Measurements Of Lumbar Lordosis Research Articles

Can minimally invasive transforaminal lumbar interbody fusion achieve a better clinical and radiological outcome than traditional open technique in isthmic spondylolisthesis?

BackgroundSpondylolisthesis is a prevalent condition in the lumbar spine that can cause low back pain, leg pain, neurogenic claudication, and impact health-related quality of life in symptomatic individuals.Aimto assess the results of minimally invasive TLIF (MIS-TLIF) versus open-TLIF and the impact of correcting spino-pelvic parameters on the Health-Related Quality of Life (HRQoL) in patients with low-grade isthmic spondylolisthesis. The primary objective was to compare the effectiveness of both methods in correcting spinopelvic parameters. The secondary objectives involved comparing clinical improvement, operating time, blood loss, complications, and postoperative hospital stays between the two procedures.Patients and methodsSeventy-two patients with low-grade isthmic spondylolisthesis were enrolled in this retrospective cohort-control study, with a minimum follow-up period of 18 months. Disability was assessed using the Oswestry Disability Index (ODI), while back and leg discomfort were rated using the Visual Analogue Scale (VAS) for each patient. The measurements comprised the sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and Meyerding slip grades. We measured lumbar lordosis (LL), and segmental lordosis.ResultsThe seventy-two patients were 60 female and 12 males. There was no statistically significant difference in the duration of operation between the two groups. In the MIS group, there was a notable reduction in blood loss, higher radiation exposure, and a shorter hospital stay (P < 0.001). The back VAS showed more favorable outcomes in the MIS-TLIF, while the leg VAS showed better results in the Open-TLIF in the early outcome. Both procedures significantly reduced leg and back pain VAS scores and ODI, with no notable difference between the two groups at the final follow-up. Post-surgery, the pelvic incidence (PI) and lumbar lordosis (LL) matched properly in all patients, showing a rise in LL and sacral slope along with a decrease in pelvic tilt.ConclusionBoth open-TLIF and MIS-TLIF are effective methods for correcting spino-pelvic parameters and improving HRQoL in patients with low-grade isthmic spondylolisthesis. The rapid improvement in back pain experienced by these patients favored the use of MIS-TLIF. However, the cost-effectiveness of this approach must be carefully evaluated.

Strategies for Minimizing the Effects of Observer Variability on Sagittal Parameter Measurements of the Spine.

Exploratory-descriptive study. Evaluate the influence of observer variability on the measurements of both thoracic kyphosis (TK) and lumbar lordosis (LL) obtained with anatomic and functional spinal segmentation methods. Parametric analysis for spinal surgery planning typically relies on anatomic parameters. However, incorporating functional parameters that consider the vertebrae orientation is important to minimizing surgical calculation errors. The authors developed parametric analysis software that integrates traditional and functional methodologies. The proposed method included functional thoracic kyphosis and functional lumbar lordosis calculated from the lines normal to the inflection points of the spine model. Using a synthetic lateral X-ray, the observer variability was computer-simulated generating 20 landmark sets that replicate the annotations of 20 observers. The analysis also included 10 clinical X-rays, annotated twice by 3 judges with a minimum 1-week interval. The spinal curvature angles were derived using the anatomic and functional methods. Statistical analysis were performed for comparison. For the synthetic X-ray, the proposed method presented significantly less variability: TK (<±2.5 degrees, P=0.00023) and LL (<±5 degrees, P=0.00012). For the clinical X-rays, the interobserver reliability analysis yielded higher intraclass correlation coefficients (ICC) for functional TK (ICC>0.97) and functional LL (ICC>0.87) than for TK (ICC<0.91) and LL (ICC<0.89). Statistically significant differences were observed for both TK (P=0.001) and LL (P=0.030). Under the traditional method, observer variability led to measurement differences surpassing ±19 degrees, whereas differences with the proposed method were within ±10 degrees for both parameters. The vertebral endplate is not the most suitable place to measure spinal sagittal curvatures. Small changes in landmark position significantly alter the measured Cobb angle. The proposed method offers a substantial advantage regarding the influence of observer variability, in addition to the more individualized analysis.

