Lumbar Hyperlordosis Research Articles

ANALYSIS OF THE SPINAL CURVATURE IN RHYTHMIC GYMNASTICS ATHLETES OF DIFFERENT COMPETITIVE LEVELS AND WITH DIFFERENT POSTURES

Rhythmic gymnastics is characterized by high mobility demands on the spine, which can lead to structural changes and associated injuries or pain. The aim of this study is to assess and compare spinal posture in different positions, mobility, and pain perception among RG athletes. The sample consisted of 34 gymnasts (age: 14.18 ± 2.17) of grassroots and federation levels. Spinal posture and mobility were analyzed using the Spinal Mouse® system, along with pain perception (location and intensity) and body composition. Most gymnasts exhibited normal spinal curvature in both standing and sitting positions. Significant differences (p<0.05) were only found in the sacral curve during extension. Regarding lumbar mobility, differences in sacral mobility from standing to extension were noted, with the federation-level gymnasts showing a greater tendency for hyperlordosis in extension. In terms of pain, the lumbar region was the most affected, with 32.4% of cases reporting pain. It was observed that gymnasts experiencing pain displayed more pronounced lumbar hyperlordosis in the standing position. A low but significant correlation was found between lumbar pain and its intensity (p=0.045), and a moderate correlation was observed between hip pain and pelvic tilt. The gymnasts demonstrated a greater tendency for lumbar hyperlordosis in the standing position and during the transition from standing to extension, which was more pronounced among federation-level gymnasts. Furthermore, there appears to be a stronger correlation between hyperlordosis and the occurrence of lumbar pain, as well as the intensity of pain.

Phenotypic Variability of LGMD 2C/R5 in a Genetically Homogenous Group of Bulgarian Muslim Roma.

Sarcoglycanopathies are among the most frequent and severe forms of autosomal recessive forms of limb-girdle muscular dystrophies (LGMDs) with childhood onset. Four subtypes are known: LGMDR3, LGMDR4, LGMDR5 and LGMDR6, which are caused, respectively, by mutations in the SGCA, SGCB, SGCG and SGCD genes. We present the clinical variability of LGMD 2C/R5 among a genetically homogeneous group of 57 patients, belonging to 35 pedigrees. Molecular genetic analysis showed that all 57 patients were homozygous for the C283Y variant. The muscles of the pelvic girdle and the trunk were affected early and were more severely affected, followed by the shoulder girdle. Macroglossia, hypertrophy of the calves, scapular winging and lumbar hyperlordosis were common in the ambulatory phase. A great intra and interfamilial variability in the clinical presentation of LGMD 2C/R5 was observed, despite having the same underlying molecular defect. Females demonstrated a relatively milder clinical course compared to males. Mean creatine phosphokinase (CK) CK levels were 20 times above normal values. Muscle computer tomography (CT) CT or MRIs showed earlier and more severe involvement of the flexor proximal limb muscles in comparison to extensor muscles.

Management of spinal deviations in physical medicine and functional rehabilitation

Objectives: To analyze cases of spinal deviations in the Physical Medicine and Rehabilitation (PMR) department at Mohammed VI University Hospital Center in Marrakech, with a focus on the role of rehabilitation in their management. Methods and Patients: We conducted a cross-sectional, observational descriptive study over a six-month period involving 52 patients with spinal deviations, treated in the PMR department. Data were meticulously collected using a questionnaire completed during consultations with patients selected according to specific criteria. Results: The study revealed that the average age of the patients was 21.25 years, with a predominance of females (68%). Among the spinal deviations, scoliosis was the most common (68%), followed by scoliotic posture (18%), hyperkyphosis (11%), and compensatory lumbar hyperlordosis (3%). The primary reason for consultation was aesthetic concern (56%), with the most frequent symptoms being gibbus deformity (54%) and shoulder asymmetry (35%). Rehabilitation was prescribed for all patients, sometimes as the sole treatment or in combination with bracing. Orthoses were used to correct foot deformities and leg length discrepancies. Only one patient underwent surgical intervention. The outcome was positive for 63% of patients, with improvement in the Cobb angle and pain reduction. However, a 5° worsening was observed in one patient (2% of the sample), while the others remained stable. Conclusion: In conclusion, the therapeutic approaches employed in our sample demonstrated their effectiveness in managing spinal deviations. Rehabilitation proved to be particularly essential as an adjunct treatment, enhancing the outcomes of other therapies and contributing to the relief of back pain, which had a positive impact on patients' quality of life.

