Kyphosis Research Articles

Spine Kinematics Behavior During the Handstand Posture: A Biplanar Radiographic Analysis

Background/Objectives: The handstand is an exercise performed in many sports, either for its own sake or as part of physical training. Unlike the upright bipedal standing posture, little is known about the sagittal alignment and balance of the spine during a handstand, which may hinder coaching and reduce the benefits of this exercise if not performed correctly. The purpose of this study was to quantify the sagittal alignment and balance of the spine during a handstand using radiographic images to characterize the strategies employed by the spino-pelvic complex during this posture. Methods: Nineteen national-level artistic gymnasts participated in this study and underwent a low-dose biplanar (frontal and lateral) radiograph in both upright bipedal standing posture and during a handstand. Then, 3D reconstruction of the spine, based on biplanar radiographic images, enabled the determination of key pelvic (pelvic incidence, sacral slope, pelvic tilt) and spinal (lumbar lordosis, thoracic kyphosis, T9 sagittal offset) parameters in both postures. Results: The results showed that most gymnasts performed pelvic retroversion during the handstand, which was accompanied by an average decrease in lumbar lordosis, thoracic kyphosis, and T9 sagittal offset. Additionally, lumbar curvature was found to depend on pelvic orientation in upright bipedal standing posture, whereas it was associated with the thoracic spine during the handstand. Conclusions: This study provides new insights into how the spine kinematically adapts to an inverted body load. The results may help coaches and physiotherapists in teaching the handstand or using it to rehabilitate and strengthen the spine through the handstand posture.

Does Trunk Self-Elongation Instruction Lead to Changes in Effective Trunk Height and Spino-Pelvic Parameters? A Radiographic Analysis

Background/Objectives: The aim of this study was to evaluate changes in trunk height and variations in spino-pelvic parameters during trunk self-elongation. Two populations were studied: non-athletes and gymnasts, who differ in their engagement with core-strengthening exercises. Methods: EOS biplanar radiographs were taken on 14 non-athletes and 24 gymnasts in both neutral and trunk self-elongation positions. Three-dimensional reconstructions of the pelvis and spine were used to calculate effective trunk height, thoracic and lumbar contributions, and spino-pelvic parameters. Results: Trunk self-elongation resulted in a significant increase in trunk height for both groups (7 mm on average, range: −1 to 14 mm), accompanied by a reduction in thoracic kyphosis for all participants (−10° for non-athletes and −17° for gymnasts, on average) and a reduction in lumbar lordosis in most participants (−5° for non-athletes and −7° for gymnasts, on average). However, some individuals in both groups exhibited an increase in lumbar lordosis, which reduced the contribution of the lumbar region to overall trunk height. Conclusions: Trunk self-elongation instruction effectively increases trunk height, but additional instructions, such as pelvic retroversion, may enhance its effectiveness.

Patterns of sitting spinal alignment in non-ambulatory scoliosis patients with paraplegia: an observational study.

To classify sagittal spinopelvic alignment patterns of non-ambulatory scoliosis patients with paraplegia based on lateral sitting radiographs and explore their relation to clinical background and physical function. We reviewed non-ambulatory scoliosis patients with paraplegia, excluding those with prior spinal surgery from a single-center database. Alignment patterns in sitting postures were classified into slump sitting (SS) and erect sitting (ES) based on the most posterior edge of the spine's location on lateral sitting radiographs. Radiographical spinopelvic sagittal alignment, demographics, and physical functions were analyzed. Clinical scoring for physical functions included Hoffer's ambulator classification, Hoffer's modified sitting classification, and the Modified Ashworth Score (MAS) for the severity of spasticity in the lower extremities. Percentages of patients without spasticity, with MAS of 0 indicating "no spasticity." were also compared between the two alignment patterns. Of 172 patients screened, 86 met inclusion criteria, revealing two distinct alignment patterns: SS showed greater thoracic kyphosis, smaller lumbar lordosis, pelvic retroversion, and hip hyperflexion compared to ES. No significant differences in demographic data or curve patterns were observed between groups. The SS group had a significantly higher percentage of patients without spasticity compared to the ES group (39.2% vs. 14.3%, P = 0.016). Identified were two distinct sagittal alignment patterns in seated scoliosis patients with paraplegia, with potential influences from spasticity in the lower extremities. Recognizing these patterns can aid in assessing the function of sitting balance that includes the hip joint and in optimizing strategies for the treatment of scoliosis patients with paraplegia.

