Kyphosis Research Articles

Spontaneous recovery of postsurgical progressive cervical spine kyphosis following intramedullary spinal cord tumor resection in a 4-year-old boy: illustrative case.

Postsurgical kyphosis is relatively common in children who have undergone resection of intramedullary spinal cord tumors. Progressive kyphosis almost always requires instrumentation and fusion surgery, which can delay or interfere with adjuvant oncological treatments and can deleteriously impact the long-term performance status of the patient. Here, the authors report a case of near-complete spontaneous recovery (i.e., without spinal fusion surgery) of postsurgical progressive cervical spine kyphosis following intramedullary spinal cord tumor resection and discuss the potential factors that may have contributed to this positive outcome. This case serves as a reminder that spontaneous recovery from postsurgical progressive cervical spine kyphosis can occur and that some patients (i.e., those without neurological deficits) can be monitored closely, with a watch-and-wait approach, before subjecting them to additional surgical risks, delays in other treatments, and potential morbidity. https://thejns.org/doi/10.3171/CASE24187.

Sagittal Realignment Following Decompression for Lumbar Spinal Stenosis in Elderly Patients: A Comprehensive EOS Imaging Analysis

Background/Objectives: This study investigated whether decompression surgery for lumbar spinal stenosis can effectively improve sagittal alignment in elderly patients. With the growing focus on sagittal balance in spinal surgery, this study aimed to evaluate post-decompression alignment changes and identify the factors influencing these changes using the EOS imaging system. Methods: A retrospective analysis was conducted on 49 elderly patients who underwent decompression surgery alone for lumbar spinal stenosis. Radiologic parameters, measured using the EOS system, and clinical outcomes were assessed preoperatively, at two weeks postoperatively, and at one year postoperatively. Patients were grouped based on the improvement of the sagittal vertical axis (SVA) by 25 mm or more. A multivariate analysis was performed to identify factors affecting sagittal alignment changes. Results: Significant sagittal alignment improvements were observed postoperatively, including a notable increase in thoracic kyphosis and a decrease in SVA observed at one year. Clinical outcomes, such as the Oswestry disability index (ODI) and EQ-5D, significantly improved at both two weeks and one year postoperatively compared to preoperative values (all p-values < 0.05). Multivariate analysis revealed that greater preoperative SVA and higher ODI were significant predictors of sagittal alignment changes (odds ratio [OR] for SVA = 1.014, OR for ODI = 1.034). Conclusions: Decompression surgery for lumbar spinal stenosis in elderly patients can result in significant improvements in sagittal alignment and clinical outcomes. The study suggests that decompression alone is a viable surgical option for elderly patients, particularly those with a greater preoperative sagittal imbalance and disability, even in the absence of major deformities.

Anatomical landmark detection on bi-planar radiographs for predicting spinopelvic parameters.

Accurate landmark detection is essential for precise analysis of anatomical structures, supporting diagnosis, treatment planning, and monitoring in patients with spinal deformities. Conventional methods rely on laborious landmark identification by medical experts, which motivates automation. The proposed deep learning pipeline processes bi-planar radiographs to determine spinopelvic parameters and Cobb angles without manual supervision. The dataset used for training and evaluation consisted of 555 bi-planar radiographs from un-instrumented patients, which were manually annotated by medical professionals. The pipeline performed a pre-processing step to determine regions of interest, including the cervical spine, thoracolumbar spine, sacrum, and pelvis. For each ROI, a segmentation network was trained to identify vertebral bodies and pelvic landmarks. The U-Net architecture was trained on 455 bi-planar radiographs using binary cross-entropy loss. The post-processing algorithm determined spinal alignment and angular parameters based on the segmentation output. We evaluated the pipeline on a test set of 100 previously unseen bi-planar radiographs, using the mean absolute difference between annotated and predicted landmarks as the performance metric. The spinopelvic parameter predictions of the pipeline were compared to the measurements of two experienced medical professionals using intraclass correlation coefficient(ICC) and mean absolute deviation (MAD). The pipeline was able to successfully predict the Cobb angles in 61% of all test cases and achieved mean absolute differences of 3.3° (3.6°) and averaged ICC of 0.88. For thoracic kyphosis, lumbar lordosis, sagittal vertical axis, sacral slope, pelvic tilt, and pelvic incidence, the pipeline produced reasonable outputs in 69%, 58%, 86%, 85%, 84%, and 84% of the cases. The MAD was 5.6° (7.8°), 4.7° (4.3°), 2.8mm (3.0mm), 4.5° (7.2°), 1.8° (1.8°), and 5.3° (7.7°), while the ICC was measured at 0.69, 0.82, 0.99, 0.61, 0.96, and 0.70, respectively. Despite limitations in patients with severe pathologies and high BMI, the pipeline automatically predicted coronal and sagittal spinopelvic parameters, which has the potential to simplify clinical routines and large-scale retrospective data analysis.

