Lumbosacral Angle Research Articles

Enhancing understanding: Back muscle strength and individual flexibility impact on the flexion-relaxation phenomenon in the lumbar erector spinae

The flexion-relaxation phenomenon (FRP) refers to the deactivation of back muscles during deep forward trunk bending. This study examined the effects of back muscle strength, individual flexibility, and trunk angle on FRP in the back muscles. Forty male participants were classified into four groups according to toe-touch flexibility and back muscle strength. Lumbar erector spinae (LES) activity and the lumbosacral angle (LSA) were measured at incremental trunk flexion angles (0°–90°, with increments of 15°) to analyze FRP. Results indicated significant effects of back muscle strength, flexibility, and trunk angle on LES activity (all p < 0.001). Flexibility (p < 0.05) and trunk angle (p < 0.001) also influenced LSA. Additionally, an interaction between flexibility and trunk angle impacted LES activation (p < 0.001). Flexibility mainly determined FRP onset, while back muscle strength influenced efforts during moderate trunk flexion (30°–60°). These findings indicate that differences in lower back load among individuals with varying back muscle strengths become apparent even at relatively small trunk flexion angles (approximately 30°). When prolonged static trunk flexion in workplace settings places considerable strain on the lower back, we recommend utilizing toe-touch flexibility and back muscle strength assessments as practical screening tools for identifying early and subtle indicators of the FRP in workers.

Differential Back Muscle Flexion-Relaxation Phenomenon in Constrained versus Unconstrained Leg Postures.

Previous studies examining the flexion-relaxation phenomenon (FRP) in back muscles through trunk forward flexion tests have yielded inconsistent findings, primarily due to variations in leg posture control. This study aimed to explore the influence of leg posture control and individual flexibility on FRP in back and low limb muscles. Thirty-two male participants, evenly distributed into high- and low-flexibility groups, were recruited. Activities of the erector spinae, biceps femoris, and gastrocnemius muscles, alongside the lumbosacral angle (LSA), were recorded as participants executed trunk flexion from 0° to 90° in 15° increments, enabling an analysis of FRP and its correlation with the investigated variables. The findings highlighted significant effects of all examined factors on the measured responses. At a trunk flexion angle of 60°, the influence of leg posture and flexibility on erector spinae activities was particularly pronounced. Participants with limited flexibility exhibited the most prominent FRP under constrained leg posture, while those with greater flexibility and unconstrained leg posture displayed the least FRP, indicated by their relatively larger LSAs. Under constrained leg posture conditions, participants experienced an approximate 1/3 to 1/2 increase in gastrocnemius activity throughout trunk flexion from 30° to 90°, while biceps femoris activity remained relatively constant. Using an inappropriate leg posture during back muscle FRP assessments can overestimate FRP. These findings offer guidance for designing future FRP research protocols.

Correlation Between Direction of Prolapsed Intervertebral Disc (PIVD) And Lumbar Vertebral Alignment

Abstract Purpose: The purpose of this research was to establish a link between direction of a prolapsed intervertebral disc (PIVD) and lumbar vertebral alignment. Methods: This cross-sectional study included 102 participants with prolapsed intervertebral discs in the lumbar segment and lumbar vertebral mal-alignment of both sexes between the ages of 30 and 50 who had undergone MRI and X-ray for the lumbo-sacral spine. The Numerical Pain Rating Scale (NPRS) was used to assess outcome, MRI scans were used to determine the direction and amount of PIVD, and lumbar spinal alignment was assessed using X-rays in the AP and lateral views. SPSS version 26.0 was used for statistical analysis. Findings: Among the 102 participants, The study found that only 2.94% of 102 participants had Prolapsed Intracranial Disc Disease (PID) at the L1-2 level, with many on multiple levels. Prolapsed intervertebral discs were prevalent in 46.07% of individuals, with scoliosis in 33.33%, exaggerated lumbar lordosis in 4 subjects, and anterolisthesis in 20.59%. The study found a significant correlation between posterocentral and anterolisthesis, biforaminal and flatback, right paracentral and left paracentral prolapse and scoliosis (p&amp;lt;0.0001), with biforaminal direction being particularly significant for anterolisthesis and retrolisthesis (p=0.0050, 0.0014). The lumbosacral angle had a mean value of 31.79, and the mean of pain on rest was 1.99±1.38 and during activity was 5.51±1.66. Conclusion: It concluded that there was a significant relationship between the direction of prolapsed intervertebral disc (PIVD) and lumbar vertebral alignment.