Breast size, thoracic kyphosis, and thoracic spine pain: a correlational survey of Nigerian postpartum mothers.

Thoracic spine postural dysfunctions are common postpartum-related health problems, compromising breastfeeding efficacy and quality of life among women. Previous studies have particularly associated these conditions with increased breast sizes in several populations. However, such empirical evidence is scarce in the Nigerian population. To investigate the relationship among breast size, thoracic-kyphosis, and -spine pain among postpartum Nigerian women. This correlational survey involved 400 consenting postpartum mothers (between 0 and 24 months of postpartum period). Their breast size, thoracic spine posture, and pain were measured using a measuring tape (cm), inclinometer, and Revised Oswestry thoracic spine pain disability questionnaire, respectively. Data were analyzed using descriptive and relevant inferential statistics at p < 0.05. The majority of the participants fall under the category of breast cup size B (61.75%), have no history of thoracic spine pain (87.4%), and about half of them (50.2%) have normal thoracic spine posture (low category with values ranging between 20⁰ and 35⁰. Breast size was significantly (r = 0.162, p = 0.001) correlated with thoracic spine posture but showed no significant correlation (r = 0.066, p = 0.622) with thoracic spine pain. Increasing breast size is weakly associated with a tendency towards a kyphotic posture of the thoracic spine. Postural education and care around adequate support of the breast with suitable fitting brassieres may help prevent kyphotic deformities. Future research with a randomized control trial and long-term follow-up is recommended to further confirm the causal relationship of these variables.

A Novel Preoperative Scoring System to Accurately Predict Cord-Level Intraoperative Neuromonitoring Data Loss During Spinal Deformity Surgery

Background: An accurate knowledge of a patient’s risk of cord-level intraoperative neuromonitoring (IONM) data loss is important for an informed decision-making process prior to deformity correction, but no prediction tool currently exists. Methods: A total of 1,106 patients with spinal deformity and 205 perioperative variables were included. A stepwise machine-learning (ML) approach using random forest (RF) analysis and multivariable logistic regression was performed. Patients were randomly allocated to training (75% of patients) and testing (25% of patients) groups. Feature score weights were derived by rounding up the regression coefficients from the multivariable logistic regression model. Variables in the final scoring calculator were automatically selected through the ML process to optimize predictive performance. Results: Eight features were included in the scoring system: sagittal deformity angular ratio (sDAR) of ≥15 (score = 2), type-3 spinal cord shape (score = 2), conus level below L2 (score = 2), cervical upper instrumented vertebra (score = 2), preoperative upright largest thoracic Cobb angle of ≥75° (score = 2), preoperative lower-extremity motor deficit (score = 2), preoperative upright largest thoracic kyphosis of ≥80° (score = 1), and total deformity angular ratio (tDAR) of ≥25 (score = 1). Higher cumulative scores were associated with increased rates of cord-level IONM data loss: patients with a cumulative score of ≤2 had a cord-level IONM data loss rate of 0.9%, whereas those with a score of ≥7 had a loss rate of 86%. When evaluated in the testing group, the scoring system achieved an accuracy of 93%, a sensitivity of 75%, a specificity of 94%, and an AUC (area under the receiver operating characteristic curve) of 0.898. Conclusions: This is the first study to provide an ML-derived preoperative scoring system that predicts cord-level IONM data loss during pediatric and adult spinal deformity surgery with &gt;90% accuracy. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Despite a Multifactorial Etiology, Rates of Distal Junctional Kyphosis After Adult Cervical Deformity Corrective Surgery Can be Dramatically Diminished by Optimizing Age Specific Radiographic Improvement.

