Apex Of Lumbar Lordosis Research Articles

Sex-based differences in clinical and radiological presentation of patients with degenerative lumbar scoliosis: a cross-sectional study

BackgroundTo evaluate the sex-based differences in clinical and radiological presentation of patients with degenerative lumbar scoliosis (DLS) and to explore whether the difference is helpful in investigating the etiology and progression of DLS.MethodA retrospective review of 199 patients (41 males, 158 females) with DLS was included. Patient demographics including age, gender, bone mineral density were collected. Back and leg pain was assessed by visual analog scale, and general physical condition was assessed by Oswestry Disability Index. Cobb’s angle was measured, and direction of scoliosis, position of the superior, inferior and apex vertebrae, number of vertebrae included in the scoliosis, rotation of apex vertebrae (Nash-Mo index), translation of apex vertebrae were recorded. Sagittal longitudinal axis, thoracolumbar kyphosis, lumbar lordosis (LL), pelvic incidence angle (PI), sacral slope, apex of lumbar lordosis and coronal balance distance were measured by whole spine lateral radiographs, and type of coronal imbalance was evaluated in all patients. Fat infiltration rate (FIR) of the paraspinal muscles at the vertebral apex was measured by MRI.ResultCompared to female patients, male patients showed more back and leg pain on clinical presentation and smaller Cobb angle, less parietal rotation, larger LL, smaller PI-LL and lower paravertebral muscle FIR on radiologic features.ConclusionGender differences do exist in DLS patients with regard to clinical and radiological presentation, low back pain was more pronounced in male patients, and scoliosis was more severe in female patients based on this cross-sectional study.

The correlation of sacral table angle to spinopelvic sagittal alignment in healthy adults

BackgroundThe sacrum plays an important role in sagittal balance of the spine, whereas the exact association between sacral parameters, specifically the sacral table angle (STA) and spinopelvic parameters has been only scarcely assessed. It aims to investigate the correlations between the sacral parameters and spinopelvic sagittal alignment parameters in healthy adults.MethodsA cohort of 142 Northern Chinese healthy adults between 18 and 45 years old were recruited between April 2019 and March 2021. Full-spine standing X-ray films were performed for every volunteer. The sacral parameters were measured: sacral table angle (STA), sacral inclination (SI) and sacral slope (SS). The spinopelvic sagittal alignment parameters included: pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis and the apex of lumbar lordosis (LLA). The correlations analysis, as well as the linear regression analysis, were performed between STA, SI and the spinopelvic parameters.ResultsAn equation ‘STA = SI + 90 − SS’ was revealed to represent the interrelationships between STA, SI and SS. STA was statistically correlated with PI (rs = − 0.693), PT (rs = − 0.342), SS (rs = − 0.530), LL (rs = 0.454), and LLA (rs = 0.438). SI correlated with STA (rs = 0.329), PT (rs = − 0.562), SS (rs = − 0.612) and LL (rs = 0.476). Simple linear regression analysis also verified the correlation between STA and PI (y = − 1.047x + 149.4), SS (y = − 0.631x + 96.9), LL (y = 0.660x − 117.7), LLA (y = 0.032x + 0.535), and SI (y = 0.359x + 8.23).ConclusionThe equation ‘STA = SI + 90 − SS’ indicates the exact geometric relationship between STA, SI and SS. The sacral parameters, both STA and SI, correlate to the spinopelvic sagittal alignment parameters in healthy adults. The linear regression analysis results also give predictive models for spinopelvic sagittal alignment parameters based on the invariant parameter STA, which are helpful for surgeons in designing an ideal therapeutic plan.

The Impact of Spinopelvic Alignment on the Facet Joint Degeneration.

