniation in H. sapiens is connected with vertebral shape. Specifically, they suggest that individuals whose vertebrae are towards the ancestral end of the range of shape variation within H. sapiens have a greater propensity to develop the condition than other individuals. More generally, the study shows that evolutionary thinking has the potential to shed new light on human skeletal pathologies.
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Affiliation(s)
- Kimberly A Plomp
- Department of Archaeology, Classics and Egyptology, University of Liverpool, 14 Abercromby Square, Liverpool, L69 7WZ, UK.,Department of Archaeology, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada
| | - Keith Dobney
- Department of Archaeology, Classics and Egyptology, University of Liverpool, 14 Abercromby Square, Liverpool, L69 7WZ, UK.,Department of Archaeology, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada.,Department of Archaeology, School of Geosciences, University of Aberdeen, St Mary's, Elphinstone Road, Scotland, UK, AB24 3UF, Aberdeen
| | - Darlene A Weston
- Department of Anthropology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Una Strand Viðarsdóttir
- Biomedical Center, University of Iceland, Læknagarður, Vatnsmýrarvegi 16, 101, Reykjavík, Iceland
| | - Mark Collard
- Department of Archaeology, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada.
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Selby MS, Gillette A, Raval Y, Taufiq M, Sampson MJ. Modern Medical Consequences of the Ancient Evolution of a Long, Flexible Lumbar Spine. J Osteopath Med 2019; 119:622-630. [PMID: 31449308 DOI: 10.7556/jaoa.2019.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Modern human bipedality is unique and requires lumbar lordosis, whereas chimpanzees, our closest relatives, have short lumbar spines rendering them incapable of lordosis. To facilitate lordosis, humans have longer lumbar spines, greater lumbosacral angle, dorsally wedged lumbar vertebral bodies, and lumbar zygapophyseal joints with both increasingly coronal orientation and further caudal interfacet distances. These features limit modern lower lumbar spine and lumbosacral joint ailments, albeit imperfectly. The more coronal zygapophyseal orientation limits spondylolisthesis, while increasing interfacet distance may limit spondylolysis. Common back pain, particularly in people who are obese or pregnant, may result from increased lumbar lordosis, causing additional mass transfer through the zygapophyseal joints rather than vertebral bodies. Reduction in lumbar lordosis, such as in flatback syndrome from decreased lumbosacral angle, can also cause back pain. Human lumbar lordosis is necessary for placing the trunk atop the pelvis and presents a balancing act not required of our closest primate relatives.
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Galbusera F, Bassani T. The Spine: A Strong, Stable, and Flexible Structure with Biomimetics Potential. Biomimetics (Basel) 2019; 4:E60. [PMID: 31480241 PMCID: PMC6784295 DOI: 10.3390/biomimetics4030060] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 02/07/2023] Open
Abstract
From its first appearance in early vertebrates, the spine evolved the function of protecting the spinal cord, avoiding excessive straining during body motion. Its stiffness and strength provided the basis for the development of the axial skeleton as the mechanical support of later animals, especially those which moved to the terrestrial environment where gravity loads are not alleviated by the buoyant force of water. In tetrapods, the functions of the spine can be summarized as follows: protecting the spinal cord; supporting the weight of the body, transmitting it to the ground through the limbs; allowing the motion of the trunk, through to its flexibility; providing robust origins and insertions to the muscles of trunk and limbs. This narrative review provides a brief perspective on the development of the spine in vertebrates, first from an evolutionary, and then from an embryological point of view. The paper describes functions and the shape of the spine throughout the whole evolution of vertebrates and vertebrate embryos, from primordial jawless fish to extant animals such as birds and humans, highlighting its fundamental features such as strength, stability, and flexibility, which gives it huge potential as a basis for bio-inspired technologies.
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Affiliation(s)
- Fabio Galbusera
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy.
