Lumbosacral Junction Research Articles

Distal Junctional Failure After Fusion Stopping at L5 in Patients With Adult Spinal Deformity: Incidence, Risk Factors, and Radiographic Criteria.

To identify risk factors and establish radiographic criteria for distal junctional failure (DJF) in patients with adult spinal deformity (ASD), who underwent fusion surgery stopping at L5. This retrospective study was undertaken from January 2016 to December 2020. Patients with ASD who underwent fusion surgery (≥5 levels) stopping at L5 were analyzed. DJF was defined as symptomatic adjacent segment pathology at the lumbosacral junction necessitating consideration for revision surgery. Demographic data and radiographic measurements were compared between the DJF and non-DJF groups. Receiver operating characteristic curve analysis was performed to identify the radiographic cutoff value for DJF. Among 76 patients, 16 (21.1%) experienced DJF. DJF was associated with older age, antidepressant/anxiolytic medication, longer level of fusions, and worse preoperative sagittal alignment. Antidepressant/anxiolytic medication (odds ratio, 5.60) and preoperative pelvic incidence (PI)-lumbar lordosis (LL) mismatch>40° (odds ratio, 5.87) were independent risk factors for DJF. Without both factors, the incidence of DJF has been greatly reduced (9.1%). Two radiographic criteria were determined for DJF: last distal junctional angle (DJA)>-5° and Δ last DJA-post DJA>5°. When both criteria were met, the sensitivity and specificity of the DJF were 93.3% and 91.7%, respectively. Use of antidepressant/anxiolytic medication and preoperative PI-LL mismatch >40° were independent risk factors for DJF. DJF could be diagnosed using postoperative changes in the DJA. If both criteria were met, DJF could be strongly suggested.

Historical Perspectives on the Evolution of Spino-Pelvic Fixation and its Implications on Clinical Care A Narrative Review.

Broad narrative review. To review and summarize the evolution of spinopelvic fixation (SPF) and its implications on clinical care. A thorough review of peer-reviewed literature was performed on the historical evolution of sacropelvic fixation techniques and their respective advantages and disadvantages. The sacropelvic junction has been a long-standing challenge due to a combination of anatomic idiosyncrasies and very high biomechanical forces. While first approaches of fusion were determinated by many material and surgical technique-related limitations, the modern idea of stabilization of the lumbosacral junction was largely initiated by the inclusion of the ilium into lumbosacral fusion. While there is a wide spectrum of indications for SPF the chosen technique remains is defined by the individual pathology and surgeons' preference. By a constant evolution of both instrumentation hardware and surgical technique better fusion rates paired with improved clinical results could be achieved.

Spinal magnetic resonance imaging in cats: differences in clinical significance of intervertebral disk extrusion, intervertebral disk protrusion, and degenerative lumbosacral stenosis.

To determine the occurrence of degenerative changes affecting the vertebral column in cats, assess their clinical significance, and determine the occurrence in cats with intervertebral disk herniation compared to other spinal diseases. 114 client-owned cats. Hospital records were retrospectively reviewed for cats with suspected myelopathy that had undergone spinal MRI. Signalment; history; neurological examination; neurolocalization; primary diagnosis; presence, type, and location of intervertebral disk herniation; and presence and location of other degenerative spinal changes (intervertebral disk degeneration [IVDD], spondylosis deformans [SD], end plate changes, dorsal compressions [DC], and foraminal stenosis [FS]) were recorded. 70% of cats showed at least 1 spinal degenerative change. The most common change was IVDD, followed by SD and intervertebral disk protrusion (IVDP), while intervertebral disk extrusion (IVDE), end plate changes, DC, and FS were uncommon to rare. Primary complaint was attributed to a degenerative condition in 22% of cats, including 100% with IVDE, 9% with IVDP, and 43% with degenerative lumbosacral stenosis (DLSS). The occurrence of degenerative spinal changes and number of intervertebral disks affected by IVDD significantly increased with age and body weight. Age was positively correlated with the occurrence of SD and DLSS. Intervertebral disk degeneration, IVDP, SD, DC, and FS were more prevalent in the lumbosacral junction. Cats with IVDD were significantly more likely to show IVDE and IVDP. This study revealed that in a population of cats presenting for signs of myelopathy, IVDE was always responsible for the clinical presentation, DLSS was commonly considered incidental, and IVDP was infrequently related to neurological signs.