Sagittal spinopelvic alignment in ambulatory persons with cerebral palsy.

This study aimed to describe the spinopelvic alignment of a cohort of young ambulatory individuals with cerebral palsy (CP) and compare it to published spinopelvic alignment data for the typically developing adolescents. Thirty-seven adolescents (18 females) with CP at GMFCS I-III were included in this retrospective case series. Lumbar lordosis and pelvic incidence were measured, and their mismatch was calculated. A model that calculates predicted lumbar lordosis based on pelvic incidence in normative data was utilized to calculate a predicted lumbar lordosis in this cohort with cerebral palsy. At imaging, ages were mean and standard deviation 13.5 ± 3.0years. Pelvic incidence was 46.2° ± 12.9°, pelvic tilt was 2.8° ± 9.4°, sacral slope was 43.6° ± 10.8°, and measured lumbar lordosis was 59.4° ± 11.6°. There were no differences in pelvic incidence or lumbar lordosis among the GMFCS levels; however, pelvic incidence was higher in females. Pelvic incidence-lumbar lordosis mismatch greater than 10° was found in 67% of the cohort. Mean predicted lumbar lordosis based on the model was 54.7° ± 8.5°, averaging 8° less than measured lordosis. PI-LL mismatch was identified in 67% of this cohort of ambulatory adolescents with CP, in part due to greater lordosis than predicted by a model based on data from adolescents without CP. The implications of this finding, such as the correlation between sagittal spinopelvic alignment and quality of life in this population, should be assessed further in ambulatory patients with cerebral palsy. Level IV-retrospective cohort study and literature comparison.

Can the Mismatch of Measured Pelvic Morphology vs. Lumbar Lordosis Predict Chronic Low Back Pain Patients?

Background: Measures of lumbar lordosis (LL) and elliptical modeling variables have been shown to discriminate between normal and chronic low back pain (CLBP) patients. Pelvic morphology influences an individual's sagittal lumbar alignment. Our purpose is to investigate the sensitivity and specificity of lumbar sagittal radiographic alignment and modeling variables to identify if these can discriminate between normal controls and CLBP patients. Methods: We conducted a computer analysis of digitized vertebral body corners on lateral lumbar radiographs of normal controls and CLBP patients. Fifty normal controls were attained from a required pre-employment physical examination (29 men; 21 women; mean age of 27.7 ± 8.5 years), with no history of low back pain, a normal spinal examination, no pathologies, anomalies, or instability. Additionally, 50 CLBP patients (29 men; 29.5 ± 8 years of age) were randomly chosen and matched to the characteristics of the controls. The inclusion criteria required no abnormalities on lumbar spine radiographs. The parameters included the following: ARA L1-L5 lordosis, ARA T12-S1 lordosis, Cobb T12-S1, b/a elliptical modelling ratio, sacral base angle (SBA), and S1 posterior tangent to vertical (PTS1). Two measures of pelvic morphology were determined for each person-the angle of pelvic incidence (API) and posterior tangent pelvic incidence angle (PTPIA)-and the relationships between API - ARA T12-S1, API - Cobb T12-S1, and API - ARA L1-5 was determined. Descriptive statistics and correlations among the primary variables were determined. The receiver operating characteristic curves (ROC curves) for primary variables were analyzed. Results: The mean values of LL were statistically different between the normal and CLBP groups (p < 0.001), indicating a hypo-lordotic lumbar spine for the CLBP group. The mean b/a ratio was lower in the chronic pain group (p = 0.0066). The pelvic morphology variables were similar between the groups (p > 0.05). API had a stronger correlation to the SBA and Cobb T12-S1 than PTPIA did, while PTPIA had a stronger correlation to the S1 tangent and ARA T12-S1 than API did. While CLBP patients had a stronger correlation of ARA T12-S1 and Cobb T12-S1 relative to the pelvic morphology, they also had a reduced correlation of ARA L1-L5 lordosis relative to their SBA and pelvic morphology measures. API - T12-S1, API - L1-L5, and API - Cobb T12-S1 were statistically different between the groups, p < 0.001. Using ROC curve analyses, it was identified that ARA L1-L5 lordosis of 36° and ARA T12-S1 of 68° have a good sensitivity and specificity to discriminate between normal and CLBP patients. ROC curve analyses identified that lordosis ARAT12-S1 < 68° (AUC = 0.83), lordosis ARAL1-L5 < 36° (AUC = 0.78), API - ARA T12-S1 < -18° (AUC = 0.75), API - ARAL1-L5 > 35° (AUC = 0.71), and API - Cobb T12-S1 < -5° (AUC = 0.69) had moderate to good discrimination between groups (AUC = 0.83, 0.78, 0.75, and 0.72). Conclusions: Pelvic morphology is similar between normal and CLBP patients. CLBP patients have an abnormal 'fit' of their API - ARAT12-S1 and L1-L5 lumbar lordosis relative to their pelvic morphology and sacral tilt shown as a hypolordosis.