Retrospective Cohort. This study aims to evaluate the relations between facet joint degeneration (FD) and sagittal spinopelvic parameters. Second, the association of FD with degenerative disc disease (DDD) and lumbar disc herniations (LDH) was assessed. The radiologic data of 192 patients was retrospectively analyzed. Total, proximal, and distal lumbar lordosis (LL, PLL, and DLL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sacral table angle (STA) were measured on lumbar x-ray plates. DDD and FD was graded on the MRI images. The apex of lumbar lordosis and PI-LL imbalance were noted in each patient. Correlation analyses were performed. Age and body mass index (BMI) were correlated with FD. LL and DLL are positively associated with upper-level FDs (L1-2 and L2-3) (P < 0,05). PLL were positively associated with lower level FD (L5-S1) (P < 0,05). A significant increase in PI was associated with FD in L2-3 and L4-5. A larger PT was found in FD in L4. The PI-LL imbalance was not correlated with the FD. Correlation between DDD and LDH and FD was observed in each level (P < 0,01). The level of FD is not affected by the apex of the curve. Age and BMI have a direct impact on FD. However, spinopelvic parameters influence the severity of FD rather than its occurrence. In addition to the effects of lumbar lordosis as a single entity, it is essential to consider separately the effects of proximal and distal lumbar lordosis at the FD level.

Core Stabilization Exercise on the Lumbar Lordosis and Pelvic Inclination Among Chronic Nonspecific Low Back Pain Patients

Introduction: Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders and it is documented that &gt;90% of the cases have no defined cause for pain, called nonspecific low back pain (NSLBP). Alteration in the joint position, abnormal posture, and impaired muscle recruitment may result in recurrent CLBP. Lumbar lordosis (LL) provides strength against the compressive forces of gravity and it also protects the posterior spinal ligament and acts as a shock absorber for vertical forces. Increased LL is considered as a reason for radiculopathy, facet pain, and postural pain. Spinal posture and pelvic position were analyzed and documented as altered in CLBP patients. Anatomically, the anterior and posterior tilt of the back and pelvis by the force of different muscles can alter the spinal curvature. Posterior pelvic tilt in a standing position can decrease the LL. The pelvic inclination is related to the lumbar curve, and both are related to the performance and length of the back and abdominal muscles. Therefore, in this study, we aimed to evaluate the effect of core stabilization exercise on pain intensity, functional disability, LL, and pelvic inclination in NSLBP.&#x0D; Methodology: A total of 63 patients aged between 20 and 60 years who met the selection criteria were included. All participants gave their written consent to participate in this study. Demographic data such as age, weight, height, and duration of the back pain were documented. Patients were asked to report their pain using the Visual Analogue Scale (VAS) and Disability in Roland Morris Disability Questionnaire (RMDQ). Exclusion criteria were participants with musculoskeletal disorders (osteoarthritis and rheumatoid arthritis) and a history of previous fractures and systemic diseases. DIERS Formetric 4D spine and posture analyzer were used to assess spinal alignment using the light-optical scanning method on the back of patient in standing position. Angle of LL: the angle formed by the apex of LL and the T12 and L5 spinous processes. Pelvic tilt is the orientation of the pelvis in respect to the thighbones and the rest of the body. Core stabilization exercises were given for 30 min, five days a week, for 12 sessions. Pre- and posttest values were documented and analyzed.&#x0D; Result: In this experimental study, we used Pearson’s correlation coefficient to find the correlation between LL and pelvic inclination angle and found a strong positive correlation (r = 0.76; P = 0.001). The study showed that core stabilization exercise for 12 weeks’ duration had statistically significant reduction in the pain intensity (p &lt; 0.01), functional disability (p &lt; 0.002), LL (p &lt; 0.05), and pelvic inclination angle (p &lt; 0.05) among patients with chronic NSLBP.&#x0D; Conclusion: From this research, we conclude that core stabilization exercises decrease the pain intensity, functional disability, LL, and pelvic inclination angle in patients with chronic NSLBP. Thus, evaluation of the lumbar curvature and pelvic inclination, and designing the appropriate exercise is recommended in the management of NSLBP.

Predictive formulae of ideal lumbar lordosis determined by individual pelvic incidence and thoracic kyphosis in asymptomatic adults

