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Wang D, Wang W, Wang Y, Kong C, Wang S, Buser Z, Diwan AD, Chen X, Lu S. Identification and impact of failure of pelvic compensation in patients with adult spinal deformity. Spine J 2024:S1529-9430(24)00303-6. [PMID: 38925300 DOI: 10.1016/j.spinee.2024.06.011] [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: 04/07/2024] [Revised: 06/09/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND CONTEXT Previous research has identified a specific subtype known as failure of pelvic compensation (FPC) in patients with adult spinal deformity (ASD). However, the criteria for assessing FPC remain inconsistent, and its impacts on spinal sagittal alignment and health-related quality-of-life (HRQoL) scores remain unclear. PURPOSE To propose a novel criterion for identifying FPC based on variations in spinopelvic alignment during the transition from the supine to upright position and to evaluate the effects of FPC on patients' spinal sagittal alignment and HRQoL scores. STUDY DESIGN/SETTING Retrospective cross-sectional study. PATIENT SAMPLE Patients with ASD from a monocenter database. OUTCOME MEASURES Radiographic measures, including thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt, pelvic incidence (PI), and sagittal vertical axis (SVA), were measured on lateral whole-spine radiographs. LL and SS were also measured on reconstructed lumbar computed tomography images in the sagittal view taken in the supine position. The relative functional cross-sectional area (rFCSA) of paraspinal muscles was evaluated via lumbar magnetic resonance imaging. HRQoL measures, encompassing visual analog scale for back pain (VAS-BP), Oswestry Disability Index (ODI), and Scoliosis Research Society-22R (SRS-22R), were collected. METHODS A total of 154 patients were enrolled. Based on the calculated minimum detectable change of SS, FPC was defined as the change in SS of less than 3.4° between supine and upright positions. Patients were divided into 3 groups: sagittal balance with pelvic compensation (SI-PC), sagittal imbalance with pelvic compensation (SI-PC), and sagittal imbalance with failure of pelvic compensation (SI-FPC). Radiographic parameters and HRQoL scores were compared among the groups. RESULTS Thirty-six patients were categorized into the SB-PC group, 87 into the SI-PC group, and 31 into the SI-FPC group. Patients with low PI and small paraspinal muscles rFCSA were more prone to experiencing FPC accompanied by severe sagittal imbalance. The SI-FPC group exhibited less TK and a larger SS than the SI-PC group exhibited and had a similar SVA as that of the SI-PC group. Additionally, they displayed worse VAS-BP, ODI, SRS-function, and SRS-22 total scores than the SB-PC group displayed. CONCLUSIONS In patients with ASD, an inherently low pelvic compensatory reserve and a high fatty infiltration in paraspinal muscles are pivotal factors contributing to FPC. Compared with SI-PC patients, SI-FPC patients demonstrate a thoracic-dominant compensatory pattern for sagittal malalignment. In addition, these patients experienced more severe pain and functional decline than the SB-PC patients experienced.
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Affiliation(s)
- Dongfan Wang
- Department of Orthopedics & Elderly Spinal Surgery, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing 100053, China
| | - Wei Wang
- Department of Orthopedics & Elderly Spinal Surgery, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing 100053, China
| | - Yu Wang
- Department of Orthopedics & Elderly Spinal Surgery, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing 100053, China
| | - Chao Kong
- Department of Orthopedics & Elderly Spinal Surgery, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing 100053, China
| | - Shuaikang Wang
- Department of Orthopedics & Elderly Spinal Surgery, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing 100053, China
| | - Zorica Buser
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, USA
| | - Ashish D Diwan
- Department of Orthopaedic Surgery, Spine Service, St. George Hospital Campus, Sydney, New South Wales, Australia
| | - Xiaolong Chen
- Department of Orthopedics & Elderly Spinal Surgery, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing 100053, China
| | - Shibao Lu
- Department of Orthopedics & Elderly Spinal Surgery, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing 100053, China.
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Iplikcioglu AC, Karabag H. L1 slope: an overlooked spinal parameter. Arch Orthop Trauma Surg 2024; 144:2077-2083. [PMID: 38642160 PMCID: PMC11093775 DOI: 10.1007/s00402-024-05311-8] [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: 01/16/2023] [Accepted: 03/28/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE Lumbar lordosis can be divided into two parts by a horizontal line, creating the L1 slope and the sacral slope. Despite being a major spinopelvic parameter, the L1slope (L1S) is rarely reported. However, there is some evidence that L1S is a relatively constant parameter. This study aimed to analyze the L1 slope and its relationships with other spinopelvic parameters. METHODS Standing lateral lumbosacral x-ray radiographies of 76 patients with low back pain and CT scans of 116 asymptomatic subjects were evaluated for spinal and spinopelvic parameters including L1 slope (L1S). The x-ray and CT groups were divided into subgroups according to mean sacral slope (SS) or pelvic incidence (PI) values. The mean values of the spinopelvic parameters and the correlations between them were investigated and compared. RESULTS L1S was 19.70 and 18.15 in low SS and high SS subgroups of x-ray respectively. L1S was 7.95 and 9.36 in low and high PI subgroups of CT, respectively, and the differences were insignificant statistically. L1S was the only spinal parameter that did not change as SS or PI increased in standing and supine positions. L1S was correlated with lumbar lordosis (LL) proximal lumbar lordosis (PLL) and distal lumbar lordosis (DLL) in both x-ray and CT groups. L1S was also the strongest correlated parameter with pelvic incidence lumbar lordosis mismatch (PI-LL) mismatch in supine position. CONCLUSIONS L1S is a relatively constant parameter and is around 16°-18° and 8°-9° in the standing and supine positions, respectively. It was significantly correlated with LL, PLL, DLL, and PI-LL. In the standing position it was nearly equal to PLL while this equality was present in low PI subgroups of CT. There is strong evidence that L1S is significantly correlated with health-related quality of life scores.