Inter-rater and Intra-rater Reliability of a Mobile App Method to Measure Lumbar Lordosis.

Background Measuring the exact quantitative values of lordotic curves is a vital factor in clinical settings to prevent musculoskeletal deformities in the future. Existing lordotic assessment methods are very diverse, expensive, inaccurate, and not handy, and their availability cannot be maintained in every clinic setup. Aim The purpose of this research was to study the reliability of a mobile app as a feasible method to measure lumbar lordosis angle using a lateral view radiograph. Methodology A lateral view low back region radiograph of 58 participants was taken based on the criteria, and the experienced physiotherapists uploaded the X-ray to the mobile app and measured the lordotic angles with the support of machine learning algorithms. Descriptivestatistics were used to calculate the average and dispersion of the data of the lumbar lordosis angle measured using the mobile app method (Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 23, Armonk, NY)). Results Associations between and within raters were assessed using the Karl Pearson coefficient of correlation (1.000). Inter-rater and intra-rater reliability were determined by using Cronbach's alpha (.966) and the split-half method. The internal consistency of the mobile app was found to be good. Conclusions Based on our findings, we conclude that the mobile app method is reliable and useful in measuring lumbar lordosis objectively with less effort. Since the app is handy on smartphones, physiotherapists can conduct an objective lumbar lordosis assessment in clinical settings.

EFFECTIVENESS OF POSTERIOR PELVIC TILT EXERCISE ON STABLE AND UNSTABLE SURFACE IN PATIENTS WITH CHRONIC LOW BACK PAIN

Purpose: The objective of this study was to assess and evaluate the efficacy of posterior pelvic tilt exercises on pain reduction, functional disability, muscle strength, and lumbopelvic angle in patients with Chronic Low Back Pain (CLBP). These exercises were conducted on stable and unstable surfaces. Methods: This was a single-blinded randomized two-group pre-test and post-test experimental study. Men and women with CLBP, with an age between 18 and 50 years, were divided into two groups at random. Group A performed the exercises on a stable surface, and Group B performed the exercises on an unstable surface. The Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI) for functional disability, Flexi Ruler for measuring lumbar lordosis angle, and Surface Electromyography (SEMG) for Transverse Abdominis (TA) and Rectus Abdominis (RA) muscles were used for pre- and post-treatment analysis. Results: Significant improvements in SEMG activity of TA and RA muscles were observed in both intervention groups following conventional exercises ([Formula: see text] &lt; 0.05). However, the unstable surface group had a higher increase in SEMG amplitude during Maximal Voluntary Isometric Contraction (MVIC) and the percentage of MVIC for the TA muscles. Conclusion: Posterior pelvic tilt exercises performed on stable and unstable surfaces effectively reduced pain, decreased the angle of lumbar lordosis, improved functional disability, and enhanced activity and strength of the pelvic muscles in patients with CLBP.

Early Compensatory Segmental Angle Changes at L3-L4 and L4-L5 After a L5-S1 Interbody Fusion for a Grade 1 Spondylolisthesis.

