Pelvic Tilt Angle Research Articles

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

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

Association of Various Spinopelvic Parameters and the Quality of Life in Those With Degenerative Lumbar Scoliosis in the Indian Population.

Purpose The current study aimed to find any association between various spinopelvic parameters and the quality of life in patients with degenerative lumbar scoliosis (DLS) measured as per the Oswestry disability index (ODI) and visual analog scale (VAS) in the Indian population. Methods We included 20 DLS patients of more than 40 years with a Cobb angle of more than 10° and without any trauma, tumour, infection, or congenital scoliosis presented in our tertiary care centre in the study. The VAS and ODI were calculated for each patient. Radiological parameters were recorded for every patient, including sagittal balance, coronal balance, Cobb angle, pelvic incidence, pelvic tilt, and lumbar lordotic angle. We evaluated the results and sought any association between clinical and radiological variables for DLS. Results Patients with positive sagittal balance had significantly higher disability than those with neutral sagittal balance (p-value 0.007). Furthermore, patients with coronal imbalance had more severe pain (p-value 0.013) and disability (p-value 0.038) than those with neutral coronal balance. We also found that the ODI and VAS were not associated with any other spinopelvic parameters. Conclusion From the present study, we can conclude that in the Indian population, both positive sagittal and coronal imbalances are associated with poor functional status in patients with DLS. Therefore, while planning surgical correction for these patients, both coronal and sagittal balance are important and need to be considered.

Effect of COVID-19 on Musculoskeletal Performance in Gait and the Timed-Up and Go Test.

The total number of confirmed cases of COVID-19 caused by the SARS-CoV-2 virus infection is over 621 million in the world. In approximately 63% of cases, the patient still experiences persistent symptoms 30 days after the onset of symptoms or hospitalisation, and 45.9% of patients have experienced or will experience symptoms for at least three months. Despite the prevalence of chronic symptoms and pathological changes that may affect gait and functional mobility in people with a history of COVID-19, there are few publications investigating the impact of these abnormalities. This study aims to determine the long-term effects of COVID-19 on gait and the Timed-Up and Go Task. A total of 30 individuals took part in the experiment. The subjects in the study group were infected with the COVID-19 virus and required hospital treatment. Prior to the study, the subjects had no chronic diseases or other conditions affecting the musculoskeletal system. The non-infected by COVID-19 group was a healthy population with no history of COVID-19 disease. The study used the inertial system wireless motion analysis system based on 15 inertial sensors (inertial measurement units, IMUs). IMU sensors were placed on the following body segments: head, sternum, middle and lower spine, shoulder, arm, forearm, hand, shank, for the left and right limb. Movement task reports generated from the recording were created using myoRESEARCH 3.10. The subjects in the study group were asked to perform a movement task test-the Timed-Up and Go Test (TUG): sit-to-stand, walk (3 m) without change in direction, walk termination, and stand-to-sit. It took 46% longer for those infected by COVID-19 (participants) to complete the entire movement task compared to those in the not-infected by COVID-19 group. Sit-to-Stand Time [s] was greater in the infected by COVID-19 group and was 2.1 ± 0.7. Mean Walking Speed [m/s] was lower than in the not-infected by COVID-19 group and was 0.26 ± 0.07. Walking cadence [steps/min] was lower and was 21.2 ± 1.2. Infected by COVID-19 participants achieved a smaller anterior pelvic tilt angle (p < 0.001) and a smaller hip flexion angle (p = 0.025), with an increase in knee (p < 0.001) and ankle (p < 0.001) flexion angles. Individuals in the infected by COVID-19 group present changes in the ranges of motion and the time to complete the TUG task, despite the fact that at least eight weeks passed after hospital discharge.

