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Vignolles-Jeong J, Weber MD, Xu DS, Elder JB, Chakravarthy VB. Letter: Global Spinal Alignment Considerations in the Oncological Spine Population. Neurosurgery 2023; 93:e105-e106. [PMID: 37489901 DOI: 10.1227/neu.0000000000002615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/06/2023] [Indexed: 07/26/2023] Open
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Najjar E, Pasku D, Mardashti A, Meshneb M, Komaitis S, Salem KM, Quraishi NA. The influence of osteoporotic vertebral fractures on global sagittal alignment in elderly patients: 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; 32:2580-2587. [PMID: 37222801 DOI: 10.1007/s00586-023-07780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Thoracic kyphosis, or loss of lumbar lordosis, is often equated with osteoporosis because vertebral fractures are assumed to be a major causative factor, in addition to degeneration related to age. Despite the few studies aiming to measure the natural change in global sagittal alignment (GSA) that occurs with advancing age, the overall effect of conservatively managed osteoporotic vertebral compression fractures (OVCF) on the GSA in the elderly remains poorly understood. OBJECTIVE To systematically evaluate the relevant literature regarding the influence of OVCF on the GSA compared to patients of similar age without fractures using the following radiological parameters: Pelvic Incidence (PI), Pelvic Tilt (PT), Lumbar Lordosis (LL), Thoracic Kyphosis (TK), Sagittal Vertical Axis (SVA) and Spino-sacral Angle (SSA). METHODS A systematic review of the English language literature dating up until October 2022, was undertaken utilizing the PRISMA guidelines. RESULTS Of a total of 947 articles, 10 studies met the inclusion criteria (4 Level II, 4 level III and 2 level IV evidence) and were subsequently analyzed. Overall, 584 patients (8 studies) of mean age 73.7 years (69.3-77.1) had acute OVCF of one or more vertebra that were managed conservatively. The male to female ratio was 82:412. Five studies mentioned the number of fractured vertebrae, with a total of 393 in 269 patients (average of 1.4 fractured vertebrae per patient). Their pre-operative radiological parameters on standing X-rays showed a mean PI of 54.8°, PT 24°, LL 40.8°, TK 36.5°, PI-LL 14°, SVA 4.8 cm, and SSA 115°. In addition, 437 patients were used as a control group with osteoporosis without fractured vertebrae, (6 studies) with an average age of 72.4 years (67-77.8) and male to female ratio of 96:210 (5 studies). They all had upright X-rays to assess their global sagittal alignments. Radiological parameters showed an average PI of 54.3°, PT 17.3°, LL 43.4°, TK 31.25°, PI-LL 10.95°, SVA 1.27 cm and SSA 125°. A statistical analysis comparing the OVCF group with the control group (4 studies), showed a significant increase in PT of 5.97° (95%CI 2.63, 9.32; P < 0.0005), a significant increase in TK by 8.28° (95%CI 2.15, 14.4; P < 0.008), an increase in PI-LL by 6.72° (95%CI 3.39, 10.04; P < 0.0001), an increase in SVA by 1.35 cm (95%CI 0.88, 1.83; P < 0.00001), and a decrease in SSA by 10.2° (95%CI 10.3, 23.4; P < 0.00001). CONCLUSION Osteoporotic vertebral compression fractures managed conservatively appear to be a significant causate factor of global sagittal imbalance.
