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Martin S, Cobetto N, Larson AN, Aubin CE. Biomechanical modeling and assessment of lumbar vertebral body tethering configurations. Spine Deform 2023; 11:1041-1048. [PMID: 37179281 DOI: 10.1007/s43390-023-00697-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Vertebral body tethering (VBT) is a fusionless spinal growth modulation technique, which shows promise for pediatric idiopathic scoliosis (IS) curve correction. This technique, mainly used for thoracic curves, is increasingly being used to treat lumbar curves in order to preserve spine flexibility. It remains necessary to adequately define the cord tension to be applied during the operation and the instrumented levels to biomechanically predict correction over time for the lumbar spine. METHODS Twelve pediatric patients with lumbar IS, treated with lumbar-only or lumbar and thoracic VBT, were selected for this study. Three independent variables were tested alternately using a patient-specific finite element model (FEM), which includes an algorithm modeling vertebra growth and spine curve changes due to growth modulation for 24 months post-operatively according to the Hueter-Volkmann principle. Parameters included cable tensioning (150N/250N), upper instrumented level (actual UIV, UIV-1) and lower instrumented level (actual LIV, LIV + 1). Each FEM was personalized using 3D radiographic reconstruction and flexibility supine radiographs. RESULT An increase in cord tension (from 150 to 250N) had significant effects on main thoracic and thoraco-lumbar/lumbar Cobb angles, as well as on lumbar lordosis, after surgery (supplementary average correction of 3° and 8°, and increase of 1.4°, respectively) and after 24 months (4°, 10° and 1.1°) (p < 0.05). Adding a level to the actual UIV or LIV did not improve correction. CONCLUSION This parametric study showed that cord tension is the most important biomechanical parameter on the simulated immediate and 2-year increase in lumbar curve correction. Our preliminary model suggests that it is not advantageous to add additional instrumented levels. LEVEL OF EVIDENCE This computational study uses a retrospective validation cohort (level of evidence 3).
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Affiliation(s)
- Sophie Martin
- Department of Mechanical Engineering, Polytechnique Montréal, Downtown Station, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada
| | - Nikita Cobetto
- Department of Mechanical Engineering, Polytechnique Montréal, Downtown Station, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada
- Research Center, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Carl-Eric Aubin
- Department of Mechanical Engineering, Polytechnique Montréal, Downtown Station, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada.
- Research Center, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada.
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Lai J, Tan H, Feng H, Lan Z, Sun Z, Wang J, Fu Y, He S. Treatment of degenerative lumbar scoliosis using transforaminal lumbar interbody fusion based on the concept of intervertebral correction. Int Orthop 2023. [PMID: 36933036 DOI: 10.1007/s00264-023-05774-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The study aimed to examine the outcomes of posterior approach transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS) based on the concept of intervertebral correction. METHODS A retrospective analysis was performed on 76 surgical patients (36 males and 40 females) who underwent posterior TLIF and internal fixation based on the concept of intervertebral correction in Shenzhen Traditional Chinese Medicine Hospital from February 2014 to March 2021.The operation duration, intraoperative blood loss, incision length, and complications were recorded. Clinical efficacy was evaluated preoperatively and postoperative time points through the visual analog scale (VAS) and the Oswestry disability index (ODI). The changes in the coronal scoliosis curve (Cobb angle), coronal balance distance (CBD), the sagittal vertical axis (SVA), lumbar lordosis (LL), and pelvic tilt angle (PT) were assessed perioperatively at the last follow-up. RESULTS All patients successfully underwent the operation. The average operation duration was 243.81 ± 35.35 (220 - 350) min; the average intraoperative blood loss was 836.27 ± 50.28 (700 - 2500) mL; the average incision length was 8.30 ± 2.33 (8 - 15) cm. The total complication rate was 18.42% (14/76). The VAS score of low back pain, lower extremity pain, and ODI score of patients at the last follow-up was significantly improved compared with those before the operation (P < 0.05). At the last follow-up, the Cobb Angle, CBD, SVA, and PT of patients were significantly lower than those before the operation (P < 0.05), and LL was higher than those before the operation (P < 0.05). CONCLUSION TLIF based on the concept of intervertebral correction for the treatment of DLS may provide favourable clinical outcomes.
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Tanaka M, Fujiwara Y, Uotani K, Yamauchi T, Misawa H. C-Arm-Free Anterior Correction for Adolescent Idiopathic Scoliosis (Lenke Type 5C): Analysis of Early Outcomes and Complications. World Neurosurg 2021; 150:e561-e569. [PMID: 33746101 DOI: 10.1016/j.wneu.2021.03.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Computer-assisted spinal surgery as a technique for reducing radiation exposure to the operating staff and the complications of spinal deformity are receiving considerable attention. However, no technical reports have described the technique for navigating anterior correction of adolescent idiopathic scoliosis without C-arm fluoroscopy. The purpose of this study was to evaluate the efficacy and safety of this new C-arm-free anterior correction for scoliosis. METHODS This study investigated 38 consecutive patients with Lenke type 5C curves who underwent selective lumbar or thoracolumbar fusion, comprising 26 patients with conventional anterior correction surgery, and 12 patients with C-arm-free navigation surgery. The 2 groups were evaluated immediately postoperatively and at the 2-year follow-up. RESULTS No vascular injuries, screw malpositioning, or major complications were associated with the surgical procedure in either group. Correction rates of the lumbar curve were satisfactory with no significant difference between groups (mean, 82.6% ± 5.7% vs. 80.7% ± 10.2%, respectively). However, mean time for fluoroscopy in group C was 133 ± 9.5 seconds (P < 0.0001). No significant differences in intraoperative blood loss (642 ± 123 mL vs. 731 ± 222 mL, respectively) or surgical time (251 ± 13 min vs. 301 ± 38 min, respectively) were seen between groups. Mean final follow-up Scoliosis Research Society Outcomes Questionnaire (SRS-22) was also excellent for both group C (4.2 ± 0.19) and group N (4.3 ± 0.20). CONCLUSIONS C-arm-free anterior correction offers safe, effective surgery for adolescent idiopathic scoliosis. The advantage of this new technique is no radiation exposure for medical staff at centers performing large numbers of spinal procedures.