Sagittal Spinopelvic Alignment in the Standing and Prone Positions of Patients with Old Traumatic Thoracolumbar Kyphosis: Relationship with Immediately Postoperative Parameters

The aim of this study was to investigate the changes in spine-pelvis sagittal parameters from the standing position to the prone position and to study the relationship between sagittal parameters and immediately postoperative parameters. Thirty-six patients with old traumatic spinal fracture combined with kyphosis were enrolled. The preoperative standing position, prone position and postoperative sagittal parameters of the spine and pelvis, including the local kyphosis Cobb angle (LKCA), thoracic kyphosis angle (TK), lumbar lordosis angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence minus lumbar lordosis angle (PI-LL), and sagittal vertebral axis (SVA), were measured. The data of kyphotic flexibility and correction rate was collected and analyzed. The parameters of the preoperative standing position, prone position and postoperative sagittal position were analyzed statistically. Correlation analysis and regression analysis of the preoperative standing and prone sagittal parameters and postoperative parameters were conducted. There were significant differences in the preoperative standing position, prone position and postoperative LKCA and TK. Correlation analysis showed that preoperative sagittal parameters of the standing position and prone position were all correlated with postoperative homogeneity. Flexibility was not related to the correction rate. Regression analysis showed preoperative standing, prone LKCA, and TK were linear with postoperative. The LKCA and TK of old traumatic kyphosis obviously changed from the standing position to the prone position, which were linear with postoperative LKCA and TK and can be used to predict postoperative sagittal parameters. This change should be taken into account in the surgical strategy.

Is dynamic spino-pelvic alignment during gait associated with lumbar function in patients with degenerative lumbar spinal stenosis?

IntroductionStatic spine and pelvic posture has been reported to be associated with symptoms in patients with lumbar spinal stenosis (LSS), but it is unknown whether dynamic alignment of the spine and pelvis is associated with lumbar function in daily life. This study aims to investigate the relationship between dynamic alignment of the spine and pelvis during gait and lumbar function in daily life in patients with LSS. MethodsWe evaluated lumbar function in daily life using the Oswestry Disability Index (ODI), trunk and hip muscle strength as physical function, static spinal alignment, and dynamic spinal/pelvic alignment during gait. The relationship between the ODI score and physical function or static and dynamic alignment was examined. ResultsA total of 35 preoperative patients with LSS participated in this study. ODI score significantly correlated with trunk extension strength (r = −0.578, p = 0.000), hip extension strength (r = −0.472, p = 0.004), maximum spinal flexion angle during gait (r = −0.473, p = 0.004) and maximum pelvic anterior tilt angle (r = 0.510, p = 0.002). Multiple regression analysis showed that trunk extension strength (standardized β; - 0.309), hip extension strength (standardized β; −0.287), maximum spinal flexion angle (standardized β; - 0.306) and maximum pelvic anterior tilt angle (standardized β; 0.271) significantly affected the ODI score, with adjusted coefficient of determination of 0.529. ConclusionThe results of this study showed that the patients with LSS with weak hip or trunk extensor muscles, a greater angle of pelvic tilt or a less spinal flexion during gait had a lower lumbar function in daily life.

Development of an Integrated Powered Hip and Microprocessor-Controlled Knee for a Hip-Knee-Ankle-Foot Prosthesis.

Hip-knee-ankle-foot prostheses (HKAF) are full lower-limb devices for people with hip amputations that enable individuals to regain their mobility and move freely within their chosen environment. HKAFs typically have high rejection rates among users, as well as gait asymmetry, increased trunk anterior-posterior lean, and increased pelvic tilt. A novel integrated hip-knee (IHK) unit was designed and evaluated to address the limitations of existing solutions. This IHK combines powered hip and microprocessor-controlled knee joints into one structure, with shared electronics, sensors, and batteries. The unit is also adjustable to user leg length and alignment. ISO-10328:2016 standard mechanical proof load testing demonstrated acceptable structural safety and rigidity. Successful functional testing involved three able-bodied participants walking with the IHK in a hip prosthesis simulator. Hip, knee, and pelvic tilt angles were recorded and stride parameters were analyzed from video recordings. Participants were able to walk independently using the IHK and data showed that participants used different walking strategies. Future development of the thigh unit should include completion of a synergistic gait control system, improved battery-holding mechanism, and amputee user testing.

