Lumbar Kyphosis Research Articles

Dynamic sagittal balance evaluated by 3-dimentional gait analysis in patients with degenerative lumbar kyphosis

Method Twenty-six patients with DLKS underwent gait analysis using 3-dimentional motion analysis system (3D-MAS). Two reflection markers were attached to the skin surface on C7 and S1 spinous processes in all patients. Then they walked on treadmill at self-selected walking speed, and 3-dementional location of these surface makers (C7.S1) were recorded by synchronized 4 cameras that were placed separately. The angles between vertical axis and the line C7-S1 (dynamic-trunk angle: D-TA) and horizontally projected distance of the line C7-S1 (dynamic sagittal vertical axis; D-SVA) were continuously recorded during walking. D-TA and D-SVA were compared to static trunk angle (S-TA) and static SVA(S-SVA) that were obtained regular standing fulllength lateral X-ray.

Effects of Exercise on Spinal Deformities and Quality of Life in Patients with Adolescent Idiopathic Scoliosis.

Objectives. This systematic review was conducted to examine the effects of exercise on spinal deformities and quality of life in patients with adolescent idiopathic scoliosis (AIS). Data Sources. Electronic databases, including PubMed, CINAHL, Embase, Scopus, Cochrane Register of Controlled Trials, PEDro, and Web of Science, were searched for research articles published from the earliest available dates up to May 31, 2015, using the key words “exercise,” “postural correction,” “posture,” “postural curve,” “Cobb's angle,” “quality of life,” and “spinal deformities,” combined with the Medical Subject Heading “scoliosis.” Study Selection. This systematic review was restricted to randomized and nonrandomized controlled trials on AIS published in English language. The quality of selected studies was assessed by the PEDro scale, the Cochrane Collaboration's tool, and the Grading of Recommendations Assessment, Development, and Evaluation System (GRADE). Data Extraction. Descriptive data were collected from each study. The outcome measures of interest were Cobb angle, trunk rotation, thoracic kyphosis, lumbar kyphosis, vertebral rotation, and quality of life. Data Synthesis. A total of 30 studies were assessed for eligibility. Six of the 9 selected studies reached high methodological quality on the PEDro scale. Meta-analysis revealed moderate-quality evidence that exercise interventions reduce the Cobb angle, angle of trunk rotation, thoracic kyphosis, and lumbar lordosis and low-quality evidence that exercise interventions reduce average lateral deviation. Meta-analysis revealed moderate-quality evidence that exercise interventions improve the quality of life. Conclusions. A supervised exercise program was superior to controls in reducing spinal deformities and improving the quality of life in patients with AIS.

Inter- and intra-tester reliability when measuring seated spinal postures with inertial sensors

Prolonged awkward sitting postures may be associated with neck or back pain, but it is often unclear which specific postures cause most problems and which mechanisms that may underlie the pain. In order to increase the knowledge in this field, it seems crucial first of all to be able to analyse, in depth, different seated spinal postures. A problem is however the lack of reliable and direct measurement methods of the posture, especially for sitting. Recently developed systems with inertial sensor attached along the spine have potential for this purpose. The aim of the present study was therefore to test the reliability of using such a system to assess various seated postures.Inter- and intra-tester as well as intra-subject relative reliability was estimated with intra-class correlation coefficient (ICC). Absolute reliability was estimated with standard error of measurement (SEM) and smallest detectable change (SDC). Ten + ten healthy subjects and four testers participated. Three standardised unsupported seated postures (lumbar lordosis, lumbar kyphosis and neutral posture) and two standing postures (neutral and lumbar kyphosis) were evaluated using five sensors attached to the head, the thorax (high and low), the lumbar spine and the pelvis. The ICC for intra-tester reliability ranged from 0.37 to 0.90, SEM 2.5–12.0°, and SDC 7.1–33.3° where the largest measurement error was from the head. Intra-tester reliability was higher than inter-tester reliability but not as good as intra-subject reliability. The intra-tester absolute reliability was nevertheless not considered sufficient to distinguish smaller differences. The low reliability may depend on inertial sensor size and attachment but also on the tester's accuracy. This study shows that assessing unsupported seated spinal postures with inertial sensors could be performed with higher reliability if done by the same, rather than different, testers. Relevance to industryProlonged awkward seated postures at work may be associated with back and neck pain and should therefore be analysed. Inertial sensor units is a promising tool to measure spinal posture. Smaller sensors attached by one skilled tester directly onto the body will most likely improve assessment in the future.