The retrospective study included patients who underwent an L5-S1 anterior (ALIF) or transforaminal (TLIF) lumbar interbody fusion with posterior pedicle screw instrumentation for grade 1 spondylolisthesis from 2018 to 2022. To compare early reciprocal changes at the L3-L4 and L4-L5 adjacent levels 6 months after ALIF or TLIF at L5-S1. Degenerative and chronic isthmic spondylolistheses often result in decreased segmental lordosis (SL) at L5-S1. This can lead to lordotic overcompensation at adjacent levels to maintain spinopelvic balance. However, the fate of adjacent angles after interbody fusion is not well understood. Preoperative and 6-month postoperative measurements of SL (L3-L4, L4-L5, and L5-S1), lumbar lordosis, and pelvic incidence (PI) were obtained from sagittal standing radiographs. Preliminary t tests were performed for descriptive purposes, and multiple regression was used for hypothesis testing. Ninety-eight patients met the inclusion criteria (50 ALIF and 48 TLIF). A greater amount of lordosis achieved at L5-S1 was significantly associated with a greater reduction of SL at L4-L5 ( r = -0.65, P < 0.001) or L3-L4 ( r = -0.46, P < 0.001). A greater preoperative PI was associated with a greater reduction of SL at L4-L5 ( r = -0.42, P < 0.001) and at L3-L4 ( r = -0.44, P < 0.001). At 6 months after a lumbar interbody fusion at L5-S1, greater compensatory changes with lordosis reduction are observed at the supra-adjacent L4-L5 and L3-L4 levels in patients achieving greater L5-S1 SL. In addition, preoperative PI played a role in influencing lordotic correction.

Evaluation of lumbar lordosis in symptomatic individuals and comparative analysis of six different techniques: a retrospective radiologic study.

The aim of this study; evaluate lumbar lordosis (LL) in symptomatic individuals with six different techniques and to examine the techniques comparatively. Thus, to provide an overview of lumbal lordosis and techniques. Cobb L1-L5, Cobb L1-S1, Posterior Tangent, tangential radiologic assessment of lumbar lordosis (TRALL), vertebral centroid measurement of lumbar lordosis (CLL) and Risser Ferguson measurement techniques were used to assess LL from radiographs of 175 symptomatic adults. Correlations between techniques and relationship between the measurements obtained, gender and age were analyzed. Also ınterclass correlation (ICC) analyzed. Bland-Altman plots were performed to compare the techniques with Cobb. ICC for all methods were greater than 0.96. For each method, no difference in LL was observed with respect to gender or age (p > 0.05). High positive correlation was observed between the Risser Ferguson, Posterior Tangent, Cobb L1-L5, Cobb L1-S1 and CLL techniques (p < 0.001), and moderate positive correlation between TRALL and all other techniques (p < 0.001). In this study, it was found that the mean lumbar lordosis values of symptomatic participants were lower than most of the other asymptomatic studies in the literature and there was no significant difference in lumbar lordosis values in terms of gender and age in symptomatic individuals. Based on statistical findings, Risser Ferguson can be used to assess LL. These results and the data obtained as a result of the comparative examination of techniques according to age groups and gender will benefit clinicians and those working in the field by providing a better understanding LL.

Validity and Reliability of Non-invasive Methods for Evaluating Kyphosis and Lordosis Curvatures: A Literature Review

Introduction: A few instruments are accessible for clinical estimation of the thoracic and lumbar curvatures. This methodical survey aims to identify the validity and reliability of non- invasive thoracic kyphosis and lumbar lordosis measurements.&#x0D; Materials and Methods: This research is a literature review. The process was performed on articles in credible databases, such as Medline, Embase, AMED, CINAHL, PubMed, and Biomedical Reference Collection, Expanded, Sport Discus, Science Direct, Web of Science, searching for the terms thoracic kyphosis, lordosis, spinal curvature, lordosis and reliability, lordosis and validity, kyphosis and reliability, kyphosis and validity, test, measure, flexi curve, radiograph, spinal mouse, inclinometer, kyphometer, image processing, Cobb, during 1960 to 2020.&#x0D; Results: The result of the systematic search revealed that ten methods among all related papers have inclusion criteria, 3D ultrasound, Arco meter, DE Brunner’s kyphometer, digital inclinometer, electro goniometer, goniometer, flexi curve angle, image processing, pantograph, and spinal mouse.&#x0D; Conclusion: The validity and reliability of non-invasive methods for estimating kyphosis and lordosis curvatures were indicated in 26 papers. Based on the current little evidence, non- invasive procedures have high to very high reliability and moderate to high validity.