Retrospective cohort study of a prospectively collected single-center database. Distal Junctional Kyphosis (DJK) is one of the most common complications in adult cervical deformity (ACD) correction. The utility of radiographic alignment alone in predicting and minimizing DJK occurrence warrants further study. To investigate the impact of post-operative radiographic alignment on development of DJK in ACD patients. ACD patients (≥18yrs) with complete baseline (BL) and two-year (2Y) radiographic data were included. DJF was defined as DJK greater than 15° (Passias et al) or DJK with reop. Multivariable logistic regression (MVA) identified 3-month predictors of DJK. Conditional inference tree (CIT) machine learning analysis determined threshold cutoffs. Radiographic predictors were combined in a model to determine predictive value using area under the curve (AUC) methodology. "Match" refers to ideal age-adjusted alignment. 140 cervical deformity patients met inclusion criteria (61.3yrs, 67% F, BMI: 29kg/m2, CCI: 0.96 ± 1.3). Surgically, 51.3% had osteotomies, 47.1% had a posterior approach, 34.5% combined approach, 18.5% anterior approach, with an average 7.6 ± 3.8 levels fused and EBL of 824mL. Overall, 33 patients (23.6%) developed DJK, and 11 patients (9%) developed DJF. MVA controlling for age, and baseline deformity, followed by CIT found 3M cSVA <3.7cm (OR: .2, 95% CI:.06-.6), and TK T4-T12 <50 (OR:.17, 95% CI:.05-.5, both P < .05) were significant predictors of a lower likelihood of DJK. Receiver operator curve AUC using age, T1S match, TS-CL match, LL-TK match, cSVA <3.7cm, and T4-T12 <50 predicted DJK with an AUC of .91 for DJK by 2Y, and .88 for DJF by 2Y. These findings suggest post-operative radiographic alignment is strongly associated with distal junctional kyphosis. When utilizing age-adjusted realignment in addition to newly developed thresholds, a suggested post-operative cSVA target of 3.7cm and thoracic kyphosis less than 50, it is possible to substantially reduce the occurrence of distal junctional kyphosis and distal junctional failure.

Epidural Anesthesia in a Patient with Severe Thoracic Kyphosis Undergoing Primary Cesarean Delivery: A Case Report

The administration of neuraxial anesthesia among parturient patients with concomitant spine deformity poses challenges to anesthesiologists. The apprehension stems from the increased possibility of a failed block and complications arising from potential neurologic injury due to anatomic variance. This is a case report of a 30-year old female gravida 1 para 0 at 36 4/7 weeks age of gestation with severe thoracic kyphosis who underwent emergency primary low segment cesarean section under epidural anesthesia. Ultrasonography of the spine was done pre-induction to visualize spinal anatomy and verify anatomic landmarks. Epidural anesthesia was attempted twice before achieving adequate block to dermatomal level T4 within approximately seven minutes. The patient was able to tolerate the procedure well without significant intraoperative events. Fetal outcomes were also favorable with APGAR scores of 9,9. This case report emphasizes that with extensive preoperative evaluation and preparation, an individualized anesthetic plan may be devised. Ultrasound-guided epidural catheter insertion can be a safe option for obstetric patients with thoracic kyphosis.

Comparing outcomes for single-segment vertebral column decancellation performed at different vertebras in ankylosing spondylitis-an observational study