| | - Tito Bassani
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
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Severijns P, Overbergh T, Scheys L, Moke L, Desloovere K. Reliability of the balance evaluation systems test and trunk control measurement scale in adult spinal deformity. PLoS One 2019; 14:e0221489. [PMID: 31449540 PMCID: PMC6709918 DOI: 10.1371/journal.pone.0221489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/07/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To test the reliability of the Balance Evaluation Systems Test (BESTest) and Trunk Control Measurement Scale (TCMS) between sessions and raters in the adult spinal deformity (ASD) population. SUMMARY OF BACKGROUND DATA Up to now evaluation in ASD was mainly based on static radiographic parameters. Recently literature showed that dynamic balance was a better predictor of health-related quality of life than radiographic parameters, stressing the importance of balance assessment. However, to the best of our knowledge, reliability of balance assessment tools has not yet been investigated in the ASD population. METHODS Twenty ASD patients participated in this study. Ten patients were included in the test-retest study, including repeated measurements. Ten patients were measured once, simultaneously but independently by three raters. Each participant performed two balance scales, namely the BESTest and the TCMS. Statistical analysis consisted of intra class correlations (ICC) on scale- and subscale level, and kappa scores on item-level. Cronbach's alpha on total scores, standard errors of measurement (SEM), smallest detectable differences and percentages of agreement were also calculated. Bland-altman plots were created to investigate systematic bias. RESULTS ICC scores between sessions and raters for TCMS (0.76 and 0.88) and BESTest (0.90 and 0.94) total scores were good to excellent. SEM's between sessions and raters were also low for total scores on TCMS (1.66 and 2.35) and BESTest (2.99 and 2.32). However, on subscale- and item-level reliability decreased and ceiling effects were observed. No systematic bias was observed between sessions and raters. CONCLUSION BESTest and TCMS showed to be reliable tools to measure balance in ASD on scale-level. However, on subscale- and item-level reliability decreased and ceiling effects were observed. Therefore, the question arises if there is need for an ASD-specific balance scale.
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Affiliation(s)
- Pieter Severijns
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium
| | - Thomas Overbergh
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Lennart Scheys
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Lieven Moke
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium
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Wang Y, Ding H, Wang X, Wei Z, Feng S. Associated Factors for Osteoporosis and Fracture in Chinese Elderly. Med Sci Monit 2019; 25:5580-5588. [PMID: 31350990 PMCID: PMC6681684 DOI: 10.12659/msm.914182] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The factors associated with osteoporosis are poorly understood in the Chinese population. This study aimed to examine the factors associated with osteoporosis and with fractures in a Chinese elderly population. Material/Methods This was a cross-sectional study of elderly people living in Tianjin between 2012 and 2014. Bone mineral density was measured by dual X-ray absorptiometry. The subjects completed a questionnaire about lifestyle habits, personal and family medical history, calcium intake, and exercising. Data were gathered on occurrence of fracture at 5 years or August 2018, whichever occurred first. Results There were 298 individuals with osteoporosis (18.5% male, median age 67 years) and 397 without (46.3% male, median age 62 years). Male sex (OR=0.051, 95% CI: 0.021–0.126), age (OR=1.049, 95% CI: 1.099–1.202), being divorced/widowed (OR=2.445, 95% CI: 1.219-4.904), digestive ulcer history (OR=3.805, 95% CI: 1.539–9.405), family history of hunchback (OR=2.659, 95% CI: 1.145–6.175), family history of osteoarthropathy (OR=4.222, 95% CI: 2.128–8.375), fracture history (OR=2.138, 95% CI: 1.307–3.496), drinking green tea (OR=0.352, 95% CI: 0.217–0.574), and exercising (OR=0.303, 95% CI: 0.193–0.475) were independently associated with osteoporosis. Digestive ulcer history (OR=3.183, 95% CI: 1.178–8.5992), exercising (OR=0.354, 95% CI: 0.139–0.903), and taking calcium supplements during follow-up (OR=0.262, 95% CI: 0.112–0.611) were independently associated with fractures in patients with osteoporosis. Conclusions Female sex, age, marital status, history of digestive ulcer and fracture, and family history of hunchback and osteoarthropathy are associated with osteoporosis among elderly subjects, while drinking green tea and exercising are inversely associated. Among the patients with osteoporosis, a history of digestive ulcer is associated with fractures, while exercising and taking calcium supplements are inversely associated.
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Affiliation(s)
- Yuqiang Wang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China (mainland).,Department of Orthopedic Surgery, Affiliated Hospital of Logistics, University of Chinese Armed Police Force, Tianjin, China (mainland)
| | - Han Ding
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Xiaohua Wang
- Department of Neurological, Intensive Care Unit, Tianjin Huanhu Hospital, Tianjin, China (mainland)
| | - Zhijian Wei
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Shiqing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China (mainland)
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Diebo BG, Shah NV, Boachie-Adjei O, Zhu F, Rothenfluh DA, Paulino CB, Schwab FJ, Lafage V. Adult spinal deformity. Lancet 2019; 394:160-172. [PMID: 31305254 DOI: 10.1016/s0140-6736(19)31125-0] [Citation(s) in RCA: 236] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022]
Abstract
Adult spinal deformity affects the thoracic or thoracolumbar spine throughout the ageing process. Although adolescent spinal deformities taken into adulthood are not uncommon, the most usual causes of spinal deformity in adults are iatrogenic flatback and degenerative scoliosis. Given its prevalence in the expanding portion of the global population aged older than 65 years, the disorder is of growing interest in health care. Physical examination, with a focus on gait and posture, along with radiographical assessment are primarily used and integrated with risk stratification indices to establish optimal treatment planning. Although non-operative treatment is regarded as the first-line response, surgical outcomes are considerably favourable. Global disparities exist in both the assessment and treatment of adults with spinal deformity across countries of varying incomes, which represents an area requiring further investigation. This Seminar presents evidence and knowledge that represent the evolution of data related to spinal deformity in adults over the past several decades.