Laminoplasty and In-Site Regrafting for the Treatment of Thoracic Ossification of the Ligamentum Flavum: A Surgical Technique.

Current surgical strategies for thoracic ossification of the ligamentum flavum (TOLF) are denounced by thoracic kyphosis, loss of spinal motion range, etc. A new surgical technique, laminoplasty and in-site regrafting (LPIR), was modified to address the problems. This study aimed to report the safety and feasibility of LPIR for TOLF treatment. This retrospective study reported the outcome of eight consecutive patients (3 males and 5 females, mean age 52.87 years) with TOLF who underwent LPIR surgery from January 2019 to March 2024. Pre- and post-operative data including x-ray, computerized tomography (CT), magnetic resonance imaging (MRI), the modified Japanese Orthopedic Association score (mJOA), the visual analog scale (VAS), and complications were collected to evaluate the outcome. All surgeries were performed successfully, significantly alleviating symptoms postoperatively. During an average follow-up period of 28.63 months, the VAS score reduced from 4.50 ± 1.00 pre-operatively to 1.63 ± 0.48 on the third post-operative day and further reduced to 0.50 ± 0.70 during the last follow-up. The mJOA score increased from 3.63 ± 0.70 pre-operatively to 6.13 ± 0.78 on the third postoperative day and further increased to 8.88 ± 1.27 during the last follow-up. No severe complications were observed. LPIR exhibited significant safety and feasibility for treating TOLF, offering a novel strategy for managing this problem.

The Implications of Sacralized Transitional Vertebra on Spinal Alignment.

Retrospective study of a multicentric prospective database. This study aimed to determine, in a cohort of healthy volunteers, the impact of sacralized lumbo-sacral transitional vertebra (LSTV) on spinal alignment according to its grade, particularly regarding lumbar lordosis magnitude and distribution, and the implications for spinopelvic parameters measurement. There is little data regarding spinopelvic alignment assessment in LSTV patients. This study included healthy volunteers with full-body stereoradiographs in free-standing position aged over 18. Castellvi grade, pelvic parameters (measured on S1 and L5), L1-S1 lumbar lordosis (LL) and segmental lordosis for each disc and vertebral body, thoracic kyphosis, cervical lordosis, lower limb, and global alignment parameters were assessed. Castellvi I and II were considered as Low-grade and Castellvi III and IV as High-grade LSTV. Alignment parameters between No-LSTV, Low- and High-grade LSTV were compared. Propensity score matching was used to match PI in No-LSTV and Low-grades. Spinopelvic parameters measured on S1 in No-LSTV group and on L5 in High-grade were compared. 713 subjects were included, of whom 23 Low-grades and 27 High-grades. Mean pelvic incidence was 51.0±11.0° and mean age was 37.5±16.2 years. LL distribution was different between groups, with an apex and inflexion point significantly higher in High-grade (P<0.001). Kyphosis in the LSTV segment was compensated for by a steeper increase of LL above L5 in the High-grades. Low-grades and PI-matched No-LSTV presented similar alignment parameters. There were minor differences in parameters measured on S1 in No-LSTV and no L5 in High-grades. Subjects with low-grade LSTV present similar alignment as PI-matched No-LSTV subjects, and S1 should be taken as reference to measure spinopelvic parameters. High-grade LSTV subjects have kyphotic L5-S1 segment with more cranial lumbar apex and thoracolumbar inflexion point. In these subjects, spinopelvic parameters should be measured on L5.