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Affiliation(s)
- Masato Tanaka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan.
| | - Yoshihiro Fujiwara
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Koji Uotani
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Taro Yamauchi
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Hauo Misawa
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
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Farshad M, Frey A, Jentzsch T, Betz M, Widmer J, Spirig JM. Reducing the kyphosis effect of anterior short thoracolumbar/ lumbar scoliosis correction with an autograft fulcrum effect. BMC Musculoskelet Disord 2021; 22:216. [PMID: 33622298 PMCID: PMC7903709 DOI: 10.1186/s12891-021-04083-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background Anterior scoliosis correction is a powerful technique with the disadvantage of a kyphotic effect on lumbar and thoracolumbar curves. We aimed to investigate whether a cognizant interposition of a rib graft anteriorly and at the concave side of the scoliotic curve causes significant fulcrum effect to enforce scoliosis correction and to reduce interfusional kyphosis in anterior scoliosis corrections. Methods Twenty otherwise comparable patients with lumbar and thoracolumbar adolescent idiopathic scoliosis (AIS) curves undergoing anterior short scoliosis correction with (n = 10) or without (n = 10, matched for age, gender and degree of deformity) fulcrum effect were retrospectively compared by means of radiographic measurements (sagittal and coronal profile, Cobb angles and intersegmental deformity correction angles) to evaluate the effect of this modified surgical technique. Results The overall amount of scoliosis correction was similar with 74 and 60% of initial curves of 57° and 53° in the case and control group respectively with a mean of 3 fused segments (4 screws). Statistically relevant differences were found for intersegmental coronal cobb angles at the apex of 20° to 3° and 17° to 9° with and without fulcrum, respectively (p < 0.05). Creation of kyphosis in the fused segments was reduced with an interfusional kyphotic sagittal cobb angle of 15° pre-operatively vs. 3° post-operatively compared to the control group (13° pre-operatively vs. 18° post-operatively), (p < 0.05). Conclusions Interfusional hyperkyphosis associated with anterior scoliosis correction for thoracolumbar/lumbar curves can be reduced with cognizant positioning of the bone autograft at the antero-lateral (concave) site in the intervertebral region to create a fulcrum effect. Trial registration Registered at swissethics: BASEC No.: 2018–00180.
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Affiliation(s)
- Mazda Farshad
- Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Andrea Frey
- Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Thorsten Jentzsch
- Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Michael Betz
- Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Jonas Widmer
- Laboratory for Orthopaedic Biomechanics, Balgrist University Hospital, Zürich, Switzerland.,Institute of Biomechanics, ETH Zurich, Zurich, Switzerland
| | - José Miguel Spirig
- Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
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Hori Y, Matsumura A, Namikawa T, Kato M, Iwamae M, Nakamura H. Comparative Study of the Spinopelvic Alignment in Patients With Idiopathic Lumbar Scoliosis Between Adulthood and Adolescence. World Neurosurg 2021; 149:e309-15. [PMID: 33601080 DOI: 10.1016/j.wneu.2021.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Understanding the natural history of the spinopelvic alignment in adolescent idiopathic scoliosis (AIS) is important in developing surgical strategies for patients with adult idiopathic lumbar scoliosis (AdLS). Because it is challenging to follow individuals without any treatments, we sought to estimate its natural history by comparing radiographic characteristics of patients with AIS and AdLS. METHODS We included patients with Lenke 5 AIS and patients with AdLS who were diagnosed with Lenke 5 AIS in adolescence. The Cobb angle of the curve and spinopelvic parameters were measured by whole spine radiographs. The AdLS patients were divided into 2 groups according to age <50 years (AdLS<50) or ≥50 years (AdLS≥50). Radiographic parameters were compared among the AIS, AdLS<50, and AdLS≥50 groups. The relationship between age and each parameter was analyzed using nonlinear regression analysis. RESULTS We analyzed 40 patients with AIS (all female, mean age 16.8 ± 3.2 years) and 35 patients with AdLS (34 female and 1 male, mean age 55.4 ± 12.1 years). Thoracolumbar/lumbar curve and thoracolumbar kyphosis was significantly greater in the AdLS<50 group compared with the AIS group, without progression after age 50 years. Lumbar lordosis and pelvic tilt deteriorated linearly with age. AIS and AdLS<50 patients maintained sagittal balance, which deteriorated in AdLS≥50 patients. CONCLUSIONS Our results may predict the following natural course of Lenke 5 AIS: (1) progression of scoliotic deformity of thoracolumbar/lumbar curve with increased thoracolumbar kyphosis; (2) subsequent lumbar hypolordosis followed by pelvic retroversion; and (3) sagittal imbalance after failure of compensation.