A Cross-sectional Study on Association of Iliopsoas Muscle Length with Lumbar Lordosis Among Desk Job Workers

Background: Prolonged hours of sitting in sustained posture is a common job requirement of desk job workers. Potential risk of iliopsoas muscle shortening leading to lumbar hyperlordosis, which in turn may cause low-back pain was identified. Thus, this study determined association between iliopsoas muscle length and lumbar lordosis in desk job workers. Methods and Material: This cross-sectional study was conducted on forty-six desk job workers working for 5 hrs/day for at least 5 years. Workers were assessed for iliopsoas muscle length using Modified Thomas test and flexi-ruler was used to measure lumbar lordosis. Pearson’s correlation was operated for association of iliopsoas length with lumbar lordosis. Results: Lumbar lordosis demonstrated moderate positive correlation with both right (r = 0.628) and left Iliopsoas muscle length (r = 0.647). Conclusion: This study concluded workers with higher degree of lumbar lordosis presented with shorter iliopsoas length. Timely intervention to maintain the length of this muscle will ensure low incidence of low-back pain among desk job workers thereby safeguarding their spine due to cumulative trauma.

Effectiveness of Three-Dimensional Myofascial Release on Lumbar Lordosis in Individuals with Asymptomatic Hyperlordosis: A Placebo Randomized Controlled Trial.

Lumbar hyperlordosis is the most prevalent musculoskeletal postural deformity. Maintenance of normal limits of lumbar lordosis is necessary for obtaining an ideal posture. Literature suggests that poor posture results in fascial restriction in which the fascia reorganizes in response to tension. Gross myofascial release (MFR) combined with posterior pelvic tilting exercises proved to be beneficial in improving the lumbar range of motion. Three-dimensional (3D) MFR is a novel approach toward reducing fascial restrictions. However, the literature determining the effects of 3D MFR is still emerging. To determine the effect of 3D MFR on a lumbar lordosis angle and lumbar range of motion, in individuals with asymptomatic hyperlordosis. Participants (n = 30) with hyperlordosis were randomly assigned to either the experimental group receiving 3D MFR (n = 15) or the control group (n = 15) that received sham 3D MFR for six sessions (3 alternate days for 2 weeks). The outcomes were assessed at day 1 and day 6. Lumbar range of motion was assessed using modified-modified Schober's test and the lumbar lordosis angle was measured using x-ray and flexicurve. There was significant decrease (p = 0.0001) in the lumbar lordosis angle, increase in the lumbar flexion (p = 0.0001), and decrease in the extension (p = 0.0011) range of motion in the experimental group when compared to the control group. Lumbar lordosis decreased and the lumbar range of motion increased in the experimental group only with 3D MFR and not with sham 3D MFR. Hence, 3D MFR is an effective method in the correction of lumbar hyperlordosis and improving the lumbar range.Clinical Trial Registry of India (CTRI) trial number CTRI/2023/03/050340.

Improvement in Pain, Quality of Life, and Urinary Dysfunction following Correction of Lumbar Lordosis and Reduction in Lumbar Spondylolistheses Using Chiropractic BioPhysics® Structural Spinal Rehabilitation: A Case Series with >1-Year Long-Term Follow-Up Exams.