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Affiliation(s)
- Elie Najjar
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Dritan Pasku
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Ali Mardashti
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Mustafa Meshneb
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Spyridon Komaitis
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Khalid M Salem
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Nasir A Quraishi
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
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Chen Z, Shi T, Li W, Sun J, Yao Z, Liu W. Role of paraspinal muscle degeneration in the occurrence and recurrence of osteoporotic vertebral fracture: A meta-analysis. Front Endocrinol (Lausanne) 2023; 13:1073013. [PMID: 36686478 PMCID: PMC9845601 DOI: 10.3389/fendo.2022.1073013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose Recently, the effects of paraspinal muscle degeneration on osteoporotic vertebral fractures (OVFs) have attracted the attention of researchers; however, studies are limited, and their results vary. Hence, this study aimed to determine the role of paraspinal muscle degeneration in the occurrence and recurrence of OVF. Methods Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline, the PubMed, Embase, Web of Science, Wanfang Data, China National Knowledge Infrastructure, and ClinicalTrials.gov databases were comprehensively searched for relevant studies. Studies comparing the cross-sectional area (CSA) or fatty infiltration (FI) of the paraspinal muscles (including the psoas (PS), erector spinae plus multifidus (ES+MF), quadratus lumborum) in patients with and without initial OVF, or with and without recurrent OVF were included and analyzed. Results Eleven studies were included in the meta-analysis. Seven studies investigated the effects of paraspinal muscles on initial OVF, and the overall results revealed significantly lower CSAES+MF (SMD: -0.575, 95% CI: -0.866 to -0.285) and CSAPS (SMD: -0.750, 95% CI: -1.274 to -0.226), and higher FI (SMD: 0.768, 95% CI: 0.475 to 1.062) in the fracture group. Meanwhile, four studies evaluated the effects of the paraspinal muscles on recurrent OVF, and the pooled results demonstrated significantly higher FI (SMD:0.720, 95% CI: 0.258 to 1.182) in the refracture group, although no significant difference in CSAES+MF (SMD: -0.103, 95% CI: -0.395 to 0.189) was observed between the two groups. Conclusions Paraspinal muscle degeneration plays a role in the occurrence and recurrence of OVF. Assessing the paraspinal muscles may be useful for identifying high-risk populations. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier (CRD42021276681).
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Affiliation(s)
- Zhi Chen
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Tengbin Shi
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Wenwen Li
- The School of Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Jun Sun
- Department of Emergency, Zhaotong Traditional Chinese Medicine Hospital, Zhaotong, Yunnan, China
| | - Zhipeng Yao
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Wenge Liu
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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Niu J, Feng T, Huang C, Yan Q, Song D, Gan M, Yang H, Zou J. Characteristics of Osteoporotic Low Lumbar Vertebral Fracture and Related Lumbosacral Sagittal Imbalance. Orthopedics 2021; 44:e7-e12. [PMID: 33141233 DOI: 10.3928/01477447-20201028-05] [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: 08/16/2019] [Accepted: 11/07/2019] [Indexed: 02/03/2023]
Abstract
Osteoporotic vertebral fracture (OVF) usually occurs in the thoracolumbar region and rarely affects the low lumbar region. The characteristics of osteoporotic low lumbar fracture (OLLF) have not been reported. Lumbosacral sagittal balance plays an important role in preserving the normal physiologic function of the spine. However, it is unknown how lumbosacral parameters vary in patients with OLLF. The authors retrospectively analyzed the clinical and radiologic characteristics of patients with OLLF and osteoporotic thoracolumbar vertebral fracture (OTVF) who were treated at their institution. Vertebral height, local deformity angle, and visual analog scale and Oswestry Disability Index scores were assessed preoperatively and postoperatively for both groups. The changes in lumbosacral parameters were measured for patients with OLLF. The results showed that OLLF was more likely to occur at L3 (53.66%) and that the prevalence of severe trauma (29.27%) was higher among patients with OLLF (P<.05). The most common morphologic type of the vertebrae affected by OLLF was biconcave (58.54%, P<.05). Patients who had OLLF showed an apparent increase in pelvic tilt and a decrease in local lordosis and sacral slope. Postoperatively, vertebral height, local deformity angle, and visual analog scale and Oswestry Disability Index scores were significantly improved compared with preoperative values (P<.05). Among patients with OLLF, local lordosis and sacral slope increased significantly, whereas pelvic tilt decreased significantly after percutaneous kyphoplasty. Restoration of local lordosis had a mean value of 6.29°±4.80°. These results indicate that OLLF has unique characteristics compared with OTVF and that it results in lumbosacral sagittal imbalance. Percutaneous kyphoplasty is effective and safe for the treatment of OLLF and plays an important role in postoperative improvement of sagittal imbalance. [Orthopedics. 2021;44(1):e7-e12.].