Clinical Implications of Surgical Resection without Spinal Fixation in Lumbar Dumbbell Tumors: Evaluating Postoperative Lumbar Alignment and Patient Outcomes

This study examined radiographic changes in local and global spinal alignments and clinical outcomes following tumor resection without spinal fixation in patients with lumbar dumbbell tumors (LDTs). We included 28 patients with LDTs who were followed for at least two years after surgery. We analyzed variations in the outcome variables by measuring individual coronal and sagittal parameters from radiographs. Clinical outcomes were assessed using the modified McCormick scale (MMCS), the Japanese Orthopaedic Association (JOA) score, and the visual analog scale (VAS). To evaluate the impact of tumor location on these outcomes, we categorized the patients into three groups based on tumor location: Upper (T12-L1), Middle (L2-3), or Lower (L4-S1) group. The local and global spinal parameters (including Cobb angle, cervical lordosis, T1 slope, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis [global, upper, middle, lower], sacral slope, pelvic incidence, pelvic tilt) did not show significant changes after surgery. Preoperatively, all patients experienced gait disturbances, but at the final follow-up, nearly all of them (27 cases, 96.4%) could walk without support. The JOA score and VAS demonstrated significant postoperative improvements. There were no statistically significant group differences in postoperative coronal and sagittal profiles or clinical outcomes among the upper, middle, and lower groups. Tumor resection without spinal fixation had no substantial impact on local and global spinal alignments and led to satisfactory clinical outcomes, suggesting that spinal fixation may not always be necessary when resecting LDTs.

Gender Differences in the Relationship between Physical Activity, Postural Characteristics and Non-Specific Low Back Pain in Young Adults.

Background/Aim: University students are a particularly vulnerable population, as they spend increasing amounts of time sitting, which poses a major threat to their musculoskeletal health and posture. The aim of this cross-sectional study was to investigate gender differences in the relationships between physical activity (PA) and sedentary behavior, spinal curvatures and mobility, the endurance and balance of the trunk muscles, and the possible presence of non-specific low back pain (NS-LBP) in young adults aged 18-25 years. Methods: A total of 139 students completed all required tests. Results: Male students engaged in significantly more PA related to recreation, sports and leisure and were significantly more likely to be hyperkyphotic than female students. The more the male students participated in sports, the more pronounced the thoracic kyphosis. Female students had significantly more pronounced lumbar lordosis and anterior pelvic tilt that correlated with lumbar lordosis. Female students generally had significantly higher trunk extensor endurance and more balanced trunk musculature than males. NS-LBP correlated with PA in female students who generally had higher levels of NS-LBP than male students, with a statistically significant difference between those who practiced the most PA. Conclusions: Our results suggest that female students practice less PA and have pronounced lordosis and trunk extensor endurance, in contrast to males who practice more PA and have pronounced trunk flexor endurance and hyperkyphosis. Our findings suggest that more PA should be encouraged but implemented with caution and as an individualized gender-specific approach to prevent postural deformities and chronic musculoskeletal disorders, including NS-LBP.

The Effect of Night-time versus Full-time Bracing on the Sagittal Profile in Adolescent Idiopathic Scoliosis: A Propensity Score-matched Study.

Retrospective multicenter cohort study. To investigate the impact of night-time bracing (NTB) and full-time bracing (FTB) on the sagittal profile in adolescent idiopathic scoliosis (AIS) patients. Recent studies have shown that FTB in AIS patients may induce hypokyphosis. Whether this effect differs between NTB and FTB is unknown. We included skeletally immature AIS patients with main curves ranging from 20-45° treated with either NTB or FTB. The two cohorts were propensity-score matched on Risser stage, age, major curve size, and kyphosis at brace initiation. Coronal and sagittal radiographic parameters were gathered at the initiation and completion of brace treatment. Two-hundred fifty-seven patients were eligible for inclusion. The matched cohorts included 62 patients in each group. During bracing, the thoracic kyphosis increased from 31±11° to 35±13° in the NTB group compared to a decrease from 30±12° to 28±13° in the FTB group (P=0.011). Eight percent were hypokyphotic (<20°) after bracing in the NTB group compared to 24% in the FTB group (P=0.015). Pelvic incidence, sacral slope, and pelvic tilt were not significantly different between the groups. In the coronal plane, curve progression >50° was seen in 50% in the NTB group and 31% in FTB (P=0.028). We saw a small increase in thoracic kyphosis in the NTB group vs. a small decrease in the FTB group. Eight percent in the NTB group vs 24% in the FTB group showed substantial hypokyphosis after bracing. The impact of minor changes in thoracic kyphosis remains uncertain; however, a threefold difference in the occurrence of hypokyphosis is notable and merits further attention.