Association between kyphosis and subacromial impingement syndrome: LOHAS study

Kyphosis is a cause of scapular dyskinesis, which can induce various shoulder disorders, including subacromial impingement syndrome (SIS). This study aimed to clarify the impact of kyphosis on SIS with use of cross-sectional data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). The study enrolled 2144 participants who were older than 40years and participated in health checkups in 2010. Kyphosis was assessed by the wall-occiput test (WOT) for thoracic kyphosis and the rib-pelvic distance test (RPDT) for lumbar kyphosis. The associations between kyphosis, SIS, and reduction in shoulder elevation (RSE) were investigated. Age- and gender-adjusted logistic regression analysis demonstrated significant association between SIS and WOT (odds ratio, 1.65; 95% confidence interval, 1.02, 2.64; P<.05), whereas there was no significant association between SIS and RPDT. Multivariable logistic regression analysis demonstrated no significant association between SIS and both WOT and RPDT, whereas there was significant association between SIS and RSE. RSE plays a key role in the development of SIS, and thoracic kyphosis might influence the development of SIS indirectly by reducing shoulder elevation induced by the restriction of the thoracic spine extension and scapular dyskinesis.

Surgical treatment of degenerative lumbar kyphosis (literature review)

An analytical review of scientific information on surgical treatment of degenerative lumbar kyphosis have been represented. It outlines the main stages of history of development of a trend in vertebrology which is associated with correction of kyphotic deformity of the lumbar spine as well as with evolution of the spinal implants and surgical approaches to treatment of patients with this pathology. Information on normal values of segmental and total lumbar lordosis as well as on common surgical procedures for correction of lumbar kyphosis have been represented. Correlation between the lumbar-pelvic balance and sagittal lumbar contour was revealed. Perspectives of scientific research in this direction were targeted.

Relationship between kyphosis and shoulder disorder; an epidemiologic study

The purpose of this study was to investigate the relationship between kyphosis and shoulder disorder. 2448 residents who lived in a mountain village of Fukushima prefecture were investigated in this study. Occiput-wall distance (OWD) was used to assess the thoracic kyphosis, and rib-pelvis distance (RPD) was used to assess the lumbar kyphosis. The number in the OWD positive group was 571 (23.9%), and in the RPD positive group was 1095 (45.0%). In the OWD positive group, shoulder flexion was significantly limited and the incidence rate of shoulder pain and the positive subacromial impingement sign were significantly higher compared with the OWD negative group.

SAGITTAL SPINAL CURVATURES IN MAXIMAL TRUNK FLEXION OF YOUNG FEMALE DANCERS

BackgroundKyphotic postures in both thoracic and lumbar curves have been associated to increased shear and compressive forces in the intervertebral joints. Hamstring extensibility influences pelvic, thoracic and lumbar curvatures when...

Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms

Sagittal balance is an independent predictor of clinical outcomes in spinal care. Surgical treatment is challenging and jeopardized by frequent complications. Guidelines for surgical treatment are currently not based on a classification of the disease. A comprehensive classification of sagittal balance based on regional deformities and compensatory mechanisms combined in deformity patterns is proposed. Though the sagittal shape of the spine can change due to degeneration or trauma, correlations between sagittal shape parameters and pelvic incidence (PI) have been described. Pelvic incidence is not changed by degeneration, thus representing a permanent source of information on the original sagittal shape of the spine. One hundred and twenty-eight full-spine lateral standing radiographs of patients with different spinal conditions were evaluated and classified by one rater. One random subseries of 35 patients was evaluated by two raters for calculation of inter-rater agreement. Spinopelvic parameters were measured in all the radiographs. Internal validity of the classification system was evaluated comparing the values of regional sagittal parameters that distinguish one category from the others. Eight different patterns were identified regarding the site of the deformity and the presence of compensatory mechanisms: cervical, thoracic, thoracolumbar junction, lumbar, lower lumbar, global and pelvic kyphosis and normal sagittal alignment. Inter-rater agreement was almost perfect (κ = 0.963). Statistically significant differences were found comparing the means of selected sagittal spinopelvic parameters that conceptually divide pairs or groups of categories: C2-C7 SVA for cervical kyphosis vs all other patients, TK-PI mismatch for thoracic kyphosis vs all other patients, T11-L2 kyphosis for thoracolumbar kyphosis vs all other patients, global alignment (LL+TK-PI) and SVA for lumbar kyphosis vs global kyphosis and pelvic tilt for pelvic kyphosis vs lumbar, lower lumbar and global kyphosis. A comprehensive classification of sagittal imbalance is presented. This classification permits a better interpretation of the deformity and muscle forces acting on the spine, and helps surgical planning. Preliminary validation has been provided.