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Affiliation(s)
| | - Hamza Karabag
- Department of Neurosurgery, Faculty of Medicine, Harran University, Şanlıurfa, Turkey.
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Giorgi H, Tomi F, Glard Y, Afonso D, Montanari L, Faure A. Change of vertebral orientation, between the supine position and the prone position. Spine Deform 2023; 11:1079-1092. [PMID: 37221317 DOI: 10.1007/s43390-023-00704-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/06/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE Our aim was to assess the change of vertebral orientation, expressed in the sagittal plane, in the transversal plane and in the frontal plane, at each level from T1 to S1 between the supine position (like in in a CT scan) and the prone position lying on bolsters like in an OR. METHODS Thirty-six patients were selected and included for a total number of one hundred and forty-eight vertebral levels. There were 30 females and 6 males. The mean age was 15 years and 9 months. A semi-automatic image processing technique and software (3D slicer), with a custom-made python script add-on, was used for each patient: paired preoperative CT scan and intraoperative cone beam computed tomography (CBCT) scan were processed to acquire complete spinal reconstructions in a consistent 3D coordinate system. The aim was to automatically compute a set of sagittal, transversal, and frontal rotations of each vertebral level of the same patient describing the 3D vertebral rotation between the supine position and the prone position lying on bolsters. RESULTS For sagittal analysis, the results showed a behavior in the evolution of rotation depending on the level. Between T01 and T10, the rotation was between - 14° and - 8°. Between T10 and L05, the sagittal rotation increased from - 10° up to + 10°. For frontal and transversal analysis, the rotations were under 6.5°. CONCLUSION These results could be valuable to perform a safe virtual templating: the information given by the virtual templating seems to be more accurate in the transversal plane than in the sagittal plane.
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Affiliation(s)
- Hadrien Giorgi
- Institut Méditerranéen du Dos, 232 Av. du Prado, 13008, Marseille, France
| | - Florent Tomi
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Univ, Univ Gustave Eiffel, IFSTTAR, LBA, 13016, Marseille, France
| | - Yann Glard
- Hôpital Saint Joseph, Service de Chirurgie Pédiatrique, 13008, Marseille, France.
| | - David Afonso
- Hôpital Saint Joseph, Service de Chirurgie Pédiatrique, 13008, Marseille, France
| | - Lucrezia Montanari
- Hôpital Saint Joseph, Service de Chirurgie Pédiatrique, 13008, Marseille, France
| | - Aymeric Faure
- Institut Méditerranéen du Dos, 232 Av. du Prado, 13008, Marseille, France
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Xilong C, Kangkang W, Wanmei Y, Beibei L, Yunlei Z, Haiyang Y, Zikai H. Sagittal Spinopelvic Alignment in the Standing and Prone Positions of Patients with Old Traumatic Thoracolumbar Kyphosis: Relationship with Immediately Postoperative Parameters. World Neurosurg 2023; 176:e692-e696. [PMID: 37295468 DOI: 10.1016/j.wneu.2023.05.121] [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: 01/19/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the changes in spine-pelvis sagittal parameters from the standing position to the prone position and to study the relationship between sagittal parameters and immediately postoperative parameters. METHODS Thirty-six patients with old traumatic spinal fracture combined with kyphosis were enrolled. The preoperative standing position, prone position, and postoperative sagittal parameters of the spine and pelvis, including the local kyphosis Cobb angle (LKCA), thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sacral slope (SS), pelvic tilt (PT), pelvic incidence minus lumbar lordosis angle (PI-LLA), and sagittal vertebral axis (SVA), were measured. The data of kyphotic flexibility and correction rate werecollected and analyzed. The parameters of the preoperative standing position, prone position and postoperative sagittal position were analyzed statistically. Correlation analysis and regression analysis of the preoperative standing and prone sagittal parameters and postoperative parameters were conducted. RESULTS There were significant differences in the preoperative standing position, prone position, and postoperative LKCA and TK. Correlation analysis showed that preoperative sagittal parameters of the standing position and prone position were all correlated with postoperative homogeneity. Flexibility was not related to the correction rate. Regression analysis showed preoperative standing, prone LKCA, and TK were linear with postoperative standing. CONCLUSIONS The LKCA and TK of old traumatic kyphosis obviously changed from the standing position to the prone position, which were linear with postoperative LKCA and TK and can be used to predict postoperative sagittal parameters. This change should be taken into account in the surgical strategy.