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Glassman SD, Carreon LY, Shaffrey CI, Kelly MP, Crawford CH 3rd, Yanik EL, Lurie JD, Bess RS, Baldus CR, Bridwell KH. Cost-effectiveness of adult lumbar scoliosis surgery: an as-treated analysis from the adult symptomatic scoliosis surgery trial with 5-year follow-up. Spine Deform 2020; 8:1333-9. [PMID: 32632890 DOI: 10.1007/s43390-020-00154-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/06/2020] [Indexed: 10/23/2022]
Abstract
STUDY DESIGN Longitudinal comparative cohort. OBJECTIVE The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis. Adult spinal deformity is a relatively prevalent condition for which surgical treatment has become increasingly common but concerns surrounding complications, revision rates and cost-effectiveness remain unresolved. Of these issues, cost-effectiveness is perhaps the most difficult to quantify as the requisite data is difficult to obtain. The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for ASLS using the as-treated data and provide a comparison to previously reported ITT analysis. METHODS Patients with at least 5-year follow-up data within the same treatment arm were included. Data collected every 3 months included use of nonoperative modalities, medications and employment status. Costs for surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on the reported employment status and income. Quality-Adjusted Life Years (QALY) was determined using the SF-6D. RESULTS Of 226 patients, 195 patients (73 Non-op, 122 Op) met inclusion criteria. At 5 years, 29 (24%) patients in the Op group had a revision surgery of whom two had two revisions and one had three revisions. The cumulative cost for the Op group was $111,451 with a cumulative QALY gain of 2.3. The cumulative cost for the Non-Op group was $29,124 with a cumulative QALY gain of 0.4. This results in an ICER of $44,033 in favor of Op treatment. CONCLUSION This as-treated cost-effectiveness analysis demonstrates that surgical treatment for adult lumbar scoliosis becomes favorable at year-three, 1 year earlier than suggested by a previous intent-to-treat analysis. LEVEL OF EVIDENCE II.
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Sundaram V, Mohammed T, Rampersad S, Williams G. A rare report on 18-month survival of a dog born with multiple anomalies including atresia ani. Morphologie 2020; 105:252-258. [PMID: 33172785 DOI: 10.1016/j.morpho.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
Long term survival of animals with major congenital anomalies is very rare. This report documents the 18-month survival of a dog with multiple anomalies including atresia ani. An 18-month-old black Cocker Spaniel bitch was presented for evaluation of prolapsed glands of the third eyelid involving both the eyes. Clinical examination revealed a single perineal opening, fecal matter in the vestibule, distended abdomen, hypoplastic vulva, and the absence of a tail without any neurological deficits. Abdominal contrast radiography revealed a distended colon with fecal stasis, rectovestibular fistula, termination of the rectum as a blind pouch, lumbar scoliosis due to block vertebrae, and the presence of only two hypoplastic coccygeal vertebrae. The case was diagnosed as atresia ani type II with rectovestibular fistula, hypoplastic vulva, lumbar scoliosis, and anury, in the global context of a caudal regression syndrome. The wide aperture fistula, connected to the vestibule, undamaged spinal cord and sacrum without any neurological deficits were the favorable prognostic factors that maintained continence and allowed the dog to survive to adult life with these anomalies. Thus, an appropriate bowel management program and specialty care can improve the quality of life and longevity of this animal.
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Affiliation(s)
- V Sundaram
- Anatomy Unit, Department of Basic Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - T Mohammed
- Anatomy Unit, Department of Basic Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - S Rampersad
- Anatomy Unit, Department of Basic Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - G Williams
- Anatomy Unit, Department of Basic Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
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Shimizu M, Kobayashi T, Chiba H, Senoo I, Ito H, Matsukura K, Saito S. Adult spinal deformity and its relationship with height loss: a 34-year longitudinal cohort study. BMC Musculoskelet Disord 2020; 21:422. [PMID: 32611342 PMCID: PMC7331160 DOI: 10.1186/s12891-020-03464-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Age-related height loss is a normal physical change that occurs in all individuals over 50 years of age. Although many epidemiological studies on height loss have been conducted worldwide, none have been long-term longitudinal epidemiological studies spanning over 30 years. This study was designed to investigate changes in adult spinal deformity and examine the relationship between adult spinal deformity and height loss. Methods Fifty-three local healthy subjects (32 men, 21 women) from Furano, Hokkaido, Japan, volunteered for this longitudinal cohort study. Their heights were measured in 1983 and again in 2017. Spino-pelvic parameters were compared between measurements obtained in 1983 and 2017. Individuals with height loss were then divided into two groups, those with degenerative spondylosis and those with degenerative lumbar scoliosis, and different characteristics were compared between the two groups. Results The mean age of the subjects was 44.4 (31–55) years at baseline and 78.6 (65–89) years at the final follow-up. The mean height was 157.4 cm at baseline and 153.6 cm at the final follow-up, with a mean height loss of 3.8 cm over 34.2 years. All parameters except for thoracic kyphosis were significantly different between measurements taken in 1983 and 2017 (p < 0.05). Height loss in both sexes was related to changes in pelvic parameters including pelvic incidence-lumbar lordosis (R = 0.460 p = 0.008 in men, R = 0.553 p = 0.012 in women), pelvic tilt (R = 0.374 p = 0.035 in men, R = 0.540 p = 0.014 in women), and sagittal vertical axis (R = 0.535 p = 0.002 in men, R = 0.527 p = 0.017 in women). Greater height loss was more commonly seen in women (p = 0.001) and in patients with degenerative lumbar scoliosis (p = 0.02). Conclusions This longitudinal study revealed that height loss is more commonly observed in women and is associated with adult spinal deformity and degenerative lumbar scoliosis. Height loss is a normal physical change with aging, but excessive height loss is due to spinal kyphosis and scoliosis leading to spinal malalignment. Our findings suggest that height loss might be an early physical symptom for spinal malalignment.