Comparison of staged lateral lumbar interbody fusion combined two-stage posterior screw fixation and two osteotomy strategies for adult degeneration scoliosis: a retrospective comparative study

AimsThe commonly used treatments of adult degeneration scoliosis (ADS) were posterior long segment screw fixation with osteotomies. Recently, lateral lumbar intervertebral fusion combined two-stage posterior screw fixation (LLIF + PSF) as a new strategy without osteotomy. Herein, this study aimed to compare the clinical and radiological outcomes among LLIF + PSF and pedicle subtraction osteotomy (PSO), posterior column osteotomies (PCO).MethodsTotals of 139 ADS patients underwent operation with 2 years longer follow-up visit between January 2013 and January 2018 in Ningbo No.6 Hospital were enrolled into this study. 58 patients were included in PSO group, 45 in PCO group and 36 in LLIF + PSF group, The clinical and radiological data were reviewed from medical records. Baseline characteristic, perioperative radiological data (sagittal vertical axis (SVA), coronal balance (CB), Cobb angle of Mian curve (MC), Lumbar lordosis (LL), pelvic tilt (PT) and pelvic incidence-lumbar lordosis mismatch (PI-LL)), clinical outcomes (VAS of back and leg, Oswestry disability index (ODI) and Scoliosis Research Society 22-question Questionnaire (SRS-22)) and complications were evaluated and compared.ResultThere were no significantly difference in baseline characteristics, preoperative radiological parameters and clinical outcomes among three groups. LLIF + PSF group was significantly shorter in operation time than other two groups (P < 0.05), whereas significant longer hospital stay was observed in LLIF + PSF group (P < 0.05). As for radiological parameters, LLIF + PSF group had significantly improvement in SVA, CB, MC, LL and PI-LL (P < 0.05). Moreover, LLIF + PSF group achieved significantly less correction loss in SVA, CB and PT than PSO and PCO group (1.5 ± 0.7 VS 2.0 ± 0.9 VS 2.2 ± 0.8, P < 0.05; 1.0 ± 0.4 VS 1.3 ± 0.5 VS 1.1 ± 0.7, P < 0.05 and 4.2 ± 2.8 VS 7.2 ± 3.1 VS 6.0 ± 2.8, P < 0.05). Significantly recovery in VAS of back and leg, ODI score and SRS-22 were found among all groups, however, LLIF + PSF shown significant better clinical therapy maintain at follow-up visit than other two groups (P < 0.05). There were no significantly difference in complications among groups (P = 0.66).ConclusionLateral lumbar interbody fusion combined two-stage posterior screw fixation (LLIF + PSF) can achieve comparable clinical therapy for adult degeneration scoliosis as osteotomy strategies. However, furthermore more studies need be taken for verifying the effect of LLIF + PSF in the future.

Measurement of the normal contralateral hip flexion angle and posterior pelvic tilt angle using a pelvic guide pin in total hip arthroplasty

BackgroundWe aimed to measure the posterior pelvic tilt angle at maximum hip flexion and hip flexion range of motion at the femoroacetabular joint using a pelvic guide pin and to examine the difference in flexion range of motion when determined by a physical therapist and under anesthesia. MethodsData of 83 consecutive patients undergoing primary unilateral total hip arthroplasty were assessed. Using a pin inserted into the iliac crest to define the cup placement angle under anesthesia before and after total hip arthroplasty, the posterior pelvic tilt angle was determined as the change in pin tilt from the supine position to maximum hip flexion. Flexion range of motion under anesthesia was calculated as the difference in the angle between the trunk and thigh at maximum flexion and the posterior pelvic tilt angle. Flexion range of motion with a fixed pelvis measured preoperatively by a physical therapist was compared to that under anesthesia. A goniometer was used for all measurements and the number of measurements was one. FindingsMean posterior pelvic tilt angle of the pin inserted into the pelvis under anesthesia was 15.8° ± 5.3° (3°–26°) preoperatively and 12.1° ± 4.9° (3°–26°) postoperatively. Mean flexion range of motion under anesthesia was 109.4° ± 6.9° (88°–126°) and that measured by a physical therapist was 101.1° ± 8.2° (80°–120°); the difference was significant (9.7°; p < 0.01). InterpretationThese results highlight the difficulty in accurately determining hip flexion angles without the use of special devices and may help surgeons and physical therapists recognize and address this issue.

Effects of Slide Sheet Use and Bed Position on Muscle Activities in the Low Back and Extremities: A Pilot Experimental Simulation Study.