Use of a machine learning algorithm with a focus on spinopelvic parameters to predict development of symptomatic tethered cord after initial untethering surgery.

Among patients with a history of prior lipomyelomeningocele repair, an association between increased lumbosacral angle (LSA) and cord retethering has been described. The authors sought to build a predictive algorithm to determine which complex tethered cord patients will develop the symptoms of spinal cord retethering after initial surgical repair with a focus on spinopelvic parameters. An electronic medical record database was reviewed to identify patients with complex tethered cord (e.g., lipomyelomeningocele, lipomyeloschisis, myelocystocele) who underwent detethering before 12 months of age between January 1, 2008, and June 30, 2022. Descriptive statistics were used to characterize the patient population. The Caret package in R was used to develop a machine learning model that predicted symptom development by using spinopelvic parameters. A total of 72 patients were identified (28/72 [38.9%] were male). The most commonly observed dysraphism was lipomyelomeningocele (41/72 [56.9%]). The mean ± SD age at index MRI was 2.1 ± 2.2 months, at which time 87.5% of patients (63/72) were asymptomatic. The mean ± SD lumbar lordosis at the time of index MRI was 23.8° ± 11.1°, LSA was 36.5° ± 12.3°, sacral inclination was 30.4° ± 11.3°, and sacral slope was 23.0° ± 10.5°. Overall, 39.6% (25/63) of previously asymptomatic patients developed new symptoms during the mean ± SD follow-up period of 44.9 ± 47.2 months. In the recursive partitioning model, patients whose LSA increased at a rate ≥ 5.84°/year remained asymptomatic, whereas those with slower rates of LSA change experienced neurological decline (sensitivity 77.5%, specificity 84.9%, positive predictive value 88.9%, and negative predictive value 70.9%). This is the first study to build a machine learning algorithm to predict symptom development of spinal cord retethering after initial surgical repair. The authors found that, after initial surgery, patients who demonstrate a slower rate of LSA change per year may be at risk of developing neurological symptoms.

Comparative Analysis of Three Posterior-Only Surgical Techniques for Isthmic L5-S1 Spondylolisthesis.

To compare adults with isthmic L5-S1 spondylolisthesis who were treated with three different surgical techniques: PS-only, TS, and transforaminal lumbar interbody fusion/posterior lumbar interbody fusion (TLIF/PLIF). This is a retrospective analysis of adults with L5-S1 isthmic spondylolisthesis (grade ≥2) who underwent primary all-posterior operations with pedicle screws. Patients were excluded if they had <1 year follow-up, anterior approaches, and trans-sacral fibular grafts. Patient demographics and surgical, radiographic, and clinical data were compared between groups based on the method of anterior column support: none (PS-only), TS, and TLIF/PLIF. Sixty patients met inclusion criteria (male patients 21, female patients 39, average age 47 ± 15 years, PS-only 16; TS 20; TLIF/PLIF 24). TS patients more commonly had high-grade slips and markedly greater slip percentage, lumbosacral kyphosis, and pelvic incidence. The three groups were similar for smoking status, visual analog scores/Oswestry Disability Index scores (VAS/ODI), surgical data, and average follow-up (40.1 ± 31.2 months). All groups had similarly notable improvements in Meyerding grade and lumbosacral angle. Slip reduction percentage was similar between groups. While there was a markedly higher overall complication rate for PS-only constructs, all groups had similarly notable improvements in ODI and VAS back scores. All-posterior techniques for L5-S1 isthmic spondylolisthesis resulted in excellent improvement in preoperative symptoms and HRQoL scores and similar radiographic alignment. Trans-sacral screws were more commonly used for high-grade slips. The use of anterior column support resulted in fewer overall complications than posterior-only instrumentation.

Is it necessary to extend fusion to L4 when correcting pediatric L5-S1 spondylolisthesis?