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Affiliation(s)
- Mutsuya Shimizu
- Department of Orthopaedic Surgery, Asahikawa Medical University, 2-1E Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Tetsuya Kobayashi
- Department of Orthopaedic Surgery, Asahikawa Medical University, 2-1E Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Hisashi Chiba
- Department of Rehabilitation and Physical Therapy, Furano Kyokai Hospital, Furano, Japan
| | - Issei Senoo
- Department of Orthopaedic Surgery, Asahikawa Medical University, 2-1E Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, 2-1E Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Keisuke Matsukura
- Department of Orthopaedic Surgery, Furano Kyokai Hospital, Furano, Japan
| | - Senri Saito
- Department of Orthopaedic Surgery, Furano Kyokai Hospital, Furano, Japan
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Fujihara R, Komatsubara S, Arima N, Yamamoto T. Scoliosis, diabetes mellitus and total laminectomy at the 4th lumbar vertebra are independent risk factors for post-laminectomy fracture around the isthmus. Neurochirurgie 2020; 66:232-239. [PMID: 32502562 DOI: 10.1016/j.neuchi.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/14/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We aimed to identify the risk factors and clinical outcomes for post-laminectomy fracture around the isthmus, which can cause back pain or radiculopathy. METHODS We performed a retrospective cohort study involving all patients who underwent laminectomy splitting the spinous process for lumbar spinal stenosis between 2010 and 2014. The primary outcome measure was post-laminectomy fracture around the isthmus. Clinical outcomes were evaluated based on reoperation rate. To evaluate risk factors for fracture, the following parameters were collected: (1) patient characteristics and concomitant diabetes mellitus, (2) lumbar scoliosis and sagittal alignment parameters, and (3) surgical data, such as rate of total laminectomy. Logistic regression analysis was performed to identify the independent risk factors for post-laminectomy fracture. RESULTS Twelve of the 92 patients suffered a post-laminectomy fracture around the isthmus. Logistic regression analysis revealed that diabetes mellitus (odds ratio [OR]: 15.41; 95% confidence interval [CI]: 2.93-80.98; P=0.001), L4 total laminectomy (OR: 14.68; 95% CI: 1.51-142.76; P=0.021), and lumbar scoliosis (OR: 5.72; 95% CI: 1.16-28.21; P=0.032) were independent risk factors. The fracture group included 2 patients (16.7%) who required reoperation at the decompression level for recurrent leg pain, whereas the non-fracture group included 2 (2.5%) who underwent reoperation at a level different from the index procedure. CONCLUSIONS Post-laminectomy fractures around the isthmus were significantly associated with scoliosis, diabetes mellitus, and total laminectomy at L4. Total laminectomy at L4 is best avoided to reduce the risk of post-laminectomy fracture in patients with scoliosis or diabetes mellitus.
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Affiliation(s)
- R Fujihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
| | - S Komatsubara
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - N Arima
- Department of Orthopaedic Surgery, Sanuki Municipal Hospital, 387-1, Ishidahigashi-kou, Sangawa-cho, Sanuki, Kagawa 769-2393, Japan
| | - T Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
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Suratwala SJ, Kondra K, Cronin M, Leone V. Malignant peripheral nerve sheath tumor of the sciatic nerve presenting with leg pain in the setting of lumbar scoliosis and spinal stenosis. Spine Deform 2020; 8:333-338. [PMID: 31925758 DOI: 10.1007/s43390-019-00013-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/21/2019] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Case report. OBJECTIVE We present a case of malignant peripheral nerve sheath tumor (MPNST) presenting as neuropathic pain in the setting of lumbar scoliosis and spinal stenosis. Most peripheral nerve sheath tumors are benign, and malignant cases are more commonly associated with neurofibromatosis type 1 or prior radiation exposure. MPNST is a rare tumor with a poor prognosis. We report a case of MPNST that presented as neuropathic pain following lumbar decompression and fusion surgery. METHODS A 60-year-old woman presented for management of lumbar scoliosis, stenosis, and left leg pain. After lumbar decompression and fusion surgery, the patient was readmitted to the hospital after falling 10 weeks post-op. She reported gradual recurrence of leg pain. Left foot drop was noted on exam. Imaging studies showed no spinal changes postoperatively or residual stenosis. Obesity limited electrodiagnostic studies. Hip MRI revealed a lobular soft tissue mass in the left sciatic notch. Surgical resection and pathology provided the diagnosis of MPNST. The patient declined wide resection and other interventions after seeking a second opinion. Palliative pain management was implemented. RESULTS The patient expired 15 months after her index spinal surgery. CONCLUSIONS MPNST is an extremely rare tumor that can present with symptoms similar to radiculitis. Clinical signs and symptoms of MPNST are vague and nonspecific due to compression of surrounding structures. Surgical wide resection is the first line of treatment for MPNST with chemotherapy and radiotherapy as adjuvant treatments. MPNST has a poor prognosis with reported 5-year survival ranging from 16 to 54%. This case demonstrates the need to pursue additional workup when diagnostic imaging and objective findings do not satisfactorily explain the clinical presentation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sanjeev J Suratwala
- Northwell Health, New York Orthopaedic and Spine Center, 833 Northern Boulevard, Suite 220, Great Neck, NY, 11021, USA.