The Impact of Video Game Addiction on Spinal Health

This study aimed to determine how the level of video game addiction has an effect on thoracic kyphosis curvature in secondary school students. The sample group of the study consisted of 5th, 6th, 7th and 8th grade students studying in Çınarcık Firuzan Kınal Primary-Secondary School by deliberate sampling method. The data were collected from 87 students (47 girls, 40 boys) who participated in both the initial and subsequent measurements. The students were selected on the basis of volunteerism and completed the questionnaire questions entirety. The data was collected by using the Personal Information Form, the Video Game Addiction Scale for Children and the flexicurve. The SPSS 21 package programme and the kyphosis index (KI = (TW/TL) x 100) were used to evaluate the data. According to the obtained results, it was determined that video game addiction did not have a statistically significant effect on the kyphosis index in children, the addiction scores of children who participated in recreational activities (p=0.01

How global spine sagittal alignment and spinal degeneration affect locomotive syndrome risk in the elderly.

The aim of this study was to delineate the features of the locomotive syndrome (LS) risk stage in the elderly population, encompassing global spine sagittal alignment, visible spinal degenerative changes on plain radiographs, muscle strength, physical capabilities, and low back pain (LBP). The study enrolled 232 subjects, evaluated using plain radiographs. The evaluation included measurements of lumbar lordosis (LLA), thoracic kyphosis (TKA), spinal inclination (SIA) angles, and sagittal vertical axis. Assessments included lumbar osteophyte formation (LOF) and lumbar disc height (LDH) to examine spinal degenerative changes. LS evaluation used the locomotive syndrome risk test based on LS risk criteria, classifying participants into no risk, stage 1 LS, and stage 2 LS groups. Using a visual analogue scale (VAS), we investigated the prevalence of low back pain (LBP) and assessed physical performances across these groups. There were 132 participants with no LS risk, 71 with stage 1 LS risk, and 29 with stage 2 LS risk. As LS risk increased, LBP prevalence and VAS scores rose, physical abilities, and back muscle strength decreased. TKA showed no variation across groups, while LLA decreased with advancing LS risk stage. Except for L1-L2 and L5-S1, lumbar disc height (LDH) decreased with higher LS risk stages. LOF occurrence increased notably with higher LS risk stages. Spinal inclination angle (SIA) significantly increased with advancing LS risk stages. Participants diagnosed with LS exhibited an increased incidence of spinal degeneration, reduced LLA, and global spinal imbalance characterized by anterior spinal inclination.

Longitudinal impact of multi-segment spinal fixation surgery on mobility status and clinical outcomes in adult spinal deformity: a multicenter retrospective study.

To investigate changes in postoperative mobility status in patients with ASD, and the determining factors that influence these changes and their impact on clinical outcomes, including the rate of home discharge and long-term mobility. A total of 299 patients with ASD who underwent multi-segment posterior spinal fusion were registered in a multi-center database were investigated. Patient mobility status was assessed using walking aids and classified into five levels (1: independent, 2: cane, 3: walker, 4: assisted, and 5: wheelchair) preoperatively, at discharge, and after 2years. We determined improvements or declines in the patient's mobility based on changes in the classification levels. The analysis focused on the factors contributing to the deterioration of postoperative mobility. Two years postoperatively, 87% of patients maintained or improved mobility. However, 27% showed decreased mobility status at discharge, associated with a lower rate of home discharge (49% vs. 80% in the maintained mobility group) and limited improvement in mobility status (35% vs. 5%) after 2years. Notably, postoperative increases in thoracic kyphosis (7.0 ± 12.1 vs. 2.0 ± 12.4°, p = 0.002) and lower lumbar lordosis (4.2 ± 13.1 vs. 1.8 ± 12.6°, p = 0.050) were substantial factors in mobility decline. Postoperative mobility often temporarily decreases but generally improves after 2years. However, an overcorrection in sagittal alignment, evidenced by increased TK, could detrimentally affect patients' mobility status. Transient mobility decline associated with overcorrection may require further rehabilitation or hospitalization. Further studies are required to determine the biomechanical effects of surgical correction on mobility.

