Increase In Thoracic Kyphosis Research Articles

Does Minimally Invasive Hemilaminectomy for Intradural Extramedullary Tumor Resection Prevent Postlaminectomy Kyphosis or Lordosis Loss?

Minimally invasive hemilaminectomy is a safe and effective alternative to open laminectomy for treating intradural extramedullary tumors. There are no reports of postoperative kyphosis after this approach. This study aims to determine whether performing minimally invasive spine surgery hemilaminectomy for intradural extramedullary tumors can prevent the development of postlaminectomy kyphosis (PLK) or lordosis loss. Sixty-five patients with spinal intradural extramedullary tumors who underwent minimally invasive hemilaminectomy surgery and complete pre and postoperative radiologic imaging were included. The effect of the surgical approach on the spinal sagittal axis was assessed by comparing pre- versus postoperative segmental and local Cobb angles at different spinal levels, considering anatomical localization (cervical, thoracic, lumbar, and transition segments) and functional features (mobile, semi-rigid, and transition segments), as well as the extent of the surgical approach (1, 2, or 3 levels) and follow-up. None of the patients had an increase in thoracic kyphosis nor a loss of cervical or lumbar lordosis greater than or equal to 10° after undergoing the minimally invasive spine surgery hemilaminectomy approach.More than 5° of increase in kyphosis was detected on 7.4% and 11.1%, for the segmental and the local angles, respectively; meanwhile, for patients with loss of lordosis, this deviation was detected in 5.3%, for both angles. The occurrence of PLK was more common than that of lordosis loss, but mainly manifested in postoperative angle impairment of less than 5°. No significant differences were evidenced, considering theapproach length. Hemilaminectomy represents a promising approach for preventing PLK and postlaminectomy lordosis loss following intradural extramedullary tumor resection.

Explaining and predicting the increased thorax injury in aged females: age and subject-specific thorax geometry coupled with improved bone constitutive models and age-specific material properties evaluated in side impact conditions.

Predicting and understanding thorax injury is fundamental for the assessment and development of safety systems to mitigate injury risk to the increasing and vulnerable aged population. While computational human models have contributed to the understanding of injury biomechanics, contemporary human body models have struggled to predict rib fractures and explain the increased incidence of injury in the aged population. The present study enhanced young and aged human body models (HBMs) by integrating a biofidelic cortical bone constitutive model and population-based bone material properties. The HBMs were evaluated using side impact sled tests assessed using chest compression and number of rib fractures. The increase in thoracic kyphosis and the associated change in rib angle with increasing age, led to increased rib torsional moment increasing the rib shear stress. Coupled with and improved cortical bone constitutive model and aged material properties, the higher resulting shear stress led to an increased number of rib fractures in the aged model. The importance of shear stress resulting from torsional load was further investigated using an isolated rib model. In contrast, HBM chest compression, a common thorax injury-associated metric, was insensitive to the aging factors studied. This study proposes an explanation for the increased incidence of thorax injury with increasing age reported in epidemiological data, and provides an enhanced understanding of human rib mechanics that will benefit assessment and design of future safety systems.

Risk factors of proximal junctional kyphosis after surgical correction of spinal deformities caused by Scheuermann’s disease

Objective. To identify risk factors for the development of Proximal Junctional Kyphosis (PJK) in patients with Scheuermann’s kyphosis operated on using segmental instrumentation.Material and Methods. The study group consisted of 43 patients (13 females, 30 males), mean age was 17 years, and mean postoperative follow-up was 6 years. Spondylograms with a patient in a standing position performed before surgery, a week after surgery, and at the end of the follow-up period were analyzed. Radiological parameters were studied: cervical lordosis, absolute rotation angle, thoracic entry angle, T1 vertebral body tilt, neck tilt, skull tilt, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, vertebral and pelvic parameters (Pelvic Incidence, Pelvic Tilt, Sacral Slope), sagittal vertical axis, proximal junctional angle (PJA), and length of the posterior spinal fusion.Results. The mean PJA before surgery was 7° [3°; 8°], immediately after surgery – 10° [8°; 13°], by the end of the follow-up period – 25°[19°; 32°]. The incidence of PJK by the end of the follow-up period was 79.1 % (in 34 out of 43 patients). The initial value of thoracic kyphosis was 77° [72°; 86°], after surgery – 41° [31°; 46°], at the last examination – 43° [35°; 53°]. The inclination of the T1 vertebral body in the sagittal plane before surgery was 39° [30°; 45°], at the stages of follow-up – 33° [22°; 37°] and 39° [27°; 45°]. Some significant predictors were identified. An increase in the inclination of the T1 vertebral body (p = 0.005) by k° is associated with an increase in the risk of PJK by 1.19k [1.08k; 1.37k] times, and an increase of thoracic kyphosis by k° (p = 0.023) – by 1.12k (1.03k; 1.27k) times. The formula for preoperative predicting the likelihood of this complication is: P (PJK) = 1 - 1/(1 + exp (-23.14 + 0.26 × T1 + 0.21 × TK)), where P(PJK) is the probability of proximal junctional kyphosis; exp(z) is the exponential function to the power of z; T1 (T1 vertebral body tilt) and TK (thoracic kyphosis) are preoperative values of variables. Using ROC analysis, the threshold value for predicting PJK was determined to be 74.2 %, that is, the development of PJK was predicted in patients with a PJK probability greater than the threshold value calculated by the model formula. The predictive ability of the multivariate model was tested on the basis of the available initial data with a known final result. The prediction was correct in 41 cases out of 43.Conclusion. Using the multivariate logistic regression method, two mutually independent multiplicative indicators were determined for predicting PJK with high accuracy (sensitivity 94.1 %, specificity 100.0 %) – inclination of the T1 vertebral body and thoracic kyphosis.

