Lumbopelvic rhythm describes the relationship between the lumbar spine and hip motion during trunk bending tasks, while the lumbar lordosis angle represents the normal sagittal curvature of the lumbar spine. This study aimed to investigate the effect of core stabilisation exercises on lumbopelvic rhythm, lumbar lordosis angle, and pain in men with chronic nonspecific low back pain (CNSLBP). This clinical trial was conducted among men aged 30-50years with CNSLBP in Chaharmahal and Bakhtiari provinces of Iran. Participants (n=28) were randomly assigned to an experimental group (n=14), which received core stabilisation training for eight weeks (three sessions per week, 45-60min per session), and a control group (n=14) with no intervention. Lumbopelvic rhythm during trunk flexion and return was assessed using Kinovea software and smartphone video analysis; lumbar lordosis angle was measured using a flexible ruler; and pain levels were assessed using the Visual Analog Scale (VAS). At baseline, there were no significant differences between groups in pain, lumbopelvic rhythm, or lumbar lordosis. After 8weeks, the experimental group showed a significant reduction in pain compared with the control group (p≤0.05). However, significant changes in lumbopelvic rhythm were only observed in the hip return angle and the lumbar-to-hip ratio during forward bending. No significant differences were found in other angles or in lumbar lordosis. The findings suggested that core stabilisation exercises significantly reduced pain in men with CNSLBP; however, no significant changes were observed in lumbopelvic rhythm patterns or lumbar lordosis angle, suggesting that pain relief may occur through neuromuscular or functional adaptations rather than structural changes in the spine or pelvis. IRCT20240210060953N1 Registration date: 2024/03/09.

With the rising prevalence of marijuana use and increasing rates of complex spinal deformity surgeries, understanding the impact of cannabis on perioperative outcomes is crucial. Previous studies yield mixed results on fusion success, complications, and opioid use in spine surgery, but none have focused on long-segment spinopelvic fusions. This retrospective cohort study analyzed 155 adult patients undergoing posterior spinal fusion from the pelvis to L2 or higher between 2015 and 2023. Patients were stratified by preoperative marijuana use (n = 34 users vs n = 121 nonusers). Baseline demographics, surgical parameters, clinical outcomes [Oswestry Disability Index (ODI), visual analog scale], radiographic measures (pelvic tilt, lumbar lordosis, and sagittal vertical axis), and complications were compared using t-tests, χ2 tests, and logistic regression, with P < .05 considered significant. Marijuana users had higher preoperative opioid dependence (64.7% vs 42.9%, P = .025), more previous spine surgeries (52.9% vs 19.0%, P < .001), and elevated preoperative ODI scores (56.9 vs 52.8, P = .038), but demonstrated greater ODI improvement (43.7 vs 37.1, P = .003). No significant differences were observed in visual analog scale changes, radiographic corrections, hospital stay (8.8 vs 8.9 days, P = .920), transfusions (2.2 vs 1.5 units, P = .240), medical complications (eg, deep vein thrombosis/pulmonary embolism: 4 vs 21, P = .599), or mechanical complications (eg, pseudarthrosis: 10 vs 36, P > .999, and hardware failure: 12 vs 53, P = .434). In this cohort, preoperative marijuana use was not associated with statistically significant differences in complication rates or inferior outcomes after long-segment spinopelvic fusion. Users experienced enhanced functional recovery, although this finding must be interpreted in the context of their higher baseline disability. Given the modest sample size, these findings should be viewed as preliminary; prospective studies with standardized cannabis exposure metrics are needed to confirm these results.

BACKGROUND AND IMPORTANCE: Restoring distal lumbar lordosis at a fused L5-S1 junction is challenging in adult spinal deformity surgery, particularly in revision cases with limited anterior access. Posterior intradiscal osteotomy (IDO) with posterior approach anterior column release (P-ACR) provides a single-posterior approach for mobilizing the anterior column and restoring distal lumbar lordosis without the risks of retroperitoneal exposure. This report details the operative nuances and technical sequence for L5-S1 IDO with P-ACR and summarizes early outcomes from complex revision cases. CLINICAL PRESENTATION: Four patients with rigid sagittal imbalance, prior multilevel lumbar surgery, and near-complete L5-S1 autofusion underwent L5-S1 IDO with P-ACR. Three patients were nonambulatory preoperatively. In each case, the fused disc space was mobilized through controlled P-ACR, permitting insertion of an anteriorly positioned expandable cage at L5-S1. The mean lumbar lordosis improved from −28.6° preoperatively to −46.9° postoperatively (mean gain 18.3°). Sagittal vertical axis improved from 107.9 mm to 65.4 mm (mean reduction 42.6 mm, 39.4%). These radiographical gains were accompanied by reductions in pelvic tilt (−13.1°) and improvements in functional status and pain scores. CONCLUSION: L5-S1 IDO with P-ACR offers a posterior-only solution for restoring distal lumbar lordosis in patients with rigid lumbosacral deformity. By enabling anterior cage placement from a posterior corridor, this approach avoids the exposure-related risks of anterior lumbar interbody fusion and the morbidity of pedicle subtraction osteotomy while providing effective correction in heavily scarred revision fields. The stepwise description and illustrative cases may assist spine surgeons in incorporating this technique into practice.