BackgroundThe precise prediction of ideal lumbar lordosis (LL) has become increasingly important in clinical practice. The aim of this study was to explore the regulatory mechanisms of sagittal spinopelvic alignment and to predict ideal LL based on individual pelvic incidence (PI) and thoracic kyphosis (TK) parameters in asymptomatic adults. MethodsA total of 233 asymptomatic subjects older than 18 years were consecutively enrolled in our study between April 2017 and December 2019. A full-spine, standing X-ray was performed for each subject. The following parameters were measured in the sagittal plane: the apex of lumbar lordosis (LLA), the distance between the plumb line of the lumbar apex (LAPL) and the gravity plumb line, the inflection point (IP), LL, the upper arc and lower arc of lumbar lordosis (LLUA and LLLA, respectively), PI and TK. Stepwise multiple linear regressions were conducted, and the statistical significance level was P < 0.05. ResultsBoth PI and TK were two important predictive variables for LLA, LAPL, IP and LL. In addition, the LLUA was mainly explained by TK, while the LLLA was explained by PI. The corresponding predictive models are listed as follows: LLA = 17.110 − 0.040∗PI + 0.023∗TK (R2 = 0.380), LAPL = 31.296 + 0.467∗PI − 0.126∗TK (R2 = 0.309), IP = 10.437 + 0.091∗TK − 0.029∗PI (R2 = 0.227), LL = 2.035 + 0.618∗PI + 0.430∗TK (R2 = 0.595), LLUA = 0.893 + 0.418∗TK (R2 = 0.598), LLLA = 3.543 + 0.576∗PI (R2 = 0.433). ConclusionThe specific sagittal lumbar profile should be regulated by both pelvic and thoracic morphology. Such predictive models for lumbar parameters determined by individual PI and TK parameters have been established, which are meaningful for surgeons to better understand the regulatory mechanisms of sagittal spinopelvic alignment and reconstruct a satisfactory lumbar alignment.

Correlation between the apex of lumbar lordosis and pelvic incidence in asymptomatic adult.

The objective of this study was to test the correlation between the apex of lumbar lordosis (LLA) and pelvic incidence (PI) in asymptomatic adults, and to establish predictive formulae based on the PI to obtain the reference values of lumbar sagittal parameters. A cohort of 183 asymptomatic volunteers older than 18years was enrolled in this study between April 2017 and May 2019. A full-spine, standing X-ray was taken for each subject. The following parameters in the sagittal plane were measured: the LLA, the distance between the plumb line of the lumbar apex (LAPL) and gravity plumb line, lumbar lordosis (LL), the upper arc of lumbar lordosis (LLUA), the lower arc of lumbar lordosis (LLLA) and the PI. The correlations between lumbar parameters and PI were analysed, and simple linear regressions were simultaneously constructed. The statistical significance level was P < 0.05. The PI was statistically correlated with the LLA (rs = - 0.595, P < 0.001), LAPL (rs = 0.503, P < 0.001), LL (rs = 0.605, P < 0.001), LLUA (r = 0.354, P < 0.001) and the LLLA (r = 0.658, P < 0.001). The corresponding regression formulae were as follows: LLA = - 0.042*PI + 6.134 (R2 = 0.306), LAPL = 0.448*PI + 26.570 (R2 = 0.279), LL = 0.888*PI - 2.667 (R2 = 0.370), LLUA = 0.272*PI - 2.297 (R2 = 0.126) and LLLA = 0.607*PI + 0.177 (R2 = 0.433). The PI has strong correlations with the LLA, LAPL, LL, LLUA and LLLA, which demonstrates that the specific lumbar shape can be affected by the pelvic morphology. Moreover, predictive models for ideal lumbar sagittal parameters based on the PI have been developed, contributing to the design of precise and individualized preoperative plans. These slides can be retrieved under Electronic Supplementary Material.

Adjacent segment degeneration and topping off. Never stop at the apex!

We investigated if applying the Transition system (Globus Medical Inc., Audubon, PA, USA) as topping off can prevent Adjacent Segment Degeneration (ASD) and if rate of ASD is increased if instrumentation stopped at the apex of the Lumbar Lordosis (LL). We enrolled 99 consecutive patients in a retrospective study who have been operated by instrumented fusion of the lumbar spine. Thirty patients were treated by topping of (Group 1), 69 patients received the standard procedure (Group 2). 18 patients of group 1 (60%) and 38 patients of group 2 (55%) developed ASD. The difference was not significant (P>0.05). In 17 patients (17%) instrumentation stopped at apex of LL. 14/17 patients (82%) developed an ASD. This influence was significant (P<0.05). Instrumented fusion of the lumbar spine should not stop at the apex of the lumbar curve. Topping off by hybrid dynamic fixation does not reduce the rate of ASD.

Lumbar lordosis does not correlate with pelvic incidence in the cases with the lordosis apex located at L3 or above.