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Affiliation(s)
- Cui Xilong
- School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China; Spinal Deformity Clinical and Research Center of Anhui Province, Fuyang City, Anhui, China
| | - Wang Kangkang
- Department of Orthopedics, Fuyang People's Hospital, Fuyang City, Anhui, China; Spinal Deformity Clinical and Research Center of Anhui Province, Fuyang City, Anhui, China
| | - Yang Wanmei
- Department of Orthopedics, Fuyang People's Hospital, Fuyang City, Anhui, China; Spinal Deformity Clinical and Research Center of Anhui Province, Fuyang City, Anhui, China
| | - Li Beibei
- Spinal Deformity Clinical and Research Center of Anhui Province, Fuyang City, Anhui, China; Department of Orthopedics, The Sixth Fuyang People's Hospital, Fuyang City, Anhui, China
| | - Zhai Yunlei
- Department of Orthopedics, Fuyang People's Hospital, Fuyang City, Anhui, China; Spinal Deformity Clinical and Research Center of Anhui Province, Fuyang City, Anhui, China
| | - Yu Haiyang
- Department of Orthopedics, Fuyang People's Hospital, Fuyang City, Anhui, China; Spinal Deformity Clinical and Research Center of Anhui Province, Fuyang City, Anhui, China
| | - Hua Zikai
- School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China; Spinal Deformity Clinical and Research Center of Anhui Province, Fuyang City, Anhui, China.
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Sato K, Ito T, Endo T, Miura T, Iwabuchi M, Shirado O. Novel assessment of physiotherapy outcomes in adults with structural spinal disorders. 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 2023:10.1007/s00586-023-07696-3. [PMID: 37039881 DOI: 10.1007/s00586-023-07696-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/25/2023] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE The aim is to investigate whether a simple prone posture assessment test (P-test) at baseline can be predict the effectiveness of at least 3 months of physiotherapy for adults with structural spinal disorders. METHODS Seventy-six adults (age 71.0 ± 7.1 years) with structural spinal disorders who visited our outpatient clinic and underwent physiotherapy, which included muscle strength and range of motion training was provided once a week for a minimum of 3 months, and where the load was adjusted individually by the physiotherapist. The P-test is performed with the subject lying on the bed in a prone position and is positive if no low back pain is seen and the abdomen touches the bed. The Oswestry Disability Index (ODI) was used to assess disability. The minimum clinically important difference (MCID) was set at 10% improvement of the ODI score. Logistic regression analysis was performed to investigate the association between baseline P-test and achievement of ODI-MCID. RESULTS The study population characteristics were: Sagittal vertical axis 138.1 ± 73.2 mm; Pelvic tilt, 36.9 ± 9.8 degrees; Pelvic incidence minus lumbar lordosis, 45.3 ± 22.1 degrees; and maximum coronal Cobb angle, 21.3 ± 19.7 degrees. Logistic regression analysis showed that being positive on the P-test was associated with the achievement of ODI-MCID (Odds ratio, 8.381; 95% confidence interval, 2.487-35.257). CONCLUSIONS This study found that our developed P-test was a useful predictor of achieving the ODI-MCID in a cohort of adults with structural spinal disorders receiving at least 3 months of physiotherapy.
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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, Fukushima, 969-3492, Japan.
| | - Toshikazu Ito
- Departments of Rehabilitation/Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-Aza-Maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
- Hokkaido Chitose College of Rehabilitation, Chitose, Hokkaido, Japan
| | - Tatsuya Endo
- Departments of Rehabilitation/Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-Aza-Maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Takuya Miura
- Departments of Rehabilitation/Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-Aza-Maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Masumi Iwabuchi
- Departments of Rehabilitation/Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-Aza-Maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Osamu Shirado
- Departments of Rehabilitation/Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-Aza-Maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
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Iplikçioğlu AC, Karabağ H. Posterior Pubic Incidence: A Novel Morphologic Spinopelvic Parameter Nearly Equal to Pelvic Incidence. World Neurosurg 2023; 172:e100-e106. [PMID: 36640837 DOI: 10.1016/j.wneu.2022.12.050] [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: 11/02/2022] [Accepted: 12/11/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pelvic incidence (PI) and Jackson's angle are 2 major spinopelvic parameters that define the position of the sacrum within the pelvis. These parameters are measured on standing lateral radiography, and the identification of the hip axis is essential for measurements. Moreover, identifying the hip axis in patients with hip diseases or femoral head deformity is challenging. In this study, we described a novel parameter named posterior pubic incidence (PPI) that could be measured using the posterior pubic edge instead of the hip axis. METHODS Group A comprised 50 volunteers who underwent standing lateral lumbosacral radiography. Group B comprised 54 patients with abdominal or urologic problems who underwent supine computed tomography. The PI, pelvic tilt (PT), sacral slope, PPI, and posterior pubic tilt were measured. The differences between PI and PPI were evaluated. Linear regression analysis was used to predict the PI value from PPI. RESULTS The mean PI and PPI values were 47.41° ± 12.32° and 49.32° ± 11.94° in group A and 49.19° ± 9.99° and 49.99° ± 9.25° in group B, respectively. The mean absolute differences in groups A and B were 2.41° ± 1.63° and 1.9° ± 1.62°, respectively. High correlations were obtained between PI/PPI and pelvic tilt/posterior pubic tilt. PI could be calculated as PI° = PPI° - 2° on plain radiography and as PI° = PPI° - 1° on computed tomography. CONCLUSIONS PPI was strongly correlated with PI, which was nearly equal to PI, and may replace PI in formulas containing PI.