Prevalence of presumed endplate junction failure at the lumbosacral intervertebral junction in dogs on computed tomography.

Lumbosacral intervertebral disc herniation (IVDH) is a common cause of lower back pain in dogs and humans. In humans, the vertebral endplate to annulus fibrosus (AF) attachment was implicated as an alternative failure site besides rupture through the dorsal AF (AFF). Endplate junction failure (EPJF) is characterized by IVDH, accompanied by endplate irregularities (type A), rim avulsions (type B), or larger bony avulsions on one (type C) or both endplates (type D), associated with an adjacent endplate defect. This retrospective study reports the CT prevalence of presumed EPJF in dogs and its associations with signalment and other lumbosacral CT abnormalities. CT scans, including the lumbosacral spine of dogs obtained at two institutions, were assessed, yielding 324 scans. Presumed EPJF was found in 69 dogs (21%) and AFF in 68 dogs (21%), commonly at the caudal endplate of the last lumbar vertebra (71%). The remaining 187 dogs did not show presumed EPJF or AFF. Presumed EPJF type A occurred in 49/69, type B in 19/69, and type C in 1/69 dogs. Univariable logistic regression showed that presumed EPJF was associated with significantly higher IVDH grades than AFF. In the multiple regression model, presumed EPJF and AFF remained associated with increasing age and spondylosis deformans. Presumed EPJF was associated with vertebral endplate sclerosis and AFF with zygapophyseal joint osteoarthritis. In conclusion, presumed EPJF was observed on CT in 21% of dogs with lumbosacral IVDH. Prospective studies correlating EPJF on CT with clinical, surgical, and histopathological findings are needed for a better understanding of the underlying pathology and clinical relevance.

Effects of pelvic fixation strategies and multi-rod constructs on biomechanics of the proximal junction in long thoracolumbar posterior instrumented fusions: a finite-element analysis.

To assess the effect of various pelvic fixation techniques and number of rods on biomechanics of the proximal junction of long thoracolumbar posterior instrumented fusions. A validated spinopelvic finite-element (FE) model was instrumented with L5-S1 ALIF and one of the following 9 posterior instrumentation configurations: (A) one traditional iliac screw bilaterally ("2 Iliac/2 Rods"); (B) T10 to S1 ("Sacral Only"); (C) unilateral traditional iliac screw ("1 Iliac/2 Rods"); (D) one traditional iliac screw bilaterally with one midline accessory rod ("2 Iliac/3 rods"); (E) S2AI screws connected directly to the midline rods ("2 S2AI/2 Rods"); and two traditional iliac screws bilaterally with two lateral accessory rods connected to the main rods at varying locations (F1: T10-11, F2: T11-12, F3: T12-L1, F4: L1-2) ("4 Iliac/4 Rods"). Range of motions (ROM) at T10-S1 and T9-T10 were recorded and compared between models. The T9-T10 intradiscal pressures and stresses of the T9-10 disc's annulus in addition to the von Mises stresses of the T9 and T10 vertebral bodies were recorded and compared. For T10-S1 ROM, 4 iliac/4 rods had lowest ROM in flexion and extension, while 2 S2AI/2 rods showed lowest ROM in rotation. Constructs with 3 or 4 rods had lower stresses on the primary rods compared to 2-rod constructs. At the proximal adjacent disc (T9-10), 4 iliac/4 rods showed lowest ROM, lowest intradiscal pressures, and lowest annular stress in all directions (most pronounced in flexion-extension). Under flexion and extension, 4 iliac/4 rods also showed the lowest von Mises stresses on the T10 vertebral body but the highest stresses on the T9 vertebral body. Dual iliac screws with 4 rods across the lumbosacral junction and extending to the thoracolumbar junction demonstrated the lowest T10-S1 ROM, the lowest adjacent segment disc (T9-T10) ROM, intradiscal pressures, and annular stresses, and the lowest UIV stresses, albeit with the highest UIV + 1 stresses. Additional studies are needed to confirm whether these biomechanical findings dictate clinical outcomes and effect rates of proximal junctional kyphosis and failure.

Iliac Accessory Rod Technique for Rod Fracture Prevention in Long Fusion Constructs: 2-Dimensional Operative Video.