Low-friction slide sheets (SS) are designed to reduce compression loads on the body during manual handling tasks, such as boosting patients. Using SS has been shown to decrease muscle activity in the lower back and upper extremities. However, it is unclear if this effect varies with different bed positions. To investigate this, we studied the effects of SS use, bed height, and their combination on muscle activity during a simulated patient boost. Thirty-three Japanese undergraduate students (age 21.0 ± 1.1 years; 14 men, 19 women) participated. Participants were asked to boost a dummy figure on the bed three times each using four conditions. During the repositioning task, electromyography of eight muscles of the lower back and upper and lower extremities, hip and knee joint flexion angles, pelvic forward tilt angle, and position of the center of mass based on the posterior superior iliac spine were evaluated. Electrophysiological activities of muscles of lower back and upper extremities were significantly lower with SS than without it in both bed positions (30% and 40% of body height); the reduction in muscle activities with SS use was 20% to 40%. Lowering the bed did not affect the SS effect magnitude on reducing muscle activities, although postural changes, including hip and knee joint flexion, were observed. SS reduced muscle activities in the back, upper, and lower extremities when the bed was in the low position, and this effect persisted at a bed height of ≥30% of the participant's height.

The Sacro-femoral-pubic Angle Is Unreliable to Estimate Pelvic Tilt: A Meta-analysis.

The accurate measurement of pelvic tilt is critical in hip and spine surgery. A sagittal pelvic radiograph is most often used to measure pelvic tilt, but this radiograph is not always routinely obtained and does not always allow the measurement of pelvic tilt because of problems with image quality or patient characteristics (such as high BMI or the presence of a spinal deformity). Although a number of recent studies have explored the correlation between pelvic tilt and the sacro-femoral-pubic angle using AP radiographs (SFP method), which aimed to estimate pelvic tilt without a sagittal radiograph, disagreement remains about whether the SFP method is sufficiently valid and reproducible for clinical use. The purpose of this meta-analysis was to evaluate the correlation between SFP and pelvic tilt in the following groups: (1) overall cohort, (2) male and female cohort, and (3) skeletally mature and immature cohorts (young and adult groups, defined as patients older or younger than 20 years). Additionally, we assessed (4) the errors of SFP-estimated pelvic tilt angles and determined (5) measurement reproducibility using the intraclass correlation coefficient. This meta-analysis was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (record ID: CRD42022315673). PubMed, Embase, Cochrane, and Web of Science were screened in July 2022. The following keywords were used: sacral femoral pubic, sacro femoral pubic, or SFP. The exclusion criteria were nonresearch articles such as commentaries or letters and studies that only investigated relative pelvic tilt rather than absolute pelvic tilt. Although the included studies had different patient recruitment strategies, study quality-wise, they all used an adequate amount of radiographs for landmark annotation and applied a correlation analysis for the relationship between the SFP angle and pelvic tilt. Thus, no risk of bias was found. Participant differences were mitigated via subgroup and sensitivity analyses to remove outliers. Publication bias was assessed using the p value of a two-tailed Egger regression test for the asymmetry of funnel plots, as well as the Duval and Tweedie trim and fill method for potential missing publications to impute true correlations. The extracted correlation coefficients r were pooled using the Fisher Z transformation with a significance level of 0.05. Nine studies were included in the meta-analysis, totaling 1247 patients. Four studies were used in the sex-controlled subgroup analysis (312 male and 460 female patients), and all nine studies were included in the age-controlled subgroup analysis (627 adults and 620 young patients). Moreover, a sex-controlled subgroup analysis was conducted in two studies with only young cohorts (190 young male patients and 220 young female patients). The overall pooled correlation coefficient between SFP and pelvic tilt was 0.61, with high interstudy heterogeneity (I 2 = 76%); a correlation coefficient of 0.61 is too low for most clinical applications. The subgroup analysis showed that the female group had a higher correlation coefficient than the male group did (0.72 versus 0.65; p = 0.03), and the adult group had a higher correlation coefficient than the young group (0.70 versus 0.56; p < 0.01). Three studies reported erroneous information about the measured pelvic tilt and calculated pelvic tilt from the SFP angle. The mean absolute error was 4.6° ± 4.5°; in one study, 78% of patients (39 of 50) were within 5° of error, and in another study, the median absolute error was 5.8º, with the highest error at 28.8° (50 female Asian patients). The intrarater intraclass correlation coefficients ranged between 0.87 and 0.97 for the SFP angle and between 0.89 and 0.92 for the pelvic tilt angle, and the interrater intraclass correlation coefficients ranged between 0.84 and 1.00 for the SFP angle and 0.76 and 0.98 for the pelvic tilt angle. However, large confidence intervals were identified, suggesting considerable uncertainty in measurement at the individual radiograph level. This meta-analysis of the best-available evidence on this topic found the SFP method to be unreliable to extrapolate sagittal pelvic tilt in any patient group, and it was especially unreliable in the young male group (defined as patients younger than age 20 years). Correlation coefficients generally were too low for clinical use, but we remind readers that even a high correlation coefficient does not alone justify clinical application of a metric such as this, unless further subgroup analyses find low error and low heterogeneity, which was not the case here. Further ethnicity-segregated subgroup analyses with age, sex, and diagnosis controls could be useful in the future to determine whether there are some subgroups in which the SFP method is useful. Level III, diagnostic study.