Investigation of lumbopelvic region flexibility, trunk muscle endurance and lower extremity neuromuscular activity in hyperlordosis females.

Microdamage accumulation in the femoral head and its association with subchondral insufficiency fractures: A retrospective study.

Adult spinal deformity (ASD) leads to pain, disability, and reduced quality of life. Traditional multilevel posterior osteotomies are associated with complication rates up to 78%. Anterior column realignment (ACR) through an oblique minimally invasive surgery (MIS) approach offers direct visualization of the anterior longitudinal ligament, reducing motor injury risk. This study evaluates the safety and efficacy of this technique through illustrative case series, systematic review, and meta-analysis. A single-center retrospective case series presents 3 patients with class III ASD undergoing oblique ACR with robot-assisted posterior fixation. PubMed, Embase, and Cochrane were searched (July 25, 2025) for studies on MIS oblique ACR for ASD. Studies lacking sagittal imbalance or complete clinical data were excluded. Three studies met inclusion criteria and passed Joanna Briggs Institute critical appraisal. In the case series, sagittal alignment improved: mean sagittal vertical axis decreased from 11.1 to 3.7 cm, lumbar lordosis increased from 12.7° to 61.0°, and pelvic incidence-lumbar lordosis decreased from 50.3° to 4.7°. Postoperative L1-pelvic angle improved to within 6° of each patient's ideal, highlighting correction toward contemporary targets. Functional gains were notable, no complications occurred, and improvements persisted at 6 to 24 months. The systematic review corroborated low complication rates and effective correction with pooled vessel injury rate of 1.6% (95% CI, 0%-3.8%) and no proximal junctional failure. Across 124 patients and 222 segments, pooled disc angle correction was 11.53° (95% CI, 10.73-12.33), pooled fusion rate was 95.4% (95% CI, 91.7%-99.0%), and pooled complication rate was 21.9% (95% CI, 12.0%-36.6%). Oblique ACR is an emerging MIS strategy for ASD, providing robust spinal realignment. Our findings suggest that this advanced technique may be considered in medically and radiographically complex patients. Future studies are needed to evaluate long-term durability and comparative effectiveness vs alternative MIS or open techniques.

Early postoperative L1 pelvic angle and T10 pelvic angle as predictors of proximal junctional kyphosis in adult spinal deformity.

Development and validation of a clinical risk stratification model for lumbar vertebral compression fractures in patients with lumbar disc herniation.

The pararectus approach is a complementary option for lower lumbar vertebral body replacement: Clinical feasibility and anatomical considerations.