Spinal alignment measurement with Kinect sensor is valid for thoracic kyphosis but not for lumbar lordosis

BackgroundSpinal alignment evaluation is commonly performed in the clinical setting during rehabilitation. However, there is no simple method for its quantitative measurement. Recently, the depth cameras in Kinect sensors have been employed in various commercial and research projects in the healthcare field. We hypothesized that the time-of-flight technology of the Kinect sensor could be applied to quantitatively evaluate spinal alignment. The purpose of this study was to develop a simple and noninvasive evaluation for spinal alignment using the Kinect sensor and to investigate its validity.MethodsTwenty-four healthy men participated in the study. Measurement outcomes were the thoracic kyphosis and lumbar lordosis angles in the standing position, using a Spinal Mouse, the validity of which has been previously reported, and the Kinect sensor. In the measurement by the Kinect sensor, a program was created to obtain the three-dimensional coordinates of each point within an area marked on the monitor, and the sums of the angles at each vertebral level were calculated for the thoracic and lumbar areas. Pearson's correlation coefficient was used to analyze the relationship between the Kinect sensor and Spinal Mouse measurements of thoracic kyphosis and lumbar lordosis angles.ResultsThere was a significant positive and moderate correlation between the thoracic kyphosis measurements taken by each device. Contrarily, there was no significant correlation in the lordosis angle between measurements using the Kinect sensor and Spinal Mouse.ConclusionsOur results demonstrated the validity of measuring the thoracic kyphosis angle using the Kinect sensor. This indicates that the depth camera in the Kinect sensor is able to perform accurate thoracic alignment measurements quickly and noninvasively.

The Reliability of the Projection Area Per Length Squared for Measuring Lumbar Lordosis on Lateral Radiographs: A Comparison with Cobb Method

Objective: The assessment of the degree of lumbar lordosis in patients with spinal disorders is essential to determine disease progression and the effectiveness of treatment. The aim of this study was to examine the reliability of the projection area per length squared (PAL) for measuring lumbar lordosis on lateral radiographs and to compare it with the Cobb method. Methods: Two independent investigators measured lumbar lordosis twice on 100 lateral radiographs using PAL and Cobb methods. Intra- and interobserver agreements of each radiological method were evaluated using intraclass correlation coefficients (ICC) and Bland–Altman plots. Correlations between the PAL estimations and Cobb angle measurements were tested using the Spearman rank correlation coefficient. Results: Intra- and interobserver agreements for PAL and Cobb methods were excellent with all ICC values&gt;0.976. The Bland–Altman plots indicated strong intra-observer and interobserver concordance in the measurement of the lumbar lordosis using the PAL method. A strong correlation was determined between the PAL and Cobb angle values in the first and second measurements (r=0.825; p&lt;0.001 and r=0.815; p&lt;0.001, respectively). Conclusion: The PAL technique is easy to apply on digital images and provides quantitative information independent of the vertebral surface pathologies of the end vertebrae. It could be used as an alternative and potent diagnostic criterion for evaluating lumbar lordosis.

Novel artificial intelligence algorithm: an accurate and independent measure of spinopelvic parameters.

