Loss Of Lordosis Research Articles

P91. How does gravity influence the distribution of lordosis in sagittal malalignment?

<h3>BACKGROUND CONTEXT</h3> Supine imaging reveals the contour of the spine without gravity, a key consideration in surgical planning. Comparing supine to standing radiographs may reveal differences in regional flexibility in adult spinal deformity (ASD). <h3>PURPOSE</h3> To determine differences in regional flexibility of the lumbar spine in patients with ASD. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> Fifty-six patients with sagittal ASD (SRS-Schwab Type N, no previous fusion) and 119 asymptomatic volunteers. <h3>OUTCOME MEASURES</h3> PI-LL, L1-L4, and L4-S1 alignment. <h3>METHODS</h3> Asymptomatic volunteers underwent full length standing radiographs, ASD patients had standing and supine radiographs taken for preoperative planning. The standing alignment of the asymptomatic volunteers (50.7±17 years, PI 52±11.4°) was analyzed using linear regression in order to calculate PI-based formulas for normative, age-adjusted standing PI-LL, L4-S1, and L1-L4. These formulas were applied to the ASD cohort and compared to their standing and supine alignment. Given the potential for confounding by ASD patients with stiff lumbar spines, analyses were repeated in a cohort of 25 patients with at least 5° of flexibility (defined as the difference between supine and standing lordosis) and 5 degrees of offset from regional alignment norms. <h3>RESULTS</h3> Linear regression in the asymptomatic cohort resulted in the following PI based formulas: PI-LL= -38.3 +0.41*PI +0.21*Age, L4-S1= 45.3 -0.18*Age, L1-L4= -3 + 0.48*PI). The ASD cohort had a mean age of 65±14 years, BMI 29±7 kg/m2, standing PI-LL 14±22°, T1PA 22±11°). Eighty-seven percent of patients had a lordotic apex between the L3-L4 inferior endplates. PI-LL improved with supine positioning (mean 8.9±18.7°, p<0.001), though not enough to correct to age-matched norms (mean offset 12.2±16.9°). Compared to mean normative alignment at L1-L4 (22.1±6.2°), L1-L4 was flatter on standing (7.2±17.0°, p<0.001) and supine imaging (8.5±15.0°, p<0.001) while L4-S1 was comparable (norm 33.6±2.6 vs standing 30.9±12.9, p=0.325; vs supine 34.5±10.3, p=1.000). Subgroup analysis of subjects with L1-S1 flexibility >5° demonstrated a more dramatic effect—the standing loss of lordosis (32.6±1.7° norm vs 25.5±12.7° standing, p=0.031) at L4-S1 corrected on supine imaging (33.9±11.1°, p=1.000), while L1-L4 alignment did not (23.0±6.2° norm vs 2.2±14.4° standing, p<0.001; vs 7.3±12.9° supine, p<0.001). <h3>CONCLUSIONS</h3> When the effect of gravity is removed, the distal portion of the lumbar spine (i.e., below the apex of lordosis) corrects, suggesting that deformity is contained in the proximal lumbar region. These findings illuminate the etiology of lumbar hypolordosis and may influence selection of fusion levels. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants.

Adults with spinal deformity (ASD) are known to have postural malalignment affecting their quality of life. Classical evaluation and follow-up are usually based on full-body static radiographs and health related quality of life questionnaires. Despite being an essential daily life activity, formal gait assessment lacks in clinical practice. What are the main alterations in gait kinematics of ASD and their radiological determinants? 52 ASD and 63 control subjects underwent full-body 3D gait analysis with calculation of joint kinematics and full-body biplanar X-rays with calculation of 3D postural parameters. Kinematics and postural parameters were compared between groups. Determinants of gait alterations among postural radiographic parameters were explored. ASD had increased sagittal vertical axis (SVA:34 ± 59 vs -5 ± 20 mm), pelvic tilt (PT:19 ± 13 vs 11 ± 6°) and frontal Cobb (25 ± 21 vs 4 ± 6°) compared to controls (all p < 0.001). ASD displayed decrease walking speed (0.9 ± 0.3 vs 1.2 ± 0.2 m/s), step length (0.58 ± 0.11 vs 0.64 ± 0.07 m) and increased single support (0.45 ± 0.05 vs 0.42 ± 0.04 s). ASD walked with decreased hip extension in stance (-3 ± 10 vs -7 ± 8°), increased knee flexion at initial contact and in stance (10 ± 11 vs 5 ± 10° and 19 ± 7 vs 16 ± 8° respectively), and decreased knee flexion/extension ROM (55 ± 9 vs 59 ± 7°). ASD had increased trunk flexion (12 ± 12 vs 6 ± 11°) and reduced dynamic lumbar lordosis (-11 ± 12 vs -15 ± 7°, all p < 0.001). Sagittal knee ROM, walking speed and step length were negatively determined by SVA; lack of lumbar lordosis during gait was negatively determined by radiological lumbar lordosis. Static compensations in ASD persist during gait, where they exhibit a flexed attitude at the trunk, hips and knees, reduced hip and knee mobility and loss of dynamic lordosis. ASD walked at a slower pace with increased single and double support times that might contribute to their gait stability. These dynamic discrepancies were strongly related to static sagittal malalignment.