Pregnancy produces numerous physiological and structural changes in the pregnant person as the fetus grows. An increase in the hormone relaxin throughout pregnancy causes ligamentous laxity to allow the body to stretch and make room for the fetus and prepare the body for birth. This relaxation of the musculoskeletal system contributes to lumbar lordosis, pelvic pain, lumbar disc herniation, and joint pain. These changes may persist after delivery, causing years of lumbar and sacral pain. Although multiple reports indicate that 50 % of delivered patients will develop back pain, which is likely multifactorial, few studies have evaluated postpartum people for sacral dysfunctions. Our study focused on investigating the incidence of sacral dysfunctions in recently postpartum patients. The objectives for this study include: (1) to assess the type of sacral somatic dysfunction present in postpartum patients; and (2) to investigate the correlation between various demographic factors (age of mother, gravida, para, gestational age, utilization of anesthesia, postpartum day of osteopathic evaluation, position of baby at delivery, operative delivery via forceps or suction, weight of baby) and sacral somatic dysfunctions. This study was conducted by third year osteopathic medical students recruited during their obstetrics and gynecology clerkship rotation. Study participants were evaluated for sacral dysfunction utilizing a standardized palpatory technique. The findings made by student evaluators at each palpated site were recorded in a password-protected Microsoft Teams account. Principal investigators utilized this data to make a specific sacral diagnosis for each patient. Additional demographic data were recorded and utilized for analysis of risk factors. All data were analyzed and compared utilizing ttest, analysis of variance (ANOVA) methods, chi-square tests, and descriptive statistics with the aid of JASP and SPSS software. A total of 62 patients participated in the study. Sacral dysfunction has been identified in 100 % of patients. The total incidence of each diagnosis includes: three nonphysiologic, 24 physiologic neutral, and 35 physiologic nonneutral. There was a statistically significant association between nonphysiological diagnoses and an increased fetal weight as well as a shorter interval between birth and evaluation. Additionally, vacuum-assisted deliveries were more likely to result in a nonphysiologic or physiologic nonneutral diagnosis. Understanding the incidence of various sacral dysfunctions in postpartum patients can provide us with a deeper understanding of potential causes of back pain following vaginal delivery. In the future, we hope that this pilot study will contribute to further understand factors contributing to sacral dysfunctions in parturient. Our aim is to take a more proactive approach to addressing specific sacral dysfunctions, thereby decreasing postpartum lower backpain.

The objective of this study was to develop and validate a radiographic method to quantify the lumbar apex on calibrated EOS imaging, to compare the anatomical lumbar apex with the rod apex, and to evaluate the impact of pedicle subtraction osteotomy (PSO) on apex location. This retrospective cohort included 53 patients (mean age 52 ± 16 years) with a 2-year follow-up who underwent L4 or L5 PSO with sacral fixation using 40°, 65°, or 90° pre-bent rods. Pre- and immediate postoperative EOS images were assessed to measure spinopelvic parameters and spinal lordosis ratio (SLR). Differences between the lumbar and rod apices (ΔApexLL-Rod) and between pre- and postoperative spinal apices (ΔApexPreop-Postop) were calculated. Analyses used paired t-tests, ANOVA, and Pearson correlations. The lumbar apex was on average 6.1mm (p < 0.001) higher than the rod apex. PSO induced a significant distal migration of the spinal apex of - 28.6mm (p < 0.001). SLR increased by 92.7% postoperatively (p = 0.05). No significant subgroup differences for both ΔApex were found. Both ΔApex values correlated significantly with preoperative pelvic incidence, pelvic tilt, lumbar lordosis, and SLR. Reproducibility was excellent, with ICC values over 0.87. The spinal apex lies on average higher than the rod apex, and PSO induces a marked distal migration of the anatomical apex. Combined with SLR, apex analysis refines the description of early postoperative sagittal construct geometry. Clinically meaningful thresholds and associations with longer-term outcomes (mechanical events, radiographic maintenance, and PROMs) remain unknown and require longitudinal validation. Retrospective, single-center observational cohort study, Level of evidence IV.

With the rising incidence of degenerative lumbar spine disorders, accurate segmentation of spinal structures based on magnetic resonance imaging (MRI) is crucial for intelligent clinical diagnosis and surgical planning, while automated measurement of the lumbar lordosis angle based on segmentation can further support quantitative assessment of the condition. To overcome the issues of limited receptive field and loss of detail in existing deep learning methods when processing low-resolution, edge-blurred images, this paper proposes a segmentation architecture called MDVM-UNet. This architecture integrates three complementary mechanisms: the VSS module constructs a computationally efficient, multi-scale collaborative receptive field through parallel multi-scale hole convolution; the dual-path fusion module performs feature alignment using global average pooling and channel-spatial attention; and the edge enhancement module sharpens blurred boundaries through reverse attention and Laplacian pyramid decomposition. Experiments conducted on both private and public lumbar MRI datasets demonstrate that this method achieves excellent segmentation results for vertebral bodies and intervertebral discs, with an average Dice coefficient of 0.943, a 6.4% improvement over the standard U-Net;The mean absolute error between the lumbar lordosis angle measured automatically based on segmentation results and the manually annotated measurements was [Formula: see text], which is below the clinically acceptable threshold. Overall, the method described in this paper demonstrates excellent performance in both segmentation accuracy and clinical quantification, offering a viable approach for the intelligent assessment of degenerative lumbar spine diseases.