Development and validation of machine learning-based models for prediction of adolescent idiopathic scoliosis: A retrospective study

Adolescent idiopathic scoliosis (AIS) can cause abnormal body posture, which has a negative impact on the overall posture. Therefore, timely prevention and early treatment are extremely important. The purpose of this study is to build an early warning model of AIS risk, so as to provide guidance for accurately identifying early high-risk AIS children and adolescents. We conducted a retrospective study of 1732 children and adolescents with or without AIS who underwent physical examination in Longgang District Central Hospital of Shenzhen (LDCHS queue) from January 2019 to October 2022 and 1581 children and adolescents with or without AIS in Shenzhen People Hospital (January 2018 to December 2022) as external validation queues (SPH queue). The random forest model (RFM), support vector machine model, artificial neural network model (ANNM), decision tree model (DTM), and generalized linear model (GLM) were used to build AIS model for children and adolescents. The predictive efficacy of 5 machine learning models was evaluated by receiver operating characteristic curve and decision curve analysis. For screening candidate predictors of AIS, the ratio of sitting height to standing height (ROSHTSH), angle of lumbar rotation, scapular tilt (ST), shoulder-height difference (SHD), lumbar concave (LC), pelvic tilt (PT) and angle of thoracolumbar rotation (AOTR) can be used as a potential predictor of AIS. The effectiveness of the prediction model constructed by the 5 machine learning algorithms was between (area under the curve [AUC]: 0.767, 95% confidence interval [CI]: 0.710-0.824) and (AUC: 0.899, 95% CI: 0.842-0.956) in the training set and internal verification set, respectively. Among them, the ANNM was equipped with the best prediction effectiveness (training set: AUC: 0.899, 95% CI: 0.842-0.956) and (internal verification set: AUC: 0.897, 95% CI: 0.842-0.952). The prediction model of AIS based on machine learning algorithm can achieve satisfactory prediction efficiency, among which ANNM is the best, which can be used to guide clinicians in diagnosis and treatment and improve the prognosis of AIS children and adolescents.

Evaluation of lateral and anterior center-edge angles according to sex and anterior pelvic plane tilt angle: a three-dimensional quantitative analysis

BackgroundThis study aimed to quantitatively evaluate lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) according to sex and the anterior pelvic plane (APP) tilt angle and analyze the correlation between these measurements and acetabular coverage.MethodsComputed tomography scans of 71 adults (38 men and 33 women) with normal hip joints were obtained. LCEA, anterior ACEA, and acetabular coverage were measured with APP tilt every 5° from − 30° to + 30° and were compared between the sexes. The correlation between acetabular coverage and LCEA/ACEA was also analyzed.Results(1) LCEA, ACEA, and acetabular coverage were statistically larger in men than in women at all APP tilt angles (with the exception of acetabular coverage ≥ 25°). (2) LCEA, ACEA, and acetabular coverage differed according to APP tilt angle. LCEA and acetabular coverage showed maximum values at 10°. ACEA showed a tendency to increase by an average of 3.6° for every 5° increase in the APP tilt angle. LCEA demonstrated strong and very strong associations across all APP tilting angles, whereas ACEA showed a moderate association at angles ≥ 15° in men and ≥ 30° in women.ConclusionsThe LCEA and ACEA are adequate measurement methods that reflect actual acetabular coverage unless the pelvis is tilted excessively anteriorly. While pelvic tilting does not need to be considered for LCEA within the physiologic range, it should always be taken into account for ACEA, as it increases by an average of 3.6° for every 5° increase in APP tilt angle.Level of evidenceLevel III: retrospective cohort study.

Treatment of degenerative lumbar scoliosis using transforaminal lumbar interbody fusion based on the concept of intervertebral correction.