Implant-related complications in surgery for adult spinal deformity (ASD) account for roughly $1 billion US health care expenditures over 5 years, with a majority due to primary rod fracture.1,2 Traditional two-rod constructs have demonstrated rod fracture rates of up to 40%, with a median time to fracture of 3 years.3 Current supplementary rod techniques for decreasing rod fractures inadequately address the issue of increased strain across the lumbosacral junction.4 Here, we describe a novel four-rod technique using "iliac accessory rods," designed to mitigate rod fractures by reinforcing osteotomy levels and dispersing biomechanical stress across the lumbosacral junction. Compared with other supplementary rod techniques for ASD, iliac accessory rods anchor to independent iliac bolts.5 The added fixation points across the lumbosacral junction (4 iliac bolts total) substantially offloads stress on primary rods, most of which fracture near the lumbosacral junction.3 Additionally, connecting these rods to primary rods rostrally via side-to-side connectors, above the osteotomy levels, ensures mobile osteotomy segments are reinforced. Presented is a 78-year-old woman with ASD and worsening lower back pain, radiculopathy, and bilateral leg weakness who failed nonoperative management. She underwent T9 to bi-iliac instrumented fusion with L1-S1 posterior column osteotomies, L4-S1 transforaminal lumbar interbody fusions, and bilateral iliac accessory rod fixation. Postoperatively, she recovered well and had improvement in her symptoms. Imaging revealed correction of spinal alignment. The patient consented to the procedure, and the participants and any identifiable individuals consented to publication of his/her image. Institutional Review Board approval was waived because of institutional exemption policy.

Surgical Strategy to Correct Coronal Decompensation in an Autofused Growing Rod “Graduate”: A Case Report

Abstract Management of patients implanted with growing rods who reach skeletal maturity (growing rod “graduates”) often poses challenging situation for spine surgeons. A 14-year-old female was implanted with traditional growing rods (TGR) – and presented to us with a coronally decompensated deformity. Imaging investigations revealed lumbosacral take-off due to a hemivertebra at the lumbosacral junction distal to the construct and “adding on” of the curve proximal to the construct. Autofusion of the spine was noted intraoperatively – correction was achieved whilst retaining the TGR, and using separate proximal and distal extensions of the construct to correct the deformity, connecting these to the previously implanted TGR. Improvement was noted in lumbosacral take-off angle, coronal shift, and T1 tilt, with no implant-related complications at final follow-up. The case describes a rational thought process and surgical strategy to deal with a challenging presentation of a patient with implanted TGR reaching skeletal maturity.

Open Versus Percutaneous Stabilization of Thoracolumbar Fractures: A Large Retrospective Analysis of Safety and Reoperation Rates.

Thoracolumbar fractures (TLF) requiring surgical intervention can be treated with either open or percutaneous stabilization, each with some distinct risks and benefits.There is insufficient evidence available to support one approach as superior. Patients who underwent spinal fixation for TLF between 2008 and 2020 were reviewed.Patients with one or two levels of fracture treated with either open or percutaneous stabilization were included.Exclusion criteria were more than two levels of fracture, patients requiring corpectomy, stabilization constructs that crossed the cervicothoracic or lumbosacral junction, history of previous thoracolumbar fusion at the same level, spinal neoplasm, anterior or lateral fixation, and spinal infection.Demographic, operative, and clinical data were collected for all patients. 691 patients (377 open, 314 percutaneous) met the inclusion criteria.Patients in the percutaneous cohort sustained lower estimated blood loss (73 vs 334 ml; p< 0.001) and shorter length of surgery (114 vs. 151 minutes; p< 0.001).No differences were observed in the length of hospital stay or overall reoperation rates. Asymptomatic (7.0% vs 0.8%) and symptomatic (3.5% vs 0.5%) hardware removal was more common with the percutaneous cohort, while the incidence of revision surgery due to hardware failure requiring the extension of the construct (1.9% vs 5.8%) and infection (1.9% vs 6.4%) was greater in the open group. Percutaneous stabilization for TLF was associated with shorter operative time, less blood loss, lower infection rate, higher rates of elective hardware removal, and lower rates of hardware failure requiring extension of the construct compared to open stabilization.