Lumbar spine neuroarthropathy (Charcot joint) caused by a myxopapillary ependymoma

A 57-year old highly functional paraplegic man status post T10–S1 laminectomy and tumor resection followed by cobalt irradiation of a myxopapillary ependymoma 47 years previously, presented with increasing lumbar pain when upright and when transitioning from his wheelchair. Pain improved when supine. Lower extremity pain and spasms/spasticity were treated 30 years previously with a L3 and L4 rhizotomy/nerve transection. Continence required bladder selfcatheterization and maintenance of a colostomy. Examination was notable for flaccid paraplegia (longstanding and unchanged), a T10 segmental sensory level (also longstanding) and lumbar kyphosis. Current MRI (Fig. 1) revealed a pseudoarthrosis at the L2–3 disc interspace (1). Charcot joints may be seen in patients with loss of sensation (deafferentation) affecting a limb or trunk and are most often a complication of diabetes, syringomyelia or spinal cord trauma (2). Charcot arthropathies are however rare in spine. Spinal neuroarthropathies are induced by abnormal motion between vertebral bodies that lead to articular fracture and joint disruption together with disc degeneration and endplate fragmentation. These processes eventually lead to joint widening and subluxation that may be very deforming. The predominant changes may be atrophic, as in this case, with endplate and vertebral body resorption or, more commonly, there may be hypertrophic changes characterized by osteophyte formation, bony sclerosis and formation of a paraspinal mass of mixed bone formation and fragmentation [1]. The radiographic differential diagnosis includes pathologic vertebral fracture from primary or metastatic tumor or from osteomyelitis. These entities may be distinguishable most reliably on MRI with identification of an enhancing tumor mass or abnormal inflammatory infiltration of the disc space and paravertebral tissues with high T2 signal along with enhancement of the inflammatory tissue with or without abscess formation. In comparison, Charcot spine shows endplate and facet disruption, subluxation, bone fragmentation, intradiscal vacuum phenomena or intradiscal fluid collection [2]. Limited long-term outcome data on the surgical treatment of spinal Charcot joints is available. Nonetheless, the principles of surgical intervention focus on the immobilization of the unstable pseudoarthrosis. Strategies include circumferential debridement and stabilization across the pseudoarthrosis, use of a 4-rod construct to provide greater rigidity and improved biomechanical stress distribution, extension of constructs to the pelvis, and adjunctive use of bone-morphogenic protein [3]. M. C. Chamberlain (&) Department of Neurology, Seattle Cancer Care Alliance, Fred Hutchison Cancer Research Center, University of Washington, 825 Eastlake Ave East, MS G4940, Box 19023, Seattle, WA 98109, USA e-mail: chambemc@u.washington.edu; chambemc@uw.edu

Letter to the editor: Duddy et al. repair of a large thoracolumbar myelomeningocele with associated lumbar kyphosis. October 2013, Volume 155, Issue 10, pp 1965-1968

Letter to the editor: Duddy et al. repair of a large thoracolumbar myelomeningocele with associated lumbar kyphosis. October 2013, Volume 155, Issue 10, pp 1965-1968

Anterior Hip Subluxation due to Lumbar Degenerative Kyphosis and Posterior Pelvic Tilt