Long-term Clinical Outcomes of Microendoscopic Laminotomy for Cervical Spondylotic Myelopathy: A 5-Year Follow-up Study Compared With Conventional Laminoplasty.

This was a retrospective cohort study. The objective of this study was to characterize the long-term clinical and radiographic results of articular segmental decompression surgery using endoscopy [cervical microendoscopic laminotomy (CMEL)] for cervical spondylotic myelopathy (CSM) and to compare outcomes to conventional expansive laminoplasty (ELAP). The spinal cord compression in CSM consists of a pincer mechanism due to bulging disk and a hypertrophied ligamentum flavum. The long-term clinical benefits of segmental decompression surgery, which removes the dorsal compressive elements of articular segment in CSM patients, have not yet been elucidated. Consecutive patients with CSM who required surgical treatment were enrolled. All enrolled patients (n=81) underwent CMEL or ELAP. All patients were followed postoperatively for >5 years. The preoperative and 5-year follow-up evaluation included neurological assessment [Japanese Orthopaedic Association (JOA) score], JOA recovery rates, axial neck pain (visual analog scale), and cervical sagittal alignment (C2-C7 subaxial cervical angle). Sixty-four patients (CMEL group: 33, ELAP group: 31) were included for analysis. The preoperative JOA score was 10.1 points in the CMEL group and 11.1 points in the ELAP group (P=0.15). The JOA recovery rates were similar, 58.6% in the CMEL group and 55.2% in the ELAP group (P=0.55). The axial neck pain in the CMEL group was significantly lower than that in the ELAP group (P<0.01). At 5-year follow-up, cervical alignment was more favorable in the CMEL group, with an average 2.9 degrees gain in lordosis [vs. 2.3 degrees loss of lordosis in the ELAP group (P<0.05)] and lower incidence of postoperative kyphosis. CMEL is a novel, less invasive, technique that allows for multilevel posterior cervical decompression for treatment of CSM. Our 5-year follow-up data demonstrates that patients after CMEL have similar neurological outcomes to conventional laminoplasty, with significantly less postoperative axial pain and improved subaxial cervical lordosis when compared with their traditional laminoplasty counterparts.

The Preoperative Cross-sectional Area of the Deep Cervical Extensor Muscles Does Not Predict Loss of Lordosis After Cervical Laminoplasty.

This was a retrospective, single center. The objective of this study was to investigate the association between the cross-sectional area (CSA) of the deep extensor muscles (DEM) and postlaminoplasty alignment. The preoperative CSA of the semispinalis cervicis (SC) has been reported to correlate with loss of lordosis (LL) after laminoplasty, with a CSA <154.5 mm2 associated with a 10 degrees LL. Laminoplasty patients at the University of California San Francisco between 2009 and 2018 by 2 spine surgeons were retrospectively studied. Patients with previous cervical surgery or nondegenerative diagnoses were excluded. Measurements included the C2-C7 Cobb, T1 slope, and cervical sagittal vertical axis. Preoperative DEM CSA was measured on magnetic resonance imaging. Variables associated with lordosis were analyzed with univariate analysis and multivariate logistic regression, and association between postoperative cervical alignment and the musculature was evaluated. Seventy-six patients with a mean age of 64 years were included. The average follow-up was 22.53 months. The overall average CSA of the DEM was 2274.55 mm2 and that of the SC was 275.64 mm2. Means of both CSAs were higher in men (P<0.001). Linear regression showed no correlation between LL with CSA of the DEM or the SC (r=0.005, P=0.119; r=0.001, P=0.095). Univariate and multivariate regression showed no differences in the CSA of the DEM and SC between groups with and without LL (P=0.092, 0.117 and 0.163, 0.292). There was no correlation in LL with sex or body mass index (P>0.05). Preoperative CSA of the deep cervical extensor muscles may not predict LL after cervical laminoplasty. The correlation between the preoperative SC CSA and postoperative cervical alignment may not be as strong as previously reported.