Neurological complications following spinal anaesthesia in a goat

AbstractA 2‐year‐old, female, mixed breed goat presented for an abdominal hernia repair. After anaesthetic induction, spinal anaesthesia at the level of the lumbosacral junction was performed with preservative‐free morphine. After extubation, the patient developed neurological symptoms, which included extensor rigidity in the hindlimbs, twisting and bending at the thoracolumbar junction, and horizontal nystagmus. The patient also began vocalising and had hypersalivation. Three hours after the completion of anaesthesia, the patient was able to rise on its own. Two days after general anaesthesia, the patient collapsed unexpectedly. The postmortem examination revealed spinal haemorrhage and pulmonary thrombosis. Pulmonary thrombosis might have led to the death of the goat; however, a definitive conclusion was not reached regarding the cause of the pulmonary thrombosis and spinal haemorrhage. Veterinarians should be aware of possible complications with spinal anaesthesia, although rare; the evident cause for the neurological symptoms in this case remains unclear.

Lumbosacral Transitional Disorder as a Missing Link in Symptomatic Scoliosis

Back pain in the presence of LSTVs (lumbosacral transitional vertebrae) was originally noted by Mario Bertolotti in 1917. The Lenke classification for scoliosis forms the current international standard. However, the connection between LSTVs and scoliosis is still poorly understood. The aim of this study is to show the connection between scoliosis and LSTVs in terms of their frequency and impact on further development. Our scoliosis outpatient clinic has an examination period that covers the years from 2014 to 2021. If LSTVs are radiologically suspected (AP and lateral X-ray of the spine) according to the Castellvi classification (II–IV), a further MRI investigation is initiated. Scoliosis shape is assigned according to the Lenke classification. Sagittal segmental differences are observed according to the vertical mean vertebral angle (VMVA) and its difference (Diff-VMVA). Assignment to the lumbar pain group is made in cases of a history of chronic or recurrent pain of more than 6 months. Differentiation is made at the initial presentation according to gender (male–female) and age (children and adults). Other associated diagnoses such as family correlations and the question of brace fitting are cited. Finally, the literature is reviewed from a scoliosis perspective and compared with the findings of the authors of this paper. A total of 1332 patients were evaluated, and LSTV Castellvi II–IV was confirmed in 72 of them (58 female and 14 male). The curvature extent of scoliosis in children and adults had a mean Cobb angle of 24.3° with a range from 11° to 55° (n-42) and 32.4° with a range from 12° to 66° (n-30), respectively. This indicates that 75% of n-54 patients were mostly classified as Castellvi II (pseudarthrosis) (IIA, 54.2%; IIB, 20.8%) in the total data. There were few patients classified with Castellvi III (22.2%) and IV (2.8%). A proportion of 87.5% of 72 patients were mostly classified as Lenke 1 (25.0% n-18) and Lenke 5 (62.5% n-45). According to the literature, the Diff-VMVA shows Cobb angles of 9.3° for Castellvi III and 5.3° for Castellvi IV. Half of the patients complain of chronic low back pain for at least 6 months or have recurrent complaints (48.6%). The complaints are mostly classified as Castellvi IIA (27.8%) and B (9.7%). The association of scoliosis and LSTVs yields only 13 studies (PubMed 04/18/2022) that focus on spine surgery issues and not on diagnostics. Attention should be given to the lumbosacral junction in Lenke 1 and Lenke 5. Nearly half of the patients in each category complain of chronic lumbar symptoms. This is notable in individual cases due to its rounding and thus its increased Diff-VMVA. Since only Castellvi II–IV is considered, a comparison of the frequency with other studies is not permissible. In conclusion, for scoliosis Lenke 5 and Lenke 1, the lumbosacral junction should be examined.

Analysis of the Research Progress on the Impact of Lumbosacral Transitional Vertebra on the Lumbopelvic-Hip Complex

The lumbosacral transitional vertebra is a common congenital variation. The presence of LSTV can result in smaller benefits for the population after total hip arthroplasty. Although extensive research has been conducted on the association between LSTV and lumbopelvic-hip complex syndrome in populations undergoing total hip arthroplasty, with convincing evidence suggesting that the presence of LSTV can have a negative impact on the outcomes of total hip arthroplasty, there is currently a lack of exploration into the association between LSTV and hip joint anatomical development, as well as its correlation with lumbopelvic-hip complex syndrome. The lumbopelvic-hip complex (LPHC) is a key structure for maintaining body stability and transmitting forces. Lumbosacral transitional vertebra (LSTV) is one of the most common congenital variations at the lumbosacral junction, which has a certain influence on the line of force transmission to the pelvis and hip joints and plays a role in the occurrence and development of hip and lumbar back pain.