Nontraumatic anterior subluxation and dislocation of the hip joint are extremely rare. A 58-year-old woman presented to our outpatient clinic with left hip pain with a duration of 15 years. There was no history of trauma or other diseases. Her hip pain usually occurred only on walking and not at rest. Physical examinations demonstrated no tenderness in the hip joint. The range of motion of both hip joints was almost normal. Laxity of other joints was not observed. The bone mineral density of the lumbar spine and proximal femur confirmed a diagnosis of osteoporosis. A plain radiograph showed osteoarthritic changes of the hip joints, severe posterior pelvic tilt, and superior displacement of both femoral heads, especially in a standing position. Three-dimensional computed tomography (3DCT) revealed anterior subluxation of both femoral heads. Seven years after the initial visit, both hip joints showed progression to severe osteoarthritis. Although the exact cause remains unclear, lumbar kyphosis, posterior pelvic tilt, and a decrease in acetabular coverage may have influenced the current case. We should be aware of these factors when we examine patients with hip osteoarthritis.

Lumbar Extension during Stoop Lifting is Delayed by the Load and Hamstring Tightness

[Purpose] This study investigated the relationship between lumbar pelvic rhythm and the physical characteristics of stoop lifting. [Subjects and Methods] Participants performed a stoop lifting task under two conditions: with and without load. We assessed the lumbar kyphosis and sacral inclination angles using the SpinalMouse® system, as well as hamstring flexibility. During stoop lifting, surface electromyograms and the lumbar and sacral motions were recorded using a multi-channel telemetry system and flexible electrogoniometers. [Results] In the initial phase of lifting, lumbar extension was delayed by load; the delay showed a negative correlation with sacral inclination angle at trunk flexion, whereas a positive correlation was observed with electromyogram activity of the lumbar multifidus. Additionally, a positive correlation was observed between sacral inclination angle and hip flexion range of motion during the straight leg raise test. [Conclusion] We found that a disorder of the lumbar pelvic rhythm can be caused by both load and hamstring tightness. In the initial phase of stoop lifting, delayed lumbar extension is likely to lead to an increase in spinal instability and stress on the posterior ligamentous system. This mechanism shows that stoop lifting of a load may be harmful to the lower back of people with hamstring tightness.

Increase in paravertebral muscle activity in lumbar kyphosis patients by surface electromyography compared with lumbar spinal canal stenosis patients and healthy volunteers. Enomoto M, Ukegawa D, Sakaki K, et al. J Spinal Disord Tech 2012;25(6):E167-73

Increase in paravertebral muscle activity in lumbar kyphosis patients by surface electromyography compared with lumbar spinal canal stenosis patients and healthy volunteers. Enomoto M, Ukegawa D, Sakaki K, et al. J Spinal Disord Tech 2012;25(6):E167-73

Assessment of respiratory involvement in children with mucoplysaccharidosis using pulmonary function tests

BackgroundMucopolysaccharidosis (MPS) are classified into seven clinical types based on eleven known lysosomal enzyme deficiencies of glycosaminoglycan (GAG) metabolism. Respiratory involvement seen in most MPS types includes recurrent respiratory infections, upper and lower airway obstruction, tracheomalacia, restrictive lung disease, and sleep disturbances. Aim of the studyTo delineate the pattern of respiratory compromise and pulmonary function abnormalities in MPS patients. MethodsThis is a cross section observational study conducted on 30 patients recruited from the Neurometabolic Clinic, Children’s Hospital, Cairo University over a period of 18months. All patients were screened first by the quantitative determination of GAGs in urine, and diagnosis was confirmed by unidimensional electrophoresis for GAGs in urine and/or specific enzymatic assay in blood leucocytes. Infant pulmonary functions (IPFT) were done in twenty-two patients (<3years of age), while 8 cases performed impulse oscillometry (IOS) test (3–6years of age). ResultsAges at diagnosis ranged from 1 to 9years with a median of 2.3years. Male to female ratio was 4:1. Consanguinity was observed in 53.3% whereas similar family condition was present in 40% of cases. Lumbar kyphosis was detected in 60% of cases, while scoliosis was detected in 46.7%. Results of pulmonary functions were mainly obstructive in 20 (66.6%) cases; however, combined obstructive and restrictive were detected in only 6 (20%) of cases. Data showed no association between the presence of scoliosis or the presence of organomegaly and the pattern of pulmonary function abnormalities. ConclusionsEvaluation and follow up of patients with MPS using pulmonary function tests are essential to detect early involvement of respiratory system and hence start treatment for respiratory complications early in the course of the disease.