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Affiliation(s)
| | - Hamza Karabağ
- Department of Neurosurgery, Harran Üniversity, Şanlıurfa, Turkey.
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Wang K, Zhang W, Zhai Y, Zhang F, Yin W, Sun L, Hua Z, Cui X, Yu H. Effect of Position on Regional Kyphosis Angle in Patients with Kyphosis Secondary to Symptomatic Old Osteoporotic Thoracolumbar Fracture. World Neurosurg 2023; 171:e731-e737. [PMID: 36581156 DOI: 10.1016/j.wneu.2022.12.096] [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: 10/13/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of position on regional kyphosis angle (RKA) in patients with kyphosis secondary to symptomatic old osteoporotic thoracolumbar fracture (so-OTLF). METHODS The authors evaluated the radiographic data of patients with kyphosis secondary to so-OTLF who underwent posterior corrective fusion surgery in our hospital. The spine sagittal parameters were evaluated in the standing position preoperatively. RKA was measured under standing radiograph, full-length spine computed tomography image in prone position and intraoperative prone X-ray radiograph, respectively. Changes in RKA were compared between groups. RESULTS Thirty-three patients were included. The average RKAs in the standing position, preoperative prone position, and intraoperative prone position were 46.2°, 31.1°, and 30.5° respectively. RKA decreased significantly from standing to preoperative prone position or intraoperative prone position (P < 0.001). In 93.9% (31/33) of the patients, the difference between preoperative prone RKA and intraoperative prone RKA was within 5°. The changes in RKA from standing to intraoperative prone position in the moderate to severe kyphosis group were significantly greater than those in the mild kyphosis group (P < 0.001). CONCLUSIONS The reductive effect of the intraoperative prone position was greater in patients with moderate to severe kyphosis deformities. RKA in the preoperative prone position was almost the same as the RKA in the intraoperative prone position. Therefore, assessing preoperative full-length spine computed tomography in the prone position helped formulate the plan for corrective surgery in patients with kyphosis secondary to so-OTLF.
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Affiliation(s)
- Kangkang Wang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Wei Zhang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Yunlei Zhai
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Feng Zhang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Wen Yin
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Lele Sun
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Zikai Hua
- School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China
| | - Xilong Cui
- School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China
| | - Haiyang Yu
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China; School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China.
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Karabag H, Iplikcioglu AC, Dusak A, Karayol SS. Pelvic incidence measurement with supine magnetic resonance imaging: A validity and reliability study. Clin Neurol Neurosurg 2022; 222:107424. [PMID: 36030728 DOI: 10.1016/j.clineuro.2022.107424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/13/2022] [Accepted: 08/20/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Classically, pelvic incidence (PI) and other spinopelvic sagittal parameters are measured using plain x-ray obtained with the patient standing. However, it is difficult to obtain a perfect mid-sagittal appearance of the sacral endplate and superimposition of both femoral heads from a plain x-ray. Overlapping of the iliac wings also could obscure the appearance of the sacral endplate. Recent studies showed that MRI was more reliable than x-ray for evaluating some spinal sagittal parameters. To our knowledge, measurements of spinopelvic sagittal parameters using supine MRI have not been reported previously. We assessed the validity and reliability of measurements of spinopelvic sagittal parameters from standing lateral x-rays and supine magnetic resonance imaging (MRI). METHODS We recruited 26 asymptomatic volunteers for this study. Standing lateral lumbosacral radiographs, including femoral heads and spinopelvic MRI images with coronal images of the femoral heads were performed. The anatomic reference point required to measure PI was found on coronal MRI images and transferred to the midline sagittal MRI using the bladder wall as a second reference point. PI, sacral slope (SS), and pelvic tilt (PT) were measured on x-ray and MRI images. Validity and reliability of results also were tested. RESULTS Of 14 males and 12 females (average age, 31.30), PI was obtained from x-ray and MRI in 52. ± 6.89 and 51.42 ± 6.43, respectively. From standing x-ray to supine MRI, PT decreased by 3.16°, while SS increased 2.5°. A paired t-test showed a significant difference between PT values from x-ray and MRI. The correlation was highest between the x-ray and MRI measurements of PI, PT, and SS, respectively. Intraobserver and interobserver reliabilities were between 0.88 and 0.96 on x-ray and MRI. All reliabilities were excellent, although MRI values were higher. CONCLUSION MRI was more reliable in the measurement of spinopelvic parameters than classic standing x-ray examination. Higher reliability and being radiation-free could make MRI a good alternative to standing x-ray.