Compensation mechanisms for post-traumatic thoracolumbar kyphosis

Objective. To identify the mechanism of deformity compensation in patients with post-traumatic kyphosis of the thoracolumbar junction, based on the analysis of X-ray results of surgical treatment.Material and Methods. The study included data obtained from medical records of 69 patients (47 women, 22 men) operated on for painful post-traumatic kyphosis at the levels of T12, L1 and L2 vertebra. Patients underwent staged surgical interventions in a single surgical session. Demographic data and X-ray results of surgical treatment were evaluated.Results. As a result of surgical interventions, post-traumatic kyphosis (LK) was corrected to an average of 1.9°. After correction of kyphosis, statistically significant changes in the parameters of sagittal spinal curvatures were revealed: an increase in thoracic kyphosis (TK), a decrease in lumbar lordosis (LL), including due to lower lumbar lordosis (LowLL). At the same time, the parameters of the spinopelvic balance (PT, SS) did not change. Statistically significant correlations (p < 0.001) were detected between the magnitude of local kyphosis correction (LK preOP-LKpostOP), which amounted to 33.63° ± 8.77°, and parameters of lumbar lordosis ΔLL, thoracic kyphosis ΔTK and ΔPI-LL. Parameters of global sagittal balance and pelvic balance did not show correlations with the magnitude of kyphosis correction. The X-ray study of patients in Group I (without signs of initial sagittal imbalance) and Group II (with signs of sagittal imbalance) revealed a statistically significant difference in global balance (GT) and spinopelvic balance (PT, SS, LowLL), both before and after correction intervention in the thoracolumbar junction area, despite comparable indicators of sagittal spinal curvatures and the magnitude of post-traumatic kyphosis,.Conclusion. The main compensation mechanism includes changes in the spinal departments adjacent to kyphosis: a decrease in thoracic kyphosis and an increase in lumbar lordosis, rather than changes in the global or spinopelvic balance.

Low radius of curvature growth-friendly rib-based implants increase the risk of developing clinically significant proximal junctional kyphosis.

Clinically significant proximal junctional kyphosis (PJK) occurs in 20% of children with scoliosis treated with posterior distraction-based growth-friendly surgery. In an effort to identify modifiable risk factors, it has been theorized biomechanically that low radius of curvature (ROC) implants (i.e., more curved rods) may increase post-operative thoracic kyphosis, and thus may pose a higher risk of developing PJK. We sought to test the hypothesis that early onset scoliosis (EOS) patients treated with low ROC distraction-based implants will have a greater risk of developing clinically significant PJK as compared to those treated with high ROC (straighter) implants. We conducted a retrospective review of prospectively collected data obtained from a multi-centre EOS database on children treated with rib-based distraction with a minimum 2-year follow-up. Variables of interest included: implant ROC at index (220mm or 500mm), participant age, pre-operative scoliosis, pre-operative kyphosis, and scoliosis etiology. PJK was defined as clinically significant if revision surgery with a superior extension of the upper instrumented vertebrae was performed. In 148 participants with scoliosis, there was a higher risk of clinically significant PJK with low ROC (more curved) rods (OR: 2.6 (95% CI 1.09-5.99), χ2 (1, n = 148) = 4.8, p = 0.03). Participants had a mean pre-operative age of 5.3years (4.6y 220mm vs 6.2y 500mm, p = 0.002). A logistic regression model was created with age as a confounding variable, but it was determined to be not significant (p = 0.6). Scoliosis etiologies included 52 neuromuscular, 52 congenital, 27 idiopathic, 17 syndromic with no significant differences in PJK risk between etiologies (p = 0.07). Overall, participants had pre-op scoliosis of 69° (67° 220mm vs 72° 500mm, p = 0.2), and kyphosis of 48° (45° 220mm vs 51° 500mm, p = 0.1). The change in thoracic kyphosis pre-operatively to final follow-up (mean 4.0 ± 0.2years) was higher in participants treated with 220mm implants compared to 500mm implants (220mm: 7.5 ± 2.6° vs 500mm: - 4.0 ± 3.0°, p = 0.004). Use of low ROC (more curved) posterior distraction implants is associated with a significantly greater increase in thoracic kyphosis which likely led to a higher risk of developing clinically significant PJK in participants with EOS. Level III - retrospective comparative study.