Root joint involvement in spondyloarthritis: a post hoc analysis from the international ASAS-PerSpA study

Primary objective was to compare the clinical characteristics of spondyloarthritis (SpA) patients with and without root joint disease (RJD+ and RJD-). Secondary objectives were to compare the prevalence of RJD across various SpA subtypes and in different world regions, to compare the SpA axial severity and SpA burden between RJD+ and RJD-. This is a post-hoc analysis of the ASAS-PerSpA study (PERipheral involvement in SpondyloArthritis), which included 4,465 patients with SpA (axial (axSpA), peripheral (pSpA), psoriatic (PsA), inflammatory bowel disease, reactive and juvenile) according to the rheumatologist's diagnosis. RJD was defined as the "ever" presence of hip or shoulder involvement related to SpA, according to the rheumatologist. The patient's characteristics were compared between RJD+ and RJD-. Multivariable stepwise binary logistic regression analyses were conducted to identify factors associated with "RJD", "hip" and "shoulder" involvement. RJD was significantly associated with the SpA main diagnosis (highest in pSpA), a higher prevalence of HLA-B27 positivity, enthesitis, tender and swollen joints, CRP, cs-DMARDs, loss of lumbar lordosis and occiput-wall distance > 0. RJD was more prevalent in Asia, and occurred in 1,503 patients (33.7%), with more hip (24.2%) than shoulder (13.2%) involvement. Hip involvement had a distinct phenotype, similar to axSpA (including younger age at onset, HLA-B27 positivity), whereas shoulder involvement was associated with features of pSpA (including older age at onset). RJD+ SpA patients had a distinctive clinical phenotype compared with RJD-. Hip involvement, based on the rheumatologist's diagnosis, was more prevalent than shoulder involvement and was clinically distinct.

Artificial intelligence clustering of adult spinal deformity sagittal plane morphology predicts surgical characteristics, alignment, and outcomes.

AI algorithms have shown promise in medical image analysis. Previous studies of ASD clusters have analyzed alignment metrics-this study sought to complement these efforts by analyzing images of sagittal anatomical spinopelvic landmarks. We hypothesized that an AI algorithm would cluster preoperative lateral radiographs into groups with distinct morphology. This was a retrospective review of a multicenter, prospectively collected database of adult spinal deformity. A total of 915 patients with adult spinal deformity and preoperative lateral radiographs were included. A 2 × 3, self-organizing map-a form of artificial neural network frequently employed in unsupervised classification tasks-was developed. The mean spine shape was plotted for each of the six clusters. Alignment, surgical characteristics, and outcomes were compared. Qualitatively, clusters C and D exhibited only mild sagittal plane deformity. Clusters B, E, and F, however, exhibited marked positive sagittal balance and loss of lumbar lordosis. Cluster A had mixed characteristics, likely representing compensated deformity. Patients in clusters B, E, and F disproportionately underwent 3-CO. PJK and PJF were particularly prevalent among clusters A and E. Among clusters B and F, patients who experienced PJK had significantly greater positive sagittal balance than those who did not. This study clustered preoperative lateral radiographs of ASD patients into groups with highly distinct overall spinal morphology and association with sagittal alignment parameters, baseline HRQOL, and surgical characteristics. The relationship between SVA and PJK differed by cluster. This study represents significant progress toward incorporation of computer vision into clinically relevant classification systems in adult spinal deformity. Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Unintentional Fusion in Preserved Facet Joints without Bone Grafting after Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion.