The purpose was to describe cervical sagittal alignment in adolescent idiopathic scoliosis (AIS) compared to a normal group of adolescents and young adults, seeking for differences by Lenke type. Radiographs of 1779 AIS patients and 1115 controls were analyzed. Lenke types were determined. Spinopelvic parameters, thoracic kyphosis (TK), lumbar lordosis and sagittal vertical axis (SVA) CAM, C2, and C7 were measured. Cervical parameters included McGregor slope, C1-C2 and McGregor-C2 lordosis, C2-C7 lordosis (subdivided into cranial and caudal arches), C7 and T1 slopes. Cervical alignment patterns were classified as lordotic, kyphotic or sigmoid shapes. Lenke 1, 2, 3 and 6 curves showed decreased C2-C7 and caudal arch lordosis associated with decreased C7 and T1 slopes and TK (p < 0.001) compared to normal. Cranial cervical parameters were comparable to the normal group. Lenke 5 patients demonstrated TK, C7 and T1 slopes, and cervical alignment parameters close to the normal group. In AIS, TK correlated with caudal cervical (r = 0.76) and C2-C7 lordosis (r = 0.52), but only weakly with cranial cervical parameters. Cervical sagittal alignment compensatory changes in AIS predominantly involve the caudal cervical segment and are closely related to TK, while cranial alignment remains close to normal, supporting horizontal gaze. As opposed to other AIS types with thoracic deformity, Lenke 5 patients had no cervical compensation, and sagittal alignment was close to normal. Distinguishing normative from pathologic compensation across AIS curve types may help optimize surgical planning and restoration of TK to indirectly improve cervical alignment.

Normatıve sagıttal spınopelvıc profıles: A systematıc revıew of the Roussouly classıfıcatıon across dıfferent ethnıc groups ın asymptomatıc adults.

Hip arthroscopy for femoroacetabular impingement yields favorable average results, yet many patients do not achieve truly excellent function. The influence of pre-operative radiographic and spinopelvic parameters on excellent short-term outcomes remains uncertain. We aimed to identify pre-operative radiographic and spinopelvic factors associated with achieving an excellent patient-reported outcome at 12 months after arthroscopic treatment of femoroacetabular impingement. A retrospective multicenter study of prospectively collected data was performed across six French centers. Consecutive patients treated arthroscopically for symptomatic femoroacetabular impingement between September 2020 and October 2021 were included if the 12-month Non-Arthritic Hip Score was available. Standard hip radiographs were used to measure degenerative grade, lateral centre-edge angle, and the Dunn alpha angle. Spinopelvic parameters were assessed on low-dose biplanar imaging in standing and sitting, including intrinsic pelvic mobility (standing minus sitting sacral slope). The primary endpoint was an excellent outcome defined as a 12-month Non-Arthritic Hip Score of at least 92. Missing spinopelvic data were handled by multiple imputation, and univariate then multivariable logistic regression was used, adjusted for age, sex, and body mass index. Of 200 eligible patients, 178 (89.0%) had 12-month outcome data; 82 (46.1%) achieved a Non-Arthritic Hip Score of at least 92. In the adjusted model, standing pelvic tilt of 10 degrees or less (odds ratio 2.82; 95% confidence interval 1.35-5.90), degenerative grade 0 (odds ratio 5.15; 95% confidence interval 2.19-12.09), lateral centre-edge angle greater than 25 degrees (odds ratio 3.08; 95% confidence interval 1.41-6.74), and male sex (odds ratio 3.18; 95% confidence interval 1.38-7.32) independently predicted an excellent outcome. Intrinsic pelvic mobility, standing lumbar lordosis, Dunn alpha angle, age, and body mass index were not independently associated with excellent outcome. Only about half of patients undergoing hip arthroscopy for femoroacetabular impingement achieved an excellent 12-month outcome. Tonnis grade 0, lateral centre-edge angle greater than 25 degrees, standing pelvic tilt of 10 degrees or less, and male sex independently predicted excellent results, whereas pelvic mobility, standing lumbar lordosis, age, and body mass index did not.

Comparative Analysis of Relaxed- and Flexed-Seated Radiographs for Assessing Spino-Pelvic Mobility in Total Hip Arthroplasty.