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Cho HJ, Kwak DS. Movement of the sacroiliac joint: Anatomy, systematic review, and biomechanical considerations. Proc Inst Mech Eng H 2020; 235:357-364. [PMID: 33256545 DOI: 10.1177/0954411920978021] [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: 12/28/2022]
Abstract
Several researchers investigated the anatomy and biomechanics of the sacroiliac joint (SIJ) to understand the relationship between lower back pain and the SIJ. Many studies concluded that the SIJ has little movement; however, some studies using spinopelvic parameters mentioned high change in pelvic incidence (PI). In this study, SIJ movement and PI change reported in previous studies were reviewed according to position and posture changes. Literature on SIJ movement was reviewed by searching through the publication databases. In biomechanical studies, the result of the rotational angle in the sagittal plane was mainly investigated to compare with the results of PI change. From the results of SIJ movement studies, the minimum movement of nutation and count-nutation was 0.01°, and maximum movement was 2.27°. From the results of PI change studies with different positions and movements, the highest change was 9°, and the lowest change was 0°. Movement of the SIJ was limited by its anatomical structure; maximum movement of the SIJ was 9° in a previous study. Therefore, SIJ movement should be studied more intensely as biomechanical perspective to understand its movement.
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Affiliation(s)
- Ho-Jung Cho
- Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dai-Soon Kwak
- Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kaneko A, Naito K, Nagura N, Obata H, Goto K, Sugiyama Y, Koike M, Nojiri H, Iwase Y, Kaneko K. Characteristics of sagittal spine alignment in female patients with distal radius fractures due to fall. Heliyon 2020; 6:e04756. [PMID: 32904191 PMCID: PMC7452564 DOI: 10.1016/j.heliyon.2020.e04756] [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] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/17/2020] [Accepted: 08/17/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives Distal radius fractures occur due to reflex clasp when falling. Recently, attention has been focused on the strong relationship between sagittal spine alignment and falls. Therefore, we investigated the parameters of sagittal spinal alignment in distal radius fractures in female patients. Patients and methods The subjects were group D: 28 female patients with distal radius fractures aged 50 years or older (mean age: 69.3 years), and group C: 26 healthy female patients without a history of fragility fractures (mean age: 70.5 years). Height, body weight, and body mass index (BMI) were measured as physical indices. As parameters of sagittal spinal alignment, the sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumber lordosis (LL), and thoracic kyphosis (TK) were measured on lateral whole-spine plain radiographs in a standing position. The measured physical indices and sagittal spinal alignment parameters were compared between groups. Results Height, weight, and BMI did not differ significantly between the two groups. Among the sagittal spinal alignment parameters, PT, PI, SS, LL, and TK did not differ significantly between groups, whereas SVA was significantly higher in group D than in group C (P < 0.05). Conclusion In this study, SVA was significantly higher in group D than in group C. As SVA increased, the center of gravity of the body shifts forward, which can cause the body to lose balance and fall. This study suggested that an increase in SVA is associated with distal radius fractures.