Assessing Abnormal Proximal Junctional Angles in Adult Spinal Deformity: A Normative Data Approach to Define Proximal Junctional Kyphosis.

Multicentric retrospective study of prospectively collected data. Based on normative data from a cohort of asymptomatic volunteers, this study sought to determine the rate of abnormal values of proximal junctional angles (PJA) in adult spinal deformity (ASD) surgery patients, and compare it with PJK rate. Proximal junctional kyphosis (PJK) definition does not take the vertebral level into account. This study included 721 healthy volunteers and 824 ASD surgery patients with 2-year postoperative follow-up. Normative values for each disc and vertebral body between T1 and T12 were analyzed, then normative values for PJA at each thoracic level were defined in the volunteer cohort as the mean±2 standard deviations. PJA abnormal values at the upper instrumented vertebra (UIV) were compared with Glattes' and Lovecchio's definitions for PJK in the ASD population at two years. Mean age was 37.7±16.3 in the volunteer cohort, with 50.5% of females. Mean thoracic kyphosis (TK) was -50.9±10.8°. Corridors of normality included PJA greater than 20° between T3 and T12. Mean age was 60.5±14.0 years in the ASD cohort, with 77.2% of females. Mean baseline TK was -37.4±19.9°, with a significant increase after surgery (-15.6±15.3°, P<0.001). There was 46.2% of PJK according to Glattes' versus 8.7% according to Lovecchio's and 22.9% of kyphotic PJA compared to normative values (P<0.001). This study provides normative values for segmental and regional alignment of thoracic spine, used to describe abnormal values of PJA for each level. Using level-adjusted PJA values allows a more precise assessment of abnormal proximal angles and question the definition for PJK. II.

Incidence and Risk Factors of Proximal Junctional Complications and Rod Fractures After Long-Segment Fusion Surgery With Anterior Column Realignment for Adult Spinal Deformity: A Minimum 2-Year Follow-Up.

To investigate the incidence and risk factors of proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and rod fractures in patients undergoing long-segment (≥4 levels) fusion surgery with anterior column realignment (ACR) for adult spinal deformity. Patients aged ≥60 years with at least a 2-year follow-up were grouped based on PJK, PJF, and rod fracture occurrence. Patient, surgical, and radiographic factors were compared to identify risk factors for these complications. Independent risk factors were identified using univariate and multivariate logistic regression. Among 106 patients, the incidence rates of PJK, PJF, and rod fractures were 15.1%, 28.3%, and 17.9%, respectively. PJK was significantly associated with fewer fusion levels (odds ratio [95% CI], 0.30 [0.13-0.69]), a cranially directed uppermost instrumented vertebra (UIV) screw angle (1.40 [1.13-1.72]), postoperative overcorrection of age-adjusted pelvic incidence-lumbar lordosis (LL) (7.22 [1.13-45.93]), and a large increase in thoracic kyphosis (1.09 [1.01-1.17]). PJF risks were associated with a cranial UIV screw orientation (1.23 [1.09-1.39]), overcorrection of age-adjusted pelvic incidence-LL (10.80 [2.55-45.73]), and a smaller change in sacral slope (0.87 [0.80-0.94]). For rod fractures, prominent factors included a greater number of fusion levels (1.70 [1.17-2.46]), a larger postoperative LL (1.07 [1.01-1.15]), a smaller postoperative thoracic kyphosis (0.92 [0.86-0.98]), and smaller changes in sacral slope (0.73 [0.58-0.92]) and pelvic tilt (0.72 [0.56-0.91]). The incidence and risk factors of PJK, PJF, and rod fractures were similar to those observed in previous studies on long-segment fusion surgery without ACR. The number of ACR levels was not a significant risk factor for PJK, PJF, or rod fractures. When performing deformity correction using ACR, surgeons should carefully consider the direction of the UIV screw and ensure that overcorrection is avoided.