The objective of this study was to investigate whether extending fusion to L4 is imperative in the surgical treatment of pediatric L5-S1 spondylolisthesis. This retrospective analysis encompassed 68 pediatric cases of dysplastic L5-S1 spondylolisthesis who underwent posterior lumbar interbody fusion surgery at two hospitals. Patients were categorized into two groups based on the upper instrumented vertebra (group L4 and group L5). Data were collected from medical records and radiological images obtained preoperatively and at last follow-up. Radiographic parameters including slip percentage (SP), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), Spinal Deformity Study Group dysplastic lumbosacral angle (SDSG-LSA), pelvic tilt (PT), Dubousset's lumbosacral angle (Dub-LSA), sacral slope (SS), and severity index (SI) were measured. Surgery-related data and complication data were also collected. The incidence rates of complications were compared, including those of neurological deficit, adjacent-segment instability (ASI), and other complications. ASI was defined as progression of slippage > 3 mm or posterior opening > 5° in the adjacent segment. Clinical outcomes were assessed with the numeric rating scale (NRS) and the Oswestry Disability Index (ODI) scores. The follow-up period for all patients lasted a minimum of 2 years. Among all 68 patients, group L4 consisted of 15 patients and group L5 comprised 53 patients. The patients included in both groups had comparable baseline demographic characteristics and radiographic parameters. Postoperative SP and SDSG-LSA were significantly lower in group L5 (p < 0.05). No other postoperative radiographic differences were observed between groups. One patient in group L4 and 3 patients in group L5 experienced transient neurological deficits (p > 0.05). There were 13 cases of ASI in group L5 compared with none in group L4 (24.5% vs 0%, p > 0.05). Of the 13 patients with ASI, 4 underwent revision surgery due to L4-5 level instability and clinical symptoms. The remaining individuals exhibited no symptoms, and regular annual follow-up assessments are being conducted for all patients. The NRS and ODI scores at final follow-up did not exhibit any significant differences between the two groups. Fusion to L5 could achieve comparable satisfactory results to fixation to L4, albeit with increased likelihood of ASI. Extension of fusion to L4 may not be necessary for most patients with pediatric L5-S1 spondylolisthesis.

Surgical Treatment of Developmental Dysplastic Lumbosacral Spondylolisthesis: Additional Help from an Intervertebral Distraction, Correction, and Reduction Device.

In mid- to high-grade adult dysplastic spondylolisthesis, surgeons are faced with three underlying components: angular, translational, and collapse of the disk. In extremely narrow intervertebral spaces, it is difficult to distract and lift the vertebral bodies by the pedicle screw system alone. In this prospective case control study, we analyzed the efficacy of the latest prototypes (distraction, correction, and reduction [DCR] instrument) with intervertebral application in terms of distraction, correction of segmental kyphosis, and slip reduction. Twelve adult patients (5 male and 7 female patients) were enrolled in this study. The average age was 42 years (range: 17-67 years) and in all cases the maneuver was documented during the surgery. The amount of slip reduction, the lumbosacral angle according to the Spinal Deformity Study Group dysplastic angle (dys-SDGG), and the disk height were measured preoperatively, intraoperatively, 3 months after surgery, and during the latest follow-up (range: 3-44 months). The relative height of the lumbosacral disk was determined in relation to the disk height in L3/L4. Slippage ranged from 17 to 67%. Overall, the average slippage was 45% preoperatively and 4.8% after the reduction maneuver. The average ratio of the disk height was 0.3 preoperatively, 1.0 intraoperatively, and 0.9 at the latest follow-up. Two patients showed significant kyphotic changes, and these patients had an 18- and 21-degree lordotic improvement. From those who had a lumbosacral kyphosis >20 degrees, only one patient did not show any lordotic improvement. All other patients had a significant lordotic improvement. In total, the lumbosacral angle changed from 15 to 23 degrees. The application of an intervertebral distractor with a mobile thigh has a good clinical and radiologic outcome for mid- to high-grade adult dysplastic spondylolisthesis in terms of distraction, kyphosis correction, and reduction of underlying slippage. The described hardware failures and the complications were not related to the DCR device.

Does the Extent of Rod Bending and Actual Lumbar Lordosis Mismatch Affect Quality of Life?