Introduction A percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) procedure has been previously developed. During postoperative follow-up, in some patients, bone fusion occurred between opened facet joints, despite not having bone grafting in the facet joints. Here, we investigated facet fusion's frequency and tendencies following PETLIF. Methods A retrospective analysis was conducted on a prospectively collected, nonrandomized series of patients. Forty-two patients (6 males and 36 females, average age: 69.9 years) who underwent single-level PETLIF at our hospital from February 2016 to March 2019 were included in this study. Patients were assessed with lumbar X-ray images and computed tomography (CT) prior to, immediately after, and 1 year after surgery. Results Pseudarthrosis was not observed in any patients, and facet fusion was observed in 26 of 42 post-PETLIF patients (61.9%) by CT 1 year postoperatively. The average interfacet distance increased from 1.3 mm preoperatively to 4.5 mm postoperatively, and facet fusion was observed under the opened conditions of 3.8 mm at 1 year. Segmental lordotic angle of the fusion segment in the lumbar X-ray images was significantly larger in the facet fusion subgroup prior to surgery, immediately following surgery, and 1 year after surgery compared to the facet non-fusion group (p=0.02, p<0.01, p=0.01, respectively). There were no significant differences in patient background, correction loss of segmental lordosis, interfacet distance, or clinical score between the facet fusion and facet non-fusion subgroups. Conclusions Facet fusion was achieved over time within the facet joints that were opened through indirect decompression after PETLIF. We hypothesized that the preserved facet joints potentially became the base bed for spontaneous bone fusion due to the preserved facet joint capsule and surrounding soft tissue, which maintained cranio-caudal facet traffic and blood circulation in the facet joints. The complete preservation of the facet joints was a key advantage of minimally invasive lumbar interbody fusion procedures. Level of evidence Level III

Kim, KR; Lee, CK; Park, JY. Preoperative Parameters for Predicting the Loss of Lordosis After Cervical Laminoplasty. Spine (Phila Pa 1976) 2020; 45(21):1476-1484.

Kim, KR; Lee, CK; Park, JY. Preoperative Parameters for Predicting the Loss of Lordosis After Cervical Laminoplasty. Spine (Phila Pa 1976) 2020; 45(21):1476-1484.

The Effect of Anterior Cervical Discectomy and Fusion on Cervical Sagittal Vertical Axis and Lordosis with Minimum 2-Year Follow-Up

Anterior cervical discectomy and fusion (ACDF) can induce lordosis and improve cervical sagittal vertical axis (SVA), but multilevel ACDF may inadvertently increase cervical SVA because of insufficient lordosis induction. Patients who underwent 1-, 2-, or ≥3-level ACDF in the subaxial spine with minimum 2-year follow up were retrospectively studied. C2-C7 Cobb angle (lordosis), cervical SVA, and T1 slope were measured preoperatively, immediately postoperatively, and at last follow-up. Inclusion criteria were met by 127 patients. There were no differences in baseline demographics among 1-, 2-, and ≥3-level ACDF groups. Mean follow-up was 43.7 months (range, 24-142 months). Increase of cervical SVA immediately postoperatively was 1.94 mm,-1.44 mm, and 7.25 mm for 1-, 2-, and ≥3-level ACDF (P= 0.041) and at last follow-up was 2.97 mm, 0.70 mm, and 9.32 mm for 1-, 2-, and ≥3-level ACDF (P= 0.026). At last follow-up, 2-level ACDF patients had the greatest decrease in T1 slope (-0.43°) compared with increase of 2.71° for 1-level and 2.84° for ≥3-level patients (P= 0.028). In all 3 groups, segmental (ACDF levels) lordosis, cervical SVA, and T1 slope did not decrease from immediate postoperative to last follow-up. Only 2-level ACDF maintained C2-7 lordosis (2.16°) compared with loss of lordosis in 1-level (-0.84°) and ≥3-level (-2.00°) ACDF (P= 0.008) at last follow-up. Linear regression analysis showed that T1 slope had no relationship with correction of cervical SVA (P= 0.5310) but had a significant correlation with Cobb angle loss of C2-C7 lordosis (P= 0.0016). Compared with 1- and 2-level ACDF, ≥3-level ACDF resulted in significant increase of cervical SVA and loss of overall lordosis. Compared with 1- and ≥3-level ACDF, 2-level ACDF had the greatest ability to maintain lordosis. T1 slope had a significant correlation with loss of C2-C7 lordosis after ACDF.

