Sacropelvic Balance Research Articles

Лечение костно-болевого синдрома у пациентов с компрессионными, неосложненными переломами поясничных позвонков на II-III этапах восстановительного лечения

The aim of this prospective study is to improve the results of treating type A1 and A2 uncomplicated vertebral compression fractures using intratissual electric stimulation (ITES) during II and III stages of rehabilitation treatment. Materials and Methods. The study analyses the use of intratissual electric stimulation (ITES) for treating bone pain syndrome of the patients with type A1 and A2 mono and bisegmental spinal fractures (according to Magerl classification) in a distant period. The whole population is 86 patients, aged from 45 to 65. In-patients were treated using vertebral column extension, some physical therapy and medication. The observation period lasted 12-36 months. It is the stage of control observation. The patients who complained of constant and reemerging pain syndrome were treated using intratissual electric stimulation (ITES). Immediate, short- and long-term outcome analysis was carried out. It is the final stage of the treatment. Clinical, neurotic and rehabilitation status of the patients is analized taking into account Sagittal balance parameters, the spinal canal condition and rehabilitation vectors with numerical ratings. The objective pain assessment was performed by measuring skin surface electric potential according to Gerasimov (1991). The quality of life was assessed using Oswestry Disability Index (ODI). Results. The analysis of morphometric characteristics pointed out changes in sacro-pelvic correlation (LSB), flattening of lumbar lordosis, stenosis of the spinal canal, post-traumatic changes and involution in lumbar and thoracic vertebrae. The control stage of the research revealed significant improvement of patients’ sacro-pelvic balance parameters, pain syndrome elimination and the improvement of the quality life. Conclusion. The pathogenetically substantiated method of treating adult or elderly patients with spinal traumas, the use of intratissual electric stimulation at the outpatient rehabilitation stage prove to be effective.

Sagittal spinal alignment in asymptomatic patients over 30years old in the Korean population.

We aim to provide sagittal and pelvic parameters according to different age groups in an asymptomatic population all over 30years old and to investigate the possible causes of changes in these parameters. Whole-spine, standing lateral radiographs were taken in 128 asymptomatic Korean people over 30years old. The spinal parameters (the total thoracic kyphosis (TTK), maximal lumbar lordosis (MLL), total lumbar lordosis (TLL), lower lumbar lordosis (LLL), thoracolumbar junctional angle (TLJA), and lumbar inclination (LI)), pelvic parameters (pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT)), and spinal balance parameters (spinal balance, sacropelvic balance, and spinopelvic balance) were measured. The body mass index, body protein mass, waist line, skeletal muscle mass, and body fat mass were also measured for potential causes. TTK and TLJA were significantly increased in the group over 70years of age compared to the other age groups (p = 0.0002, <0.001). TLL was significantly decreased in the group over 70years of age (p = 0.002), whereas the PI values were similar to PI even in over 70-year age group. LLL did not differ in the group over 70years of age (p = 0.29), gradually increasing with an increase in age. SS was significantly decreased and PT was significantly increased in the group over 70years of age as compared to the other age groups (p = 0.049, 0.049, respectively). PI was similar in all age groups (p = 0.75). Spinal balance was significantly decreased in the group over 70years of age (p = <0.0001). PT was significantly associated with body protein mass and skeletal muscle mass (p = 0.01, 0.001, respectively). Body protein mass and skeletal muscle mass were significantly lower in the group over 70years of age (p = 0.02, 0.02) and were possible causes. Several sagittal and pelvic parameters are different in asymptomatic adults over 70years of age. Decreased body protein mass and skeletal muscle mass are possible causes of these changes.

Surgical treatment of low grade spondylolisthesis: the modern state of the problem

The paper presents a literature review on contemporary problems of surgical treatment of low grade spondylolisthesis. The results of various surgical techniques including modern minimally invasive methods of treatment are provided. The importance of selecting a method of surgical intervention depending on the type of spondylolisthesis, sacro-pelvic balance, and global sagittal balance is indicated, as well as their influence on the quality of life of patients. Complications and causes of pseudoarthrosis development depending on different methods of interbody fusion are discussed. The choice of optimal treatment tactic is the main problem in surgery of low grade spondylolisthesis.