BackgroundTo evaluate any mismatch between rod bending and actual lordosis during posterior lumbar instrumentation and its effects on the quality of life of patients. MethodsPatient records for posterior lumbar fusion in 2018-2023 were retrospectively reviewed. The radiological parameters consisted of pelvic incidence, sacral slope, L1S1 lumbar lordosis, lumbosacral angle, the distance between the posterior wall of the vertebra and the rod, lordosis of the rod. The postoperative quality of life of patients was assessed using Oswestry Disability Index. The patients were grouped postoperative into Group-1 (minimal/moderate disability) and Group-2 (severe disability/crippled/bed bound). ResultsTotal of 133 patients were included; 99 women, 34 men. The difference was significant for patients with diabetes to be presented in the more disabled Group-2. The distance between the posterior vertebral wall and the rod was found to be short in Group-2. Preoperative and postoperative sagittal lumbar Cobb angles were significantly higher in Group-2. The changing degree of pain was found to score high in Group-2. The postoperative visual analog scale was high in Group-2. The difference between the preoperative and postoperative lumbar sagittal Cobb and rod Cobb-angles was found to be high in Group-2. ConclusionThe results of our study confirm the importance of considering the preoperative actual lumbar lordosis during bending and maintaining it as much as possible. To our knowledge, this is the first study that evaluated the effect of rod bending on quality of life and supports that this might be affected in case of any mismatches.

Assessment of Lumbosacral Angle Variation Among Middle Adults with Chronic Low Back Pain

Purpose: To Assess Assessment of lumbosacral angle variation in middle adults with chronic low back pain.&#x0D; Methodology: A cross sectional study was conducted with sample size of 267 individuals from middle adults of Sikandar Medical complex Gujranwala, District Headquarter hospital Gujranwala, Gujranwala medical complex, Gujranwala. The population was Middle Adults (45-65) of both genders. Angle was measured by Measuring scale and Protractor using X-ray of lateral view of lumbosacral spine. Obtained data were analyzed using statistical package of social sciences (SPSS).&#x0D; Findings: The data has been obtained from 267 chronic low back pain patient in which 143 were male and 124 were female. Data was collected using lateral radiograph. The results show significant relation between chronic low back pain and lumbosacral angle with p-value ˂0.5. The result further shows that 32 male and 27 female were hypo lordotic while 89 male and 92 female were hyper lordotic.&#x0D; Conclusion: The study concluded that lumbosacral angle increases with chronic low back pain among middle adults. The study also concludes that age, gender also associated with lumbosacral angle variation.&#x0D; Recommendations: Future study needs a through physical examination. This study focuses on radiographs only but future study needs to focus on MRI and CT scan also for better understanding of pain causes. Awareness program should be conducted on causes, prevention, complication and treatment of chronic low back pain among middle adults

A retrospective cohort study on the significance of preoperative radiological evaluation of lumbar degenerative diseases for surgical reference.

Radiography has low radiation exposure and the ability to acquire information. Due to its cost-effectiveness and availability, preoperative radiographic imaging examination is considered to be a valuable method to evaluate the condition of patients with spinal disease. The aim of this cohort study is to analyze the impact of evaluating preoperative X-rays on the surgical management of lumbar degenerative diseases (LDD). We reviewed 49 patients with LDD underwent single-level posterior instrumented lumbar fusion (PILF) between November 2017 and October 2022 in this cohort study. The median iliac angle (MIA), iliac crest height, intervertebral facet joint degeneration, lumbosacral angle (LSA), L5/S1 intervertebral space angle (ISA), intervertebral foramen height (IFH) and intervertebral space height (ISH) were measured on preoperative radiographs. In addition, operative time, intraoperative blood loss and postoperative complications were used to evaluate the surgical management. Correlation analysis was used to determine the correlation between preoperative radiographic presentation and surgical managements. Multivariate linear regression analysis was used for determination of risk factors for surgical management. Correlation analysis showed that the median iliac angle, height of iliac crest, lumbosacral angle and intervertebral facet joint degeneration were significantly correlated with surgical managements (P<0.05). Height of iliac crest, intervertebral facet joint degeneration and lumbosacral angle were positively correlated with surgical management. Meanwhile, MIA was negatively correlated with surgical management. No significant difference was found between the IFH, ISA, ISH and surgical managements in posterior lumbar surgery (P>0.05). After multiple linear regression analysis, height of iliac crest, median iliac angle and intervertebral facet joint degeneration were independent influence factors for the single-level lumbar surgical managements. Some variables measured in radiograph shows that height of iliac crest, median iliac angle and intervertebral facet joint degeneration have a potential influence on surgical managements. The lumbosacral angle was positively associated with surgical management, but it was not statistically significant in multiple linear regression analysis (P>0.05). The above measurements in plain film can reflect the surgical procedure and have some guiding implications for the operation.