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Affiliation(s)
- Hamza Karabag
- Department of Neurosurgery, Harran University Faculty of Medicine, Şanlıurfa, Turkey.
| | | | - Abdurrahim Dusak
- Department of Radiology, Harran University Faculty of Medicine, Şanlıurfa, Turkey.
| | - Sunay Sibel Karayol
- Department of Radiology, Harran University Faculty of Medicine, Şanlıurfa, Turkey.
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Camargo C, Abode-Iyamah K, Shah JS, Bechtle PS, Freeman WD. Comprehensive Perioperative Approach to Complex Spine Deformity Management. Clin Spine Surg 2022; 35:310-318. [PMID: 34334699 DOI: 10.1097/bsd.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Study perioperative strategies for optimizing neuroprotection in complex spine deformity correction surgery. METHODS We report the case of a patient with severe lumbar dextroscoliosis, thoracolumbar junction hyperkyphosis with a 40-degree Cobb angle levoconvex scoliosis who underwent spinal deformity correction with loss of neuromonitoring during surgery. We performed a literature review on perioperative management of complex spine deformity. RESULTS A 50-year-old man presented with lumbar pain and right L4 radiculopathy. Surgical intervention for deformity correction and decompression was indicated with T4-L4 posterior instrumentation L2/L3 and L3/L4 transforaminal lumbar interbody fusion. Surgery was aborted due to the loss of neuromonitoring. Postsurgery, the patient had left sensory deficit and the neurocritical care team clinically suspected and deduced the anatomic location of the spinal cord compression. Magnetic resonance imaging confirmed a T10-T11 hyperintensity suggestive of cord ischemia due to osteophyte compressing the spinal cord. The patient underwent a second corrective surgery with no intraoperative events and has no long-term neurological sequela. CONCLUSIONS This case illustrates that a comprehensive perioperative approach and individualized risk factor assessment is useful in complex spine deformity surgery. Further research is needed to determine how this individualized comprehensive approach can lead to intraoperative and postoperative countermeasures that improved spine surgery outcomes. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
| | | | | | | | - William D Freeman
- Departments of Neurologic Surgery
- Neurology
- Critical Care Medicine, Mayo Clinic, Jacksonville, FL
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Single-position prone transpsoas fusion for the treatment of lumbar adjacent segment disease: early experience of twenty-four cases across three tertiary medical centers. 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; 31:2255-2261. [PMID: 35590015 DOI: 10.1007/s00586-022-07255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/21/2022] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Prone transpsoas fusion (PTP) is a minimally invasive technique that maximizes the benefit of lateral access interbody surgery and the prone positioning for surgically significant adjacent segment disease. The authors describe the feasibility, reproducibility and radiographic efficacy of PTP when performed for cases of lumbar ASD. METHODS Adult patients undergoing PTP for treatment of lumbar ASD at three institutions were retrospectively enrolled. Demographic information was recorded, as was operative data such as adjacent segment levels, operative time, blood loss, laterality of approach, open versus percutaneous pedicle screw instrumentation and need for primary decompression. Radiographic measurements including segmental and global lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope and sagittal vertical axis were recorded both pre- and immediately post-operatively. RESULTS Twenty-four patients met criteria for inclusion. Average age was 60.4 ± 10.4 years and average BMI was 31.6 ± 5.0 kg/m2. Total operative time was 204.7 ± 83.3 min with blood loss of 187.9 ± 211 mL. Twenty-one patients had pedicle screw instrumentation exchanged percutaneously and 3 patients had open pedicle screw exchange. Two patients suffered pulmonary embolism that was treated medically with no long-term sequelae. One patient had transient lumbar radicular pain and all patients were discharged home with an average length of stay of 3.0 days (range 1-6). Radiographically, global lumbar lordosis improved by an average of 10.3 ± 9.0 degrees, segmental lordosis by 10.1 ± 13.3 degrees and sagittal vertical axis by 3.2 ± 3.2 cm. CONCLUSION Single-position prone transpsoas lumbar interbody fusion is a clinically reproducible minimally invasive technique that can effectively treat lumbar adjacent segment disease.