The analysis of sagittal alignment by measuring spinopelvic parameters has been widely adopted among spine surgeons globally, and sagittal imbalance is a well-documented cause of poor quality of life. These measurements are time-consuming but necessary to make, which creates a growing need for an automated analysis tool that measures spinopelvic parameters with speed, precision, and reproducibility without relying on user input. This study introduces and evaluates an algorithm based on artificial intelligence (AI) that fully automatically measures spinopelvic parameters. Two hundred lateral lumbar radiographs (pre- and postoperative images from 100 patients undergoing lumbar fusion) were retrospectively analyzed by board-certified spine surgeons who digitally measured lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope. The novel AI algorithm was also used to measure the same parameters. To evaluate the agreement between human and AI-automated measurements, the mean error (95% CI, SD) was calculated and interrater reliability was assessed using the 2-way random single-measure intraclass correlation coefficient (ICC). ICC values larger than 0.75 were considered excellent. The AI algorithm determined all parameters in 98% of preoperative and in 95% of postoperative images with excellent ICC values (preoperative range 0.85-0.92, postoperative range 0.81-0.87). The mean errors were smallest for pelvic incidence both pre- and postoperatively (preoperatively -0.5° [95% CI -1.5° to 0.6°] and postoperatively 0.0° [95% CI -1.1° to 1.2°]) and largest preoperatively for sacral slope (-2.2° [95% CI -3.0° to -1.5°]) and postoperatively for lumbar lordosis (3.8° [95% CI 2.5° to 5.0°]). Advancements in AI translate to the arena of medical imaging analysis. This method of measuring spinopelvic parameters on spine radiographs has excellent reliability comparable to expert human raters. This application allows users to accurately obtain critical spinopelvic measurements automatically, which can be applied to clinical practice. This solution can assist physicians by saving time in routine work and by avoiding error-prone manual measurements.

Comparing Lumbar Lordosis in Functional Dance Positions in Collegiate Dancers With and Without Low Back Pain.

Limited research has explored the relationship between lumbar lordosis and incidence of low back pain in dancers. The purpose of this study was to investigate the relationship between lumbar lordosis in functional dance positions and low back pain (LBP). Thirty full-time undergraduate ballet and modern collegiate dancers (28 female, 2 male) from three university dance programs participated in this study. Functional lumbar lordosis, hip passive range of motion, and core endurance were measured in a single session. Dancers participated in weekly follow-up surveys over a 4-month period to track the presence and severity of LBP. Primary analysis was performed using independent t-tests between groups who did and did not develop pain. Secondary analyses were performed using Pearson's r correlation. Eleven dancers reported no pain during the follow-up period, 16 reported pain, and three did not respond to follow-up surveys. Lumbar lordosis in right developpé á la seconde and right retiré was significantly greater (p < 0.05) in the group who reported pain compared to the group who reported no pain. Increased hold times in the supine bridge position was shown to be fairly correlated (p < 0.05) to reduced lumbar lordosis in first position (Pearson's r = 0.381), left retiré (Pearson's r = 0.396), and right developpé á la seconde (Pearson's r = 0.365). The results of this study suggest a relationship between increased lumbar lordosis in the retiré and developpé á la seconde dance positions and development of LBP. Increased endurance of posterior core musculature and gluteal muscles was inversely related to the magnitude of lumbar lordosis in some dance-specific positions. The measurement of lumbar lordosis during functional dance positions, particularly those requiring single leg stances, may help identify collegiate dancers with increased risk of developing low back pain.

Factors Affecting the Outcome of Lumbar Canal Stenosis Surgery: A Two-year Follow-up Study

Background: Lumbar Canal Stenosis (LCS) is the most common reason for spinal surgery in older patients. Identifying factors influencing the outcome of surgical management is important in clinical research. Objectives: This study aims to identify the factors affecting the outcome of surgical management for LCS. Materials &amp; Methods: This prospective non-randomized cohort study was conducted at the spine center of Imam Khomeini Hospital in Tehran, Iran from March 2017 to January 2019 on 135 patients with symptomatic LCS, confirmed by MRI. Clinical and functional outcomes were measured using the 12-Item Short form Health Survey (SF-12), Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) the day before surgery, and 12 and 24 months after surgery. Radiographical parameters was assessed by measuring lumbar lordosis, sacral slope, pelvic tilt and pelvic incidence. Results: Of 135 patients, 120 completed the follow-up. Patients treated surgically had significantimprovement in SF-12, ODI and VAS scores after 2 years of follow-up. Higher values of BMI(P=0.031), symptom duration &gt;1 year (P=0.045 for SF-12, P=0.031 for ODI), and smoking(P=0.033 for SF-12, P=0.028 for ODI) were associated with poor outcome. Patients with higher pre-operative SF-12, ODI and VAS scores (P=0.007 for SF-12, P=0.003 for ODI, P=0.050 for VAS) and lower lumbar lordosis (P=0.055) showed significant improvement after surgery. Conclusion: Patients with LCS showed significant improvement in outcomes afterdecompression surgery. Higher values of BMI, symptom duration &gt;1 year, and smokingare associated with poor outcome, while higher pre-operative disability score and lowerlumbar lordosis are associated with better outcome after surgery.