Impact of spinal imbalance and BMI on lumbar spinal canal stenosis determined by a diagnostic support tool: cohort study in community-living people

The Japanese Society for Spine Surgery and Related Research (JSSR) developed a diagnostic support tool (score range −2 to 16) for lumbar spinal canal stenosis (LSS). It is well known that patients with LSS have a forward-bending posture while walking. We could find only one study which examined sagittal alignment of LSS patients. The objectives of this study were to screen community-living people with LSS, and to investigate the association between LSS and spinal sagittal alignment, range of motion (ROM), and other spinal or physical factors. We enrolled 286 subjects ≥50 years old in the study. We regarded those with a JSSR diagnostic risk score ≥7 as having LSS. We measured and evaluated lateral lumbar radiographs, sagittal parameters, sagittal balance, and spinal mobility as determined with SpinalMouse®, back muscle strength (BMS), and body mass index (BMI). Spinal inclination angle (SIA) was used as an index of sagittal balance. Multivariate logistic regression analysis indicated that increased BMI (OR 1.121, p < 0.05) and SIA (OR 1.144, p < 0.05) were important relevant factors for LSS. BMI had significant positive correlations with SIA (r = 0.214), and thoracic and lumbar kyphosis angles (r = 0.283, 0.131), and negative correlations with sacral slope angle (r = −0.166), and lumbar and total spinal ROMs (r = −0.270, −0.166). SIA had significant positive correlations with age (r = 0.334), BMI (r = 0.214) and lumbar kyphosis angle (r = 0.525), and negative correlations with BMS (r = −0.268), and lumbar and total spinal ROMs (r = −0.184, −0.171). Increased SIA and BMI might be the most relevant risk factors for LSS.

(iii) Sagittal spinal alignment and its clinical implications

Much is known about spinal deformity in the coronal plane, and the three dimensional deformities that are associated with coronal plane deformities. Much less attention is paid to sagittal plane deformities and this is partly because they are much less widely distributed, being much more common in the Orient, particularly in those who spend long periods of time working in a stooped posture close to the ground. This article describes normal sagittal alignment of the spine and the abnormalities that can develop, including degenerative lumbar scoliosis and degenerative lumbar kyphosis. The surgical strategies for dealing with the latter are discussed in detail.

Repair of a large thoracolumbar myelomeningocele with associated lumbar kyphosis

This report describes a novel method of repair for a large thoracolumbar myelomeningocele with an associated lumbar kyphosis in the neonate. A Caucasian male child was born at term with an antenatal diagnosis of hydrocephalus and spina bifida. Lumbar spine X-ray showed a significant kyphosis at L2-L3 level. Kyphectomy was performed and a cervical plate was used to reduce the gibbus deformity and maintain a rigid construct. Local rotation flaps were elevated and advanced to cover the defect. Wound was well healed at 3-month follow-up and the patient remained shunt-free at 1 year. To our knowledge, this is the first description of myelomeningocele repair with kyphectomy and posterior fixation in a neonate.

Orthopedic manifestations and implications for individuals with Costello syndrome