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Affiliation(s)
- Ayaka Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Obata
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan.,Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Masato Koike
- Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Hidetoshi Nojiri
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Iwase
- Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
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Characterization of Sagittal Spine Alignment With Reference to the Gravity Line and Vertebral Slopes: An Analysis of Different Roussouly Curves. Spine (Phila Pa 1976) 2020; 45:E481-E488. [PMID: 32282653 DOI: 10.1097/brs.0000000000003379] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED MINI: Spinal sagittal realignment necessitates a reference posture, and thus far this has only been defined for an "averaged" curve via horizontal offsets from the gravity line (GL). This prospective study of 169 healthy subjects demonstrates normative sagittal spatial orientation of each vertebra, for all Roussouly curve types, using vertebral slopes and horizontal offsets from the GL. STUDY DESIGN Prospective study. OBJECTIVE To map the healthy standing alignment of the adult spine, grouped according to Roussouly curve types, using both horizontal offset distance from the gravity line (GL), as well as vertebral slope measurements. SUMMARY OF BACKGROUND DATA Spinal sagittal realignment requires a reference posture, and this has been defined in the literature via horizontal offsets from the GL. While useful, this does not provide information on the orientation of each vertebral segment, or distinguish between the various physiological curve types. METHODS A total of 169 consecutive young adult subjects with healthy spines were recruited over a year. (EOS Imaging, Paris, France) whole body radiographs were performed. Radiographic measurements collected included sagittal vertical axis (SVA), T1-slope, global cervical angle (GCA), global thoracic angle (GTA), global lumbar angle (GLA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), apical and inflection vertebrae. Outcome measures comprised slope measurements, and distance offsets relative to the GL for individual vertebrae from T3 to S1. RESULTS GLA, PI, PT, SS, apex of lordosis, and inflection vertebra were significantly different across groups, while SVA, T1-slope, GCA, GTA, and apex of kyphosis were not. Mean PI to LL discrepancy for Type I to IV groups were 8.0°, 2.3°, 4.8°, and 3.0°, respectively. Between groups, T3, T7 to T12, and L2 to S1 slopes and T9 to L3 offset distances from GL were significantly different, while the distance of the hip center from the GL was not. GLA was significantly different between curve types except between Type 1 and 2 curves, while the inflection vertebrae were not significantly different between Type 1 and 2 curves, as well as Type 3 and 4 curves. CONCLUSION This study demonstrates normative sagittal spatial orientation of each vertebra in healthy adults, for each Roussouly type. Comparison across groups suggests the possibility of further refining the sagittal curve patterns described by Roussouly. LEVEL OF EVIDENCE 3.
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Sankey EW, Park C, Howell EP, Pennington Z, Abd-El-Barr M, Karikari IO, Shaffrey CI, Gokaslan ZL, Sciubba D, Goodwin CR. Importance of Spinal Alignment in Primary and Metastatic Spine Tumors. World Neurosurg 2019; 132:118-128. [PMID: 31476476 DOI: 10.1016/j.wneu.2019.08.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 12/12/2022]
Abstract
Spinal alignment, particularly with respect to spinopelvic parameters, is highly correlated with morbidity and health-related quality-of-life outcomes. Although the importance of spinal alignment has been emphasized in the deformity literature, spinopelvic parameters have not been considered in the context of spine oncology. Because the aim of oncologic spine surgery is mostly palliative, consideration of spinopelvic parameters could improve postoperative outcomes in both the primary and metastatic tumor population by taking overall vertebral stability into account. This review highlights the relevance of focal and global spinal alignment, particularly related to spinopelvic parameters, in the treatment of spine tumors.
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Affiliation(s)
- Eric W Sankey
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Christine Park
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth P Howell
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Muhammad Abd-El-Barr
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Isaac O Karikari
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA.