The study aimed to examine the outcomes of posterior approach transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS) based on the concept of intervertebral correction. A retrospective analysis was performed on 76 surgical patients (36 males and 40 females) who underwent posterior TLIF and internal fixation based on the concept of intervertebral correction in Shenzhen Traditional Chinese Medicine Hospital from February 2014 to March 2021.The operation duration, intraoperative blood loss, incision length, and complications were recorded. Clinical efficacy was evaluated preoperatively and postoperative time points through the visual analog scale (VAS) and the Oswestry disability index (ODI). The changes in the coronal scoliosis curve (Cobb angle), coronal balance distance (CBD), the sagittal vertical axis (SVA), lumbar lordosis (LL), and pelvic tilt angle (PT) were assessed perioperatively at the last follow-up. All patients successfully underwent the operation. The average operation duration was 243.81 ± 35.35 (220 - 350) min; the average intraoperative blood loss was 836.27 ± 50.28 (700 - 2500) mL; the average incision length was 8.30 ± 2.33 (8 - 15) cm. The total complication rate was 18.42% (14/76). The VAS score of low back pain, lower extremity pain, and ODI score of patients at the last follow-up was significantly improved compared with those before the operation (P < 0.05). At the last follow-up, the Cobb Angle, CBD, SVA, and PT of patients were significantly lower than those before the operation (P < 0.05), and LL was higher than those before the operation (P < 0.05). TLIF based on the concept of intervertebral correction for the treatment of DLS may provide favourable clinical outcomes.

The Impact of Spinopelvic Alignment on the Facet Joint Degeneration.

Retrospective Cohort. This study aims to evaluate the relations between facet joint degeneration (FD) and sagittal spinopelvic parameters. Second, the association of FD with degenerative disc disease (DDD) and lumbar disc herniations (LDH) was assessed. The radiologic data of 192 patients was retrospectively analyzed. Total, proximal, and distal lumbar lordosis (LL, PLL, and DLL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sacral table angle (STA) were measured on lumbar x-ray plates. DDD and FD was graded on the MRI images. The apex of lumbar lordosis and PI-LL imbalance were noted in each patient. Correlation analyses were performed. Age and body mass index (BMI) were correlated with FD. LL and DLL are positively associated with upper-level FDs (L1-2 and L2-3) (P < 0,05). PLL were positively associated with lower level FD (L5-S1) (P < 0,05). A significant increase in PI was associated with FD in L2-3 and L4-5. A larger PT was found in FD in L4. The PI-LL imbalance was not correlated with the FD. Correlation between DDD and LDH and FD was observed in each level (P < 0,01). The level of FD is not affected by the apex of the curve. Age and BMI have a direct impact on FD. However, spinopelvic parameters influence the severity of FD rather than its occurrence. In addition to the effects of lumbar lordosis as a single entity, it is essential to consider separately the effects of proximal and distal lumbar lordosis at the FD level.

라켓 스포츠, 비라켓 스포츠 종목 및 일반 대학생의 근 골격 정렬 및 균형의 차이 비교

This study is intended to analyze the characteristics and differences of posture and body unbalance among racket sport players, non-racket players, and general college students. This study conducted the posture analysis and body unbalance measurement of a total of 26 participants with racket sport players(n=5 ), non-racket p layers(n=7), and general college students(n=14). BR The results suggested that the racket sport group showed a significantly higher level in a musculoskeletal index(F=4.144, p.05), a pelvic tilt angle(F=4.844, p.05), musculoskeletal misalignment deviation(F=5.495, p.05), and a general musculoskeletal index(F=4.146, p.05) than the non-racket sport group. A pelvic tilt was significantly higher in the racket sport group than in the non-racket sport group(F=4.844, p.05). Knee flexion was significantly higher in the non-racket sport group than in the general college students(F=4.844, p.05). Ankle inclination was significantly higher in the racket sport group than in the non-racket group and the general college students(F=9.027, p.01).BR In conclusion, the racket sport group showed significantly higher results in a musculoskeletal index, a pelvic tilt, musculoskeletal misalignment, and a general musculoskeletal index than the non-racket sport group. Thus, they need to continue additional training for posture correction. This result will provide basic data to design a customized prevention program of body unbalance and musculoskeletal diseases due to sport event characteristics.