Intradiscal vacuum phenomenon matches lumbar spine degeneration patterns in an ageing population

PurposeIntra-Discal Vacuum phenomenon (IDVP) is well-recognised, yet poorly visualised and poorly understood radiological finding in disc degeneration, particularly with regard to its role in spinal alignment. CT analysis of the lumbar spine in an aging population aims to identify patterns associated with IDVP including lumbopelvic morphology and associated spinal diagnoses.MethodsAn analysis was performed of an over-60s population sample of 2020 unrelated abdominal CT scans, without acute spinal presentations. Spinal analysis included sagittal lumbopelvic reconstructions to assess for IDVP and pelvic incidence (PI). Subjects with degenerative pathologies, including previous vertebral fractures, auto-fusion, transitional vertebrae, and listhesis, were also selected out and analysed separately.ResultsThe prevalence of lumbar spine IDVP was 50.3% (955/1898) and increased with age (125 exclusions). This increased in severity towards the lumbosacral junction (L1L2 8.3%, L2L3 10.9%, L3L4 11.5%, L4L5 23.9%, and L5S1 46.3%). A lower PI yielded a higher incidence of IDVP, particularly at L5S1 (p < 0.01). A total of 292 patients had IDVP with additional degenerative pathologies, which were more likely to occur at the level of isthmic spondylolisthesis, adjacent to a previous fracture or suprajacent to a lumbosacral transitional vertebra (p < 0.05).ConclusionsThis study identified the prevalence and severity of IDVP in an aging population. Sagittal patterns that influence the pattern of IVDP, such as pelvic incidence and degenerative pathologies, provide novel insights into the function of aging spines.

Analysis of Rod Fracture at the Lumbosacral Junction Following Surgery for Adult Spinal Deformity.

Retrospective study. This study aimed to investigate the differences in the characteristics of patients with rod fracture (RF) at the lumbosacral junction from those without RF following adult spinal deformity (ASD) surgery. RF is a major complication following ASD surgery and may require reoperation because of pain and correction loss. The lumbosacral junction is a common RF site. However, risk factors for RFs at the lumbosacral junction remain unknown. The study included data from 100 patients who underwent ASD surgery between 2012 and 2020. Fifteen of these patients presented with RFs. Patient demographics, clinical outcomes, and radiographic parameters were evaluated in each group. RFs were significantly more frequent in patients with a medical history of total hip arthroplasty (THA; p=0.01) or severe obesity (p=0.04). However, no significant differences in clinical outcomes, preoperative or postoperative measurements, or changes were found between pre- and postoperative radiographic parameters within the groups. Both pre- (p=0.01) and postoperative (p=0.02) anterior disc heights were significantly greater in the RF group than in the non-RF group. In the RF group, the postoperative lordotic angles of the lumbosacral junction significantly decreased compared with preoperative angles (p=0.02). Multiple logistic regression analysis demonstrated that a THA history (odds ratio, 34.2), severe obesity (odds ratio, 14.0), and preoperative anterior disc height (odds ratio, 1.2) were significant risk factors for RFs. In this study, the greatest risk factors for postoperative lumbosacral RF after ASD surgery were THA history, severe obesity, and postoperative anterior disc height of ≥10. For patients at higher risk, the use of multirods is considered necessary.

Posterior pelvic ring injuries, lumbosacral junction instabilities and stabilization techniques for spinopelvic dissociation: a narrative review.

From transiliac Harrington rods to minimally invasive (MIS) percutaneous 3D-navigated transsacral-transiliac screw (TTS) fixation, concepts of fixation methods in pelvic injuries with spinopelvic dissociation (SPD) are steadily redefined. This narrative review examines the literature of recent years regarding surgical treatment options and trends in SPD, outlining risks and benefits of each treatment option and addressing biomechanical aspects of sacral injuries and common classification systems. A literature search on the search across relevant online databases was conducted. As a scale for quality assessment, the SANRA-scoring system was taken into account. Sacral Isler type 1 injuries of the LPJ in U- and H-type fractures are frequently treated with stand-alone TTS. Fractures with higher instability (Isler types 2 and 3) require unilateral or bilateral LPF, subject to side involvement, as a buttressing construct, or triangular fixation as additional compression and neutralization, determined by fracture radiation. A more comprehensive classification from which to derive stabilization options is provided by the 2023 301SPD classification. MIS techniques are on the rise and offer shorter OR time, less blood loss, fewer infections, and fewer wound complications. It is advisable to implement MIS techniques as much as possible, as long as decompression is not required and closed fracture reduction succeeds satisfactorily. SPD is characteristic of severe injuries, mostly in polytraumatized patients. The complication rates are decreasing due to the increasing adaptation of MIS techniques.