(1) Background: Lumbar spondylolisthesis affects ~20% of the US population and causes spine-related pain and disability. (2) Methods: This series reports on three patients (two females and one male) aged 68-71 years showing improvements in back pain, quality of life (QOL), and urinary dysfunction following correction of lumbar spondylolistheses using CBP® spinal rehabilitation. Pre-treatment radiographs showed lumbar hyperlordosis (-49.6°, ideal is -40°) and anterolisthesis (14.5 mm, ideal is 0 mm). Pre-treatment patient-reported outcome measures (PROMs) included a numeric rating scale (NRS) for back pain (7.3/10, ideal is 0), urinary urgency (8/10, ideal is 0), and SF-36 physical (PCS) and mental component score (MCS) (29.8 and 46.6, ideal is 46.8 and 52.8). Patients underwent 2-3 CBP® sessions per week to correct lumbar hyperlordosis and lumbar anterolistheses. (3) Results: Post-treatment radiographs showed improvements in lumbar curvature (-42.8°) and anterolisthesis (4.2 mm). Post-treatment PROMs showed improvements in NRS for back pain (1/10), urinary urgency (2.3/10), and SF-36 PCS and MCS (50.2 and 57.7). Long-term follow-up radiographs and PROMs showed maintained improvements. (4) Conclusions: This series documents the first-recorded long-term corrections of lumbar spondylolisthesis and concomitant improvements in back pain, urinary urgency, and QOL using CBP®. This series provides evidence for CBP® as a non-surgical approach to lumbar spinal rehabilitation and the possible impacts of spinal alignment on pain, urinary dysfunction, and QOL.

Lumbar offset distance: A simplified metric for evaluation of the lumbar spine alignment.

A healthy lower back is essential for optimal spinal function and overall wellness. Magnetic resonance imaging (MRI) has become the gold standard in assessing lumbar spine disease. This article aims to evaluate the precision and efficacy of the lumbar offset distance (LOD) as a novel MRI parameter designed to determine the lumbar spine alignment. normally measured as we compared it to a new parameter based on length. Supine sagittal magnetic resonance images of 101 patients who underwent lumbar spine MRI scans were analyzed. We focused on L1-L5 lumbar lordosis angle (LLA) and LOD to assess lumbar spine alignment. Diagnostic cutoff values for LOD measurements were determined, and their diagnostic accuracies were evaluated. The normal LLA in our dataset was 23°-45°, and the normal LOD was 5-15 mm. Using linear regression, the range of 6-14 mm correlates to the LLA range of 20°-45°, which would define the standard lumbar offset as normal between 6 and 14 mm. Hence, lumbar hypolordosis was defined as <6 mm, and lumbar hyperlordosis was defined as more than 14 mm. Our study showed a good correlation between the LOD and LLA and is particularly useful in identifying cases of normal lumbar lordosis, hypolordosis, and hyperlordosis. Linear measurements show good diagnostic accuracy of LOD in evaluating lumbar spinal alignment, including normal alignment, hypolordosis, and hyperlordosis.

Sagittal-spinopelvic alignment improves in patients with bilateral highly dislocated hip (Crowe type IV) after subtrochanteric shortening total hip arthroplasty: A retrospective radiographic study.

In patients with bilateral highly dislocated hips (HDHs), total hip arthroplasty with subtrochanteric shortening osteotomy (S-THA) is a viable option for achieving adequate reconstruction with restoration of the anatomical hip center. This procedure has the potential to improve sagittal spinopelvic alignment (SSPA). However, reports are scarce owing to the rarity of this disease. The objective of this study is to investigate pre- and post-operative SSPA in patients with HDHs who had undergone S-THA. This retrospective radiographic study included 55 patients (54 females and 1 male; average age, 63.1 ± 6.9 years) who underwent S-THA. Lateral spine radiographs in the standing position were obtained pre- and post-operatively. The SSPA included lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI), and intervertebral disc (ID) angle of L1/2-L5/S. The SSPA pre- and post-S-THA was compared using a paired t test. Pearson correlation coefficient was used to assess the relationships between parameters. The mean pre- and post-operative LL and SS values were 62° and 49° (LL) and 50° and 39° (SS), respectively (P < .001). The ID angle was significantly reduced post-operatively at all levels (P < .001). The correlation coefficients between preoperative LL and SS and postoperative LL and PI were 0.81 and 0.38, respectively (P < .01). The preoperative SSPA of Crowe type IV HDHs revealed excessive pelvic anteversion and lumbar hyperlordosis, with a high correlation between LL and SS, suggesting that these alterations were compensatory changes to maintain body balance. Furthermore, in patients with HDHs and residual spinal flexibility, restoring the original pelvic morphology with S-THA may contribute to improved SSPA.