BackgroundThe surgical procedure of vertebral column decancellation (VCD) has been increasingly performed in orthopaedic surgery for those with spinal deformity. To investigate the results of single-segment VCD performed at different vertebra for correcting thoracolumbar kyphosis in ankylosing spondylitis (AS) and to guide the osteotomy strategy.MethodsEighty-six AS patients (77 males, 9 females) having thoracolumbar kyphosis underwent single-segment VCD (ranging from T12 to L3) between January 2016 and September 2019 were enrolled and divided into four groups according to the osteotomy vertebra: T12 in 9 cases (Group A), L1 in 15 cases (Group B), L2 in 47 cases (Group C), and L3 in 15 cases (Group D). Demographics, operational data, radiological and clinical data were compared among the four groups.ResultsAll patients had significant improvements in spinopelvic alignments and health-related quality of life after correction surgeries. Having the similar demographics, patients in the group C obtained the maximum local kyphosis and global kyphosis correction of 45.05° ± 9.07° (P < 0.001) and 43.42° ± 11.24° (P < 0.001) respectively. However, those in the group A had the largest correction in thoracic kyphosis (41.88° ± 9.57°) and chin-brow vertical angle (24.74° ± 6.38°) respectively (P < 0.001). Moreover, the VCD of L2 or L3 would result in much larger correction in lumbar lordosis and sagittal vertical axis than those in the group A and B respectively (P < 0.001), patients in the group A and B suffered from much higher incidence of complications perioperatively although (P = 0.043).ConclusionSingle-segment VCD performed among thoracolumbar segments can effectively restore spinopelvic alignments and improve the health related quality of life for AS patients with thoracolumbar kyphosis deformity. Moreover, L2 may be the optimal osteotomy vertebra for those patients.Trial registrationClinical trial number: not applicable.Level of evidenceIII, therapeutic study.

The Variability of the Cervicothoracic Inflection Point: A Cohort Analysis of the Multi-Ethnic Asymptomatic Normative Study (MEANS).

Cross-sectional Cohort Study. To determine the cervicothoracic inflection point in an asymptomatic, adult population. The cervicothoracic inflection point (CTIP) is an important sagittal marker to understand for patients with cervical deformities. We aimed to identify the CTIP and understand the relationship to other sagittal alignment markers. 468 adult asymptomatic volunteers (18-80years) from 5 countries (United States, France, Japan, Singapore, Tunisia). All volunteers underwent standing full body, low dose stereo radiographs. The CTIP was identified by measuring the cervical sagittal angle (CSA) and thoracic kyphosis maximum angle (TKMax), using the end vertebra concept. The CTIP was defined as the vertebra or disc between the lower end vertebra of the CSA and upper end vertebra of TKMax. A correlation matrix was utilized to identify the relationship between the CTIP and spinopelvic sagittal parameters of interest. The most common CTIP value was the T1 vertebra. CTIPs ranged from C5 to T4, respectively. CTIP showed a weak positive correlation to age (r = 0.10, P = 0.03) and negative correlation to BMI (r = -0.11, P = 0.04). Additionally, CTIP had a minor positive correlation with OC2-CL, C7 slope, T1 slope, T1PA, T1-T12TK, and T4-T12TK, all statistically significant. Linear regression demonstrated increased cervical lordosis and increased TK was associated with more caudal CTIP segments. CTIP segments ranged from C5 to T4, with the most common segment being T1. Understanding the relationship of the CTIP to other sagittal variables is critical to patients with CD.

Effect of different corrective force directions applied by spinal orthoses on the patients with adolescent idiopathic scoliosis

BackgroundSpinal orthoses are commonly prescribed for adolescent idiopathic scoliosis (AIS), yet their three-dimensional correction was not fully understood. The amount of deformity control largely depends on the corrective forces applied, which remain empirically based due to a lack of consensus on optimal force application. This study investigated the effects of different corrective force directions exerted by spinal orthoses on patients with AIS.MethodsA retrospective analysis was conducted on 78 subjects. The trunk was segmented into four quadrants using coronal and sagittal planes from a top-down perspective. Each left or right posterolateral quadrant (with 90°) was further subdivided into zones 1–4, from the sagittal to coronal planes. Based on the zone where the resultant corrective force direction fell, the subjects were categorized into Group 1 (zone 1), Group 2 (zone 2), Group 3 (zone 3), or Group 4 (zone 4). The direction of the corrective force was estimated using modified models of the subjects’ bodies, designed through a computer-aided design and manufacturing system integral to the orthosis fabrication process. The effects of corrective forces in different zones on scoliotic spine were assessed.ResultsAmong the subjects, 3 were in Group 1, 17 in Group 2, 52 in Group 3, and 6 in Group 4. Due to the limited number of subjects, data from Groups 1 and 4 were not analysed. Groups 2 and 3 showed significant reductions in Cobb angle in the coronal plane and plane of maximum curvature (PMC) following orthosis fitting (p < 0.05). Group 2 displayed a significant decrease > 5º in thoracic kyphosis (p < 0.05). Both Groups 2 and 3 exhibited significant reductions in lumbar lordosis. PMC orientation remained unchanged over time (p > 0.05) but was notably higher in Group 2 after orthosis fitting (p < 0.05).ConclusionsCorrective forces applied by spinal orthoses in zones 2 and 3 effectively controlled lateral curve progression. Notably, only forces in zone 3 neither significantly reduced thoracic kyphosis nor exacerbated the deviation of scoliotic spine from the sagittal plane. Further research is needed to validate and expand upon these results.