The Role of Trabecular, Ligamentous-Intervertebral Disk and Facet Joints Systems: A Finite Element Analysis in the L4-S1 Vertebrae.

Descriptive. Trabecular bone in the vertebrae is critical for the distribution of load and stress throughout the neuroaxis, as well as the intervertebral disk, ligamentous complex, and facet joints. The objective was to assess the stress and strain distribution of the L4-S1 spine segment by a finite element analysis. A lumbosacral spine model was built based on a CT-Scan. Trabecular-to-cortical bone distribution, ligaments, intervertebral disk, and facet joints with cartilage were included. A perpendicular force was applied over the L4 upper terminal plate of 300N, 460N and 600N in neutral, plus 5Nm and 7.5Nm for flexion and extension movements. Maximum principal stress and total deformation were the main studied variables. Trabecular bone confers resistance to axial loads on the vertebrae by elastic capacity and stress distribution. MPS and TD showed axial stress attenuation in the nucleus pulposus and longitudinal ligaments, as well as load distribution capacity. Facet joints and discontinuous ligaments showed greater TD values in flexion moments but greater MPS values in extension, conferring stability to the lumbosacral junction and axial load distribution. We propose 3 anatomical systems for axial load distribution and stress attenuation in the lumbosacral junction. Trabecular bone distributes loads, while the ligamentous-intervertebral disk transmits and attenuate axial stress. Facet joints and discontinuous ligaments act as stabilizers for flexion and extension postures. Overall, the relationship between trabecular bone, ligamentous-intervertebral disk complex and facet joints is necessary for an efficient load distribution and segmental axial stress reduction.This slide can be retrieved from the Global Spine Congress 2023.

Garrè Sclerosing Osteomyelitis of the Clavicle: Clinical Results after Clavicular Resection.

(1) Background: Chronic non-bacterial osteomyelitis (CNO), also known as sclerosing osteomyelitis of Garrè, is a rare inflammatory bone disease with a specific clinical picture, uncertain pathogenesis, and no consensus on an effective treatment. Most frequently affecting other long bones, CNO may rarely involve the clavicle. The aim of this study was to present the results of a series of patients affected by CNO of the clavicle treated with total and partial clavicula resection. In addition, a literature review of different types of treatment of CNO was performed. (2) Methods: We retrospectively reviewed three patients with Sclerosing Osteomyelitis of Garre' of the clavicle treated with partial resection of the clavicle (one) and with total clavicular resection (two). (3) Results: Patients (two female and one male) were an average age of 35.7 years at the time of the operation. At the 4-year follow-up, the mean active ROM was: 143° forward flexion, 133° abduction, 42° external rotation with an internal rotation of two patients at the interscapular level and one patient at the lumbosacral junction. The mean ASES score was 92/100 (range 87-100). In the literature review, after screening the abstracts and full texts for eligibility, 34 studies met the inclusion criteria. Conclusions: Partial or total clavicular resection resulted an effective treatment of CNO of the clavicle. The procedure seems to be particularly indicated after the failure of more conservative treatments.

PREVALENCE AND SEVERITY OF INTRA-DISCAL VACUUM PHENOMENON IN A NORMAL AGEING POPULATION

Intra-Discal Vacuum Phenomenon (IDVP) represents an intradiscal nitrogen gas accumulation where a cavity opens in a supine position, lowering intra-discal pressure and generating a bubble. IDVP has been observed in up to 20% of elderly patients and reported in almost 50% of chronic LBP patients. With a highly accurate detection on CT, its significance lacks clarity and consideration within normative data. IDVP occurs with patterns of lumbar and/or lumbopelvic morphology and associated diagnoses. Over-60s population based sample of 2020 unrelated CT abdomen scans without acute spinal presentations, with sagittal reconstructions, inclusive of T12 to femoral heads, were analyzed for IDVP and pelvic incidence (PI). Subjects with diagnostic morphological associations of the lumbar spine, including previous fracture, autofusion, transitional vertebra and listhesis, were selected out and analyzed separately. Subjects were then equally grouped into low, medium and high PI. Prevalence of lumbar spine IDVP is 41.3%. 125 cases were excluded. 1603 subjects yielded 663 IDVP. This was increased in severity towards the lumbosacral junction (L1L2 9.4%, L2L3 10.9%, L3L4 13.7%, L4L5 19.9%, L5S1 28.5%) and those with low PI, while distribution was more even with high PI. 292 had positive diagnostic associations, which were more likely to occur at the level of isthmic spondylolisthesis, adjacent to a previous fracture or suprajacent to lumbosacral transitional vertebra (p&lt;0.05).This study has identified normative values for prevalence and severity of IDVP in a normal aging population. Morphological patterns that influence the pattern of IVDP such as pelvic incidence and diagnostic associations provide novel insights to the function of the aging spine.