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Affiliation(s)
- Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA.
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | | | - Feng Zhu
- Department of Orthopaedic and Traumatology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dominique A Rothenfluh
- Division of Spinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | - Frank J Schwab
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, USA
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48
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Kao FC, Huang YJ, Chiu PY, Hsieh MK, Tsai TT. Factors Predicting the Surgical Risk of Osteoporotic Vertebral Compression Fractures. J Clin Med 2019; 8:E501. [PMID: 31013728 PMCID: PMC6517994 DOI: 10.3390/jcm8040501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 12/30/2022] Open
Abstract
The aim of our study was to investigate the association between global spinal alignment, spinopelvic parameters, and outcomes of osteoporotic vertebral compression fractures (OVCF). Patients with vertebral compression fractures seen at our hospital between October 2017 and November of 2018 with a bone mineral density (BMD) T-score < -2.5 were recruited for the study. Surgical intervention was performed after eight weeks of conservative treatment depending on clinical symptoms and the willingness of patients. Spinopelvic and sagittal alignment parameters were compared between patients who had surgery and those that did not. Seventy-nine patients were included in the study. Twenty-five patients (31.6%, mean age: 73.28 ± 9.78 years) received surgery, and 54 (68.3%, mean age: 73 ± 8.58 years) conservative treatment only. Pelvic tilt, pelvic incidence, and local kyphotic angle were statistically different between the groups (all p < 0.05). A sagittal vertical axis ≥ 50 mm, distance between the C7 plumb line and the center of the fractured vertebra (DSVA) ≥ 60 mm, pelvic incidence outside of the range of 44 to 62°), and pelvic tilt ≥ 27° were associted with the need for surgical intervention. Measurement of spinopelvic parameters can predict the need for surgery in patients with OVCF.
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Affiliation(s)
- Fu-Cheng Kao
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Yu-Jui Huang
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Ping-Yeh Chiu
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
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49
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Nam HS, Han M, Choi HY, Song K, Kang S, Ahn SM, Lee SU. Effect of reclining angle on lumbar lordosis at driving posture: A radiological evaluation. J Back Musculoskelet Rehabil 2019; 31:923-930. [PMID: 29945341 DOI: 10.3233/bmr-170875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Optimal seatback angles for automobile drivers' seats have been investigated based on comfort and back muscle activities; however, radiology supported evidences are scarce. OBJECTIVE The aim of this study was to evaluate optimal range of the seatback reclining regarding torso angles for an automobile driver's seat to preserve lumbar lordosis. METHODS Thirty-one healthy volunteers were recruited among five body type categories. Lateral lumbar spine X-rays were obtained for the neutral sitting posture without seatback (reference), and with reclining angles of 23∘ to 33∘ by 2∘ intervals. The Cobb angles for the L1-L4, L4-S1, and L1-S1 segments were measured. RESULTS The Cobb angle for L4-S1 was nearest to the reference (18.74 ± 1.57∘, mean ± standard error mean) at reclining angles of 29∘ and 31∘ (14.51 ± 1.41∘ and 14.47 ± 1.43∘, respectively). The Cobb angle at L4-S1 between reclining angles of 27∘(12.02 ± 1.31∘) and 29∘ (14.51 ± 1.41∘) were significantly different (p< 0.001). Tall men showed relatively preserved lordosis angles at all reclining angles. Fat men and short women demonstrated prominent loss of lordosis with excessively kyphotic L1-L4 segment. CONCLUSIONS Reclining angles of 29∘ to 31∘ revealed to be optimal for preserving lordosis at the L4-S1 segment. Individualized healthcare-related guideline for driver's seat adjustment setting is necessary.
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Affiliation(s)
- Hyung Seok Nam
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Manyong Han
- Department of Mechanical and System Design Engineering, Hongik University, Seoul, Korea
| | - Hyung Yun Choi
- Department of Mechanical and System Design Engineering, Hongik University, Seoul, Korea
| | - Kyuman Song
- School of Architecture, Hongik University, Seoul, Korea
| | - Seonggyu Kang
- Hyundai Motors Namyang R&D Division, Hwaseong-si, Korea
| | - Sung Min Ahn
- Hyundai Motors Namyang R&D Division, Hwaseong-si, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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50
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Rothrock RJ, McNeill IT, Yaeger K, Oermann EK, Cho SK, Caridi JM. Lumbar Lordosis Correction with Interbody Fusion: Systematic Literature Review and Analysis. World Neurosurg 2018; 118:21-31. [DOI: 10.1016/j.wneu.2018.06.216] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/23/2018] [Accepted: 06/26/2018] [Indexed: 01/04/2023]
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