Scoliosis risk factors and outcomes in children with dysplastic spondylolisthesis undergoing surgical reduction and fixation.

To explore scoliosis risk factors and outcomes in children with dysplastic spondylolisthesis undergoing surgical reduction and internal fixation. We retrospectively analyzed 56 children with dysplastic spondylolisthesis who underwent surgical reduction and internal fixation. Patients were grouped according to presence of scoliosis before surgery. Radiographic parameters measured before surgery included pelvic incidence, pelvic tilt, sacral slope, coronal Cobb angle, slip percentage, Dubousset's lumbosacral angle, lumbar lordosis, sagittal vertical axis, and Spinal Deformity Study Group index. Groups were compared using logistic regression. Receiver operating characteristic analysis was performed to determine the optimal Spinal Deformity Study Group index cut-off value. All patients were followed up for at least 2 years. The scoliosis group comprises 36 patients (mean age: 9.6 ± 2.7 years), while the no scoliosis group comprises 20 (mean age: 9.1 ± 2.4 years). Slip percentage and Spinal Deformity Study Group index were significantly higher in the scoliosis group (p < 0.01). Sacral slope and pelvic incidence were lower in the scoliosis group (p < 0.05). Univariate logistic regression analysis showed that slip percentage, Spinal Deformity Study Group index, pelvic incidence, and sacral slope were significantly associated with scoliosis. In the multivariate logistic regression analysis, only Spinal Deformity Study Group index was an independent risk factor for scoliosis. The optimal cut-off value for Spinal Deformity Study Group index was 0.288. Mean Cobb angle decreased from 20.3° ± 8.8° before surgery to 8.5° ± 8.9° at last follow-up; the mean scoliosis correction rate was 59.3%. Severe S1 dysplasia and high slip percentage may be risk factors for developing scoliosis in patients with dysplastic spondylolisthesis. Scoliosis resolved spontaneously after spondylolisthesis reduction and fixation in most patients. 3.

Modified unilateral iliac screw fixation with partial reduction in the treatment of high-grade spondylolisthesis at L5/S1 in adult patients: introduction of key technique, report of clinical outcomes and analysis of spinopelvic parameters

BackgroundManagement of high-grade spondylolisthesis (HGS) remains challenging. Spinopelvic fixation such as iliac screw (IS) was developed to deal with HGS. However concerns regarding constructs prominence and increased infection-related revision surgery have complicated it’s use. We aim to introduce the modified iliac screw (IS) technique in treating high-grade L5/S1 spondylolisthesis and it’s clinical and radiological outcomes.MethodsPatients with L5/S1 HGS who underwent modified IS fixation were enrolled. Pre- and postsurgical upright full spine radiographs were obtained to analyze sagittal imbalance, spinopelvic parameters, pelvic incidence-lumbar lordosis mismatch (PI-LL), slip percentage, slip angle (SA), and lumbosacral angle (LSA). Visual analogue scale (VAS), Oswestry disability index (ODI) were evaluated pre- and postoperatively for clinical outcomes assessment. Estimated blood loss, operating time, perioperative complications and revision surgery were documented.ResultsFrom Jan 2018 to March 2020, 32 patients (15 males) with mean age of 58.66 ± 7.77 years were included. The mean follow-up period was 49 months. The mean operation duration was 171.67 ± 36.66 min. At the last follow-up: (1) the VAS and ODI score were significantly improved (p < 0.05), (2) PI increased by an average of 4.3°, the slip percent, SA and LSA were significantly improved (p < 0.05), (3) four patients (16.7%) with global sagittal imbalance recovered a good sagittal alignment, PI-LL within ± 10° was observed in all patients. One patient experienced wound infection. One patient underwent a revision surgery due to pseudoarthrosis at L5/S1.ConclusionThe modified IS technique is safe and effective in treating L5/S1 HGS. Sparing use of offset connector could reduce hardware prominence, leading to lower wound infection rate and less revision surgery. The long-term clinical affection of increased PI value is unknown.