5.5-mm Cobalt-Chrome vs 6-mm Titanium Alloy Rods in Surgical Treatment of Lenke 1 Adolescent Idiopathic Scoliosis With High-Density Pedicle Screws and Direct Vertebral Rotation on Differently Shaped Rods: A Retrospective Comparative Cohort Study.

The gold standard of surgical treatment of adolescent idiopathic scoliosis (AIS) consists of a posterior approach requiring complex 3-dimensional correction with multisegmental pedicle screws and 2 contoured rods. The substantial corrective forces and the ability of the rod to withstand these forces rely on its biomechanical properties. The aim of this study is to compare outcomes of 5.5-mm cobalt-chrome (CoCr) and 6-mm titanium alloy (TiAl) rods in surgical correction in Lenke 1 AIS patients. TiAl has greater elasticity, which may facilitate the correction maneuver, whereas the stiffness of CoCr may result in stronger correction forces. The literature provides no clear indications about which rod may allow better correction and safety. A total of 64 consecutive patients (30 CoCr vs 34 TiAl) with Lenke 1 AIS <100°, with 2 years minimum follow-up, requiring correction and posterior fusion at our institution were included. The primary outcome measure was coronal and sagittal correction and loss of correction at 2-year follow-up. Secondary outcome measures compared peri- and postoperative complications. The mean coronal correction was higher in the CoCr group: -73.6% ± 7.4 vs -65.5% ± 11 (P = 0.001). Mean T5-T12 kyphosis did not change significantly after surgery. In patients with hypokyphosis (<10°), an improvement in thoracic kyphosis was observed in both groups, but the improvement was significantly higher in the TiAl group (P = 0.038). In patients with hyperkyphosis (>40°), a similar reduction in thoracic kyphosis was observed in both groups. At follow-up, no coronal correction loss occurred. The sagittal correction loss was slight (0.5° ± 1.5 for the CoCr group, 1.5° ± 3 for the TiAl group) but statistically higher in the TiAl group (P = 0.032). There were no mechanical complications. One revision was required for infection in the CoCr group. In this series of Lenke 1 AIS, with the limitations of the study, 5.5-mm CoCr rods have provided better correction in the coronal plane than 6-mm TiAl rods. However, TiAl rods have been found to be associated with higher increase of thoracic kyphosis in hypokyphotic curves, although the clinical relevance of this finding could be questionable. This article provides surgeons with more information regarding rod material options when correcting Lenke 1 AIS.

Effect of postural alignment alteration with age on vertebral strength.

The purpose of this study was to analyze the impact of postural alignment changes with age on vertebral strength using finite element analysis and barycentremetry. A total of 117 subjects from 20 to 83years were divided in three age groups: young (20 to 40years, 62 subjects), intermediate (40 to 60years, 26 subjects), and elderly (60years and over, 29 subjects). EOS biplane radiographs were acquired, allowing 3D reconstruction of the spine and body envelope as well as spinal, pelvic, and sagittal alignment parameter measurements. A barycentremetry method allowed the estimation of the mass and center of mass (CoM) position of the upper body above L1, relatively to the center of the L1 vertebra (lever arm). To investigate the effect of this lever arm, vertebral strength of a generic finite element model (with constant geometry and mechanical properties for all subjects) was successively computed applying the personalized lever arm of each subject. A combination of an increase in thoracic kyphosis, cervical lordosis, and pelvic tilt with a loss of lumbar lordosis was observed between the young and the older groups. Sagittal alignment parameters indicated a more forward position as age increased. The lever arm of the CoM above L1 varied from an average of 1mm backward for the young group, to averages of 10 and 24mm forward, respectively, for the intermediate and elderly group. As a result, vertebral strength decreased from 2527N for the young group to 1820N for the elderly group. The global sagittal alignment modifications observed with age were consistent with the literature. Posture alteration with age reduced vertebral strength significantly in this simplified loading model. Postural alignment seems essential to be considered in the evaluation of osteoporotic patients.