Effect of Radical Hip Reconstruction in Children With Hip Subluxation on Sagittal Balance and Type of Vertical Posture: Mid-Term Results

Background. Hip instability in the form of hip subluxation, regardless of its etiology, leads not only to the formation of excessive pelvic anteversion and lumbar hyperlordosis, but also to the early development of hip osteoarthritis. The lack of information in the world literature on possible changes in sagittal balance parameters in this category of patients after triple pelvic osteotomy requires such studies.&#x0D; Aim of the study is to evaluate the spino-pelvic sagittal balance and the type of vertical posture in children with hip subluxation of different genesis after radical reconstructive intervention in the mid-term follow-up period.&#x0D; Methods. The study is based on the analysis of clinical and X-ray results of 50 patients (50 hip joints) aged 10 to 17 years with hip subluxation operated on between 2018 and 2019. The patients were divided into two groups: group I consisted of 30 patients (30 hip joints) with Crowe type I dysplasia; group II consisted of 20 patients (20 hip joints) with Legg-Calvé-Perthes disease. All children underwent triple pelvic osteotomy.&#x0D; Results. Different approaches to triple pelvic osteotomy in patients with hip instability of various genesis allowed to significantly affect the spino-pelvic sagittal balance and the type of vertical posture. In all patients there was a decrease in the sacral slope value, spino-sacral angle, the magnitude of lumbar lordosis, as well as a change in the sagittal vertical axis value from strongly negative to neutral.&#x0D; Conclusion. Analysis of mid-term results of surgical treatment of children with hip instability in the form of hip subluxation and Legg-Calvé-Perthes disease using 3D modeling and prototyping of individual guides showed that the triple pelvic osteotomy leads to the reduction of both excessive pelvic anteversion and lumbar hyperlordosis, resulting in the transformation of physiologically disadvantageous hyperlordotic type of vertical posture into harmonious one.

Is sagittal spinopelvic alignment a cause of low back pain in pediatric spine pathologies? A review.

Altered spinopelvic morphology is observed in many spine pathologies occurring during growth. The aim of the study is to better understand the sagittal compensatory mechanisms and their possible influence on the occurrence of pain in selected pediatric spine pathologies. A bibliographic search in the PubMed database included articles published between September 1965 and July 2023. The keywords contained in the search were "spondylolysis," "spondylolisthesis," "scoliosis," "kypho," "sagittal," "pediatric," "child," "adolescent," "grow," "development," and "pain." The largest diversity in sagittal alignment patterns was reported in idiopathic scoliosis, with global flattening of the spine being the most common. Kyphotic deformations occurring during growth are characterized by structural thoracic or thoracolumbar kyphosis compensated by lumbar hyperlordosis and lower pelvic incidence. Whereas in spondylolisthesis, altered morphology of the spinopelvic junction with high values of pelvic incidence is observed. Pain does not seem to be related to sagittal alignment in idiopathic scoliosis. In Scheuermann disease, it is localized at the apex of the deformity and is associated with the curve pattern, whereas in spondylolisthesis, sagittal alignment correlates with pain scores only in high-grade slips. Most of the patients with spine disorders that occurred during growth present a clinically balanced posture in the sagittal plane. It suggests that compensatory mechanisms before achieving skeletal maturity are really significant. A comprehension of sagittal alignment in spine deformities and its relationship to pain is essential for the proper assessment and treatment of these disorders.

A novel variant in BMPR1B causes acromesomelic dysplasia Grebe type in a consanguineous Moroccan family: Expanding the phenotypic and mutational spectrum of acromesomelic dysplasias.