Analysis of the effectiveness of two-stage and one-stage surgical treatment for idiopathic scoliosis in children using various methods for deformity mobilization

Introduction. The correction potential of modern systems is limited by the natural mobility of scoliotic deformities, which sometimes require multiple discectomy and osteotomy. Choosing the optimal method of treatment for scoliosis in the thoracic and lumbar regions is difficult due to the variety of approaches and options available for osteotomies. There is no single algorithm for the treatment of idiopathic scoliosis, making it necessary to develop a differentiated approach and treatment strategies. Purpose of the study. To optimize the choice of surgical treatment tactics for children with idiopathic scoliosis based on a compa­rative analysis of the use of one-stage and two-stage surgical treatment. Materials and methods. The study subjects were ninety four patients with idiopathic scoliosis (Lenke type 1–4), operated on between 2017 and 2023. They were divided into three groups: group I (control) — 30 patients underwent one-stage dorsal correction with G1 osteotomy, group II — 31 patients who received two-stage treatment, and group III — 33 patients who underwent a one-stage correction with apical G2 osteotomy. Depending on the initial thoracic kyphotic angle, subgroups were defined as A (hypokyphosis), B (normokyphosis) and C (hyperkyphosis). The minimum follow-up period was 12 months. Results. The frontal balance in all examined patients was in a state of relative compensation, both before surgical treatment and in the postoperative period. When comparing the results in patients from the second and third groups, we found no significant differences (p &gt; 0.05). The second group showed a higher degree of correction of the main arch of spinal deformity (p &lt; 0.05) in the frontal plane compared to the control and third group patients. When analyzing the results of thoracic kyphosis formation, we obtained reliable results in formation more significant indices in patients after surgery in Group II (subgroups A and B), for whom a two-stage applied surgical method was supplemented with anterior release and halo pelvic traction. In Group III (subgroup C), we obtained significant results in thoracic kyphosis indices when using single-stage surgery performed from the dorsal approach supplemented with G2 osteotomy. Conclusion. The condition of the sagittal profile, including the severity of thoracic kyphosis, is an important criterion for choosing the tactics of surgical treatment of scoliotic deformities of the thoracic and lumbar spine. Two-stage treatment, including ventral release and halo-pelvic traction, is recommended for rigid deformities of the thoracic or thoracolumbar spine, under conditions of initial normal kyphosis or hypokyphosis. Severe deformities with initial hyperkyphosis should be corrected preferably in a single stage using posterior surgery, supplemented by G2-osteotomy. The use of G2-osteotomies in patients with initial normal- or hypokyphoses is impractical due to the risk of neurological complications, development of pseudoarthroses, and increase in volume of perioperative bleeding.

Risk Factors Involved in Postural Disorders in Children and Adolescents.

Postural disorders in children and adolescents have an increasing incidence. The aim of this study was to identify the type of postural defects in school-age and preschool children, as well as the external risk factors determined by an inadequate lifestyle. The research included 134 children aged between 5 and 18 years, in whom postural defects were identified. The project involved an examination of the children's body posture, a survey of the parents to determine the children's lifestyle, blood tests, and spinal X-rays. A significant percentage (76%) of the children included in the study were underweight. The examination of postural defects in the students revealed scoliosis in 21% of the patients, kyphosis in 7.5%, and lordosis in 1.5%, while 70% of the patients presented an association between at least two postural defects. As far as risk factors are concerned, we identified the presence of rickets sequelae in 70% of the patients, the presence of pectus excavatum in 43% of the patients, genu varum in 15%, and flat foot in 12%. Additionally, 90% of the children had an incorrect posture at the desk, while 42% incorrectly carried their backpack on one shoulder only. In terms of diet quality, associations between an inadequate diet and postural disorders were found for kyphosis, scoliosis, and other deformities. In conclusion, postural abnormalities in children have an increased incidence from an early age and are a result of the change in lifestyle in recent years, represented by sedentarism, a lack of physical activity, the excessive use of electronic devices, stress, and an inadequate diet.