Relationship between Age and Lumbosacral Angle (LSA) of Adult Nigerians: A Cross-sectional Study

Background: The lumbosacral angle (LSA), is a key morphometric parameter important in the management of patients with low back disorders.&#x0D; Aim: The study evaluated the relationship between age and lumbosacral angle of adult Nigerians.&#x0D; Methods: Two hundred and twenty-six (226) radiographs (113 males to 113 females) were obtained from Radiology departments of Federal Medical Centre (FMC), Owerri. Inclusion criteria were, lateral radiographs of lumbosacral region marked above 18 years of ages and only clear X-ray films were used.Using the Ferguson's approach, the lumbosacral angle was measured. All data obtained were expressed both in descriptive and inferential statistics.&#x0D; Results: Both male and female categories showed a progressive increase in lumbosacral angle across age groups, but later decreased in the age group of 60 years and above. The mean lumbosacral angle of male subjects was 35.74° while that of females was 41.46°. There was a significant difference (t = 3.16, p = 0.002) between the lumbosacral angle of male and female categories. However, there was a weak, positive correlation between age and lumbosacral angle of males (r = 0.187) and females (r = 0.392).&#x0D; Conclusion: The males had a lower mean lumbosacral angle compared to the females. Age was significantly correlated with lumbosacral angle in both sexes.

Risk Factors for the Aggravation of Sagittal Balance After L5–S1 Posterior Lumbar Interbody Fusion

Retrospective comparative study OBJECTIVE: To identify the risk factors for the aggravation of sagittal alignment after single-level L5-S1 PLIF. Eighty-six patients who underwent L5-S1 PLIF were divided into two groups according to the postoperative changes in the segmental angle (SA; group I: increase; group D: decrease). The two groups were compared in terms of demographic, clinical, and radiological outcomes. Multivariate logistic regression analysis was performed to identify the risk factors for aggravation of sagittal alignment. Of the study patients, 39 (45%) were categorized as group I and 47 (55%) as group D. The demographic and clinical parameters were not significantly different between the two groups. Group D showed postoperative deteriorations in the local sagittal parameters, including lumbar lordosis (LL; p=.034), sacral slope (p=.012), and pelvic tilt (p=.003). In contrast, group I showed improved LL after surgery (p=0.021). Large preoperative values of lumbosacral angle (LSA; odds ratio [OR], 1.287; p=.001), SA (OR, 1.448; p<.001), and flexion LSA (OR, 1.173; p=.011) were independent risk factors for the aggravation of sagittal balance. Surgeons treating patients with large preoperative SA, LSA, and flexion LSA at L5-S1 level should be cautious of the possible aggravation of sagittal balance after L5-S1 PLIF and may consider different surgical approaches such as anterior or oblique lumbar interbody fusion.

Is Intervertebral Disc Degeneration a Compensatory Mechanism in Adult Tethered Cord Syndrome?

The purpose of the present study was to evaluate the influence of high nerve tension on lumbar disc degeneration and sagittal morphologies. A total of 50 young and middle-aged patients (mean age 32.1±7.4years, 22 men and 28 women) who suffered from tethered cord syndrome (TCS) were retrospectively assessed by two observers. Demographic and radiological data were recorded, including lumbar disc degeneration, disc height index and lumbar spine angle, and were compared with 50 patients (mean age 29.7±5.4 years, 22 men and 28 women) without spinal cord abnormalities. Statistical associations were assessed by student's t-test and chi-square test. Our results showed patients with TCS had a significantly higher rate of lumbar disc degeneration in L1/2, L2/3, L4/5 and L5/S1 than in those without TCS (P < 0.05). Moreover, the rates of multilevel disc degeneration and severe disc degeneration in TCS group were significantly higher than those in control group (P < 0.01). The mean disc height index of L3/4 and L4/5 in TCS group was significantly lower than that in control group (P < 0.05). The mean lumbosacral angle of TCS patients was significantly higher than that of patients without TCS (38.4±3.5°vs. 33.7±5.9°, P < 0.01). We found a certain correlation between TCS and lumbar disc degeneration and lumbosacral angle enlargement, suggesting that the spine reduces the high tension of the spinal cord through disc degeneration. Therefore, it is speculated that there is a "compromised regulation" mechanism in the body under the condition of neurological abnormalities.