Surgical increase in thoracic kyphosis predicts increase of cervical lordosis after thoracic fusion for adolescent idiopathic scoliosis.

The modification of cervical lordosis (CL) after adolescent idiopathic scoliosis (AIS) surgery is influenced by the correction of thoracic hypokyphosis. The quantification of the increase of CL as a function of the increase of thoracic kyphosis (TK) has never been calculated. A total of 92 consecutive AIS patients who underwent a posterior thoracic selective fusion, corrected by simultaneous translation on 2 rods technique, with minimum 24-month follow-up, were analyzed from a prospective database. We evaluated global sagittal kyphosis and lordosis. CL was divided by the horizontal line in proximal (PCL) and distal cervical lordosis (DCL), likewise TK in proximal (PTK) and distal TK (DTK), and lumbar lordosis (LL) in proximal (PLL) and distal LL (DLL). The mean TK gain was 16°, 14° and 28° in the whole cohort, normokyphosis group and hypokyphosis group, respectively. The mean DCL gain was, respectively, 9°, 7° and 20° and the mean CL gain 8°, 5° and 21°. There was a strong correlation between TK gain and CL gain (coefficient = 0.86) and between TK gain and DCL gain (coefficient = 0.74). The regression equation was defined as DCLgain = -3 + 0.75 × TKgain (p < 0.0001) corresponding on average to 60% of the TK gain. 60% of the TK gain was transferred to DCL gain. Correlations reflect the geometrical equivalence between PTK and DCL. The use of sagittal global measurements shows that DCL is equivalent to PTK and can be expressed as a function of pelvic parameters (DCL = PT + LL-PI). DCL must be considered to optimize the postoperative sagittal alignment of the spine.

Radiographic Analysis of the Sagittal Alignment of Spine and Pelvis in Asymptomatic Indian Population.

Study DesignThis is a descriptive observational study.PurposeThe objective of this study is to analyze and document the sagittal alignment of the spine and pelvis in normal Indian adult volunteers and compare these parameters with the study population of other races and ethnicities.Overview of LiteratureGiven the importance of the spinopelvic parameters, there is a need to describe the parameters differentially in relation to the ethnicity of the studied individual. Very few reports have defined the normal physiological value. Ethnic differences are a significant factor not only when describing the anthropometric data but also when applying the findings to a different ethnic group. We have compared these values with other races and ethnicities so that we can know whether the principles of spinal fixation can be applied globally.MethodsIn total, 100 participants were studied by using their anteroposterior and lateral radiographic images of whole of pelvic and spinal area. Additionally, various spinal and pelvic parameters were also measured. Subsequently, the outcomes were analyzed with respect to age, sex, and body mass index (BMI). The correlation between different parameters and differences in these parameters between Indians and other races/ethnicities along with population groups were also analyzed.ResultsThere was a significant increase in thoracic kyphosis (TK) from T1–T12 and T4–T12 with increasing age. Lumbar lordosis (LL), sacral translation (sagittal vertical axis), and pelvic tilt were significantly higher among females. Additionally, sacral slope (SS), pelvic incidence, C7 sagittal offset, and T9 sagittal offset were also higher in females. TK (T4–T12 and T1–T12), LL, SS, and pelvic incidence showed a significant correlation with BMI. As compared to European population, TK, segmental LL, and sacral translation were found to be significantly lesser in Indian population.ConclusionsThere is a statistically significant difference between Indians and other races/ethnicities and population groups with respect to TK, LL, and sacral translation. The values obtained can be considered as the physiological normal values for Indian population. Importantly, these values can serve as the reference values for future studies.

Retrospective analysis of the effect of breast surgery on body posture in patients with early-stage breast cancer after cancer treatment (VENUS study) (Breast cancer and body posture)

Background/aim The aim of this study was to determine whether breast surgery changes body posture in patients with early-stage breast cancer.Materials and methodsStudy variables include age, side and localization of the tumor in the breast, applied breast surgery, axillary interference, pathological tumor size, axillary lymph node metastasis, body mass index, bone density, adjuvant therapies, and histological type. Thoracic kyphosis angle due to the anatomically affected primary region to detect changes in body posture and Cobb’s method were used to measure this. Results There was a statistically significant difference in the mean Cobb’s angle between the follow-up times of 57 patients (P < 0.001), with a cumulative increase in the Cobb’s angle from baseline to the second year. As the age of the diagnosis progressed, the Cobb’s angle increased significantly at 2 years when compared to baseline (r = 0,616, P < 0,001). In terms of baseline, the higher the BMI level in the 2nd year, the higher the Cobb’s angle in the 2nd year as compared to the baseline (r = 0,529, P < 0,001). Conclusion It was concluded that the increase in thoracic kyphosis in patients with breast cancer should be examined psychosocially. The study should be supported by a larger number of patients.