Lower crossed syndrome (LCS) is a common postural dysfunction among individuals with sedentary lifestyles; however, it can also affect athletes due to sport-specific demands. This study aimed to investigate and compare the effects of core stability exercises (CSE) and National Academy of Sports Medicine (NASM) exercises on lumbar lordosis, pelvic tilt, and trunk muscle endurance in athletes with LCS. This study employed an experimental design with pretest and posttest assessments across three groups. Thirty-six male athletes with LCS (aged 20-30 years) were randomly assigned to three groups: the CSE group, the NASM group, and the control group. Participants in the experimental groups performed their respective exercise protocols for 8 weeks (3 sessions per week). Lumbar lordosis and pelvic tilt angles were assessed using a flexicurve and a pelvic inclinometer, respectively. Additionally, the McGill test was used to determine the endurance of the trunk muscles. Both exercise protocols significantly decreased the lumbar lordosis angle and pelvic tilt, and significantly increased the endurance of the trunk flexors and extensors (p < 0.05). However, the NASM protocol significantly increased the lateral trunk flexors on both the dominant side (p < 0.001) and the nondominant side (p = 0.005). Additionally, the findings revealed that the effects of 8 weeks of exercise on the lordosis angle (F(2, 33) = 0.153, p = 0.85, ηp² = 0.009), pelvic tilt (F(2, 33) = 2.01, p = 0.15, ηp² = 0.109), trunk flexor endurance (F(2, 33) = 2.875, p = 0.07, ηp² = 0.148) and extensor endurance (F(2, 33) = 1.246, p = 0.301, ηp² = 0.07) did not differ significant between the NASM and CSE group (p > 0.05); However, a significant difference was observed in the endurance of trunk lateral flexors on the dominant (F(2, 33) = 16.897, p < 0.001, ηp² = 0.506) and nondominant sides (F(2, 33) = 16.931, p < 0.001, ηp² = 0.506) among the groups and post hoc Tukey tests revealed that the NASM group exhibited significantly greater improvements than the CSE group (p < 0.001). An 8-week of core stability and NASM exercise program are recommended to reduce the lumbar lordosis angle and pelvic tilt and to improve the endurance of trunk flexors and extensors in athletes with LCS. Although only the NASM protocol increased the endurance of lateral trunk flexors on both the dominant and nondominant sides, no significant difference was observed between the two exercise protocols regarding the other variables.

Measurement Properties of Surface Topography for Scoliosis Assessment: A Systematic Review and Meta-analysis.

The theoretical Roussouly classification describes sagittal spinal profiles based on pelvic morphology. As most reference data originate from Caucasian populations, its applicability to Hispanic populations remains limited. This study aimed to describe sagittal spinal alignment in an asymptomatic Colombian population using the theoretical Roussouly classification. A retrospective cross-sectional study analyzed whole-spine standing radiographs (2020-2024) from asymptomatic adults aged 18-50 years at Clínica Tolima. Spinopelvic parameters were measured using Surgimap, and sagittal profiles were classified according to the theoretical Roussouly classification. A total of 792 participants (57.58% female) were included. All sagittal profile types were identified. Type 3 was the most prevalent (36.74%), followed by Type 4 (28.16%); Type 3 Anteverted Pelvis (AP) accounted for 11.11%. Strong correlations were observed between Pelvic Incidence (PI) and Sacral Slope (SS) (r = 0.82), PI and Lumbar Lordosis (LL) (r = 0.88), and SS and LL (r = 0.79) (all p < 0.001). Sex was associated with higher SS and LL values, while age showed a limited association with SS only. Sagittal profile distribution and spinopelvic relationships in this Colombian population were comparable to those reported in other ethnic groups.

Scheuermann kyphosis and pectus excavatum rarely present concomitantly. The sternal-rib complex functions as a "fourth column" of thoracic spine support; its disruption can destabilize the spine and exacerbate kyphosis progression. Traditional surgical indications include curves exceeding 70°-75°, but compensatory mechanism assessment may provide additional indicators. A 16-year-old male presented with thoracic kyphosis (77°) and pectus excavatum (Haller index 2.8). Staged treatment included the Nuss procedure followed by observation. Despite physical therapy, kyphosis prog ressed to 90° over 28 months. Equal standing versus supine extension lumbar lordosis measurements (78°) indicated exhausted compensatory mechanisms. The patient underwent T2-L2 posterior spinal fusion with Smith-Petersen osteotomies while the Nuss bar remained in place, with bar removal 8 months later. This case demonstrates the biomechanical interdependence between thoracic spine and anterior chest wall as a fourth column and introduces compensatory mechanism assessment as a novel surgical indication. The successful retention of the Nuss bar during spinal correction represents a technical innovation minimizing surgical morbidity. This paradigm shift from curve magnitude-based to functional capacity evaluation may revolutionize timing decisions for spinal deformity correction. https://thejns.org/doi/10.3171/CASE25496.