Acromesomelic dysplasia Grebe type (AMD Grebe type) is an autosomal recessive trait characterized by short stature, shortened limbs and malformations of the hands and feet. It is caused by variants in the growth differentiation factor 5 (GDF5) or, in rare cases, its receptor, the bone morphogenetic protein receptor-1B (BMPR1B). Here, we report a novel homozygous BMPR1B variant causing AMD Grebe type in a consanguineous Moroccan family with two affected sibs from BRO Biobank. Remarkably, the affected individuals showed additional features including bilateral simian creases, lumbar hyperlordosis, as well as lower limb length inequality and dislocated hips in one of them, which were never reported previously for AMD Grebe type patients. The identified novel BMPR1B variant (c.1201C>T, p.R401*) is predicted to result in loss of function of the BMPR1B protein either by nonsense-mediated mRNA decay or production of a truncated BMPR1B protein. Thus, these findings expand the phenotypic and mutational spectrum of AMD, and may improve the diagnosis of AMD and enable appropriate genetic counselling to be offered to patients.

Lower limb muscle activation pattern in male soccer players with lumbar hyperlordosis

Objectivethe aim of the current study was to compare the lower limb muscle activation pattern in soccer players with and without lumbar hyperlordosis during single-leg squat performance. Methodsthirty male collegiate soccer players (15 with and 15 without lumbar hyperlordosis) performed the SLS task. Surface EMG was used to record the activation of eleven lower limb muscles. The activation of these muscles reduces to 100 points during the SLS cycle, where 50% demonstrates the maximum knee flexion, and 0% and 99% demonstrate the maximum knee extension. Resultssoccer players with lumbar hyperlordosis had higher muscle activation than those with normal lumbar lordosis in gluteus maximus, biceps femoris, and medial gastrocnemius. By contrast, they had lower gluteus medius, vastus medialis oblique, rectus femoris, soleus, and medial gastrocnemius (only in the final ascent phase of the SLS) muscle activity than the normal group during the SLS. Conclusionthis alteration may negatively affect targeted muscle performance during the SLS. Subsequent study is required to specify whether such an alteration in the lower limb muscle could be accompanied by injury in soccer players and change in their athletic performance.

Correlation between frontal X-ray parameters of the hip joint and sagittal vertebral-pelvic profile in patients with cerebral palsy

BACKGROUND:Posture disorders and spinal deformity in the sagittal plane (kyphotic deformity of the thoracic region and lumbar hyperlordosis in combination with pelvic inclination) are quite common in patients with cerebral palsy. However, their relationship with the frontal indicators of the hip joint is not reported in the scientific literature.&#x0D; AIM:To reveal the relationship between the radiographic frontal indicators of the hip joint and the indicators of the spinal-pelvic sagittal balance in patients with cerebral palsy.&#x0D; MATERIALS AND METHODS:Atransverse study of the X-ray parameters of the hip joints in the frontal plane and sagittal vertebral-pelvic profile was performed in 46 patients with cerebral palsy aged 515 (mean age, 8.2 3.6) years.&#x0D; RESULTS:Asignificant difference from the norm was found in the following parameters: cervical-diaphyseal angle, pelvic tilt angle, pelvic tilt angle, sacral tilt angle, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis deviation (p 0.05). The Sharp angle, migration index, Wiberg angle, and thoracic kyphosis were normal. Measurements of the frontal radiographic parameters of the right and left hip joints do not differ significantly from each other. The pelvic tilt showedapositive and strong correlation with pelvic tilt (p= 0.71).Apositive and moderate correlation was found determined betweenasequential chain of related elements of the axial skeleton, namely, sacral inclination-lumbar lordosis (p= 0.66) and lumbar lordosis-thoracic kyphosis (p= 0.41). The deviation of the sagittal vertical axis negatively correlated with lumbar lordosis (p= 0.69) and thoracic kyphosis (p= 0.38). The results demonstrateanegative and weak correlation between SDA and sacral tilt (p= 0.40).&#x0D; CONCLUSIONS:The results of this study indicateacorrelation between the inclination of the sacrum and the lumbar spine in patients with cerebral palsy, which confirms the main theories of the formation of excessive lumbar lordosis of the spine in these patients and allows us to develop pathogenetic preventive measures against spinal deformities. In this study, we failed to identifyasignificant relationship between the frontal radiographic parameters of the hip joint and sagittal pelvic-vertebral profile. However, hip joint instability inachild with cerebral palsy can playasignificant role in the occurrence and development of sagittal spinal deformities.