Evaluation of Sagittal Spinopelvic Balance in Spinal Cord Stimulator Patients

ObjectiveSpinal cord stimulation (SCS) has become a popular nonopioid pain intervention. However, the treatment failure rate for SCS remains significantly high and many of these patients have poor sagittal spinopelvic balance, which has been found to correlate with increased pain and decreased quality of life. The purpose of this study was to determine if poor sagittal alignment is correlated with SCS treatment failure. Materials and MethodsComparative retrospective analysis was performed between two cohorts of patients who had undergone SCS placement, those who had either subsequent removal of their SCS system (representing a treatment failure cohort) and those that underwent generator replacement (representing a successful treatment cohort). The electronic medical record was used to collect demographic and surgical characteristics, which included radiographic measurements of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Also included were data on pain medication usage including opioid and nonopioid therapies. ResultsEighty-one patients met inclusion criteria, 31 had complete removal, and 50 had generator replacements. Measurement of sagittal balance parameters demonstrated that many patients had poor alignment, with 34 outside normal range for LL (10 vs 24 in removal and replacement cohorts, respectively), 30 for PI (12 [38.7%] vs 18 [36.0%]), 46 for PT (18 [58.1%] vs 28 [56.0%]), 38 for SS (18 [58.1%] vs 20 [40.0%]), and 39 for PI-LL mismatch (14 [45.2%] vs 25 [50.0%]). There were no significant differences in sagittal alignment parameters between the two cohorts. ConclusionsThis retrospective cohort analysis of SCS patients did not demonstrate any relationship between poor sagittal alignment and failure of SCS therapy. Further studies of larger databases should be performed to determine how many patients ultimately go on to have additional structural spinal surgery after failure of SCS and whether or not those patients go on to have positive outcomes.

Biomechanical and Clinical Study of Rod Curvature in Single-Segment Posterior Lumbar Interbody Fusion.

Objective: Pedicle screw fixation is a common technique used in posterior lumbar interbody fusion (PLIF) surgery for lumbar disorders. During operation, rod contouring is often subjective and not satisfactory, but only few studies focused on the rod-contouring issue previously. The aim of the study was to explore the effect of the rod contouring on the single-segment PLIF by the finite element (FE) method and retrospective study. Methods: A FE model of the lumbosacral vertebrae was first reconstructed, and subsequently single-segmental (L4/5) PLIF surgeries with four rod curvatures (RCs) were simulated. Herein, three RCs were designed by referring to centroid, Cobb, and posterior tangent methods applied in the lumbar lordosis measurement, and zero RC indicating straight rods was included as well. Clinical data of patients subjected to L4/5 segmental PLIF were also analyzed to verify the correlation between RCs and clinical outcome. Results: No difference was observed among the four RC models in the range of motion (ROM), intersegmental rotation angle (IRA), and intradiscal pressure (IDP) under four actions. The posterior tangent model had less maximum stress in fixation (MSF) in flexion, extension, and axial rotation than the other RC models. Patients with favorable prognosis had larger RC and positive RC minus posterior tangent angle (RC-PTA) of fused segments with respect to those who had poor prognosis and received revision surgery. Conclusion: All RC models had similar biomechanical behaviors under four actions. The posterior tangent-based RC model was superior in fixation stress distribution compared to centroid, Cobb, and straight models. The retrospective study demonstrated that moderate RC and positive RC-PTA were associated with better postoperative results.