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Iida K, Harimaya K, Tarukado K, Tono O, Matsumoto Y, Nakashima Y. Kyphosis Progression after Balloon Kyphoplasty Compared with Conservative Treatment. Asian Spine J 2019:928-935. [PMID: 31281176 PMCID: PMC6894976 DOI: 10.31616/asj.2018.0329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/23/2019] [Indexed: 01/08/2023] Open
Abstract
Study Design Retrospective cohort study (level of evidence: 4). Purpose To demonstrate the effects of balloon kyphoplasty (BKP) on prevention of kyphosis progression. Overview of Literature Kyphoplasty can correct local kyphosis (fractured vertebra), but its efficacy is attenuated by adjacent fracture and/or disc height reduction with endplate damage. With these attenuating factors incorporated, a comparison between BKP and conservative treatment is necessary to verify the effect of BKP on kyphosis correction. Methods This study retrospectively analyzed 129 patients treated conservatively and 95 treated with BKP in our institution. The rate of new adjacent fracture occurrence was determined using Kaplan–Meier analysis. We examined the progression of local kyphosis in patients who underwent lateral X-ray after 1 year. Local kyphosis was measured as an angle between higher end plate of the vertebra above and lower end plate of the vertebra below the fractured vertebra. The comparison included 45 patients treated conservatively and 58 treated with BKP. Results The incidence of new adjacent fracture at 1 year was 7.3% in the conservative treatment group and 23.2% in the BKP group (p<0.001), while the progression of local kyphosis at 1 year was 5.7°±4.7° and 3.2°±4.6°, respectively (p=0.01). Relative to conservative treatment, local kyphosis did not progress after BKP, despite the higher incidence of adjacent fracture. Local kyphosis progressed in cases with adjacent fracture compared with those without adjacent fracture (6.0°±4.3° vs. 2.1°±4.3°, p=0.003), and fractured vertebral instability was found to be a risk factor for adjacent fracture in BKP. Conclusions Compared with the conservative treatment, BKP suppressed the progression of local kyphosis. However, an adjacent fracture attenuated the BKP correction and was more frequently seen in patients with unstable vertebral fractures.
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Affiliation(s)
- Keiichiro Iida
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Katsumi Harimaya
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Kiyoshi Tarukado
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Osamu Tono
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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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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Bao H, Liabaud B, Varghese J, Lafage R, Diebo BG, Jalai C, Ramchandran S, Poorman G, Errico T, Zhu F, Protopsaltis T, Passias P, Buckland A, Schwab F, Lafage V. Lumbosacral stress and age may contribute to increased pelvic incidence: an analysis of 1625 adults. 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 2017; 27:482-488. [DOI: 10.1007/s00586-017-5324-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/15/2017] [Accepted: 10/02/2017] [Indexed: 11/28/2022]
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Hey HWD, Teo AQA, Tan KA, Ng LWN, Lau LL, Liu KPG, Wong HK. How the spine differs in standing and in sitting-important considerations for correction of spinal deformity. Spine J 2017; 17:799-806. [PMID: 27063999 DOI: 10.1016/j.spinee.2016.03.056] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/08/2016] [Accepted: 03/21/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The current prevailing school of thought in spinal deformity surgery is to restore sagittal balance with reference to the alignment of the spine when the patient is standing. This strategy, however, likely accounts for increased rates of proximal junctional failure. PURPOSE The purpose of this study was to investigate the differences between the spine in standing and sitting positions as these may elucidate reasons for deformity correction failure. STUDY DESIGN/SETTING A prospective, comparative study of 58 healthy patients presenting to a tertiary hospital over a 6-month period was carried out. PATIENT SAMPLE All patients presenting with a less than 3-month history of first episode lower back pain were included. Patients who had radicular symptoms, red flag symptoms, previous spine surgery, or visible spinal deformity during forward bending test were excluded. Pregnant patients were also excluded. OUTCOME MEASURES Radiographic measurements including sagittal vertical axis (SVA), lumbar lordosis (LL), thoracolumbar angle (TL), thoracic kyphosis (TK), cervical lordosis (CL), pelvic incidence (PI), and pelvic tilt (PT) were collected. The sagittal apex and end vertebrae of all radiographs were also recorded. METHODS Basic demographic data (age, gender, and ethnicity) was recorded. Lateral standing and sitting radiographs were obtained using EOS technology. Statistical analysis was performed to compare standing and sitting parameters using chi-square tests for categorical variables and paired t tests for continuous variables. RESULTS Taking the standing position as the reference point, forward displacement of the SVA occurred during sitting by a mean of 6.39±3.87 cm (p<.001). This was accompanied by a reduction of LL and TK by a mean of 24.63±12.70° (p<.001) and 8.56±7.21°(p<.001), respectively. The TL became more lordotic by a mean of 3.25±7.30° (p<.001). The CL only reached borderline significance (p=.047) for increased lordosis by a mean of 3.45±12.92°. The PT also increased by 50% (p<.001). Despite relatively constant end vertebrae, the apex vertebra moved inferiorly for the thoracic curve (p<.006) and superiorly for the lumbar curve (p<.001) by approximately one vertebral level each. CONCLUSIONS Sagittal spinal alignment changes significantly between standing and sitting positions. Understanding these differences is crucial to avoid overcorrection of LL, which may occur if deformity correction is based solely on the spine's standing sagittal profile.