Electromyographic comparison of exercises for scapulothoracic muscle activation in men with upper crossed syndrome: A cross-sectional study

ObjectiveThis study aimed to determine the optimal exercise for improving Upper Crossed Syndrome (UCS) using electromyographic (EMG) activity of upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) during ten exercises. MethodA cross-sectional study involved 30 male students (mean age: 25.3 ± 2.5 years; height: 176.8 ± 7.2 cm; weight: 77.7 ± 2.5 kg; BMI: 23.8 ± 0.72 kg/m2) with UCS. Participants were selected based on postural assessments (forward head posture ≥44°, rounded shoulder ≥49°, thoracic kyphosis ≥42°). EMG was used to measure activation levels of UT, MT, LT, and SA, and the UT activation ratio relative to MT, LT, and SA during ten exercises. One-way ANOVA was applied for data analysis. ResultsSide-lying external rotation, standing diagonal flexion with Thera-band, and lying prone “V” demonstrated the least UT activity, with the highest MT and LT activation. The standing diagonal flexion with Thera-band elicited the highest SA activity. UT/MT, UT/LT, and UT/SA ratios were less than one in multiple exercises. Significant differences in muscle activation levels and ratios were observed across all exercises (P ≤ 0.05). ConclusionThe findings suggest significant clinical implications for UCS rehabilitation. The identified exercises effectively engage MT and LT while minimizing UT activation, addressing muscular imbalances. Favorable UT/MT, UT/LT, and UT/SA ratios further support these exercises in correcting UCS. These exercises may help counteract the underlying muscular imbalance in UCS by promoting a more balanced activity ratio among the shoulder girdle muscles, potentially improving posture and reducing UCS symptoms.

Magnetic resonance imaging evaluation of the cerebellar tonsil position before and after posterior spinal fusion in adolescent idiopathic scoliosis.

Chiari malformation type I(CM-I) is one of the most common neurological malformations observed in patients with adolescent idiopathic scoliosis (AIS). It remains uncertain whether AIS patients without neurological symptoms require CM-I decompression before undergoing spinal corrective surgery to prevent cerebellar tonsil herniation and potential neurological complications. This study aims to assess variations in the position of the cerebellar tonsil after posterior spinal fusion (PSF) in neurologically intact patients with AIS. We retrospectively evaluated 40 patients with AIS who underwent posterior spinal fusion (PSF) without neurological symptoms. Sagittal hindbrain MRIs were performed before and after spinal surgery. The cerebellar tonsil's position relative to the foramen magnum was measured using the method described by Aboulezz (J Comput Assist Tomogr 1985). We assessed variations in the cerebellar tonsil position concerning spinal correction and elongation after PSF. The average preoperative magnitude of the scoliotic curve was 53.15 degrees (SD 10.46 degrees), and that of thoracic kyphosis was 35.42 degrees (SD 12.38 degrees). In the immediate postoperative period, the average magnitudes were 7.45 degrees (SD 7.33 degrees) and 27.87 degrees (SD 9.03 degrees), respectively. The average correction achieved with PSF was 86% in the coronal plane (p < 0.00001). The average length of the spine in the coronal plane was 44.5cm (SD 5.25cm) preoperatively and 48.27cm (SD 4.40cm) postoperatively (p < 0.00001). The average length of the vertebral column in the sagittal plane was 50.87cm (SD 4.47cm) preoperatively and 55.13cm (SD 3.27cm) postoperatively (p < 0.00001). No significant difference was observed in the position of the cerebellar tonsil in the measurements taken before and after spinal deformity correction (p = 0.6042). In 10 out of 40 patients, caudal displacement of the cerebellar tonsil was observed after PSF. In 28 patients, no variation in the position of the cerebellar tonsil was observed, and in 2, cephalic displacement was noted. In AIS patients with a normal position of the cerebellar tonsil undergoing posterior spinal fusion, there is no significant change in their positionafter surgery. Our analysis did not reveal any correlation between curve correction, spine elongation, and variations in the cerebellar tonsil position. The position of the cerebellar tonsil remained largely unchanged after PSF in AIS patients without neurological symptoms. Further studies would be necessary to determine whether surgical decompression is required in asymptomatic patients with CM-I before undergoing surgery to correct spinal deformity.