Stiff person spectrum disorder diagnosis, misdiagnosis, and suggested diagnostic criteria.

Stiff person spectrum disorder (SPSD) is heterogeneous, and accurate diagnosis can be challenging. Patients referred for diagnosis/suspicion of SPSD at the Mayo Autoimmune Neurology Clinic from July 01, 2016, to June 30, 2021, were retrospectively identified. SPSD diagnosis was defined as clinical SPSD manifestations confirmed by an autoimmune neurologist and seropositivity for high-titer GAD65-IgG (>20.0 nmol/L), glycine-receptor-IgG or amphiphysin-IgG, and/or confirmatory electrodiagnostic studies (essential if seronegative). Clinical presentation, examination, and ancillary testing were compared to differentiate SPSD from non-SPSD. Of 173 cases, 48 (28%) were diagnosed with SPSD and 125 (72%) with non-SPSD. Most SPSD were seropositive (41/48: GAD65-IgG 28/41, glycine-receptor-IgG 12/41, amphiphysin-IgG 2/41). Pain syndromes or functional neurologic disorder were the most common non-SPSD diagnoses (81/125, 65%). SPSD patients more commonly reported exaggerated startle (81% vs. 56%, p = 0.02), unexplained falls (76% vs. 46%, p = 0.001), and other associated autoimmunity (50% vs. 27%, p = 0.005). SPSD more often had hypertonia (60% vs. 24%, p < 0.001), hyperreflexia (71% vs. 43%, p = 0.001), and lumbar hyperlordosis (67% vs. 9%, p < 0.001) and less likely functional neurologic signs (6% vs. 33%, p = 0.001). SPSD patients more frequently had electrodiagnostic abnormalities (74% vs. 17%, p < 0.001), and at least moderate symptomatic improvement with benzodiazepines (51% vs. 16%, p < 0.001) or immunotherapy (45% vs. 13% p < 0.001). Only 4/78 non-SPSD patients who received immunotherapy had alternative neurologic autoimmunity. Misdiagnosis was threefold more common than confirmed SPSD. Functional or non-neurologic disorders accounted for most misdiagnoses. Clinical and ancillary testing factors can reduce misdiagnosis and exposure to unnecessary treatments. SPSD diagnostic criteria are suggested.

Prevalence of cervical postural alterations in oculomotor disturbances: a Brazilian cohort study

The literature suggests that maintaining correct posture depends on a balance between orientation and balance, which is linked to the reflex relationship between the oculomotor system and the superior cervical spine. Any disruption to this relationship can cause postural deviation, as the posture is dependent on head balance and eye horizontality. This study aimed to investigate the prevalence of cervical posture alterations, such as head tilt, rotation, and protrusion, scapular waist changes, scoliosis, kyphosis, and lumbar hyperlordosis, in patients with oculomotor disturbances, including convergent, divergent, and vertical squint, and convergence insufficiency. The study evaluated 24 patients aged between 4 and 39 years old, both male and female, through ocular motility and postural examination. The results showed that all patients with oculomotor disturbances also had postural imbalances, and the percentage of alterations in the posture segments was high. Therefore, oculomotor disturbances can cause postural imbalance, leading to orthopedic and facial asymmetry. The study concluded that patients with oculomotor disturbances should be evaluated to determine the compensatory positions they adopt and set a better visual performance that does not alter their appearance in the long term.

Exploring effects of Egoscue versus lumbar stabilisation exercises for lower crossed syndrome on postural stability and hyperlordotic posture correction