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Affiliation(s)
- Hwee Weng Dennis Hey
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, Singapore 119228.
| | - Alex Quok An Teo
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, Singapore 119228
| | - Kimberly-Anne Tan
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, Singapore 119228
| | - Li Wen Nathaniel Ng
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, Singapore 119228
| | - Leok-Lim Lau
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, Singapore 119228
| | - Ka-Po Gabriel Liu
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, Singapore 119228
| | - Hee-Kit Wong
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, Singapore 119228
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Kim J, Hwang JY, Oh JK, Park MS, Kim SW, Chang H, Kim TH. The association between whole body sagittal balance and risk of falls among elderly patients seeking treatment for back pain. Bone Joint Res 2017; 6:337-344. [PMID: 28536117 PMCID: PMC5457638 DOI: 10.1302/2046-3758.65.bjr-2016-0271.r2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/23/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the lower extremities, and whole body sagittal balance including the lower extremities should be assessed to evaluate actual imbalances related to falls. Methods Patients over 70 years old who visited an outpatient clinic for back pain treatment and underwent a standing whole-body radiograph were enrolled. Falls were prospectively assessed for 12 months using a monthly fall diary, and patients were divided into fallers and non-fallers according to the history of falls. Radiological parameters from whole-body radiographs and clinical data were compared between the two groups. Results A total of 144 patients (120 female patients and 24 male patients) completed a 12-month follow-up for assessing falls. A total of 31 patients (21.5%) reported at least one fall within the 12-month follow-up. In univariate logistic regression analysis, the risk of falls was significantly increased in older patients and those with more medical comorbidities, decreased lumbar lordosis, increased sagittal vertical axis, and increased horizontal distance between the C7 plumb line and the centre of the ankle (C7A). Increased C7A was significantly associated with increased risk of falls even after multivariate adjustment. Conclusion Whole body sagittal balance, measured by the horizontal distance between the C7 plumb line and the centre of the ankle, was significantly associated with risk of falls among elderly patients with back pain. Cite this article: J. Kim, J. Y. Hwang, J. K. Oh, M. S. Park, S. W. Kim, H. Chang, T-H. Kim. The association between whole body sagittal balance and risk of falls among elderly patients seeking treatment for back pain. Bone Joint Res 2017;6:–344. DOI: 10.1302/2046-3758.65.BJR-2016-0271.R2.