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Preoperative Radiographic Evaluation of Thoracic Flexibility and Compensation for Adult Spinal Deformity Surgery. How to Select Optimal Upper Instrumented Vertebra to Prevent Proximal Junctional Kyphosis. Spine (Phila Pa 1976) 2022; 47:144-152. [PMID: 34027926 DOI: 10.1097/brs.0000000000004126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study of a cohort of consecutive patients. OBJECTIVE The aim of this study was to clarify the usefulness and value of the difference in thoracic kyphosis (ΔTK) angle in various positions by imaging the patient standing, prone, and supine to evaluate TK flexibility and compensation, and to establish optimal radiography to determine an appropriate thoracic level for upper instrumented vertebra (UIV) because a strategy to select an appropriate level to avoid proximal junctional kyphosis (PJK) remains elusive. SUMMARY OF BACKGROUND DATA Postoperative reciprocal progression of TK is a significant risk factor for PJK. However, how to predict and prevent postoperative reciprocal progression of TK remains unclear. We hypothesized that preoperative evaluation of both TK flexibility and compensation is essential to predict PJK and determine the UIV level. METHODS We included 144 consecutive patients with adult spinal deformity (ASD), ≥2 years' follow-up, and UIV Th9-11 in this retrospective cohort study. TK was measured from images with patients standing, prone, and supine. Supine ΔTK was calculated as standing TK- supine TK. Prone ΔTK was calculated as standing TK - prone TK. Receiver-operating characteristic (ROC) curves were analyzed to determine the thresholds of supine ΔTK and prone ΔTK for PJK occurrence. RESULTS PJK was observed in 64 of 144 (44%) patients 2 years postoperatively. Prone and supine ΔTKs were significantly larger in patients with PJK. A significant positive correlation between prone ΔTK and supine ΔTK was observed. When data from patients with and without PJK were plotted separately, a significantly higher proportion of patients with PJK had large prone and supine ΔTKs. The cutoff values of prone and supine ΔTKs for PJK risk were determined using ROC curve analysis. CONCLUSION Because of their significantly high risk for PJK, in patients with ASD and prone ΔTK >11.5° and supine ΔTK >18.5°, the upper-thoracic spine should be considered for UIV.Level of Evidence: 3.
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Ohyama S, Aoki Y, Inoue M, Nakajima T, Sato Y, Watanabe A, Takahashi H, Kubota G, Nakajima A, Saito J, Eguchi Y, Orita S, Nakagawa K, Ohtori S. Predictors of Spontaneous Restoration of Lumbar Lordosis after Single-Level Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Diseases. Spine Surg Relat Res 2021; 5:397-404. [PMID: 34966866 PMCID: PMC8668222 DOI: 10.22603/ssrr.2020-0195] [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: 10/29/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Preoperative factors that predict postoperative restoration of lumbar lordosis (LL) are not well understood. To investigate whether preoperative postural correction of LL, sagittal malalignment, or lumbar flexibility are associated with the postoperative restoration of LL in patients treated with a single-level transforaminal lumbar interbody fusion (TLIF), a retrospective cohort study was conducted. Methods We enrolled 104 patients (mean age: 67.5±10.7 years old; 47 men and 57 women) with lumbar degenerative diseases treated with a single-level TLIF. The pre- and postoperative LL were examined using lateral radiographs in the standing position and computed tomography (CT) images in the supine position. The correlation between postoperative LL restoration and preoperative postural correction of LL (difference in LL between the standing and supine positions: D-LL), sagittal imbalance (pelvic incidence minus LL: PI-LL), and lumbar flexibility (difference in LL between the flexion and extension postures) were analyzed. Patients were divided into two groups according to the D-LL (D-LL≥0° and D-LL<0°). The rates of postoperative LL restoration (postoperative LL-preoperative LL in standing) were compared between the two groups. Results Multiple regression analysis performed after adjustment for age, gender, body mass index, and cage angle revealed that postoperative LL restoration was significantly correlated with D-LL (p<0.001), but not with PI-LL, and lumbar flexibility. Patients with a preoperative D-LL≥0° showed a significantly greater increase of LL after TLIF (7.1°±11.2°) than those with D-LL<0° (1.4°±6.6°) (p=0.003). Conclusions A preoperative evaluation of a lateral radiograph or CT taken in the supine position is useful in predicting postoperative improvement of sagittal alignment. Postoperative improvement of sagittal spinopelvic alignment would be expected when LL is corrected in the supine position preoperatively. Surgeons should pay attention to the postural correction of LL when performing short-segment fusion surgery for lumbar degenerative disease with sagittal malalignment.
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Affiliation(s)
- Shuhei Ohyama
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Chiba University, Chiba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Go Kubota
- Department of Orthopaedic Surgery, Sawara Prefectural Hospital, Katori, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
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Perna A, Proietti L, Smakaj A, Velluto C, Meluzio MC, Rovere G, Florio D, Zirio G, Tamburrelli FC. The role of femoral obliquity angle and T1 pelvic angle in predicting quality of life after spinal surgery in adult spinal deformities. BMC Musculoskelet Disord 2021; 22:999. [PMID: 34847906 PMCID: PMC8630841 DOI: 10.1186/s12891-021-04823-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adult spinal deformities (ASD) represent a growing clinical condition related to chronic pain, disability and reduction in quality of life (QoL). A strong correlation among spinal alignment, spinopelvic parameters and QoL after spinal fusion surgery in ASD patients was thoroughly investigated over the last decade, However, only few studies focused on the relationship between lumbo-pelvic-femoral parameters - such as Femoral Obliquity Angle (FOA), T1 Pelvic Angle (TPA) and QoL. METHODS Radiological and clinical data from 43 patients surgically treated with thoracolumbar posterior spinal fusion for ASD between 2015 and 2018 were retrospectively analyzed. The primary outcomes were the correlation between preoperative spino-pelvic-femoral parameters and postoperative clinical, functional outcomes and QoL. Secondary outcomes were: changes in sagittal radiographic parameters spino-pelvic-femoral, clinical and functional outcomes and the rate of complications after surgery. RESULTS Using Spearman's rank correlation coefficients, spinopelvic femoral parameters (FOA, TPA, pre and post-operative) are directly statistically correlated to the quality of life (ODI, SRS-22, pre and post-operative; > 0,6 strong correlation, p < 0.05). Stratifying the patients according pre preoperative FOA value (High FOA ≥ 10 and Normal/Low FOA < 10), those belonging to the first group showed worse clinical (VAS: 5.2 +/- 1.4 vs 2.9 +/- 0.8) and functional outcomes (ODI: 35.6+/- 6.8 vs 23.2 +/- 6.5) after 2 years of follow-up and a greater number of mechanical complications (57.9% vs 8.3% p < 0.0021). CONCLUSION Based on our results, preoperative FOA and TPA could be important prognostic parameters for predicting disability and quality of life after spinal surgery in ASD patients and early indicators of possible spinal sagittal malalignment. FOA and TPA, like other and better known spinopelvic parameters, should always be considered when planning corrective surgery in ASD patients.