Evaluation of Lumbar Spine Morphology in Magnetic Resonance Images Using Cobb's Method

Lumbar lordosis represents one of the most prevalent postural disorders; it is classified as significant lumbar curving in the vertebral column's sagittal plane. The study's aims were to investigate lumbar spine morphology in Sudanese patients using Cobb's approach, as well as magnetic resonance imaging sagittal T2-weighted images. It was carried out between August 2015 and August 2016 in Khartoum Sudan's Advanced Diagnostic Center and Baraha Medical City hospital, with 140 patients (55 male and 85 female patients). The controlled cases involved in this study consisted of 40 patients (10 male and 30 female patients), ranging in age from 13 to 90 years. The results revealed substantial variation between the population having normal health and disc herniated patients in the Cobb angle (P = .000) and intervertebral disc space of L3 (P = .011), but no substantial improvement (P &gt; .05) between individuals with abnormal values and control individuals in the lumbosacral angle, L1-L5 body vertebrae, and L1, L2, L4, and L5 intervertebral disc levels. In addition, there was a notable change among the LS and Cobb angles in the patients with abnormal values (P = .045), but not in the control individuals (P = .691). We discovered a straight linear correlation among the Cobb angle and vertebral body L5-L2 in patients with bulged disc at various levels, as well as the Cobb angle and the L5-L2 intervertebral disc spaces also exhibit an indirect linear connection. It is concluded that magnetic resonance imaging is good for diagnosing disease associated with soft tissues, particularly the spinal discs that are frequently affected and cause low back problems.

Evaluation of the Sacral and Coccygeal Curvatures Calculated via Computed Tomography Images Based on Gender

Objective: The skeletal structure has a significant role in the estimation of human gender. The os sacrum and os coccyx bones that constitute the pelvic skeleton are important in sex estimation due to their functional differences based on sex. In the present study, we aimed to determine the differences in os sacral and os coccygeal curvatures calculated with orthogonal plane computed tomography images based on gender. &#x0D; Methods: Computed tomography images of 150 healthy individuals (75 females, 75 males) between the ages of 25-50 were used in the study. The computed tomography images were edited into a suitable format by the Horos software for measurement. Six sacral and coccygeal measurements, lumbosacral angle (LSA), sacral curvature (SC), sacral kyphosis (SK), sacrococcygeal angle (SCA), sacrococcygeal joint angle (SCJA), and coccygeal curvature (CC) were conducted on the sagittal image. &#x0D; Results: The measurement results indicated that LSA and SCA values were higher in male subjects when compared to females, and SCJA values were higher in females when compared to males (p≤0.05). Quadratic Discriminant Analysis (QDA) results indicated that these parameters were 93.3% effective in estimating male gender, 85.3% effective in estimating female gender, with an overall estimation rate of 89.3%. &#x0D; Conclusion: According to these results, it was concluded that the lumbosacral and sacrococcygeal joints appear flatter in men than in women. SC, SK and CC parameters did not show sexual dimorphism. Considering all the parameters we used, we achieved a high rate of gender discrimination.

Comparison of Long-Term Clinical and Radiographical Outcomes between the Anterior and Combined Anterior and Posterior Approaches for Treating Lumbosacral Tuberculosis.

Both anterior and combined anterior and posterior approaches have been used to treat lumbosacral tuberculosis. However, long-term follow-up studies of each approach have not been conducted. We aimed to compare the long-term clinical and radiographical outcomes between the two approaches. In this retrospective cohort study, we included 49 patients with a minimum 6-year follow-up between January 2008 and March 2012. Twenty-four patients underwent the anterior approach (anterior group), and 25 underwent the combined anterior and posterior approach (anterior-posterior group). Student's t test, Mann-Whitney U test, and Pearson's chi-square test were used to compare the two groups regarding clinical data, such as visual analogue scale scores, Oswestry disability index scores and neurological status, and radiographical data, such as lumbosacral angle, lumbar lordosis, and L5-S1 height. Furthermore, operative time, length of stay, and intraoperative and postoperative blood loss (IBL, PBL) were recorded. Both groups had satisfactory clinical and radiographical outcomes until the final follow-up. All patients achieved bony fusion, and no group differences were found in any of the clinical indices. Both groups corrected and maintained the lumbosacral angle, lumbar lordosis, and L5-S1 height. However, the operative time, length of stay, maximum Hb drop, IBL, and PBL of the anterior group (140.63 ± 24.73 min, 12.58 ± 2.45 days, 28.33 ± 9.70 g/L, 257.08 ± 110.47 ml, and 430.60 ± 158.27 ml, respectively) were significantly lower than those of the anterior-posterior group (423.60 ± 82.81 min, P < 0.001; 21.32 ± 3.40 days, P < 0.001; 38.48 ± 8.03 g/L, P < 0.001; 571.60 ± 111.04 ml, P < 0.001; and 907.01 ± 231.99 ml, P < 0.001). This retrospective study demonstrated long-term efficacy of the anterior approach with a single screw fixation, which was as effective as that of the combined anterior and posterior approach, with the advantage of less trauma.