Prevalence and Risk Factors of Degenerative Spondylolisthesis and Retrolisthesis in the Thoracolumbar and Lumbar Spine - An EOS Study Using Updated Radiographic Parameters.

Single centre, cross-sectional study. The objective is to report the prevalence of spondylolisthesis and retrolisthesis, analyse both conditions in terms of the affected levels and severity, as well as identify their risk factors. A review of clinical data and radiographic images of consecutive spine patients seen in outpatient clinics over a 1-month period is performed. Images are obtained using the EOS® technology under standardised protocol, and radiographic measurements were performed by 2 independent, blinded spine surgeons. The prevalence of both conditions were shown and categorised based on the spinal level involvement and severity. Associated risk factors were identified. A total of 256 subjects (46.1% males) with 2304 discs from T9/10 to L5/S1 were studied. Their mean age was 52.2(± 18.7) years. The overall prevalence of spondylolisthesis and retrolisthesis was 25.9% and 17.1% respectively. Spondylolisthesis occurs frequently at L4/5(16.3%), and retrolisthesis at L3/4(6.8%). Majority of the patients with spondylolisthesis had a Grade I slip (84.3%), while those with retrolisthesis had a Grade I slip. The presence of spondylolisthesis was found associated with increased age (P < .001), female gender (OR: 2.310; P = .005), predominantly sitting occupations (OR:2.421; P = .008), higher American Society of Anaesthesiology grades (P = .001), and lower limb radiculopathy (OR: 2.175; P = .007). Patients with spondylolisthesis had larger Pelvic Incidence (P < .001), Pelvic Tilt (P < .001) and Knee alignment angle (P = .011), but smaller Thoracolumbar junctional angle (P = .008), Spinocoxa angle (P = .007). Retrolisthesis was associated with a larger Thoracolumbar junctional angle (P =.039). This is the first study that details the prevalence of spondylolisthesis and retrolisthesis simultaneously, using the EOS technology and updated sagittal radiographic parameters. It allows better understanding of both conditions, their mutual relationship, and associated clinical and radiographic risk factors.

The dynamic sagittal balance: Definition of dynamic spino-pelvic parameters using a method based on gait analysis

IntroductionEvaluation of sagittal balance parameters is a standard assessment before spine surgery. However, these parameters can change during walking. We aimed to describe the behavior of spino-pelvic parameters during walking in healthy subjects. Material and methodsAnalyses were performed in 60 healthy subjects. Static spinal sagittal balance parameters were assessed. We performed gait analysis and we used SMART-DX 500® to analyze parameters aimed at defining dynamic sagittal balance, including pelvic tilt angle (PTA), sagittal trunk shift (STS), and trunk angle (TA). We considered rotational and obliquity movements of the pelvis, flexo-extension movements of the hip, trunk, and knees. Analyses were performed in a standing posture and during walking. ResultsPTA-cycle, PTA-stance, PTA-swing, STS-cycle, STS-stance, and STS-swing showed good-to-excellent internal reliability (ICC = 0.867; ICC = 0.700; ICC = 0.817, respectively). The parameters with the lowest variability were radiographic PI (CV = 16.53%), PTA-stance (CV = 9.55%), and PTA-swing (CV = 17.22%). PT was directly related to PTA-cycle (r = 0.534, p = .027). PI was inversely correlated with trunk flexo-extension range of motion (r = −0.654, p = .004) and dynamic PT (r = −0.489, p = .047). LL and SS were directly related to knee flexo-extension (r = 0.505, p = .039; r = 0.493, p = .045, respectively). SVA was correlated with the trunk obliquity in dynamics (r = 0.529, p = .029). PTA-cycle was directly related to trunk obliquity (r = 0.538, p = .049). STS and TA in the three phases of step were related to the kinematic parameters of the pelvis. TA was related to flexo-extension of the hip and knee. ConclusionsVariations of dynamic spino-pelvic parameters occur during walking and modify sagittal balance from a static to a dynamic condition.