The influence of smartphone use on spinal posture – A laboratory study

BackgroundSmartphones have become increasingly more popular and complicated tasks can be performed with these devices. However, the increasing use is associated with shoulder and neck pain, as well as with psychological addiction. Research questionDo different smartphone tasks lead to changes in spinal posture and pelvic position? Is there a relationship between smartphone addiction and changes in posture? MethodsA cross-sectional study including 50 participants was performed. Test subjects completed the Smartphone Addiction Scale and the SF-36 health questionnaire. Subjects spinal posture and pelvic position during different smartphone tasks were measured through a surface topography system. The different tasks were: standing in an upright position, simulating a phone call, texting with one or two hands during standing or while walking on a treadmill. Paired T-tests and ANOVA tests were performed to evaluate differences. The Kendall rank test was used to investigate the association between clinical scores and changes in spinal posture. ResultsAll smartphone tasks lead to a significant increase in thoracic kyphosis and trunk inclination during standing and while walking. A significant increased lumbar lordosis was also found. Texting with one or two hands correlated with increased surface rotation. No associations between smartphone addiction and changes of the spinal posture were reported. SignificanceThis represents the first surface topography study that investigated the influence of different smartphone tasks on the spinal posture and pelvic position during standing and while walking. With the results of this study we demonstrated that smartphone use leads to significant changes of sagittal and frontal spine parameters. Further research should focus on the evaluation of possible detrimental effects of long-term smartphone use on the spinal posture and on the development of preventive measures.

Evaluation of Posture and Quality of Life in Females Undergone Modified Radical Mastectomy: A Research Protocol

Modified radical mastectomy performed for CA breast is a life modifying surgery for most women. It createsa profound impact on the quality of life enjoyed by the women. Body image in patients with breast cancerdiffers from all other cancers. The assessment of quality of life after modified radical mastectomy for earlybreast cancer patients using the World Health Organization Quality of Life-Brief Questionnaire (WHOQOLBREF) .Women suffers from day to day activities. Postures become impaired. Postural changes, such as increase inthoracic kyphosis , scoliosis leads to poor postural habits. There is also decrease in shoulder range of motion, scapular muscles weakness . Contractures may develop in axilla after surgery. Breast cancer survivors havemuscle weakness of upper limb are Pectoralis major, serratus anterior, upper trapezius, rhomboid muscles,latissimus dorsi .Spine alignment also may effect due to poor posture. Women with Modified Radical mastectomy may havesome social phobia . Anxiety, stress level may increase. Women may have fear of recurrence. Because of thisfactors , there is impaired Quality of Life in Women.Conclusion: Breast cancer is a serious disease that reduces the quality of life, particularly in physical domainand in the emotional area. Oncological disease is becoming a disease for a lifetime. It connected with theconstant fear of cancer recurrence and the consequences of treatment.

Risk factors for the presence of syringomyelia in idiopathic scoliosis: analysis of 3,285 cases and brief literature review

Objective. To analyze possible radiological and clinical risk factors for syringomyelia in patients with scoliotic deformity. Material and Methods. An analysis of data from 3,285 patients with idiopathic scoliosis treated from 1997 to 2020 was performed. Syringomyelia was detected in 38 (1.16 %) cases. In 26 cases, syringomyelia was combined with Chiari malformation. In order to search for information on the topic under discussion, the international databases (Scopus, Medline, and GoogleScholar) were used. Additional search for publications listed in the article references was carried out. According to the literature data, possible risk factors for the presence of syringomyelia have been identified. Results. Among patients with confirmed syringomyelia, a left-sided thoracic scoliotic curve was found in 23.7 % of cases, a double thoracic curve in 18.4 %, an upper thoracic scoliotic curve in 7.9 %, an increase in thoracic kyphosis in 60.5 %, and initial neurological deficit in 47.4 %, which is significantly higher than the same indicators in the entire group of patients. The ratio of male and female patients in the entire group was 1.0 : 6.7, in the group with syringomyelia – 1.00 : 1.71. Conclusion. According to the literature review and statistically significant factors identified in the analysis of the monocentric group, it can be said that the left-sided thoracic scoliotic curve, upper thoracic curve, double thoracic curve, increased thoracic kyphosis, initial pyramidal insufficiency in the lower extremities, male sex, and a decrease in the initial somatosensory evoked potentials are risk factors for syringomyelia. If the above factors are present in a patient, the MRI study may be recommended to determine further treatment tactics. Before surgical correction of scoliotic deformity, MRI is recommended for all patients.