AN AYURVEDIC APPROACH TO A CASE OF LOW BACK PAIN (KATIGRAHA) WITH SPECIAL REFERENCE TO LUMBAR SPONDYLOSIS

Katigraha is a condition where the lower back region is afflicted with Vitiated Vata and present with symptoms such as pain with stiffness. Katigraha mentioned in Ayurveda can be correlated with Lumbar spondylosis due to similarity of clinical manifestations. About 60% to 80% of the population in India suffer from this condition. The current case study was carried out at the Department of Panchakarma, B.S.D.Trust’s Ayurved Hospital and Research Centre,Wagholi,Pune. A 44 year male patient suffering with lumbar spondylosis was treated with samanya chikitsa of vata vyadhi i.e.Abhyanga, Swedana, Basti and Kati Basti treatment. Patient was treated for a period of 8 days. The response to the treatment was recorded and therapeutic effect was evaluated through symptomatic relief. Clinically, cardinal symptoms were significantly reduced and degree of anterior flexion increased from 40 degree to 90 degree. Radiographically, X Ray L.S. Spine showed an improvement in loss of lumbar lordosis. However, it still shows that the patient is suffering from lumbar spondylosis.

Allograft Subsidence Decreases Postoperative Segmental Lordosis With Minimal Effect on Global Alignment Following ACDF.

Study Design:Retrospective cohort study.Objective:Studies investigating the impact of interbody subsidence in ACDF suggest a correlation between subsidence and worse radiographic and patient-reported outcomes. The purpose of this study was to assess whether allograft subsidence assessed on CT is associated with worse cervical alignment.Methods:We performed a retrospective review of a prospective cohort of patients undergoing 1 to 3 level ACDF. Cervical alignment was assessed on standing radiographs performed preoperatively, less than 2 months postoperatively, and greater than 6 months postoperatively. Allograft subsidence was assessed on CT scan performed at least 6 months postoperatively. Patients with at least 1 level demonstrating greater than 4mm of cage subsidence were classified as severe subsidence. Student’s t-test was used to compare all means between groups.Results:We identified 66 patients for inclusion, including 56 patients with non-severe subsidence and 10 patients with severe subsidence. For the entire cohort, there was a significant increase in C2-7 Lordosis (p = 0.005) and Segmental Lordosis (p < 0.00 001) from preoperative to early postoperative. On comparison of severely and non-severely subsided levels, severely subsided levels demonstrated a significantly greater loss of segmental lordosis from early to mid-term follow-up than non-severely subsided levels (-4.89 versus -2.59 degrees, p < 0.0001), manifesting as a significantly lower segmental lordosis at >6 months postoperative (0.54 versus 3.82 degrees, p < 0.00 001). There were no significant differences in global cervical alignment parameters between patients with severe and non-severe subsidence.Conclusions:Severe subsidence is associated with a significant increase in loss of segmental lordosis, but has minimal effect on global cervical alignment parameters.

Prediction of angular kyphosis after cervical laminoplasty using radiologic measurements

Angular kyphosis is an important complication after cervical laminoplasty. Previous reports have suggested that T1 slope (T1s) and extension function (EF) have key roles in kyphosis, and no different radiologic measuments which affects postoperative kyphosis were seen between ossification of the posterior longitudinal ligament (OPLL) or cervical spondylotic myelopathy (CSM). We tried to find preoperative radiologic measurements predicting angular kyphosis after laminoplasty according to disease entities. We retrospectively analyzed 133 patients with OPLL or CSM who underwent expansive laminoplasty. Preoperative neutral and extension C2-7 cobb angle (CA), T1s, C2-7 sagittal vertical axis, and C2-7 slope angle (SA) were measured. EF of C2-7 CA and C2-7 SA was defined as extension CA/SA minus neutral CA/SA. Significant angular kyphosis was defined as LCL less than −10° after surgery. Mean loss of lordosis was −3.23, and 16.5% of patients showed significant kyphosis. Preoperative EF-CA, EF-SA, and T1s were found to be predictive for angular kyphosis by Pearson correlation analysis. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of radiologic measurements could not reach 0.7. In patients with OPLL, the AUC of preoperative neutral CA was 0.716. However, in patients with CSM ROC curve analysis revealed that EF-CA and EF-SA could predict the significant angular kyphotic changes. Examining OPLL and CSM separately, preoperative radiologic measurements were found to influence postoperative cervical kyphosis, respectively. However, preoperative C2-7 neutral CA in OPLL patients and both EF-CA and EF-SA in CSM patients could predict significant angular kyphosis after cervical laminoplasty.

Preoperative lordosis in L4/5 predicts segmental lordosis correction achievable by transforaminal lumbar interbody fusion.