Current concepts on the sagittal balance and classification of spondylolysis and spondylolisthesis

Treatment of spondylolysis and spondylolisthesis remains a challenge for orthopaedic surgeons, neurosurgeons and paediatrics. In spondylolisthesis, it has been clearly demonstrated over the past decade that spino-pelvic morphology is abnormal and that it can be associated to an abnormal sacro-pelvic orientation as well as to a disturbed global sagittal balance of spine. This article presents the SDSG (Spinal Deformity Study Group) classification of lumbosacral spondylolisthesis. The proper treatment of spondylolisthesis is dependent on recognizing the type of slip, sacro-pelvic balance and overall sagittal balance and its natural history. Although a number of clinical radiographic features have been identified as risk factors, their role as primary causative factors or secondary adaptative changes is not clear. The conservative treatment of adult isthmic spondylolisthesis results in good outcome in the majority of cases. Of those patients who fail conservative treatment, success with surgery is quite good, with significant improvement in neurologic function in those patients with deficits, as well as improvement in patients with back pain.

Conceitos atuais sobre equilíbrio sagital e classificação da espondilólise e espondilolistese

Treatment of spondylolisis and spondylolisthesis remains a challenge for orthopedic surgeons, neurosurgeons and pediatrics. In Spondylolysthesis, it has been clearly demonstrated over the past decade that spino-pelvic morphology is abnormal and that it can be associated to an abnormal sacro-pelvic orientation as well as to a disturbed global sagitall balance of spine. This article presents the SDSG (Spinal Deformity Study Group) classification of lumbosacral spondylolisthesis. The proper treatment of spondylolisthesis is dependent on recognizing the type of slip, sacro-pelvic balance and overall sagittal balance and its natural history. Although a number of clinical radiographic features have been identified as risk factors, their role as primary causative factors or secundary adaptative changes is not clear. The conservative treatment of adult isthmic spondylolisthesis results in good outcome in the majority of cases. Of those patients that fail conservative treatment, success with surgery is quite good, with significant improvement in neurologic function in those patients with deficits, as well as improvement in patients with back pain.

Relationship Between Dysplasia and Sagittal Sacropelvic Balance in Adolescents with Spondylolisthesis

Relationship Between Dysplasia and Sagittal Sacropelvic Balance in Adolescents with Spondylolisthesis

Normal Patterns of Sagittal Alignment of the Spine in Young Adults Radiological Analysis in a Korean Population

Radiological analysis and classification of normal patterns of sagittal alignment of the spine. To classify the patterns of sagittal alignment of the spine in young asymptomatic adults and analyze the differences in the various spinal and pelvic parameters according to these patterns. Previous studies reported that the overall sagittal pattern and balance were more important than the normative values. There are few studies on white populations, classifying the normal patterns of sagittal curvature, and no studies on Asian populations. Whole spine, standing lateral radiographs of 86 Korean volunteers were taken. The pelvic and spinal parameters (total thoracic kyphosis, horizontal thoracic level, thoracolumbar junctional angle (TLJA), total lumbar lordosis, lower lumbar lordosis, horizontal lumbar level (HLL), lumbar inclination, pelvic tilt, sacral slope (SS), pelvic incidence, spinal balance, spinopelvic balance, and sacropelvic balance) were measured and the correlations of all parameters were analyzed. The volunteers were classified in to three types according to their HLL. The data were analyzed statistically to determine the differences in the parameters and balance between the three types. The HLL showed a significant correlation with the lumbar inclination, junctional level, TLJA, spinal balance, spinopelvic balance, and SS on analyzing the correlation of the parameters. As HLL moved caudally, the TLJA and lumbar inclination increased, whereas the lower lumbar lordosis, pelvic incidence, and SS decreased and spinal balance became more negative. There were no significant differences in total thoracic kyphosis and sacropelvic balance between the three types. The patterns of sagittal alignment could be classified into three types showing that the spinal balance becomes more negative, the lumbar inclination and TLJA increase, the SS and pelvic incidence decrease, and lumbar lordotic curves becomes shorter as the patterns of sagittal curvature move toward type 3. This classification in young adults should be considered individually as a reference for surgeons aiming to restore the lumbar lordosis and sagittal alignment in degenerative lumbar fusion surgery.

Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults

Many studies suggest the importance of the sagittal sacropelvic balance and morphology in spinal and hip disorders. This study describes the normal age- and sex-related changes in sacropelvic morphology and balance in a prospective cohort of asymptomatic adults without spinal disorder. A prospective cohort of 709 asymptomatic adults without spinal pathology was recruited. There were 354 males and 355 females aged 37.9 ± 14.7 and 35.7 ± 13.9 years, respectively. For each subjects, pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured from standing lateral radiographs. Ratios of SS to PI (SS/PI), PT to PI (PT/PI), and PT to SS (PT/SS) were also calculated. There was no significant difference in PI (pelvic incidence), SS (sacral slope), PT (pelvic tilt), PT/PI, SS/PI, or PT/SS between males and females. The mean ± 2 standard deviations (SD) range was 32°-74°, 0°-27°, and 24°-55° for PI, PT and SS, respectively. The mean ± 2 SD range was greater than 0.5 for SS/PI and less than 0.5 for PT/PI. PI was not related to age in either sex group. PT, SS, PT/PI, SS/PI, and PT/SS presented only weak correlation coefficients (r ≤ 0.21) with respect to age. The current study presents the largest cohort of asymptomatic adults in the literature dedicated to the evaluation of sagittal sacropelvic morphology and balance. The range of values corresponding to the mean ± 2 SD can provide invaluable information to clinicians about the normal range of values expected in 95% of the normal population.

Reliability and development of a new classification of lumbosacral spondylolisthesis

BackgroundA classification of lumbosacral spondylolisthesis has been proposed recently. This classification describes eight distinct types of spondylolisthesis based on the slip grade, the degree of dysplasia, and the sagittal sacro-pelvic balance. The objectives of this study are to assess the reliability of this classification and to propose a new and refined classification.MethodsStanding posteroanterior and lateral radiographs of the spine and pelvis of 40 subjects (22 low-grade, 18 high-grade) with lumbosacral spondylolisthesis were reviewed twice by six spine surgeons. Each radiograph was classified based on the slip grade, the degree of dysplasia, and the sagittal sacro-pelvic balance. No measurements from the radiographs were allowed. Intra- and inter-observer reliability was assessed using kappa coefficients. A refined classification is proposed based on the reliability study.ResultsAll eight types of spondylolisthesis described in the original classification were identified. Overall intra- and inter-observer agreement was respectively 76.7% (kappa: 0.72) and 57.0% (kappa: 0.49). The specific intra-observer agreement was 97.1% (kappa: 0.94), 85.0% (kappa: 0.69) and 88.8% (kappa: 0.85) with respect to the slip grade, the degree of dysplasia, and the sacro-pelvic balance, respectively. The specific inter-observer agreement was 95.2% (kappa: 0.90), 72.2% (kappa: 0.43) and 77.2% (kappa: 0.69) with respect to the slip grade, the degree of dysplasia, and the sacro-pelvic balance, respectively.ConclusionThis study confirmed that surgeons can classify radiographic findings into all eight types of spondylolisthesis. The intra-observer reliability was substantial, while the inter-observer reliability was moderate mainly due to the difficulty in distinguishing between low- and high-dysplasia. A refined classification excluding the assessment of dysplasia, while incorporating the assessment of the slip grade, sacro-pelvic balance and global spino-pelvic balance is proposed, and now includes five types of lumbosacral spondylolisthesis.