Analyse des changements réciproques dans les profils cervicaux supérieurs après fusion vertébrale postérieure avec la technique de dérotation simultanée à double tige pour la scoliose idiopathique de l’adolescent

BackgroundThe relationship between postoperative change of cervical lordotic alignment and restoration of thoracic kyphosis with adolescent idiopathic scoliosis (AIS) is still controversial. We investigated reciprocal changes in the sagittal profiles of the upper and middle-lower cervical spinal segments after posterior spinal fusion with the simultaneous double rod rotation technique (SDRRT) for AIS. HypothesisOcciput-C2 and C2-C7 sagittal profiles of patients with AIS could change significantly after surgical adequate increase of thoracic kyphosis with SDRRT. Patients and methodsTwenty-seven consecutive patients with AIS treated with the SDRRT were retrospectively reviewed. We investigated the following parameters preoperatively, postoperatively, and at the 2-year follow-up: the Cobb angles of main thoracic curves; C7 sagittal vertical axis; thoracic kyphosis (TK) from T5 to T12; lumbar lordosis from L1 to S1; chin-brow vertical angle; McGregor's slope; occiput to C2 Cobb angle (O-C2angle); C2-C7 Cobb angle (C2-C7angle); T1-slope; and C2-C7 sagittal vertical axis. Additionally, the Scoliosis Research Society questionnaire was completed preoperatively and at the 2-year follow-up. Patients were categorised according to preoperative TK (T5-T12) into hypokyphotic (TK<20°) and normo-hyperkyphotic (TK ≥20°) groups. To assess the effect of corrective surgery on sagittal profiles, we investigated correlations among the changes in sagittal parameters. ResultsThe mean preoperative TK was 6.1±3.7° in the hypokyphotic group and 23.5±4.7° in the normo-hyperkyphotic group (p<0.001), which was significantly improved postoperatively (22.3±4.4° and 26.1±2.6°, respectively; p=0.02) and at the 2-year follow-up (23.0±6.3° and 26.8±5.0°, respectively; p=0.04). The mean preoperative C2-C7angle reflected kyphosis (7.4±9.8°) in the hypokyphotic group, and, in contrast, lordosis (−8.8°±6.8°) in the normo-hyperkyphotic group (p<0.001), which improved toward greater lordosis postoperatively (−3.7±5.8° and −14.8±5.1°, respectively; p<0.001) and at the 2-year follow-up (−5.1±4.4° and −15.3±6.4°, respectively; p<0.001). On the other hand, the mean preoperative O-C2angle was −20.5±6.5° in the hypokyphotic group and −13.1±2.8° in the normo-hyperkyphotic group (p=0.002), which was significantly changed postoperatively (−12.6±6.4° and −7.7±4.3°, respectively; p=0.04) and at the 2-year follow-up (−13.1±6.3° and −7.9±4.3°, respectively; p=0.04). ΔC2-C7 was negatively correlated with ΔT5-T12 (r=−0.298) and ΔO-C2angle (r=−0.332). DiscussionLordotic reciprocal alignment changes in the C2-C7angle can occur after adequate restoration of TK. The O-C2angle compensates the C2-C7angle for a maintained horizontal gaze. O-C2 and C2-C7 sagittal profiles of patients with AIS changed significantly after corrective surgery with SDRRT. Level of evidenceIV, Case-series.

USE OF SUBLAMINAR BANDS FOR ADOLESCENT IDIOPATHIC SCOLIOSIS - A SYSTEMATIC REVIEW

ABSTRACT Objective In 2003, Mazda et al. introduced a new device for surgical correction of Adolescent Idiopathic Scoliosis (AIS) called sublaminar bands (SB). The reduction principle that SBs use is posteromedial spinal translation, similar to Luque’s wiring, but using polyester bands. Methods We performed a systematic review of the literature on this subject, evaluating the technique in terms of coronal correction, sagittal correction, bleeding, mean surgical time, loss of correction, infection, pseudoarthrosis, and neurological and other complications. The total search resulted in 14 articles published over the last 10 years. We found that the use of SBs in hybrid AIS correction instrumentations provides an average correction of 69% in the frontal plane, a 5° increase in thoracic kyphosis (average increase of 55%), overall complications of 4.5%, and no neurological complications were reported in any of the studies analyzed.. The mean blood loss was 682.5 mL and the mean surgical time was 228.6 minutes. Conclusions We conclude that the literature suggests that this instrumentation is safe, allows good correction in the frontal plane and great correction in the sagittal plane. As for complications, mean surgical time, and blood loss, their averages are lower than those of other constructions used for AIS. Level of evidence IIA; Systematic review.

