Degrees Of Lumbar Flexion Research Articles

Risk factors for increased sagittal pelvic motion causing unfavourable orientation of the acetabular component in patients undergoing total hip arthroplasty.

It is important to consider sagittal pelvic rotation when introducing the acetabular component at total hip arthroplasty (THA). The purpose of this study was to identify patients who are at risk of unfavourable pelvic mobility, which could result in poor outcomes after THA. A consecutive series of 4042 patients undergoing THA had lateral functional radiographs and a low-dose CT scan to measure supine pelvic tilt, pelvic incidence, standing pelvic tilt, flexed-seated pelvic tilt, standing lumbar lordotic angle, flexed-seated lumbar lordotic angle, and lumbar flexion. Changes in pelvic tilt from supine-to-standing positions and supine-to-flexed-seated positions were determined. A change in pelvic tilt of 13° between positions was deemed unfavourable as it alters functional anteversion by 10° and effectively places the acetabular component outside the safe zone of orientation. For both men and women, the degree of lumbar flexion was a significant predictor of risk in hip flexion (p < 0.0001) with increased odds of unfavourable pelvic mobility in those with lumbar flexion of < 20° (men, odds ratio (OR) 6.74, 95% confidence interval (CI) 3.83 to 11.89; women, OR 2.97, 95% CI 1.87 to 4.71). In women, age and standing pelvic tilt were significant predictors of risk in hip extension (p = 0.0082 and p < 0.0001, respectively). The risk of unfavourable pelvic mobility was higher in those aged > 75 years (OR 2.28, 95% CI 1.56 to 3.32) and those with standing pelvic tilt of < -10° for extension risk (OR 7.10, 95% CI 4.10 to 10.29). In men, only standing pelvic tilt was significant (p < 0.0001) for hip extension with an increased risk of unfavourable pelvic mobility (OR 8.68, 95% CI 5.19 to 14.51). Patients found to have unfavourable pelvic mobility had limited lumbar flexion and more posterior standing pelvic tilt in both men and women, as well as increasing age in women. We recommend that patients undergo preoperative functional radiographic screening to determine specific parameters that can affect the functional orientation of the acetabular component. Cite this article: Bone Joint J 2018;100-B:845-52.

Abdominal circumference but not the degree of lumbar flexion affects the accuracy of lumbar interspace identification by Tuffier’s line palpation method: an observational study

BackgroundLumbar puncture for spinal or epidural anesthesia is commonly performed by palpating bony landmarks, but identification of the desired intervertebral level is often inaccurate. It is unclear whether such inaccuracy is related to patient factors, such as body mass index and degree of lumbar flexion. We hypothesized that overweight patients and patients with less of an ability to hyperflex their lumbar spines are prone to inaccurate lumbar spinous intervertebral level identification.Methods52 adult volunteers were included in this study. 7 anesthesiologists with different years of experience identified and marked subjects’ levels of the iliac crests, then marked the presumed interspaces. Lumbar X-ray was then performed with metal markers, and actual radiographic findings were identified and compared to the initial markings.ResultsPatients with larger abdominal circumferences (mean (SD), 94.0(12.1) cm), higher body mass indices (25.9(3.9) kg/m2), and aged between 50 and 70 years old had lumbar interspaces that were higher than the presumed level; patients with smaller abdominal circumferences (82.8(13.5) cm) and lower body mass indices (21.6(4.1) kg/m2) had intervertebral levels that were lower than the presumed level. Cobb’s angle, indicating the degree of lumbar flexion, did not affect the accuracy obtained.ConclusionsPatients’ abdominal circumference, body mass index, and age are factors that may impact the accuracy of lumbar level identification. Tuffier’s line, as identified by palpation, does not seem to be a reliable landmark for proper lumbar interspace identification in all cases.

Response of the flexion-relaxation phenomenon relative to the lumbar motion to load and speed.

Nonrandomized control trial. To determine if the variations of speed and loading conditions during trunk flexion-extension could influence the times of occurrence and disappearance of the electrical silence of the erector spinae muscles, the degrees of lumbar flexion at those instants, and the relative lumbar motion time. It has been suggested that varying either the speed of movement or the load on the trunk during trunk flexion-extension movements may influence the flexion-relaxation phenomenon or the kinesiologic data. However, no study dealt with the simultaneous effect of the speed of movement on the spine rhythm and on the occurrence of the electrical silence of the erector spinae. A total of 22 pain-free volunteers performed a series of trunk flexion-extension movements varying the speed and load. The motion of the lumbar spine ( degrees ) and the integrated electromyography (microV) of erector spinae muscles were simultaneously recorded. Two measures were calculated: the percentage of the maximum lumbar spine flexion at the instants when changes of electrical activity represented the beginning and end of the electrical silence and the relative lumbar spine motion time during trunk flexion and extension movements. The increase in speed of movement significantly increased the relative lumbar flexion time and significantly reduced the relative lumbar extension time (t = 2.49 and t = 2.25, P < 0.05); furthermore, it significantly delayed the appearance of the electrical silence in the range of flexion (t = 3.52, P < 0.01). There was no significant effect from a change in load. The relative spine motion time differed depending on the direction of movement, being longer during trunk flexion and shorter during extension. The increase in speed of movement produced greater differences in the relative time between trunk flexion and extension; furthermore, it delayed the appearance of the electrical silence of the erector spinae muscles in the range of flexion.