Prevalence of Thoracic Hyperkyphosis Posture among Female Students of Allied Health Institutes and Its Association With Rounded Shoulders

Background: Thoracic hyper kyphosis and rounded shoulders are common postural abnormalities among young females, which can lead to musculoskeletal impairments and reduced quality of life. Prolonged sitting and poor posture are key contributing factors to these conditions.Objective: To determine the prevalence of thoracic hyper kyphosis among female students at allied health institutes and its association with rounded shoulders.Methods: A cross-sectional study was conducted on 334 female students aged 18 to 25 years from three allied health institutes in Faisalabad. Thoracic hyper kyphosis was measured using a flexi curve ruler from C7 to T12, and rounded shoulders were assessed with a Vernier caliper measuring the acromion-to-bed distance. Data were analyzed using SPSS version 27, including descriptive statistics and logistic regression to assess associations.Results: The prevalence of thoracic hyper kyphosis was 19.5%, and rounded shoulders were observed in 21.6% of participants. A significant association was found between thoracic hyper kyphosis and rounded shoulders (p = 0.005). Each additional hour of sitting increased the odds of hyper kyphosis by 43% (OR = 1.43, 95% CI: 1.12 - 1.82) and rounded shoulders by 51% (OR = 1.51, 95% CI: 1.18 - 1.93).Conclusion: The study identified a significant prevalence of thoracic hyper kyphosis and rounded shoulders among female students, linked to prolonged sitting. Preventive measures focusing on postural correction and reducing sitting time are recommended.

Relationship between plantar pressure distribution and sagittal spinal curvatures among handball players: A cross-sectional study

Background: Handball affects the spinal anterior–posterior curvatures and disturbs the foot plantar pressure which provides insights into alterations in an individual’s posture. However, little is known about how the mal-alignment affects the distribution of plantar pressure. Objective: To investigate the relationship between the thoracic kyphosis angle, and plantar pressure distribution among handball players. Methods: Sixty male handball players were distributed into two groups based on their thoracic kyphosis angles. Group A: 28 handball players with an angle greater than 44∘ (kyphotic group), and group B: 32 handball players with an angle equal to or less than 44∘ (normal group). The Formetric III 4D spine and DIERS Pedoscan devices were used to measure the trunk anthropometry and plantar pressure distribution. The Pearson correlation test was used to explore the relationship between the kyphosis angle and plantar pressure distribution. Results: Group A was significantly taller, had longer trunk length, greater lumbar lordosis angles, and forefoot plantar pressure (FPP), and less rearfoot plantar pressure (RPP) than group B ([Formula: see text]). They showed a highly significant positive correlation between the thoracic kyphosis angle and FPP, and a highly significant negative correlation with the RPP ([Formula: see text], [Formula: see text], respectively). There was no correlation between the lumbar lordosis angle and FPP or RPP ([Formula: see text], [Formula: see text], respectively). Conclusion: Handball players with greater thoracic kyphosis angle have greater lumbar lordosis angle. Increasing the thoracic kyphosis angle is strongly associated with increased FPP and decreased RPP. While there is no relationship between the lumbar lordosis angle and FPP or RPP.