NIMG-04. MASSIVE THORACIC MENINGOCELE IN A PATIENT WITH NF1

Abstract Thoracic meningoceles are uncommon but when seen are often associated with neurofibromatosis 1 (NF1). Here we present a unique case where a massive thoracic meningocele presented with chest pain in a patient with NF1. A 56-year-old female with a diagnosis of NF1 presented with pain in the entire chest wall. She described the pain as circumferential around the entire chest “like a barrel”. Cardiology evaluation (with echocardiography) revealed no pulmonary hypertension or other cardiac disorder. MR angiogram of the chest also revealed no intrathoracic vascular structural abnormality. Inflammatory myopathy was considered to explain the pain but electromyography was unremarkable as were creatine kinase and erythrocyte sedimentation rate. MRI of thoracic spine demonstrated a large thoracic meningocele involving the spinal canal from T5-T10 and extending into the left hemithorax with measurements of 11.5 x 6.1 x 12.5 cm. Imaging was also notable for leftward displacement of the spinal cord toward the meningocele starting at the T6 level and extending to the T9 level with kyphosis of the thoracic spine centered on the block vertebral bodies forming the T7-T8 levels. Significant posterior scalloping was evident from T6-T10 with attendant dural ectasia. Neurosurgical consultation recommended no intervention to correct the meningocele as plication carried a risk of producing a subarachnoid-pleural fistula from the meningocele into the pleural space of the thoracic cavity. This case adds to our understanding of how unique and diverse the presentations of NF1 can be, and of the surgical challenges posed by NF1-associated meningoceles.

Decreases in lung volume and lung height among ankylosing spondylitis patients with pulmonary function impairment: a 3D CT investigation

BackgroundRespiratory compromise among ankylosing spondylitis (AS) patients is characterized by restrictive pulmonary function, leading to the need for a meticulous assessment of lung volume. Compared with conventional pulmonary function tests (PFTs), CT-based lung volume measurements have superior accuracy and are crucial for understanding functional limitations in AS. This study investigated the correlation between CT lung volume and PFT parameters in AS patients, with a focus on changes in CT parameters and lung volume in patients with compromised pulmonary function.MethodsA total of 79 AS patients were included, and their full-length radiographs, thoracic CT scans, and PFT data were analysed. Specialized software was used to estimate the total and lobar lung volumes from the CT scans. The relationship between lung volume and PFT results was examined, and a multiple linear regression model was constructed to determine the influence of radiographic and CT parameters on total lung volume (TLV). Patients were classified into normal or impaired pulmonary function groups based on PFT outcomes, thus facilitating comparative analyses of radiographic and CT parameters and lung volumes between these groups.ResultsAmong the 79 AS patients, 19 had normal function, 4 had mixed dysfunction, and 56 experienced restrictive dysfunction. PFT parameters, including FVC, FEV1, TLC, FEV1%, and TLC%, showed varying correlations with TLV and individual lobe volume. Patients with compromised pulmonary function exhibited more pronounced spinal kyphosis and experienced a decline in TLV. Multiple regression analysis revealed that lung height and horizontal and vertical lung diameters independently influenced TLV. Notably, a decrease in lung height was observed in patients with impaired pulmonary function, whereas the horizontal and vertical diameters of the lungs remained stable.ConclusionsIn AS patients, TLV was found to be correlated with pulmonary function, particularly parameter such as FVC, FEV1, and TLC. A significant reduction in TLV was observed in those with impaired pulmonary function, with the primary contributing factor being a decrease in lung height.