| | - Katelyn Kondra
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - MaryAnne Cronin
- Syosset Hospital at Northwell Health, 221 Jericho Turnpike, Syosset, NY, 11791, USA
| | - Vincent Leone
- Northwell Health, New York Orthopaedic and Spine Center, 833 Northern Boulevard, Suite 220, Great Neck, NY, 11021, USA.,Syosset Hospital at Northwell Health, 221 Jericho Turnpike, Syosset, NY, 11791, USA
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Takenaka H, Ikemoto T, Suzuki J, Inoue M, Arai YC, Ushida T, Deie M, Kamiya M. Association between Trunk Muscle Strength, Lumbar Spine Bone Mineral Density, Lumbar Scoliosis Angle, and Skeletal Muscle Volume and Locomotive Syndrome in Elderly Individuals: A Dual-Energy X-ray Absorptiometry Study. Spine Surg Relat Res 2019; 4:164-170. [PMID: 32405564 PMCID: PMC7217680 DOI: 10.22603/ssrr.2019-0083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/05/2019] [Indexed: 01/11/2023] Open
Abstract
Introduction The present study aimed to investigate the association between trunk muscle strength, lumbar spine bone mineral density (BMD), lumbar scoliosis angle (LSA), and appendicular skeletal muscle mass index (ASMI) and the severity locomotive syndrome (LS) using dual-energy X-ray absorptiometry (DXA) technology in elderly individuals. Methods In this cross-sectional study, we enrolled 168 individuals aged >60 years. We measured their trunk muscle strength (flexion and extension) and BMD, LSA, and ASMI using DXA. We defined degenerative lumbar scoliosis (DLS) as LSA ≥ 10° by the Cobb method using the DXA image. The locomotor function was evaluated using the timed up-and-go (TUG) test and the 25-question Geriatric Locomotive Function Scale (GLFS-25) score. Normal locomotor function, LS-1, and LS-2 were defined as a GLFS-25 score of <7, ≥7 and <16, and ≥16, respectively. We compared the three groups, analyzing the associations between all variables and the locomotor function using univariate and multivariate analyses. Results Although there was no significant difference in sex ratio, BMD, ASMI, and trunk-flexor strength, significant differences were observed in age (p < 0.01), the prevalence of DLS (p = 0.02), trunk-extensor strength (p < 0.01), and trunk-extensor/flexor strength ratio (p < 0.01) among the three groups. In multiple regression analyses, the significant risk factors of the TUG test were age (β = 0.26), body mass index (β = 0.36), LSA (β = 0.15), ASMI (β = -0.30), and trunk-extensor strength (β = -0.19), whereas the significant factor of the GLFS-25 score was trunk-extensor strength (β = -0.31). Conclusions The results indicate that it is clinically important for LS to pay careful attention not only to BMD but also to lumbar scoliosis when DXA examination of the lumbar spine is routinely conducted. Moreover, it is essential to note that trunk-extensor strength is more important than trunk-flexor strength in maintaining locomotor function in elderly individuals.
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Affiliation(s)
- Hiroto Takenaka
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan.,Department of Rehabilitation, Asahi Hospital, Kasugai, Japan
| | - Tatsunori Ikemoto
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan.,Department of Orthopaedics, Aichi Medical University, Nagakute, Japan
| | - Junya Suzuki
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan.,Department of Rehabilitation, Asahi Hospital, Kasugai, Japan
| | - Masayuki Inoue
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan.,Institute of Physical Fitness, Sports Medicine and Rehabilitation, Nagakute, Japan
| | - Young-Chang Arai
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan.,Institute of Physical Fitness, Sports Medicine and Rehabilitation, Nagakute, Japan
| | - Takahiro Ushida
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan.,Institute of Physical Fitness, Sports Medicine and Rehabilitation, Nagakute, Japan
| | - Masataka Deie
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan.,Department of Orthopaedics, Aichi Medical University, Nagakute, Japan
| | - Mitsuhiro Kamiya
- Department of Rehabilitation, Asahi Hospital, Kasugai, Japan.,Department of Orthopaedics, Aichi Medical University, Nagakute, Japan
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12
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Voirin-Hertz M, Carvajal Alegria G, Garrigues F, Simon A, Feydy A, Reijnierse M, van der Heijde D, Loeuille D, Claudepierre P, Marhadour T, Saraux A. Associations of lumbar scoliosis with presentation of suspected early axial spondyloarthritis. Semin Arthritis Rheum 2019; 50:48-53. [PMID: 31277929 DOI: 10.1016/j.semarthrit.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/06/2019] [Accepted: 06/10/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Scoliosis may impact the mechanical loading and cause secondary changes of the sacroiliac joints and lumbar spine. Our goal was to look how lumbar scoliosis modify the clinical and imaging-study in patients with recent-onset inflammatory back pain (IBP) suggesting axial spondyloarthritis (axSpA). METHODS Baseline weight-bearing lumbar-spine radiographs obtained in the DESIR cohort of patients aged 18-50 years and having IBP for at least 3 months but less than 3 years suggesting axSpA were studied. After training on scoliosis detection based on Cobb's angle>10° plus Nash-Moe grade≥1, readers blinded to patient data measured spine lumbar scoliosis, sacral horizontal angle, lumbosacral angle and lumbar lordosis on the radiograph of the lumbar and scored sacroiliitis on the radiograph of the pelvis. Baseline MRIs T1 and STIR of the lumbar spine and sacroiliac joints were evaluated for respectively degenerative changes and signs of axSpA. RESULTS Of the 360 patients (50.8% females) 88.7% had lumbar pain and 69.3% met ASAS criteria for axSpA. Mean Cobb's angle was 3.2°±5.0° and 28 (7.7%) patients had lumbar scoliosis. No statistical differences were observed for radiographic sacroiliitis, MRI sacroiliitis, modified Stoke Ankylosing Spondylitis Spinal Score, Pfirmmann score, high-intensity zone, protrusion, extrusion, MODIC score between patients with and without scoliosis. In both groups, degenerative changes by MRI were rare and predominated at L4-L5 and L5-S1. CONCLUSION In patients with early IBP suggesting axSpA, lumbar scoliosis was not associated with inflammatory or degenerative changes.