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Affiliation(s)
- J Kim
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - J Y Hwang
- Spine Centre, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - J K Oh
- Spine Centre, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - M S Park
- Spine Centre, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - S W Kim
- Spine Centre, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - H Chang
- Spine Centre, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - T-H Kim
- Spine Centre, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Diebo BG, Gammal I, Ha Y, Yoon SH, Chang JW, Kim B, Matsumoto M, Yamato Y, Takeuchi D, Hosogane N, Yagi M, Taneichi H, Schwab F, Lafage V, Ames C. Role of Ethnicity in Alignment Compensation: Propensity Matched Analysis of Differential Compensatory Mechanism Recruitment Patterns for Sagittal Malalignment in 288 ASD Patients From Japan, Korea, and United States. Spine (Phila Pa 1976) 2017; 42:E234-E240. [PMID: 28207663 DOI: 10.1097/brs.0000000000001744] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of adult spinal deformity patients in a multiethnic database. OBJECTIVE To investigate the role of ethnicity on recruitment of compensatory mechanisms for sagittal spinal deformity. SUMMARY OF BACKGROUND DATA While the impacts of age, sex, and pelvic morphology on the ability to compensate for sagittal malalignment have been investigated, the role of ethnicity in compensatory mechanism recruitment is poorly understood. METHODS Patients from USA (85% Caucasian) >25 y/o were propensity matched by age, sex, and pelvic incidence with patients from Korea and Japan. Only primary patients or those with existing fusion below T12 were retained for analysis. Groups were subclassified by deformity severity (aligned: sagittal vertical axis (SVA) <50 mm; moderate malalignment: SVA 50-100 mm; severe malalignment: SVA >100 mm). Radiographic measurements including pelvic retroversion, thoracic kyphosis, loss of lumbar lordosis (PI minus LL), cervical lordosis, and cervical SVA were compared between the groups. RESULTS There were 288 patients (96 each in USA, KOR, JPN), with similar age (64-67 yr) and PI (49-53°). USA had smaller pelvic incidence minus lumbar lordosis in every alignment group (P <0.05). In moderate malalignment, JPN had more pelvic retroversion than USA (30° vs. 20°), and KOR had more thoracic hypokyphosis than USA (15 vs. 31°). In severe malalignment, JPN had more pelvic retroversion than USA (39° vs. 27°), and KOR had more thoracic hypokyphosis than USA (15° vs. 31°). KOR had smaller cSVA than USA in both aligned (11 vs. 27 mm) and moderate (19 vs. 31 mm) malalignment. In severe malalignment, KOR had less cervical lordosis (13° KOR vs. 15° USA vs. 27° JPN). All differences with P <0.05. CONCLUSION Compensation for sagittal is ethnicity dependent. Korean patients favor thoracic compensation via hypokyphosis, and Japanese patients favor pelvic compensation via retroversion. Patient ethnicity should be considered when evaluating the sagittal plane and surgical correction strategies. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Bassel G Diebo
- Spine Service, Hospital for Special Surgery, New York, NY
| | - Isaac Gammal
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY
| | - Yoon Ha
- Department of Neurosurgery, College of Medicine, Yonsei University, Seoul, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Jae Won Chang
- Department of Neurosurgery, Chonnam University, Gwangju, Korea
| | - Byeongwoo Kim
- Department of Neurosurgery, College of Medicine, Yonsei University, Seoul, Korea
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Daisaku Takeuchi
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Naobumi Hosogane
- Department of Orthopaedic Surgery, National Defense Medical College, Saitama, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Frank Schwab
- Spine Service, Hospital for Special Surgery, New York, NY
| | | | - Christopher Ames
- Department of Neurosurgery, University of California, San Francisco, LA
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Mokhtarzadeh H, Anderson DE. The Role of Trunk Musculature in Osteoporotic Vertebral Fractures: Implications for Prediction, Prevention, and Management. Curr Osteoporos Rep 2016; 14:67-76. [PMID: 27040104 DOI: 10.1007/s11914-016-0305-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This review examines the current evidence for associations between vertebral fractures (VFx), the most common type of fracture in older adults, and trunk muscles, which are intimately tied to spinal loading and function. Individuals with prevalent VFxs have more fat infiltration in the trunk muscles, lower trunk extension strength, and altered muscle activation patterns. However, no longitudinal studies have examined whether assessment of trunk muscle can contribute to prediction of fracture risk. A few studies report that exercise interventions targeting the trunk muscles can reduce the risk of VFx, improve trunk strength and endurance in patients who have had a VFx, and reduce the risk of falling, a common cause of VFx, but the quality of evidence is low. Trunk muscles likely have an important role to play in prediction, prevention, and management of VFx, but additional longitudinal studies and randomized controlled trials are needed to clarify this role.
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Affiliation(s)
- Hossein Mokhtarzadeh
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave, RN115, Boston, MA, 02215, USA
- Department of Mechanical Engineering, Melbourne School of Engineering, University of Melbourne, Parkville, Australia
| | - Dennis E Anderson
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA.
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave, RN115, Boston, MA, 02215, USA.
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