“CORRELATION BETWEEN LUMBO-SACRAL ANGLE AND PROPRIOCEPTION IN SUBJECTS WITH CHRONIC LOW BACK PAIN”

Abstract: Background: chronic low back pain is a significant issue that is only becoming worse, partly as a result of the aging and expanding global population. It affects people of all ages and is typically linked to sedentary jobs, tobacco use, obesity, and low socioeconomic status. According to Andersons et al., the point prevalence of LBA in adults is estimated to be 30%, with the yearly incidence at 15%. Objective: To determine the correlation between lumbosacral angle and proprioception in subjects with chronic low back pain. Materials &amp; Methods: A total of 175 subjects have been recruited for the study out of which 120 subjects with CLBA who met the selection criteria were included in the study. The subjects who reported having chronic low back pain without any radiographically visible abnormalities were taken into consideration; the VAS score and chronicity were also gathered to gauge the severity of the pain. Lumbosacral angle and Proprioception were recorded. Results: For males and females, the correlation between LSA and VAS has an r-value of -0.131 and 0.144. It was discovered that there was no correlation between the two (p&gt;0.05). In men, the association between VAS and sickness duration has an r-value of 0.122, while in women, it has an r-value of -0.134. Both are discovered to be not significant (p&gt;0.05). Conclusion: There is a positive correlation between joint proprioception impairment and chronicity in CLBP patients. This correlation was found to be more pronounced in females than in males in (JPE) lumbar flexion movement and significant in both males and females in (JPE) lumbar extension movement.

Evaluation of Spinopelvic Parameters in Patients with Different Grades of Intervertebral Disc Degeneration in Lumbosacral Spine vs Normal Asymptomatic Population: A Retrospective Observational Study

Introduction: Spinopelvic malalignment causes continual backache. Intervertebral Disc Degeneration (IDD) is a leading cause of low backache. Understanding the relationship between spinopelvic parameters and IDD can help with better diagnosis and treatment and avoid unnecessary investigations. Aim: To measure radiographic spinopelvic parameters of patients diagnosed with varying grades of IDD in the lumbosacral spine on Magnetic Resonance Imaging (MRI), and to compare them with radiographs of the asymptomatic population (controls). Materials and Methods: A hospital-based retrospective observational study was done from January 2021 to August 2022 at a tertiary care hospital in Uttar Pradesh, India with 80 patients diagnosed with IDD on MRI and 80 controls. Cases were defined as patients diagnosed to have IDD on MRI and controls were those individuals who did not have disc degeneration on MRI. Lateral lumbosacral spine radiographs were taken, and spinopelvic parameters {Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Lumbar Lordosis (LL), lumbo-sacral angle, and sacral horizontal angle} were measured using Surgimap Spine Software. T-test and Chi-square test were used for comparison between cases and controls. Results: Six patients had asymmetric disc bulge, 11 had symmetric disc bulge, 18 had disc extrusion and 45 had disc protrusion. Mean PT in patients with IDD was 11.05±3.84°, and control was 8.65±3.19°, p-value=0.009. Mean SS in case group was 38.38±3.03° and control was 36.56±3.43°, p-value=0.031. The mean PI of cases was 49.44±8.39° and control 46.19±9.01°, p-value=0.02. LL angle was higher in IDD at 46.34°, and was 45.36° in healthy individuals, without statistically significant difference. The mean lumbo-sacral angle in both study groups was similar. The mean Sacral Inclination Angle (SIA) was found to be 43.99° and 44.96° in the case and control group respectively without showing significant differences. A statistically significant difference was found only for the comparison of PT between different grades of IDD (p-value=0.039). Conclusion: Using Surgimap Spine Software, one can predict the individuals that possess a greater propensity of developing degeneration of disc and chronic low back pain in a more costeffective manner.