COMPARISON OF PSOAS MORPHOLOGY AND LUMBAR LORDOSIS IN DIFFERENT POSTURES

ABSTRACT Objective: To compare the interobserver reliability of measurements of psoas morphology and lumbar lordosis in different positions and to standardize the performance of magnetic resonance imaging in the prone and lateral positions. Methods: This is a cross-sectional study carried out with asymptomatic volunteers of both sexes, aged over 18 years, with no known pathological changes in the lumbar region. Magnetic resonance imaging of the lumbar spine was performed in the supine, right lateral decubitus and prone positions, obtaining images in T2-weighted sequences in the sagittal and axial planes. The distances were measured from the psoas to the vertebral plateau and from the psoas to the lumbar plexus. The exams were assessed by two independent, blinded orthopedists. Results: There was excellent agreement between the measurements of vertebral size (ICC=0.92), low agreement for plexus distance (ICC=0.63) and high agreement for the anterior margin (ICC=0.84). Conclusion: There was good reproducibility of 2 of the 3 measures proposed, suggesting that the technique in the lateral and prone positions is capable of generating quality images. Level of Evidence 3B; Prospective.

AVALIAÇÃO ANATÔMICA E FUNCIONAL DA CIFOSE TORÁCICA E LORDOSE LOMBAR

ABSTRACT Objective: Rate and compare radiographic measurements of thoracic kyphosis and lumbar lordosis using anatomical and dynamic parameters. Methods: Measurements were performed on lateral radiographs of 10 adults of both sexes without spinal disease or deformity. Thoracic kyphosis and lumbar lordosis were measured using anatomical parameters (T1-T12, T4-T12, T5-T12 and L1-S1) or dynamic parameters (cervicothoracic or thoracolumbar inflection point). Results: Thoracic kyphosis and lumbar lordosis were different in 30% of subjects. Differences in thoracic kyphosis values were observed according to the anatomical reference used for measurement. Lumbar lordosis wasn`t statistical difference considering the anatomical or dynamic reference, but in 30% of the individuals the inflection point was different from the anatomical reference. Conclusions: Thoracic kyphosis and lumbar lordosis values differ according to anatomical and dynamic references. The reference used must be considered in the measurement and interpretation of values. Level of evidence IV; Case series.

Relationship Between Age-Related Spinopelvic Sagittal Alignment and Low Back Pain in Adults of Population-Based Cohorts: The ROAD Study

PurposeThe demand for surgical correction in elderly patients with adult spinal deformity (ASD) has recently increased with the growth of the aging population. Age-related changes in spinopelvic sagittal alignment have been recently reported; thus, sagittal realignment should consider age-related changes. This study aimed to investigate the relationship between age-specific sagittal spinopelvic radiographic parameters and low back pain (LBP) to support the establishment of age-specific realignment targets for patients with ASD.Materials and MethodsA population-based cohort consisting of 1461 subjects (466 men and 995 women) was used. The participants were divided into five groups based on their age: (1) younger than 50 years, (2) 50–59 years, (3) 60–69 years, (4) 70–79 years, and (5) 80 years and older. Standing lateral whole-spine radiographs were assessed to measure lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and sagittal vertical axis (SVA). In addition, all participants were asked if they had LBP or not, using the following question: “Have you experienced LBP on most days during the past month and/or now?”.ResultsThe crucial parameter associated with LBP was the mismatch between PI and LL (PI-LL). The mean values of all the radiographic parameters increased with age. PI-LL and PT reached 11.5° and 25.6°, respectively, for women without LBP in the super-aged group (age >80 years), which did not lie in the range of optimal values reported in the previous literature.ConclusionA new optimal age-related target may be needed for the management of patients with ASD.

The Reliability of the Projection Area per Length Squared for Measuring Lumbar Lordosis on Lateral Radiographs: A Comparison with Cobb Method

The Reliability of the Projection Area per Length Squared for Measuring Lumbar Lordosis on Lateral Radiographs: A Comparison with Cobb Method