AUTOMATED LANDMARK DETECTION IN FUNCTIONAL LATERAL RADIOGRAPHS USING DEEP LEARNING

Evaluation of patient specific spinopelvic mobility requires the detection of bony landmarks in lateral functional radiographs. Current manual landmarking methods are inefficient, and subjective. This study proposes a deep learning model to automate landmark detection and derivation of spinopelvic measurements (SPM).A deep learning model was developed using an international multicenter imaging database of 26,109 landmarked preoperative, and postoperative, lateral functional radiographs (HREC: Bellberry: 2020-08-764-A-2). Three functional positions were analysed: 1) standing, 2) contralateral step-up and 3) flexed seated. Landmarks were manually captured and independently verified by qualified engineers during pre-operative planning with additional assistance of 3D computed tomography derived landmarks. Pelvic tilt (PT), sacral slope (SS), and lumbar lordotic angle (LLA) were derived from the predicted landmark coordinates. Interobserver variability was explored in a pilot study, consisting of 9 qualified engineers, annotating three functional images, while blinded to additional 3D information. The dataset was subdivided into 70:20:10 for training, validation, and testing.The model produced a mean absolute error (MAE), for PT, SS, and LLA of 1.7°±3.1°, 3.4°±3.8°, 4.9°±4.5°, respectively. PT MAE values were dependent on functional position: standing 1.2°±1.3°, step 1.7°±4.0°, and seated 2.4°±3.3°, p&lt; 0.001. The mean model prediction time was 0.7 seconds per image. The interobserver 95% confidence interval (CI) for engineer measured PT, SS and LLA (1.9°, 1.9°, 3.1°, respectively) was comparable to the MAE values generated by the model.The model MAE reported comparable performance to the gold standard when blinded to additional 3D information. LLA prediction produced the lowest SPM accuracy potentially due to error propagation from the SS and L1 landmarks. Reduced PT accuracy in step and seated functional positions may be attributed to an increased occlusion of the pubic-symphysis landmark. Our model shows excellent performance when compared against the current gold standard manual annotation process.

Hip Abduction Can Be Considered the Sole Posterior Precaution Strategy to Lower the Rate of Impingement After Posterior Approach Total Hip Arthroplasty With Large Femoral Head: A Computer Simulation Study

BackgroundStudies suggest that posterior hip precautions are unnecessary after total hip arthroplasty; however, many surgeons and patients choose to follow these precautions to some extent. In this study, we hypothesized that 20° of hip abduction would be sufficient to prevent impingement and dislocation in motions requiring hip flexion when using larger prosthetic heads (≥36 mm) when the acetabular implant is placed within a reasonable orientation (anteversion:15-25° and inclination: 40-60°). MethodsUsing a robotic hip platform, we investigated the effect of hip abduction on prosthetic and bony impingement in 43 patients. For the flexed seated position, anterior pelvic tilt angles of 10 and 20° were chosen, while anterior pelvic tilt angles of 70 and 90° were chosen for the bending forward position. An additional 10° of hip external rotation and 10 or 20° of hip internal rotation were also added to the simulation. One hip received a 32-mm head; otherwise, 36-, 40-mm, or dual-mobility heads were used. The study power was 0.99, and the effect size was 0.644. ResultsIn 65% of the cases, bone-bone impingement between the calcar and anterior-inferior iliac spine was the main type of impingement. The absolute risk of impingement decreased between 0 and 16.3% in both tested positions with the addition of 20° hip abduction. ConclusionWith modern primary total hip arthroplasty stems (low neck diameter) and an overall acceptable cup anteversion angle, small degrees of hip abduction may be the only posterior hip precaution strategy required to lower the risk of dislocation among patients. Future studies can potentially investigate the concept of personalized hip precautions based on preoperative computer simulations, utilized implants, hip-spine relations, and final implant orientation.

異なる腸腰筋ストレッチングが脊椎と骨盤に与える影響

[Purpose] This study investigated the effects of three types of iliopsoas stretching method on the spine and pelvis. [Participants and Methods] The subjects were 18 healthy university students. Three sets of 20-second static stretching (SS), hold relax-proprioceptive neuromuscular facilitation stretching (HR-PNF), and dynamic stretching (DS) exercises were performed on the iliopsoas muscle, and the T12, S1, lumbar lordosis angle, lumbar range of motion, and pelvic tilt angle were measured before, immediately after, and 30, 60, and 90 minutes after stretching. [Results] HR-PNF elicited an increase in T12 and a decrease in pelvic tilt angle. A decrease in T12 was observed after DS. It was found that the range of motion of the lumbar spine increased to some extent regardless of the stretching method. [Conclusion] HR-PNF was found to be the most effective stretching method of the three for reducing pelvic tilt in healthy young subjects.