Shape of the Sagittal Curvatures of the Spine in Young Female Volleyball Players

Background: The issue of the relation betweeen training loads on the shape of the spine of young players is of significant importance, as with the advancement of training seniority, unfavorable changes may be perpetuated resulting in possible consequences in the next stages of ontogenesis. The aim of this study was to assess the formation of the sagittal curvatures of the spine in girls practicing volleyball versus their nonpractising peers. Methods: We examined 60 girls aged 10–13 years, including 30 volleyball players and 30 untrained peers. The Baseline Bubble inclinometer was applied as a research. The data were analyzed based on Mann–Whitney U test and Pearson Chi-square test. Results. There were statistically significant intergroup differences in lumbar lordosis curvature values (Z = −2.67; p = 0.007). The prevalence of correctness values of the thoracic kyphosis curvature, was group-dependent (χ2(1) = 4.34; p = 0.037). Group also determined the prevalence of lumbar lordosis normalities (χ2(1) = 5.41; p = 0.020). Conclusions. Volleyball has a beneficial effect on the formation of the thoracic kyphosis, while the lumbar lordosis is shallowed under the influence of training. This indicates the need for a holistic approach to player training and the need to supplement the technique and tactics training with exercises to strengthen the muscles that stabilize the lumbar spine, improve spinal mobility, learn how to control the anterior tilt of the pelvis and train the fascia.

Maternal Parity Effect on Spine Posture Changes and Back Pain During Pregnancy.

Background: Pregnancy can significantly alter posture and stability, thereby affecting spine curvatures. A positive relationship between the number of full-term pregnancies and the prevalence of low back pain (LBP) has been reported previously. This study aimed to analyze the impact of pregnancy on spine posture and LBP. Methods: Thirty pregnant females who were nulliparous (Group 1, n = 15) or had one or two pregnancies (Group 2, n = 15) were examined using the photogrammetric method in the first, second, and third trimesters of pregnancy. Further, a correlation analysis was conducted among the body mass index (BMI), pain intensity (VAS scale), and spine posture parameters. Results: The parous groups did not differ significantly in the parameters of the spinal posture. The thoracic angle decreased in trimester II compared to trimester I (157.77° vs. 160.55°, p = 0.004), which, according to the measurement methodology used, means that the thoracic kyphosis curvature increased. BMI was associated with the angle of trunk inclination in trimester I in Group 1 (r = 0.54, p = 0.04), as well as with the thoracic angle in trimesters II and III in Group 2 (r = 0.54-0.62, p < 0.05). A statistically significant correlation between pain intensity and spine posture parameters was more frequently observed in Group 2. Conclusions: Parity does not affect spine posture during pregnancy or pain intensity. The intensity of LBP was associated with spine posture changes during pregnancy, but the character of association differs between groups of parity. Alterations in spine posture should be monitored during pregnancy to prevent back pain.

Most AOTL type A and type B thoracolumbar primary fracture line follow the mechanism of an imaging-based injury model.

Based on the phenomenon that most thoracolumbar primary fracture line passes the center of the pedicle, we proposed an injury mechanism model to evaluate. Consecutive patients with thoracolumbar fractures treated operatively between October 2019, and December 2020 were analyzed retrospectively. Demographic and spinal radiographical parameters were measured and recorded. Pedicle hyperintensity on T2-weighted sagittal MR images was labeled. We examined the relationship between the course of the line (Radius) connecting the center of the pedicle of the injured vertebra and the IAR and orientation of the thoracolumbar primary fracture line. A partial correlation test was calculated to find correlations between demographic and spinal radiographical parameters. Nonlinear regression analysis was run with the Radius as the dependent variable and the other spinal kyphosis parameters as the independent variables to verify this model. Ninety-seven patients with 104 thoracolumbar fractures were included in this study. Ninety-four (90.4%) thoracolumbar fractures showed a high signal on MRI T2 through the pedicle. Involvement of the center of the pedicle was distributed among most AOTL Type A and Type B thoracolumbar fractures. In total, 92.3% of primary vertebral fracture lines followed the Radius of the model (r2 = 0.940). We provide a simple and quantifiable spinal instantaneous injury mechanism model for thoracolumbar fractures. Specifically, most AOTL type A and B thoracolumbar primary fracture line conforms to this model.