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Affiliation(s)
- Andrea Perna
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amarildo Smakaj
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Calogero Velluto
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Concetta Meluzio
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Florio
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Zirio
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Aoki Y, Inoue M, Takahashi H, Kubota G, Watanabe A, Nakajima T, Sato Y, Nakajima A, Saito J, Eguchi Y, Orita S, Fukuchi H, Sakai T, Ochi S, Yanagawa N, Nakagawa K, Ohtori S. Computed Tomographic Assessment of Age- and Gender-Specific Sagittal Lumbopelvic Alignment in a Japanese Population. Spine Surg Relat Res 2021; 5:278-283. [PMID: 34435152 PMCID: PMC8356231 DOI: 10.22603/ssrr.2020-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/29/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Previous studies have reported differences in lumbopelvic alignment between standing and supine positions. Computed tomography (CT) images taken in the supine position are often used for clinical studies in addition to standing radiographs, although not frequently. Our study aims to clarify normative values of CT-evaluated lumbopelvic parameters and the characteristics of age- and gender-related lumbopelvic alignment in the supine position. Methods Patients undergoing CT scans of abdominal or lumbar regions for reasons other than low back disorders were included (n=581). Sagittal multiplanar reconstruction CT images were obtained, and lumbar lordosis (LL), L5-S1 angle, and sacral slope (SS) were measured. Mean values of the parameters in patients aged 59 years and under, 60-69, 70-79, and 80 and over, and in males and females, were calculated. Age- and gender-related differences in these parameters were statistically analyzed. Results Among the four age groups, patients 80 years and over showed significantly lower LL and SS than patients aged 70-79. Females 80 years and over showed significantly lower LL and SS than all other age groups, but those in males did not. The comparison between males and females showed no significant differences in LL and SS; however, the L5-S1 angle was significantly higher in males than in females. In patients 80 years and over, females showed significantly lower LL and SS than in males. Conclusions This study provides normative CT-evaluated lumbopelvic parameters, such as LL, L5-S1 angle, and SS, which will be utilized for comparisons in future studies. The present study first revealed that pelvic retroversion and lumbar kyphosis occur in elderly females in the supine position, which raised a possibility that age-related decrease of LL and SS in females occurs at an older age in the supine position than in the standing position.
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Affiliation(s)
- Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Go Kubota
- Department of Orthopaedic Surgery, Sawara Prefectural Hospital, Katori, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroyuki Fukuchi
- Department of Radiology, Eastern Chiba Medical Center, Togane, Japan
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, Togane, Japan
| | - Shigehiro Ochi
- Department of Radiology, Eastern Chiba Medical Center, Togane, Japan
| | - Noriyuki Yanagawa
- Department of Radiology, Eastern Chiba Medical Center, Togane, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Yoshida S, Oya S, Matsui T. Risk factors of meralgia paresthetica after prone position surgery: Possible influence of operating position, laminectomy level, and preoperative thoracic kyphosis. J Clin Neurosci 2021; 89:292-296. [PMID: 34119283 DOI: 10.1016/j.jocn.2021.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022]
Abstract
Obesity and a prolonged surgical duration are reported risk factors for meralgia paresthetica (MP) after prone position surgery; however, this fails to explain why MP seldom occurs after prone position craniotomy. We reviewed the incidence of MP after spinal surgery and craniotomy in the prone position and investigated whether unidentified factors are involved in the mechanism of postoperative MP. Between January 2014 and March 2020, we performed 556 prone position surgeries. We excluded patients aged ≤16 years and those who were comatose or who required redo-surgery, and reviewed 446 eligible patients (124 who underwent craniotomies and 322 who underwent posterior spinal surgeries). Postoperative MP occurred in 46 (10.3%) patients with a higher incidence after spinal surgery than after craniotomy (13.7% vs. 1.6%, p < 0.001). Among the 322 patients who received posterior spinal surgery, thoracic and lumbar laminectomies were associated with a higher incidence of MP than cervical laminectomy. Analyses limited to those patients who received thoracic and lumbar laminectomies revealed that the preoperative thoracic kyphosis (TK) angle was significantly greater in patients with MP than in those without MP (average TK angle, 38.9° vs. 23.1°; p < 0.001), and that the preoperative lumbar lordosis angle did not significantly differ between the two groups. Apart from the known predisposing factors, we found that thoracolumbar-sacral laminectomy in patients with a greater TK angle is also a risk factor for MP after prone position surgery.