A 3D Parameter Can Guide Concave Rod Contour for the Correction of Hypokyphosis in Adolescent Idiopathic Scoliosis.

Retrospective. To evaluate the effect of preoperative rod shape on 3D spinal deformity correction. Differential rod contouring is a surgeon-dependent process based on an estimate of 3D deformity correction sought and the flexibility of the spine. An objective measure to this otherwise subjective scoliosis correction technique is lacking. A series of adolescent idiopathic scoliosis (AIS) patients with right, thoracic major curves, preoperative rod contour tracings, and EOS imaging was evaluated. All patients underwent posterior spinal fusion with 5.5 mm steel rods contoured prior to insertion. 3D reconstructions were generated pre- and postoperatively using sterEOS software (EOS Imaging) and imported into MATLAB (Mathworks) for analysis. A new measurement of the maximum perpendicular distance from the preinsertion concave rod contour to the preoperative 3D sagittal spinal reconstruction was defined as rod to 3D spine distance (RSD). Linear regressions were used to identify relationships between pre and postoperative parameters, including RSD and 3D thoracic kyphosis. Ninety-nine patients were included. Average preoperative concave rod angle decreased from (48 ± 10°) preoperatively to 26 ± 6° postoperatively (P < 0.001) for an average flattening of ∼20°. Average convex rod angle increased from 30 ± 6° to 34 ± 5° (P < 0.001). Average preoperative thoracic curve magnitude and apical vertebral rotation were 57 ± 8° and 16 ± 5° and decreased to 11 ± 6° and 5 ± 6° (P < 0.001). Average 2D and 3D thoracic kyphosis increased from 19 ± 14° and 2 ± 12° to 27 ± 6° and 22 ± 5° (P < 0.001). Preoperative RSD strongly correlated with 3D thoracic kyphosis change (P < 0.001, r = 0.796, R = 0.633). On average, the concave rod flattened ∼20° after connection to the spine. Similarly, kyphosis increased ∼20° following rod insertion. A strong correlation was identified between RSD and 3D thoracic kyphosis restoration. This novel 3D parameter can guide the degree of concave rod bend necessary to achieve a desired increase in thoracic kyphosis in AIS. 2.

Analysis of reciprocal changes in upper cervical profiles after posterior spinal fusion with the simultaneous double rod rotation technique for adolescent idiopathic scoliosis

BackgroundThe relationship between postoperative change of cervical lordotic alignment and restoration of thoracic kyphosis with adolescent idiopathic scoliosis (AIS) is still controversial. We investigated reciprocal changes in the sagittal profiles of the upper and middle-lower cervical spinal segments after posterior spinal fusion with the simultaneous double rod rotation technique (SDRRT) for AIS. HypothesisOcciput-C2 and C2-C7 sagittal profiles of patients with AIS could change significantly after surgical adequate increase of thoracic kyphosis with SDRRT. Patients and methodsTwenty-seven consecutive patients with AIS treated with the SDRRT were retrospectively reviewed. We investigated the following parameters preoperatively, postoperatively, and at the 2-year follow-up: the Cobb angles of main thoracic curves; C7 sagittal vertical axis; thoracic kyphosis (TK) from T5 to T12; lumbar lordosis from L1 to S1; chin-brow vertical angle; McGregor's slope; occiput to C2 Cobb angle (O-C2angle); C2-C7 Cobb angle (C2-C7angle); T1-slope; and C2-C7 sagittal vertical axis. Additionally, the Scoliosis Research Society questionnaire was completed preoperatively and at the 2-year follow-up. Patients were categorized according to preoperative TK (T5-T12) into hypokyphotic (TK<20°) and normo-hyperkyphotic (TK≧20°) groups. To assess the effect of corrective surgery on sagittal profiles, we investigated correlations among the changes in sagittal parameters. ResultsThe mean preoperative TK was 6.1±3.7° in the Hypokyphotic group and 23.5±4.7° in the Normo-hyperkyphotic group (p<0.001), which was significantly improved postoperatively (22.3±4.4° and 26.1±2.6°, respectively; p=0.02) and at the 2-year follow-up (23.0±6.3° and 26.8±5.0°, respectively; p=0.04). The mean preoperative C2-C7angle reflected kyphosis (7.4±9.8°) in the Hypokyphotic group, and, in contrast, lordosis (−8.8±6.8°) in the Normo-hyperkyphotic group (p<0.001), which improved toward greater lordosis postoperatively (−3.7±5.8° and −14.8±5.1°, respectively; p<0.001) and at the 2-year follow-up (−5.1±4.4° and −15.3±6.4°, respectively; p<0.001). On the other hand, the mean preoperative O-C2angle was −20.5±6.5° in the Hypokyphotic group and −13.1±2.8° in the Normo-hyperkyphotic group (p=0.002), which was significantly changed postoperatively (−12.6±6.4° and −7.7±4.3°, respectively; p=0.04) and at the 2-year follow-up (−13.1±6.3° and −7.9±4.3°, respectively; p=0.04). ΔC2-C7 was negatively correlated with ΔT5-T12 (r=−0.298) and ΔO-C2angle (r=−0.332). DiscussionLordotic reciprocal alignment changes in the C2-C7angle can occur after adequate restoration of TK. The O-C2angle compensates the C2-C7angle for a maintained horizontal gaze. O-C2 and C2-C7 sagittal profiles of patients with AIS changed significantly after corrective surgery with SDRRT. Level of evidenceIV, Case-series.