The mean potential of lordosis restoration by transforaminal lumbar interbody fusion (TLIF) is supposed to be low in general. In contrast, clinical experience shows a wide range of segmental lordosis correction. In this study, the predictability of lordosis correction should be investigated. Prospectively collected register data were analyzed retrospectively. One hundred twenty-one consecutive patients (2014-2016) operated with single-level TLIF L4/5 (10°-lordotic cage). Segmental lordosis (L4/5) and overall lordosis (L1-S1) were measured on lumbar X-rays: preoperatively (pre), after 3-5days (post), at least 24months postoperatively (2yFU). Outcome and satisfaction of patients were assessed. Parameters were statistically compared by students t-tests (a = 0.05). In addition, predictors of correction were analyzed. Age was 60.7years, rate of 2yFU 41.3% (n = 50). Lordosis correction L4/5 was statistically significant with (post-pre) 4.9 ± 5.7° (p < 0.01), but not significant for L1-S1 (post-pre) 1.6 ± 8.0° (p = 0.3). A strong-moderate correlation of lordosis L4/5 (pre) and lordosis correction L4/5 (post-pre) was shown (r = - 0.6, p < 0,01). In a rising range of preoperative lordosis L4/5 from 15-30° the likelihood of lordosis loss increased. In 2yFU correction, L4/5 was significant with (post-pre) 5.4 ± 5.4° (p < 0.01), no significant long-term change (2yFU-postop) - 1.5 ± 4.9° (p = 0.2). No correlation (r = - 0.1) of correction and ODI. VAS-B improved by means of 2.9, VAS-L by 2.5, ODI by 19.1% (pre vs. 2yFU), each statistically significant (p < 0.01). Significant segmental relordosation can be performed by TLIF L4/5. The potential of correction strongly correlates with preoperative lordosis. Therefore, TLIF technique should be considered carefully in cases with a preoperative segmental lordosis of more than 15° and additional need of lordosation.

Efficacy and Safety of Ultrasonic Bone Curette-assisted Dome-like Laminoplasty in the Treatment of Cervical Ossification of Longitudinal Ligament.

ObjectiveTo assess the efficacy and safety of ultrasonic bone curette‐assisted dome‐like laminoplasty in the treatment of ossification of longitudinal ligament (OPLL) involving C2.MethodsA total of 64 patients with OPLL involving C2 level were enrolled. Thirty‐eight patients who underwent ultrasonic bone curette‐assisted dome‐like laminoplasty were defined as ultrasonic bone curette group (UBC), and 28 patients who underwent traditional high‐speed drill‐assisted dome‐like laminoplasty were defined as high‐speed drill group (HSD). Patient characteristics such as age, sex, body mass index (BMI), symptomatic duration, and other information like the type of OPLL, the time of surgery, blood loss, C2–C7 Cobb angle change and complications were all recorded and compared. The Japanese Orthopaedic Association (JOA) score, the nerve root functional improvement rate (IR), and the visual analogue scale (VAS) were used to assess neurological recovery and pain relief. The change of the distance between the apex of ossification and a continuous line connecting the anterior edges of the lamina was measured to assess the spinal expansion extent. The measured data were statistically processed and analyzed using SPSS 21.0 software, and the measurement data were expressed as mean ± SD.ResultsIn ultrasonic bone curette (UBC) group and high‐speed drill group (HSD) group, the average time for laminoplasty was 52.3 ± 18.2 min and 76.0 ± 21.8 min and the mean bleeding loss volume was 155.5 ± 41.3 mL and 177.4 ± 54.7 mL, respectively, with a statistically significant difference between the groups. Both groups demonstrated a significant improvement in neurological function. However, the VAS score in UBC group was lower than in HSD group at the 6‐month follow‐up (P < 0.05), but there was no significant difference at 1‐year follow‐up. We found that the loss of lordosis was 1.5° ± 1.0° in UBC group, which is significantly lower than that of HSD group at 1‐year follow‐up (3.8° ± 1.2°, P < 0.05). According to the change of canal dimension, we found that the expansion extent of the spinal canal in UBC group was similar to that of HSD group (P > 0.05). Only one patient in the UBC group and five patients in the HSD group displayed cerebrospinal fluid (CSF) leakag.ConclusionsWith the use of ultrasonic bone curette in OPLL dome‐like decompression, the decompression surgery could be completed relatively safely and quickly. It effectively reduced the amount of intraoperative blood loss and complications, and had better initial recovery of neck pain.

Clinical and radiological outcomes of kinesiotaping in patients with chronic neck pain: A double-blinded, randomized, placebo-controlled study.