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Affiliation(s)
| | | | | | | | - Antoine Feydy
- Radiology B Department, Paris Descartes University, AP-HP, Cochin Hospital, Paris, France
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Pascal Claudepierre
- AP-HP, Groupe Hospitalier Henri-Mondor, Service de Rhumatologie, Créteil 94000, France; Université Paris Est Créteil, EA 7379 - EpidermE, Créteil 94000, France
| | | | - Alain Saraux
- Rheumatology Unit, CHU Brest, BP 824, F-29609 Brest Cedex, France; INSERM 1227, Université de Bretagne Occidentale, LabEx IGO, Brest, France.
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13
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Ferrero E, Khalifé M, Marie-Hardy L, Regnard N, Feydy A, De Loubresse CG, Zakine S, Guigui P. Do Curve Characteristics Influence Stenosis Location and Occurrence of Radicular Pain in Adult Degenerative Scoliosis? Spine Deform 2019; 7:472-480. [PMID: 31053318 DOI: 10.1016/j.jspd.2018.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 09/11/2018] [Accepted: 09/15/2018] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The aim of this study was to describe the various locations of spinal stenosis (LSS) in lumbar scoliosis and its related clinical symptoms. INTRODUCTION Adults with lumbar scoliosis often present with pain and disability. Association of scoliosis and stenosis is not rare, but remains sparsely explored. Consequences of scoliosis on stenosis location and treatment remain debatable. METHODS Patients operated for symptomatic LSS with lumbar scoliosis (Cobb angle >20°) from 2015 to 2016 were included. All patients completed preoperative clinical and neurologic examination. Coronal and sagittal radiographic parameters, rotatory subluxation (RS), and spondylolisthesis were analyzed on full spine radiographs. Computed tomographic scan multiplanar reconstructions were performed to measure central, foraminal, and lateral recess stenosis, from T10 to the sacrum. RESULTS A total of 76 patients were included (69 ± 9 years old, 77% female). Sixty percent had neurogenic claudication, and L5 was the most common radicular pain (41%). The mean Cobb angle was 33° ± 16°. Overall, 35 (46%) patients had coronal malalignment; in 69%, side of the coronal tilt corresponded to side of the concavity of the lumbosacral curve. Sixty patients had RS (most frequent level L3-L4). In 50% of the cohort, RS was located at the junction between the lumbar and lumbosacral curves. In 70% (n = 53) of the patients, central stenosis occurred at the junction between the lumbar and lumbosacral curves. Foraminal and lateral stenosis were most frequently observed in the concavity of the distal lumbosacral curve. L5 radicular pain was significantly more frequent in case of lumbosacral contra-curve and right coronal malalignment. CONCLUSION LSS is frequent in lumbar scoliosis. Relationships exist between curve characteristics and symptomatic LSS in lumbar scoliosis; especially, concavity of the lumbosacral contra-curve and the junctional level between the lumbar curve and the lumbosacral contra-curve. Therefore, accurate analysis of stenosis in ASD seems mandatory, to at least perform decompression because perfect planned treatment for stenosis and scoliosis correction might not always be possible because of the patient's general health status. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- E Ferrero
- Orthopedic Surgery Department, Hôpital Européen Georges-Pompidou, APHP, Paris V University, 20 rue Leblanc, 75908 Paris, Cedex 15, France.
| | - M Khalifé
- Orthopedic Surgery Department, Hôpital Européen Georges-Pompidou, APHP, Paris V University, 20 rue Leblanc, 75908 Paris, Cedex 15, France
| | - L Marie-Hardy
- Orthopedic Surgery Department, Hôpital Européen Georges-Pompidou, APHP, Paris V University, 20 rue Leblanc, 75908 Paris, Cedex 15, France
| | - N Regnard
- Radiology Department, Hôpital Cochin, APHP, Paris V University, 75014 Paris, France
| | - A Feydy
- Radiology Department, Hôpital Cochin, APHP, Paris V University, 75014 Paris, France
| | - C Garreau De Loubresse
- Orthopedic Surgery Department, Hôpital Européen Georges-Pompidou, APHP, Paris V University, 20 rue Leblanc, 75908 Paris, Cedex 15, France
| | - S Zakine
- Orthopedic Surgery Department, Clinique les Maussins, 75019 Paris, France
| | - P Guigui
- Orthopedic Surgery Department, Hôpital Européen Georges-Pompidou, APHP, Paris V University, 20 rue Leblanc, 75908 Paris, Cedex 15, France
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14
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Morimoto T, Sonohata M, Kitajima M, Yoshihara T, Hirata H, Mawatari M. Hip-Spine Syndrome: The Coronal Alignment of the Lumbar Spine and Pelvis in Patients with Ankylosed Hips. Spine Surg Relat Res 2019; 4:37-42. [PMID: 32039295 PMCID: PMC7002070 DOI: 10.22603/ssrr.2019-0008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/01/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Fixed abduction and/or adduction deformities of the hip joint may cause pelvic obliquity with subsequent development of secondary lumbar scoliosis. However, the relationships between the magnitude of a fixed angle (either abduction or adduction) of the hip and the direction of pelvic tilt and lumbar scoliosis remain unclear. The purpose of this study was to investigate the coronal alignment of the lumbar spine and pelvis in patients with ankylosed hips. Methods A total of 56 patients were analyzed, including 17 males and 39 females, with an average age of 65 years (range: 45 to 80 years). Regarding the coronal spinopelvic alignment, the following parameters were measured: the degree of lumbar scoliosis (LS; Cobb angle), pelvic obliquity (PO), and ankylosed hip angle (AHA). The PO and AHA were defined as the angle between the inter-teardrop line and a horizontal line, respectively, and the long axis of the femur on the side of the ankylosed hip. For each parameter, correlations between the parameters were evaluated using a regression analysis. A P value of <0.05 was considered significant. Results Positive linear correlations were observed between the AHA and direction of the PO angles (r = 0.831, p<0.01), the AHA and direction of the LS angles (r = 0.770, p<0.01), and the directions of the PO and LS angles (r = 0.832, p<0.01). Conclusions This study provides evidence to suggest that, in patients with ankylosed hips, the abduction position is positively correlated with the downward PO and the convexity of the LS toward the AH side. In contrast, the adduction position is positively correlated with these results on the opposite side.