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Affiliation(s)
- Shinsuke Yoshida
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
| | - Toru Matsui
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Baker JF, Robertson PA. Segmental Contributions to Lumbar Lordosis: A Computed Tomography Study. Int J Spine Surg 2020; 14:949-955. [PMID: 33560255 DOI: 10.14444/7144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the contribution of individual vertebral body lordosis to lumbar lordosis and establish the relationship of vertebral body lordosis to the pelvic incidence (PI). METHODS One-hundred and two computed tomography (CT) scans on patients free of radiographic disease were measured for PI and segmental lordosis of both bone and disc from L1 to sacrum. Correlative analysis and analysis of variance (ANOVA) were used to identify contribution from bone and disc to lordosis. RESULTS The mean total bony lordosis was 10.8° (SD 11.5°), mean total disc lordosis was 36.3° (SD 9.9°), and mean combined lordosis was 47.1° (SD 10.0°). The mean PI of the entire cohort was 49.2° (SD 9.3°). One-way ANOVA demonstrated a significant difference between the PI strata in total bony lordosis values with a mean difference of 14.0° between low and high PI cohorts (P < .001) and also mid- and high PI cohorts of 9.9° (P = .008). Overall, distal lordosis represented 80.8% of the total lordosis. In the proximal lumbar segments, the mean contribution from bone was -4.0° (SD 6.8°) and the mean contribution from disc was 13.6° (SD 6.0°). In the distal, the mean contribution from bone was 14.7° (SD 6.5°) and from disc, 22.7° (SD 6.2°). CONCLUSIONS The contribution to lordosis from the vertebral bodies is greater in the proximal lumbar spine with increasing PI. With low PI, the proximal vertebral bodies demonstrate reduced contribution to lordosis and in some instances are kyphotic. Future research efforts should place greater emphasis on providing segmental rather than just global analysis of alignment. CLINICAL RELEVANCE Restoration of lumbar spine lordosis should take into account the variation in segmental lordosis contributions as it relates to PI.
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Affiliation(s)
- Joseph F Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Peter A Robertson
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
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Endo T, Ohba T, Oba H, Oda K, Tanaka N, Haro H. Prevalence and Key Radiographic Spinal Malalignment Parameters Associated with the Risk of Pulmonary Function Impairment in Patients Treated Surgically to Correct Adult Spinal Deformity. Spine Surg Relat Res 2020; 4:347-353. [PMID: 33195860 PMCID: PMC7661027 DOI: 10.22603/ssrr.2020-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/14/2020] [Indexed: 01/16/2023] Open
Abstract
Introduction There is a significant relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae, and coronal imbalance in patients with childhood spinal deformity. By contrast, the pathophysiology, epidemiology, and influence of deformity on respiratory dysfunction in patients with adult spinal deformity (ASD) remain largely unknown. We sought to clarify and compare the prevalence of pulmonary function impairment in patients with ASD with that in patients with lumbar spinal stenosis (LSS), to determine radiographically which spinal malalignment parameters are associated with a risk of respiratory dysfunction, and to determine the association of respiratory dysfunction with corrective surgery. Methods We conducted a prospective study of consecutive patients with a diagnosis of ASD or LSS who underwent spinal surgery. We included data from 122 consecutive patients with ASD and 121 consecutive patients with LSS. Parameters were obtained from full-length lateral radiographs taken with the patients standing and in supine and prone positions. We compared respiratory dysfunction between a group of patients with ASD and LSS and determined correlations between respiratory dysfunction and spinopelvic parameters. Results Preoperative % forced vital capacity (FVC) of patients with ASD was significantly lower than that of patients with LSS, and the frequency of restrictive ventilatory impairment was significantly higher in those with ASD (15.7%) than those with LSS (7.4%). Thoracolumbar kyphotic curvature (TK) while the patients were in supine position was significantly greater in the group with restrictive ventilatory impairment, and a significant negative correlation was found between %FVC and TK with the patients in supine position. We found no significant improvement of respiratory dysfunction 1 year after surgery. Conclusions Spinal deformity is a potential risk factor for restrictive ventilatory impairment in the elderly. We propose that radiographs obtained when patients are in supine position are valuable for evaluating the flexibility of the TK. Rigid TK might be an etiology of restrictive ventilatory impairment in patients with ASD.
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Affiliation(s)
- Tomoka Endo
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University, School of Medicine, Matsumoto city, Japan
| | - Kotaro Oda
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
| | - Nobuki Tanaka
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
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Indications and limitations of minimally invasive lateral lumbar interbody fusion without osteotomy for adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1362-1370. [DOI: 10.1007/s00586-020-06352-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 02/19/2020] [Indexed: 12/12/2022]
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