Posture of adolescent volleyball players – a two-year study

Summary Study aim: The aim of this study was to assess and compare the posture of male and female adolescent volleyball players and non-training individuals over a 2-year period. Material and methods: The study group comprised 32 volleyball players and 30 non-athlete peers. Posture was assessed with a photogrammetric method based on the moiré phenomenon. Participants were examined 3 times at the ages of 14, 15 and 16 years. Training experience of the studied volleyball players at the time of the 1st measurement was less than 5 months. Results: In volleyball players greater asymmetry in the pelvis position was noted (rotation to the right). The right scapula was more outlying than the left, and the right shoulder was more elevated than the left. Volleyball training did not result in sagittal spinal curvatures. Male non-athlete participants exhibited a significant increase in thoracic kyphosis and a decrease in lumbar lordosis over a two-year period. Conclusion: Volleyball training affects the alignment of the pelvis, shoulder girdle and scapulae. The study revealed a number of differences in spinal curvatures between male volleyball players and non-athletes which could be associated with growth velocity and differences in body height.

Investigation of The Effect of Thoracic Kyphosis Degree on Physical Activity Level and Respiratory Function Tests

Purpose: Long sitting time and physical inactivity due to technological advancements may lead to an increase in thoracic kyphosis. The aim of this study was to investigate the effect of thoracic kyphosis degree on physical activity and respiratory function tests in healthy subjects.Methods: A total of 54 healthy individuals 35 female, 19 male, mean age: 21.37±1.63 years were included in the study. Thoracic kyphosis degree was measured by inclinometer. Respiratory volumes were evaluated using a respiratory function test device. Physical activity level was assessed by International Physical Activity Questionnaire IPAQ .Results: It was found negative correlations between thoracic kyphosis degree and maximum voluntary ventilation r=-0.278, p

Back pain and osteoporosis

The aging process is accompanied by a structural change and a decrease in the functional activity of organs and tissues, including the bone, with the development of osteoporosis (OP).Objective: to assess the characteristics of pain syndrome in OP patients with nonspecific chronic vertebrogenic lumbar ischialgia (CLI).Patients and methods. Sixty elderly patients with CLI in the presence and absence of OP were examined. All the patients underwent dual-energy X-ray absorptiometry and ultrasound to diagnose the degree of OP and spinal deformity; a flexible rod was used according to the method described by M.A. Kathleen to estimate the angle of kyphosis, lordosis, and scoliosis. The investigators determined pain intensity by a numerical rating scale, the presence of a neuropathic pain component by the DN4 pain scale, the level of anxiety and depression by the Hospital Anxiety and Depression Scale, cognitive status by the Montreal Cognitive Function Rating Scale, the degree of disability by the Oswestry questionnaire, and quality of life by the SF-12 Health Survey.Results and discussion. Our study showed that OP alone is not a cause of CLI in elderly patients. There were no statistically significant differences in the sources and intensity of pain, the degree of anxiety and depressive disorders, impaired quality of life, cognitive status, and degree of disability in patients with chronic lumbar pain syndrome in the presence and absence of OP. Vertebral deformity resulting from OP leads mainly to an obvious poor posture with an increase in thoracic kyphosis, straightening of lumbar lordosis, and S-curve lumbar and thoracic scoliosis, which can also cause secondary muscle spasm.Patients with back pain in the presence of OP are treated in accordance with the general principles of management of patients with non-specific back pain, but taking into account the underlying disease. The paper presents current recommendations for the treatment of nonspecific back pain, for the management of patients with OP, as well as the updated clinical recommendations for the prevention of fractures in OP and osteopenia.Conclusion. Patients with OP are noted to have predominantly chronic musculoskeletal pain in the presence of severe spinal deformity, but the level of this evidence is very low. The features of pain syndrome in patients with nonspecific vertebrogenic chronic lumbar ischialgia in the presence of OP call for further investigations.