Objectives In this study, we aimed to evaluate the efficacy of kinesiotaping (KT) in patients with chronic non-specific neck pain (NSNP) in terms of pain, disability, cervical range of motion (ROM), and cervical lordosis. Patients and methods Between October 2013 and March 2014, a total of 50 patients (10 males, 40 females; mean age 35.1±9.9 years; range, 17 to 62 years) with chronic NSNP were randomized into the KT (n=25) or the sham KT intervention (n=25) groups. Both groups were additionally given a therapeutic exercise (TE) program. The Visual Analog Scale (VAS) and Neck Disability Index (NDI) scores and ROM measurements were recorded at baseline, at the end of treatment, and at one month. Lateral cervical digital radiographs were analyzed by the Cobb, posterior tangent and effective lordosis methods at baseline and at one month after the treatment. Results There was a statistically significant decrease in the VAS scores compared to baseline in the KT group. The NDI scores significantly decreased in both groups. The patients in the KT group experienced a significant increase in all planes of cervical ROM after the treatment. Cervical radiographs revealed a significant increase in the Cobb and posterior tangent angles only in the KT group. Conclusion Our study results suggest that KT significantly improves VAS, NDI scores, ROM and cervical lordosis angles. The combination of TE and KT is useful in reducing pain and disability and improving ROM and cervical lordosis loss in patients with chronic NSNP.

Effects of Preservation of the Semispinalis Cervicis Inserted into C2 on Craniocervical Alignment After Laminoplasty

The preservation of nuchal musculature is essential for preventing axial pain and cervical malalignment after laminoplasty. A few studies have examined the effect of preservation of nuchal musculature on the degenerative progression after laminoplasty. We aimed to clarify the influence of preservation of the semispinalis cervicis inserted into C2 on cervical degenerative change and alignment after laminoplasty. We retrospectively reviewed 106 consecutive patients who underwent C3-7 laminoplasty for cervical spondylotic myelopathy during 2006-2017. Patients wereclassified into 2 groups according to the preservation (P-group; n= 33) or detachment (D-group; n= 73) of the Semispinalis cervicis muscles inserted into the C2 spinous process. Parameters of cervical sagittal alignment, range of motion, and progressive degenerative changes next to or within the range of laminoplasty were evaluated in cervical spine radiographs, and magnetic resonance images obtained during follow-up period. In the D-group, the postoperative C2-7 Cobbangle significantly decreased (-0.06°/month), while the O-C2 Cobb angle significantly increased (0.07°/month). In addition, the C2-7 range of motion significantly decreased in the D-group (-0.12°/month). Degenerative changes in the laminoplasty range were found in 5 patients per group. Three patients from the D-group developed retroodontoid pseudotumors (P < 0.001). To maintain horizontal gaze, the craniocervical segment can compensate for the loss of lordosis by increasing the Cobb angle. Excessive compensation may exert mechanical stress on the atlantoaxial junction, contributing to the development of a retroodontoid pseudotumor. Preservation of the semispinalis cervicis inserted into C2 is critical for the prevention of malalignment after laminoplasty.

Adult Spinal Deformity: Current Concepts and Decision-Making Strategies for Management

Adult spinal deformity (ASD) is characterized by three-dimensional abnormalities of the thoracic or thoracolumbar spine that exerts significant impacts on the health-related quality of life (HRQoL). With the important effects that deformity of the sagittal plane exerts on the HRQoL, there have been paradigm shifts in ASD evaluation and management. Loss of lumbar lordosis is recognized as a key driver of ASD followed by reducing kyphosis, pelvic retroversion, and knee flexion. The Scoliosis Research Society (SRS)– Schwab classification reflects the sagittal spinopelvic parameters that correlate pain and disability in ASD patients. Although the SRS–Schwab classification provides a realignment target framework for surgeons, a structured patient-specific systemic approach is crucial for the process of decision-making. ASD management should be focused on restoring age-specific harmonious alignment and should consider the comorbidities and risk factors of each patient to prevent catastrophic complications and enhance the HRQoL.