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Affiliation(s)
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Saga University, Nabeshima, Japan
| | - Masaru Kitajima
- Department of Orthopaedic Surgery, Saga University, Nabeshima, Japan
| | | | - Hirohito Hirata
- Department of Orthopaedic Surgery, Saga University, Nabeshima, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Saga University, Nabeshima, Japan
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15
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Glassman SD, Bridwell KH, Shaffrey CI, Edwards CC, Lurie JD, Baldus CR, Carreon LY. Health-Related Quality of Life Scores Underestimate the Impact of Major Complications in Lumbar Degenerative Scoliosis Surgery. Spine Deform 2018; 6:67-71. [PMID: 29287820 PMCID: PMC5751947 DOI: 10.1016/j.jspd.2017.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/29/2017] [Accepted: 05/21/2017] [Indexed: 01/13/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To examine Charlson Comorbidity Index (CCMI) as a marker for deterioration in health status not reflected in standard Health Related Quality of Life (HRQOL) measures. SUMMARY OF BACKGROUND DATA HRQOL has become a primary metric for assessing outcomes following spinal deformity surgery. However, studies have reported limited impact of complications on postoperative HRQOL outcomes. METHODS We examined serial CCMI, complications, and HRQOL outcomes for 138 adult lumbar deformity patients treated surgically with a minimum two-year follow-up that included 126 females (91%) with a mean age of 59.8 years (range, 40.2-78.5). Patients with no, minor, or major complications were compared at baseline and at one and two years postoperation. RESULTS Minor complications were observed in 26 patients (19%) and major complications in 15 (11%). Major complications included motor deficit (7), deep vein thrombosis (4), and respiratory failure (3). There was no difference in preoperative SF-36 Physical Component Summary or Scoliosis Research Society-22R (SRS-22R) scores among the groups at baseline. Preoperative CCMI was lowest in the No Complication group (3.52 ± 1.70) followed by the Major (4.00 ± 1.13) and Minor Complication groups (4.15 ± 1.71, p = .165). At one year, there was a significantly greater CCMI deterioration in the Major Complication group (0.80 ± 1.01) compared to both the Minor (0.08 ± 0.27) and No Complication groups (0.27 ± 0.47, p < .001). There was no significant difference in SF-36 Physical Component Summary or SRS-22R scores among the three groups. Similar findings were observed at two years. CONCLUSIONS Despite similar one- and two-year HRQOL improvement, patients with major complications had greater deterioration in CCMI. As CCMI is predictive of medical and surgical risk, patients who sustained a major complication now carry a greater likelihood of adverse outcomes with future interventions, including any subsequent spinal surgery. Although this increased risk may not alter the patient's perception of his or her current health status, it may be important, and should be recognized as part of the shared decision-making process. LEVEL OF EVIDENCE Level II, high-quality prognostic study.
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Affiliation(s)
- Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA
| | - Keith H Bridwell
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA 22908, USA
| | - Charles C Edwards
- The Maryland Spine Center at Mercy Medical Center, 301 St. Paul Place, Baltimore, MD 21202, USA
| | - Jon D Lurie
- Department of Medicine, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Christine R Baldus
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
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16
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Jung S, Kim MG, Lee JI. Lumbar Scoliosis in Patients With Breast Cancer: Prevalence and Relationship With Breast Cancer Treatment, Age, Bone Mineral Density, and Body Mass Index. Ann Rehabil Med 2017; 41:868-874. [PMID: 29201827 PMCID: PMC5698675 DOI: 10.5535/arm.2017.41.5.868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/23/2017] [Indexed: 01/28/2023] Open
Abstract
Objective To identify the prevalence of lumbar scoliosis in breast cancer patients and to investigate the potential risk factors of lumbar scoliosis. Methods A retrospective chart review was performed in breast cancer patients aged more than 40 years who underwent dual energy X-ray absorptiometry (DEXA) scanning between January 2014 and December 2014. We divided the patients into control and experimental groups in order to investigate the influence of breast cancer treatment. The curvature of the lumbar spine was measured by using the Cobb method on a DEXA scan. Scoliosis was defined by the presence of a curvature 10° or larger. The variables, including age, bone mineral density (BMD), body mass index (BMI), and breast cancer treatments, were also obtained from the medical chart. Prevalence of lumbar scoliosis was evaluated, and it was compared between the two groups. The relationships between lumbar scoliosis and these variables were also investigated. Results Lumbar scoliosis was present in 16 out of our 652 breast cancer patients. There was no difference in the prevalence of lumbar scoliosis between the control group (7/316) and the experimental group (9/336) (p=0.70). According to the logistic regression analysis, lumbar scoliosis had no significant association with operation, chemotherapy, hormone therapy, BMI, and BMD (p>0.05). However, age showed a significant relationship with prevalence of lumbar scoliosis (p<0.001; odds ratio, 1.11; 95% confidence interval, 1.054–1.170). Conclusion Prevalence of lumbar scoliosis in patients with breast cancer was 2.45%. Lumbar scoliosis had no association with breast cancer treatments, BMD, and BMI. Age was the only factor related to the prevalence of lumbar scoliosis.