To test the hypothesis that the relationship between PI and L1-S1 lumbar lordosis (LL) is always positive, even in cases with different lumbar sagittal profiles. Standing whole-spine sagittal alignment was measured with EOS system in 100 healthy adults (46 men, 54 women, mean age 40.9years). The apex of lumbar lordosis was defined as the most anterior lumbar vertebra or intervertebral disk from the gravity line determined by a force plate measurement. Subjects were stratified into three groups: the upper group with an apex between L1 and L3 (UppA, n = 19), the middle group with an apex from L3/4 to L4/5 (MidA, n = 67), and the lower group with an apex at L5 or below (LowA, n = 14). PI, PT, SS, thoracic kyphosis (TK), LL, SVA, T1 pelvic angle, and knee flexion angle were compared between the groups. The correlation between LL and PI in each group was also compared. PI and SS differed significantly between the three groups, and LL was significantly different between LowA and MidA and UppA. TK and KF did not differ significantly between groups. LL and PI were significantly positively correlated in the MidA and LowA groups, but not in the UppA group. Contrary to the hypothesis, the correlation coefficient between PI and LL was not significant in the cases with apex above L3, suggesting that the relationship between PI and LL is not always constant, and whole sagittal alignment should be taken into account. These slides can be retrieved under Electronic Supplementary Material.

Sagittal Alignment Following Lumbar Three-Column Osteotomy: Does the Level of Resection Matter?

3‐Column osteotomy (3CO) is an effective technique to correct sagittal malalignment, but is associated with high complication rates. Whether the angle of wedge resection and spinal level of the osteotomy are well correlated to the correction of spino‐pelvic parameters remains unclear. This study sought to investigate the impact of the osteotomy site on sagittal correction. Post‐operative apex of lumbar lordosis has a significant impact on pelvic tilt with more caudal 3CO levels associated with higher post‐operative motor deficits and revision.

Equilibrium of the human body and the gravity line: the basics

Bipedalism is a distinguishing feature of the human race and is characterised by a narrow base of support and an ergonomically optimal position thanks to the appearance of lumbar and cervical curves. The pelvis, adapted to bipedalism, may be considered as the pelvic vertebra connecting the spine to the lower limbs. Laterally, the body's line of gravity is situated very slightly behind the femoral heads laterally, and frontally it runs through the middle of the sacrum at a point equidistant from the two femoral heads. Any abnormal change through kyphosis regarding the spinal curves results in compensation, first in the pelvis through rotation and then in the lower limbs via knee flexion. This mechanism maintains the line of gravity within the base of support but is not ergonomic. To analyse sagittal balance, we must thus define the parameters concerned and the relationships between them. These parameters are as follows: for the pelvis: incidence angle, pelvis tilt, sacral slope; for the spine: point of inflexion, apex of lumbar lordosis, lumbar lordosis, spinal tilt at C7; for overall analysis: spino-sacral angle, which is an intrinsic parameter.

Anatomical configuration of the spinal column in the supine position. II. Comparison of pregnant and non-pregnant women

To assess the changes in the curvature of the spinal column in the supine position during pregnancy, we studied seven pregnant (32-37 weeks of pregnancy) and seven non-pregnant women using magnetic resonance imaging. T1-weighted sagittal midline magnetic resonance images of the spinal column were obtained with subjects in the supine position with left tilt. There was no significant difference in the maximum angle of decline of the lumbar spinal canal between the pregnant (mean 12.4 (SD 3.3) degrees) and non-pregnant (13.4 (3.9) degrees) groups. The maximum angle of incline of the upper thoracic spinal canal was smaller in the pregnant (15.8 (2.9) degrees) than in the non-pregnant (22.7 (6.0) degrees) group. The highest point of the lumbar spinal canal was located at a lower lumbar region in the pregnant (median L4-5 (range L4 to L4-5)) than in the non-pregnant (L4 (L3-4 to L4)) group. The lowest point of the thoracic spinal canal was located at a higher thoracic region in the pregnant (T6-7 (T6 to T7-8)) than in the non-pregnant (T8 (T6-7 to T9)) group. This study revealed that the apex of lumbar lordosis was caudad and thoracic kyphosis was reduced in the supine position in the later stages of pregnancy. These changes in the curvature of the spinal column may explain, in part, the enhanced cephalad spread of subarachnoid hyperbaric anaesthetic solutions in the later stages of pregnancy.