Parameters and Biomechanics of Cervical Sagittal Balance: A Concise and Precise Review

Cervical spine is a vital component of the human spine and it is different from other components. It is the most mobile part of spine and it not only holds the head load but also maintains head balance while in motion. It also helps to balance the thoracic spine which is just contrary to it. Thoracic spine is a rigid structure and its natural curve is kyphotic unlike cervical spine. The equilibrium maintained by the cervical spine for head holding and balancing thoracic kyphosis is called cervical sagittal balance. Similarly, cervical spine also maintains the balance with lumbar spine and its lordosis. In fact, various components of the human spine are not individual parts from a function standpoint, they act simultaneously in a coordinated way to maintain the global balance so that human body remains in an equilibrium at any posture and position, this is what is called a sagittal balance. Cervical spine plays a vital role in maintaining the global balance of spine. Many parameters have been identified to understand cervical sagittal balance. Surgical planning based on maintenance of sagittal balance with the help of these parameters gives the best outcome. We hereby have tried to collect the maximum information about cervical sagittal balance which otherwise is not mentioned collectively elsewhere, and this will provide guidelines and surgical hints to a spinal surgeon.

Midterm Outcomes of Multimodal Approach to Treating Severe Scoliosis in Patients With Osteogenesis Imperfecta.

The surgical management of severe scoliosis in patients with osteogenesis imperfecta (OI) is challenging because of curve rigidity, small stature, and inherent bone fragility. This study evaluated the midterm outcomes of our multimodal approach to address these issues, integrating perioperative bisphosphonate therapy, preoperative/intraoperative traction, various osteotomies, segmental pedicle screw instrumentation with cement augmentation, and bone morphogenetic protein-2 application. A single-center retrospective review of 30 patients (average age 14.1 ± 2.2 years; 18 were female) diagnosed with OI and scoliosis was conducted. These patients underwent posterior spinal fusion between 2008 and 2020 and completed a minimum follow-up of 2 years. We measured radiographic parameters at each visit and reviewed the incidence of complications. A mixed-effects model was used to evaluate changes in radiographic parameters from preoperative measurements to the first and latest follow-ups. The patient cohort consisted of 2 individuals with type I OI, 20 with type III, 6 with type IV, and 2 with other types (types V and VIII). Surgical intervention led to a notable improvement in the major curve magnitude from 76° to 36°, with no notable correction loss. In addition, the minor curve, apical vertical translation, lowest instrumented vertebra tilt, and pelvic obliquity were also improved. In the sagittal plane, thoracic kyphosis and lumbar lordosis remained unchanged while thoracolumbar kyphosis markedly improved. Two patients experienced proximal junctional kyphosis with screw pullout, one of whom required revision surgery. One patient developed a superficial infection that was successfully treated with oral antibiotics. No instances of neurologic deficits or cement extravasation were observed. This study demonstrated the effectiveness and safety of our multimodal approach to treating scoliosis in patients with OI, achieving a 53% major curve correction with minimal complications over 2-year follow-up. These findings provide notable insights into managing scoliosis in this population. Level IV (case series).

The Efficacy of Manual Therapy on Musculoskeletal Pain in Menopause: A Systematic Review.

(1) Background: The aim of this review was to evaluate the effects of manual therapy for musculoskeletal pain in menopausal women. (2) Methods: A comprehensive search of manuscripts published from inception until 29 February 2024 was conducted on PubMed, EBSCO Information Services (EBSCOhost), Physiotherapy Evidence Database (Pedro), Web of Science, Scientific Electronic Library Online (SciELO), Cochrane Central Register of Controlled Clinical Trials, and Scopus using Medical Subject Headings (MeSH) and free terms. Randomized controlled trials (RCT) investigating the effects of manual therapy for musculoskeletal pain in postmenopausal women were included. Articles published in non-English or non-Portuguese languages, case reports, expert opinions, dissertations, conference papers, and gray literature were excluded. Studies were screened for population, musculoskeletal pain, intervention, and pain outcome by two independent reviewers using an ad hoc data extraction form. (3) Results: A total of 5 RCTs (4 with high risk of bias and 1 with low risk of bias) were included (total sample = 245), addressing thumb carpometacarpal osteoarthritis, thoracic kyphosis, chronic neck and backache, knee osteoarthritis, and sternocostal joint pain. The combined results of these studies showed improved musculoskeletal pain in menopausal women; duration of the follow-up was between 4 weeks to 6 months. Conclusions: The majority of studies included in this systematic review were effective in reducing musculoskeletal pain in menopausal women. These results come mainly from studies with a high risk of bias with small sample sizes, and the most representative follow-up period was short-term. Therefore, the results of this systematic review should be interpreted with caution.