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Affiliation(s)
- Sangeun Jung
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mee Gang Kim
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong In Lee
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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17
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Ferrero E, Lafage R, Diebo BG, Challier V, Ilharreborde B, Schwab F, Skalli W, Guigui P, Lafage V. Tridimensional Analysis of Rotatory Subluxation and Sagittal Spinopelvic Alignment in the Setting of Adult Spinal Deformity. Spine Deform 2017. [PMID: 28622901 DOI: 10.1016/j.jspd.2017.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Retrospective single-center. OBJECTIVE To investigate rotatory subluxation (RS) in adult spinal deformity (ASD) with three-dimensional (3D) stereoradiographic images and analyze relationships between RS, transverse plane parameters, spinopelvic parameters, and clinical outcomes. BACKGROUND Recent research has demonstrated that sagittal plane malalignment and listhesis correlate with ASD patient-reported outcomes. However, there is still a lack of knowledge regarding the clinical impact of 3D evaluation and rotatory subluxation. Recent developments in stereoradiography allow clinicians to obtain full-body standing radiographs with low-dose radiation and 3D reconstruction. METHODS One hundred thirty lumbar ASD patients underwent full-spine biplanar radiographs (EOS Imaging, Paris, France). Clinical outcomes were recorded. Using sterEOS software, spinopelvic parameters and lateral listhesis were measured. 3D transverse plane parameters included apical axial vertebral rotation, axial intervertebral rotation (AIR), and torsion index (sum of AIR in the curve). ASD patients were divided in three groups: AIR <5°, 5°< AIR <10°, AIR >10°. Groups were compared with respect to radiographic and clinical data. Correlations were performed between the transverse and sagittal plane parameters and clinical outcomes. RESULTS Patients with AIR >10° were significantly older, with larger Cobb angle (39.5°) and greater sagittal plane deformity (pelvic incidence-lumbar lordosis mismatch 11.7° and pelvic tilt 22.6°). The AIR >10° group had significantly greater apical vertebra axial rotation apex (24.8°), torsion index (45°), and upper-level AIR (21.5°) than the two other groups. Overall, 27% of AIR patients did not have two-dimensional (2D) lateral listhesis. Patients with AIR >10° had significantly worse Oswestry Disability Index and more low back pain. CONCLUSION For patients in which lateral listhesis was unreadable in 2D imaging, rotatory subluxation was revealed using stereoradiography and at an earlier disease stage. Moreover, different 3D transverse plane parameters are related to different patient-reported outcomes. Therefore, axial rotation can be considered in evaluation of lumbar degenerative scoliosis severity and prognosis. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Emmanuelle Ferrero
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA; Orthopaedic Surgery, Hopital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France.
| | - Renaud Lafage
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Bassel G Diebo
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Vincent Challier
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Brice Ilharreborde
- Orthopaedic Surgery, Robert Debré Hospital, 48 Bd Sérurier, 75019 Paris, France
| | - Frank Schwab
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Wafa Skalli
- Laboratoire de Biomécanique, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013 Paris, France
| | - Pierre Guigui
- Orthopaedic Surgery, Hopital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France
| | - Virginie Lafage
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
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18
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Wang CW, Wang TM, Wu KW, Huang SC, Kuo KN. The comparative, long-term effect of the Salter osteotomy and Pemberton acetabuloplasty on pelvic height, scoliosis and functional outcome. Bone Joint J 2017; 98-B:1145-50. [PMID: 27482031 DOI: 10.1302/0301-620x.98b8.37215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/22/2016] [Indexed: 11/05/2022]
Abstract
AIMS This study compared the long-term results following Salter osteotomy and Pemberton acetabuloplasty in children with developmental dysplasia of the hip (DDH). We assessed if there was a greater increase in pelvic height following the Salter osteotomy, and if this had a continued effect on pelvic tilt, lumbar curvature or functional outcomes. PATIENTS AND METHODS We reviewed 42 children at more than ten years post-operatively following a unilateral Salter osteotomy or Pemberton acetabuloplasty. We measured the increase in pelvic height and the iliac crest tilt and sacral tilt at the most recent review and at an earlier review point in the first decade of follow-up. We measured the lumbar Cobb angle and the Short Form-36 (SF-36) and Harris hip scores were collected at the most recent review. RESULTS During the first decade of follow-up, there was a greater increase in pelvic height in the children who had a Salter osteotomy (Salter, 10.1%; Pemberton, 4.3%, p < 0.001). The difference in the increase in pelvic height was insignificant at the most recent review (Salter, 4.4%; Pemberton, 3.1%, p = 0.249). There was no significant difference between the two groups for the lumbar Cobb angle, (Salter, 3.1°; Pemberton, 3.3°, p = 0.906). A coronal lumbar curve was seen in 41 children (97%), 30 of these had a compensatory curve. Sacral tilt was the radiographic parameter for pelvic imbalance that correlated most with the lumbar Cobb angle (Pearson correlation co-efficient 0.59). The Harris hip score and SF-36 were good and showed no differences between the two groups. CONCLUSION In the long-term, we found no difference in the functional results or pelvic imbalance between Salter osteotomy and Pemberton acetabuloplasty in the management of children with DDH. Cite this article: Bone Joint J 2016;98-B:1145-50.
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Affiliation(s)
- C-W Wang
- Department of Orthopedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd, Zhongzheng Dist, Taipei City, 10002, Taiwan
| | - T-M Wang
- Department of Orthopedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd, Zhongzheng Dist, Taipei City, 10002, Taiwan
| | - K-W Wu
- Department of Orthopedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd, Zhongzheng Dist, Taipei City, 10002, Taiwan
| | - S-C Huang
- Department of Orthopedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd, Zhongzheng Dist, Taipei City, 10002, Taiwan
| | - K N Kuo
- Taipei Medical University, No.250, Wuxing Street, Taipei City 11031, Taiwan
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