Subsidence and Loss of Lordosis With Stand-Alone Cages for Multilevel Anterior Cervical Fusions

Subsidence and Loss of Lordosis With Stand-Alone Cages for Multilevel Anterior Cervical Fusions

Влияние реконструкции сагиттального баланса на результаты лечения пациентов пожилого и старческого возраста с дегенеративным спондилолистезом низкой степени градации: анализ моноцентровой четырехлетней когорты

Objective To explore the effect of surgical reconstruction of the local sagittal balance on the outcomes and quality of life in elderly with degenerative low-grade spondylolisthesis. Design: a retrospective non-randomized single center cohort study. Material and methods This article reviewed 110 elderly patients (91 (82.7 %) females and 19 (17.3 %) males) with degenerative spondylolisthesis who underwent surgical treatment at the Federal State Medical Center, Novosibirsk. The mean age was 66 years (range, 60 to 83 years). Radiography, spiral computed tomography, MRI of the lumbar spine were performed for all patients who were also asked to use the visual analog scale and the Oswestry disability index (ODI). Sagittal spino-pelvic radiographic parameters including PI, SS, PT, LL, SL (Segmental Lordosis), LL4–S1 (Lordosis L4–S1) were measured and related to age. Global lumbar lordosis measurements were made using the formula: LL = 0.54 × PI + 27.6°. Comorbidity assessment was produced with the body mass index (BMI) and the Charlson Comorbidity Index (CCI). Patients were subdivided into three groups according to the severity of the sagittal imbalance as described by Barrey: (1) balanced, (2) balanced with compensatory mechanisms and (3) imbalanced, and their outcomes evaluated. Results Increased body weight was observed in 97.3 % of patients. The mean BMI was 33.7. A comorbid condition was detected in all patients (n = 110). The mean CCI was 57.4 %. The mean PI was 57.4°. Most of patients (n = 95, 86.4 %) had significant segmental imbalance due to the loss of segmental lordosis at the lower lumbar motion segments. Pelvic retroversion was identified as the compensatory mechanism in the pelvis area in 95 % of patients with measurements of PT based on the available PI. A statistically significant increase in LL4-S1 was observed in the groups due to reduction of spondylolisthesis and restoration of the segmental lordosis. A statistically significant increase in LL was observed in the imbalanced group only. No statistically significant differences in ODI scores were observed in TLIF and ALIF/LLIF patients. Complications graded in the Clavien-Dindo classification were identified in 65 (59 %) cases with greater complication rate in TLIF patients (n = 59, 69 %), as compared to ALIF/LLIF (n = 6, 24 %). From them, 5 (0.5 %) were graded IIIB. Conclusion Differentiated use of surgical technologies and MIS is the method of choice for elderly patients with comorbidities. Patients with compensated sagittal balance can benefit from direct spinal canal decompression, reduction and stabilization of degenerative spondylolisthesis using the posterior approach. Treatment of patients with impaired spino-pelvic balance should be aimed at reduction and restoration of the segmental lordosis (SL) using lordotic cages to ensure good clinical and radiological results.

Risk Factors Associated With Failure to Reach Minimal Clinically Important Difference After Correction Surgery in Patients With Degenerative Lumbar Scoliosis.

A retrospective study. The aim of this study was to evaluate the factors affecting health-related quality of life (HRQOL) after surgery in patients with degenerative lumbar scoliosis (DLS) by minimum clinically important difference (MCID). MCID has been introduced in the adult spinal deformity to quantify the absolute minimum change that can be considered a success. There are limited data available to identify factors affecting reaching MCID after DLS surgery. This study reviewed a cohort of 123 DLS patients after correction surgery and with a minimum 2-year follow-up (FU). Inclusion criteria included age ≥40 and minimum five vertebrae fused and the availability of Scoliosis Research Society (SRS)-22 scores and radiographic data at baseline (BL) and FU. Using a multivariate analysis, two groups were compared to identify possible risk factors: those who reached MCID in the all four SRS domains (N = 65) at the last FU and those who missed MCID (N = 58). At baseline, patients differed significantly from matched normative data in all SRS-22 domains. The baseline HRQOL was comparable in reached MCID and missed MCID group patients (P > 0.05). The HRQOL scores at FU were significantly higher than those at baseline. Of 123 included patients, 77.2% (N = 95), 72.4% (N = 89), 76.4% (N = 94), and 89.4% (N = 110) reached MCID in SRS pain, activity, appearance, and mental domain, respectively. Pelvic incidence (PI) >55°, lumbar lordosis (LL) loss >4.65°, coronal imbalance at FU, sagittal vertical axis (SVA) at FU >80 mm, and presence of proximal junctional kyphosis (PJK) and distal junctional problem (DJP) had negative effects on the recovery process. Factors affecting reaching MCID after surgery for DLS were higher PI, LL loss, coronal imbalance, severe sagittal imbalance, and the occurrence of PJK and DJP. 4.