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 2 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, the Japanese Orthopedic Association score, and the visual analog scale. To evaluate the impact of tumor location on these outcomes, we categorized the patients into 3 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, and 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 Japanese Orthopedic Association score and visual analog scale 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.

Novel radiological predictors for the progression of proximal junctional kyphosis in osteoporotic vertebral compression fracture with kyphosis following posterior corrective surgery.

This study aimed to identify the effect of some novel risk factors associated with L1 vertebrae and parameters closely related to the sagittal alignment for the occurrence of proximal junctional kyphosis (PJK) following surgery for patients with osteoporotic vertebral compression fractures (OVCF)kyphosis. 74 OVCF patients undergoing posterior corrective surgery between January 2008 and June 2021 with a minimum 2-year follow-up were included. These patients were divided into PJK and non-PJK groups. Spinopelvic parameters, includingthoracolumbar slope (TLS)and the L1 plumb line (L1PL) were measured preoperatively, postoperatively, and at follow-up. Multivariate logistic analysis was performed on various risk factors and Global Alignment and Proportion (GAP) scores. Associations between novel parameters and PJK were analyzed using receiver operating characteristic(ROC) analysis. PJK was identified in 28.4% of patients. The mean age and follow-up were 63.45years and 38.17months, respectively. There was no difference between the PJK and the non-PJK groups in baseline demographics, pre-operative and immediate post-operative pelvic incidence-lumbar lordosis mismatch. Multiple comparisonsshowed that the proportion of PJK in the severely disproportioned group(the group with the highest GAP scores) and that of the other two groups with lower GAP scores were statistically different (P < 0.001). Potential risk factors for PJK included preoperative thoracic kyphosis (TK) (P < 0.001), TLS (P = 0.016), postoperative TLS (P < 0.001), and L1PL (P < 0.001). Postoperative TLS and L1PL were respectively independent risk factors for PJK, with the cut-off values set at 8.6° and 10.4mm to predict the occurrence of PJK. TLS and L1PL can be used to predict the occurrence of PJK in patients undergoing surgery for OVCF and are crucial for preventing the progression of PJK. Achieving a proportionate GAP Score postoperatively seems to be a viable option as higher GAP scores were associated with higher rates of PJK.

Cyclic yoga improves anthropometric indices, musculoskeletal disorders, and blood pressure in middle-aged women

BackgroundThe new and therapeutic style of cyclic yoga, which is the art of aligning asana, pranayama, and yoga mudra techniques, can be used as a non-invasive style to improve or prevent some musculoskeletal disorders. For this purpose, this study was designed to investigate a selected course of cyclic yoga practice on some anthropometric indicators, musculoskeletal disorders, and blood pressure in middle-aged women. Methodsː Forty-two middle-aged women were assigned either to cyclic yoga (n = 21, 53.76 ± 4.073 years) or the control group (n = 21, 53.57 ± 4.781 years). The cyclic yoga group received yoga intervention for 10 weeks, three sessions per week, and 50–90 min per session. MANCOVA test was used for inter-group comparison, and variance with repeated measures was used for intra-group measurement. ResultsA 10-week of yoga training decreased weight, hip circumference, body mass index, percentage of body fat, waist-to-height ratio, round shoulder, thoracic kyphosis angle, lumbar lordosis angle, systolic blood pressure, and diastolic blood pressure. In addition, a significant increase in the percentage muscle mass variable was reported in the cyclic yoga group. There was also a difference between the two cyclic yoga and control groups in the post-test in the waist-to-height ratio, round shoulder, thoracic kyphosis angle, lumbar lordosis angle, systolic blood pressure, and diastolic blood pressure variables. Conclusionsː The results suggest that cyclic yoga exercises, as an effective therapeutic alternative, low-cost, and accessible lead to the improvement of the round shoulder, hyperkyphosis, hyperlordosis, some anthropometric indices, and blood pressure.