Costello syndrome is a rare genetic condition caused by heterozygous alterations in HRAS and characterized by multi-system abnormalities. Individuals with Costello syndrome usually present with severe feeding difficulties in infancy, short stature, coarse facial features, increased tumor risks, cardiac and neurological complications, intellectual disability and orthopedic complications. This study further defines the orthopedic manifestations affecting individuals with Costello syndrome. We studied 43 participants and performed medical records review, clinical examinations and orthopedic inquiry forms. In 23 participants, hip and or spinal imaging assessments were completed. Serial radiographs were analyzed when available. A total of 25 orthopedic manifestations were identified. Ten manifestations were seen in the majority of the participants: hypotonia (87%), ligamentous laxity (85%), scoliosis (63%), kyphosis (58%), characteristic hand deformities (85%), ulnar deviation of the wrist (63%), elbow (55%) and shoulder contractures (65%), tight Achilles tendon (73%), and pes planus (53%). Other characteristics of special note were hip dysplasia (45%), foot deformities requiring surgical intervention (38%) and osteopenia/osteoporosis (47%). We also studied the development of the hips and spine. Uni- or bilateral hip dysplasia was congenital in some, while it developed throughout childhood in others. Spinal involvement included scoliosis, kyphosis, lordosis, and curvature reversal (thoracic lordosis and lumbar kyphosis). Based on these findings, we recommend routine referral to an orthopedic surgeon as well as instituting screening protocols for hips and spine for individuals with Costello syndrome.

Comparison of sagittal reconstruction in ankylosing spondylitis patients with kyphosis: Smith-Petersen osteotomies versus pedicle subtraction osteotomy

Objective To compare the effects of Smith-Petersen osteotomies (SPOs) and pedicle subtraction osteotomy (PSO) on sagittal alignment in patients with thoracolumbar kyphosis secondary to anky losing spondylitis (AS).Methods The data of the 39 patients with ankylosing spondylitis of thoracic and lumbar kyphosis were retrospectively reviewed,who received SPOs or PSO orthopedic internal fixation from August 2000 to June 2010.According to the types of osteotomies,the 39 patients were categorized into 2groups.Of them,15 patients including 13 males and 2 females comprised the SPOs group,whose average age was 28.1±7.1 years,ranging from 18 to 42,whereas the other 24 patients including 20 males and 4 females comprised the PSO group,whose average age was 38.3±7.9 years,ranging from 21 to 53.Radiographic parameters were measured and compared between the two groups including thoracic kyphosis (TK),lumbar lordosis (LL),global kyphosis (GK),sagittal imbalance (SVA),pelvic incidence (PI),sacral slope (SS),and pelvic tilting (PT) before the operation,3 months after the operation,and at the last follow-up,respectively.Results Significant differences were found in terms of the improvement of LL,PT,SS,SVA and GK except that of TK and PI.Preoperatively,no significant difference was found between the two groups in TK,SVA,PT and SS except PI,GK and LL.Postoperatively,significant differences were found between the two groups in LL,GK,PT and SS.Significant differences were found between the two groups in the mean loss of correction of GK,LL,SVA,PT and SS at the last follow-up.Conclusion For patients with ankylosing spondylitis of thoracic and lumbar kyphosis,satisfactory reconstruction of spino-pelvic alignment can be obtained by PSO,whereas loss of correction occurred frequently in SPOs. Key words: Spondylitis, ankylosing; Kyphosis; Osteotomy

Factors Predicting Change in Pelvic Posterior Tilt After THA

In total hip arthroplasty, steep cup inclination should be avoided because it increases the risk of edge loading. Pelvic posterior tilt should be carefully monitored because it increases cup inclination and anteversion, leading to edge loading or impingement. The authors evaluated how much the pelvic tilt angle changes from the supine position referenced in planning for cup orientation preoperatively to the standing position 1 year after total hip arthroplasty (Δref). The pelvic tilt angle was measured in 124 patients who underwent total hip arthroplasty due to osteoarthritis, and the mean Δref was -9.5°±5.3° (range, -23° to 5°). Preoperative compression fractures, spondylolisthesis, and disk-space narrowing were predictive of increased pelvic posterior tilt after total hip arthroplasty. The authors mathematically calculated how much change in pelvic posterior tilt was clinically possible with the original cup alignment, which ranged from 40° to 45° of radiographic inclination and 0° to 30° radiographic anteversion to more than 50° of inclination. Even if the maximum posterior tilt (23°) occurred, no edge loading would occur in almost half of those original cups. Surgeons should aim for 40° of inclination. When the original cup inclination was 40°, edge loading was prevented. Edge loading caused by steep cup inclination can be prevented by adjusting the cup orientation to account for predicted pelvic tilting, but spinal alignment must also be considered because lumbar kyphosis can increase postoperative pelvic posterior tilt.