Stabilization with a String-of-Pearls Plate as Treatment for Degenerative Lumbosacral Disease in a Young German Shepherd Dog

Abstract Objective The aim of this study was to report the use of a String-of-Pearls (SOP) plate for lumbosacral stabilization as treatment for a 1-year-old German Shepherd suffering from sacral osteochondritis and compressive myelopathy due to lumbosacral subluxation and causing a chronic right hindlimb lameness.Clinical, imaging, and surgical features are described. Study Design Case report. Results A dorsal laminectomy allowed for debridement and lumbosacral stabilization using an SOP plate which led to significant improvement of clinical signs and resolution of pain and discomfort. Conclusion Successful surgical management was achieved with good long-term results using an SOP plate to stabilize the lumbosacral junction.

The validity of smartphone-based spatiotemporal gait measurements during walking with and without head turns: Comparison with the GAITRite® system

Smartphone accelerometry has potential to provide clinicians with specialized gait analysis not available in most clinical settings. The Gait&Balance Application (G&B App) uses smartphone accelerometry to assess spatiotemporal gait parameters under two conditions: walking looking straight ahead and walking with horizontal head turns. This study investigated the validity of G&B App gait parameters compared with the GAITRite® pressure-sensitive walkway. Healthy young and older adults (age range 21–85 years) attended a single session where a smartphone was secured over the lumbosacral junction. Data were collected concurrently with the app and GAITRite® systems as participants completed the two walking conditions. Spatiotemporal gait parameters for 54 participants were determined from both systems and agreement evaluated with partial Pearson’s correlation coefficients and limits of agreement. The results demonstrated moderate to excellent validity for G&B App measures of step time (rp 0.97, 95 % CI [0.96, 0.98]), walking speed (rp 0.83 [0.78, 0.87]), and step length (rp 0.74, [0.66, 0.80]) when walking looking straight ahead, and results were comparable with head turns. The validity of walking speed and step length measures was influenced by sex and height. G&B App measures of step length variability, step time variability, step length asymmetry, and step time asymmetry had poor validity. The G&B App has potential to provide valid measures of unilateral and bilateral step time, unilateral and bilateral step length, and walking speed, under two walking conditions in healthy young and older adults. Further research should validate this tool in clinical conditions and optimise the algorithm for demographic characteristics.

Long-term comparison of anterior (ALIF) versus transforaminal (TLIF) lumbar interbody fusion: a propensity score-matched register-based study.

Anterior (ALIF) and transforaminal (TLIF) lumbar interbody fusion have shown similar clinical outcomes at short- and medium-term follow-ups. Possible advantages of ALIF in the long run could be better disc height and lumbar lordosis and reduced risk of adjacent segment disease. We aimed to study if ALIF could be associated with superior clinical outcomes than TLIF at long-term follow-up. We analysed 535 patients treated with ALIF or TLIF of the L5-S1 spinal segment between 2007 and 2017 who completed long-term follow-up in a national spine registry database (NORspine). We defined treatment success after surgery as at least 30% improvement in Oswestry Disability Index (ODI) at long-term follow-up. Patients treated with ALIF and TLIF and who responded at long term were balanced by propensity score matching. The proportions of successfully treated patients within each group were compared by numbers and percentages with corresponding relative risk. The mean (95%CI) age of the total study population was 50 (49-51) years, and 264 (49%) were females. The mean (95%CI) preoperative ODI score was 40 (39-42), and 174 (33%) had previous spine surgery. Propensity score matching left 120 patients in each treatment group. At a median (95%CI) of 92 (88-97) months after surgery, we found no difference in proportions successfully treated patients with ALIF versus TLIF (68 (58%) versus 77 (65%), RR (95%CI) = 0.88 (0.72 to1.08); p = 0.237). This propensity score-matched national spine register study of patients treated with ALIF versus TLIF of the lumbosacral junction found no differences in proportions of successfully treated patients at long-term follow-up. Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.