Abstract The aim of the study was to evaluate the comparative effectiveness of Egoscue exercises and lumbar stabilisation exercises in individuals with the lower crossed syndrome in terms of hyperlordotic posture correction, postural stability, and patient satisfaction towards treatment. The study was a randomised controlled trial. Through randomisation, 30 participants were allocated into 2 study groups, the Egoscue Exercise (EE) group (n=15) and the lumbar stabilisation exercise (LSE) group (n=15). The outcome measures were the degree of lumbar lordosis, functional disability, and postural stability parameters (risk of fall, stability index, weight distribution, anterior-posterior sway, and lateral sway) and patient satisfaction with treatment assessed at baseline and post-10th session of the intervention. Within group analysis showed significant improvement in the outcome measures, such as Index of Lumbar Lordosis, functional disability, postural stability, and patient satisfaction towards treatment with the groups (P&lt;0.05). Between groups analysis showed that EE group and LSE groups were equally effective in improving lumbar hyperlordosis (P=0.458), functional disability (P=0.545), postural stability (risk of fall P=0.781; stability index P=0.964; weight distribution index P=0.718; anterior-posterior sway P=0.402; lateral sway P=0.212) and patient satisfaction towards treatment (P=0.999). Egoscue exercises and lumbar stabilisation exercises are equally effective in correcting lumbar hyper lordotic posture, postural stability, pain, and functional disability in low back pain individuals with the lower crossed syndrome. Clinical Trials Registry – India (CTRI): CTRI/2021/09/036733

Teaching Video Neuro Images : Bent spine syndrome as an early presentation of late-onset Pompe disease

Bent spine syndrome (BSS), an abnormal trunk anteroflexion of at least 45° that increases during walking and abates in supine position, is described in parkinsonism and myopathies.1 We report a 56-year-old man with genetically proven late-onset Pompe disease (LOPD) showing BSS (figure 1 and video 1 at [Neurology.org][1]). He complained of axial weakness that progressively forced him to walk stretching his arms backward since his 20s. Whole-body muscle MRI revealed severe fatty replacement of lumbar paraspinal (figure 2) and iliopsoas muscles, and spirometry showed restrictive ventilatory defect. Periodic acid-Schiff–positive vacuoles and reduced acid α-glucosidase activity were demonstrated in muscle biopsy. While lumbar hyperlordosis is a typical feature of LOPD, other trunk abnormalities may appear early in the disease. LOPD must be included in the differential diagnosis of BSS.2 [1]: http://neurology.org/lookup/doi/10.1212/WNL.0000000000004119

Distal junctional failure after corrective surgery without pelvic fixation for thoracolumbar junctional kyphosis due to osteoporotic vertebral fracture

BackgroundThoracolumbar junctional kyphosis (TLJK) due to osteoporotic vertebral fracture (OVF) negatively impacts patients’ quality of life. The necessity of pelvic fixation in corrective surgery for TLJK due to OVF remains controversial. This study aimed to: 1) evaluate the surgical outcomes of major corrective surgery for thoracolumbar junctional kyphosis due to osteoporotic vertebral fracture, and 2) identify the risk factors for distal junctional failure to identify potential candidates for pelvic fixation. MethodsPatients who underwent surgical correction (fixed TLJK>40°, OVF located at T11–L2, the lowermost instrumented vertebra at or above L5) were included. Sagittal vertical axis, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis (L1-S1), local kyphosis, and lower lumbar lordosis (L4-S1) were assessed. Proximal and distal junctional kyphosis (P/DJK) and failures (P/DJF) were evaluated. Pre/postoperative spinopelvic parameters were compared between DJF and non-DJF patients. ResultsThirty-one patients (mean age: 72.3 ± 7.9 years) were included. PJK was observed in five patients (16.1%), while DJK in 11 (35.5%). Twelve cases (38.7%) were categorized as failure. Among the patients with PJK, there was only one patient (20%) categorized as PJF and required an additional surgery. Contrary, all of eleven patients with DJK were categorized as DJF, among whom six (54.5%) required additional surgery for pelvic fixation. In comparisons between DJF and non-DJF patients, there was no significant difference in pre/postoperative LK (pre/post, p = 0.725, p = 0.950). However, statistically significant differences were observed in the following preoperative alignment parameters: SVA (p = 0.014), LL (p = 0.001), LLL (p = 0.006), PT (p = 0.003), and PI-LL (p < 0.001). ConclusionsSpinopelvic parameters, which represent the compensatory function of lumbar hyperlordosis and pelvic retroversion, have notable impacts on surgical outcomes in correction surgery for TLJK due to OVF. Surgeons should consider each patient's compensatory function when choosing a surgical approach.

Spinopelvic sagittal compensation in adult cervical deformity.

The objective of this study was to evaluate spinopelvic sagittal alignment and spinal compensatory changes in adult cervical kyphotic deformity. A database composed of 13 US spine centers was retrospectively reviewed for adult patients who underwent cervical reconstruction with radiographic evidence of cervical kyphotic deformity: C2-7 sagittal vertical axis > 4 cm, chin-brow vertical angle > 25°, or cervical kyphosis (T1 slope [T1S] cervical lordosis [CL] > 15°) (n = 129). Sagittal parameters were evaluated preoperatively and in the early postoperative window (6 weeks to 6 months postoperatively) and compared with asymptomatic control patients. Adult cervical deformity patients were further stratified by degree of cervical kyphosis (severe kyphosis, C2-T3 Cobb angle ≤ -30°; moderate kyphosis, ≤ 0°; and minimal kyphosis, > 0°) and severity of sagittal malalignment (severe malalignment, sagittal vertical axis T3-S1 ≤ -60 mm; moderate malalignment, ≤ 20 mm; and minimal malalignment > 20 mm). Compared with asymptomatic control patients, cervical deformity was associated with increased C0-2 lordosis (32.9° vs 23.6°), T1S (33.5° vs 28.0°), thoracolumbar junction kyphosis (T10-L2 Cobb angle -7.0° vs -1.7°), and pelvic tilt (PT) (19.7° vs 15.9°) (p < 0.01). Cervicothoracic kyphosis was correlated with C0-2 lordosis (R = -0.57, p < 0.01) and lumbar lordosis (LL) (R = -0.20, p = 0.03). Cervical reconstruction resulted in decreased C0-2 lordosis, increased T1S, and increased thoracic and thoracolumbar junction kyphosis (p < 0.01). Patients with severe cervical kyphosis (n = 34) had greater C0-2 lordosis (p < 0.01) and postoperative reduction of C0-2 lordosis (p = 0.02) but no difference in PT. Severe cervical kyphosis was also associated with a greater increase in thoracic and thoracolumbar junction kyphosis postoperatively (p = 0.01). Patients with severe sagittal malalignment (n = 52) had decreased PT (p = 0.01) and increased LL (p < 0.01), as well as a greater postoperative reduction in LL (p < 0.01). Adult cervical deformity is associated with upper cervical hyperlordotic compensation and thoracic hypokyphosis. In the setting of increased kyphotic deformity and sagittal malalignment, thoracolumbar junction kyphosis and lumbar hyperlordosis develop to restore normal center of gravity. There was no consistent compensatory pelvic retroversion or anteversion among the adult cervical deformity patients in this cohort.

The burden of low back pain in children and adolescents with overweight and obesity: from pathophysiology to prevention and treatment strategies.

Nonspecific low back pain (LBP) is one of the most common causes of disability, affecting all individuals at least once in their lifetime. Such a condition is also becoming increasingly frequent in the pediatric population, especially in children and adolescents with overweight/obesity. Furthermore, new-onset LBP during adolescence has been demonstrated to be a strong predictor of developing LBP later in life, contributing to poorer outcomes and increasing social and medical costs. Several causes and different mechanisms have been considered for the development of LBP in pediatric individuals affected by obesity. For this reason, planning adequate prevention and treatment strategies, mainly through conservative lifestyle changes, would be crucial to anticipate the negative consequences of persisting LBP in adulthood. The aim of this narrative review was to characterize the relationship between LBP and overweight/obesity in the pediatric population, highlighting epidemiological and pathophysiological aspects. In addition, prevention and treatment approaches will be reviewed considering the need to reduce the burden of LBP on this population. According to our search, LBP was more frequent in children and adolescents with overweight and obesity and has been associated with several anthropometric and lifestyle factors, including lumbar hyperlordosis, sedentary habits, physical inactivity, carrying a heavy schoolbag, low vitamin D levels, psychosocial ill-being, and premature intervertebral disc degeneration. Most of these conditions may be addressed with conservative strategies mainly consisting of dietary adjustments, physical exercise, education programs, and physical therapy.