Sagittal Curvature Research Articles

The radiographic, pulmonary, and clinical outcomes of patients with severe rigid spinal deformities treated via halo\u2010pelvic traction

BackgroundThe severe rigid deformity patients with pulmonary dysfunction could not tolerate complicated corrective surgery. Preoperative traction are used to reduce the curve magnitude and improve the pulmonary function before surgery, including halo-gravity traction (HGT) and halo-pelvic traction (HPT). The present study aimed to retrospectively compare the radiographic, pulmonary and clinical outcomes of preoperative HGT and HPT in severe rigid spinal deformity with respiratory dysfunction.Methods81 cases of severe rigid kyphoscoliosis treated with preoperative traction prior to corrective surgery for spinal deformity between 2016 and 2019 were retrospectively reviewed. Two patient groups were compared, HPT group (N = 30) and HGT group (N = 51). Patient demographics, coronal and sagittal Cobb angles and correction rates, pulmonary function, traction time, osteotomy grade, and postoperative neurological complications were recorded for all cases.ResultsThe coronal Cobb angle was corrected from 140.67 ± 2.63 to a mean of 120.17 ± 2.93° in the HGT group, and from 132.32 ± 4.96 to 87.59 ± 3.01° in the HPT group (mean corrections 15.33 ± 1.53 vs. 34.86 ± 3.11 %) (P = 0.001). The mean major sagittal curve decreased from 134.28 ± 3.77 to 113.03 ± 4.57° in the HGT group and from 129.60 ± 8.45 to 65.61 ± 7.86° in the HPT group (P < 0.001); the mean percentage corrections were 16.50 ± 2.13 and 44.09 ± 9.78 % (P < 0.001). A significant difference in the pulmonary function test results was apparent between the two groups; the mean improvements in the FVC% of the HGT and HPT groups were 6.76 ± 1.85 and 15.6 ± 3.47 % (P = 0.024). The HPT group tended to exhibit more FEV% improvement than the HGT group, but the difference was not significant (5.15 ± 2.27 vs. 11.76 ± 2.22 %, P = 0.91).ConclusionsPatients with severe rigid kyphoscoliosis who underwent preoperative HPT exhibited better radiographic correction of the deformity, and pulmonary function, and required fewer osteotomies compared to the HGT group. Thus, HPT may be useful for severe rigid spinal deformity patients with pulmonary dysfunction.

Growth-Friendly Spine Surgery in Arthrogryposis Multiplex Congenita.

Arthrogryposis multiplex congenita (AMC) is a condition that describes neonates born with ≥2 distinct congenital contractures. Despite spinal deformity in 3% to 69% of patients, inadequate data exist on growth-friendly instrumentation (GFI) in AMC. Our study objectives were to describe current GFI trends in children with AMC and early-onset scoliosis (EOS) and to compare long-term outcomes with a matched idiopathic EOS (IEOS) cohort to determine whether spinal rigidity or extremity contractures influenced outcomes. Children with AMC and spinal deformity of ≥30° who were treated with GFI for ≥24 months were identified from a multicenter EOS database (1993 to 2017). Propensity scoring matched 35 patients with AMC to 112 patients with IEOS with regard to age, sex, construct, and curve. Multivariable linear mixed modeling compared changes in spinal deformity and the 24-item Early Onset Scoliosis Questionnaire (EOSQ-24) across cohorts. Cohort complications and reoperations were analyzed using multivariable Poisson regression. Preoperatively, groups did not differ with regard to age (p = 0.87), sex (p = 0.96), construct (p = 0.62), rate of nonoperative treatment (p = 0.54), and major coronal curve magnitude (p = 0.96). After the index GFI, patients with AMC had reduced percentage of coronal correction (35% compared with 44%; p = 0.01), larger residual coronal curves (49° compared with 42°; p = 0.03), and comparable percentage of kyphosis correction (17% compared with 21%; p = 0.52). In GFI graduates (n = 81), final coronal curve magnitude (55° compared with 43°; p = 0.22) and final sagittal curve magnitude (47° compared with 47°; p = 0.45) were not significantly different at the latest follow-up after definitive surgery. The patients with AMC had reduced T1-S1 length (p < 0.001), comparable T1-S1 growth velocity (0.66 compared with 0.85 mm/month; p = 0.05), and poorer EOSQ-24 scores at the time of the latest follow-up (64 compared with 83 points; p < 0.001). After adjusting for ambulatory status and GFI duration, patients with AMC developed 51% more complications (incidence rate ratio, 1.51 [95% confidence interval (CI), 1.11 to 2.04]; p = 0.009) and 0.2 more complications/year (95% CI, 0.02 to 0.33 more; p = 0.03) compared with patients with IEOS. Patients with AMC and EOS experienced less initial deformity correction after the index surgical procedure, but final GFI curve magnitudes and total T1-S1 growth during active treatment were statistically and clinically comparable with IEOS. Nonambulatory patients with AMC with longer GFI treatment durations developed the most complications. Multidisciplinary perioperative management is necessary to optimize GFI and to improve quality of life in this complex population. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Sagittal curvature of the spine as a predictor of the pediatric spinal deformity development.

The sagittal curvature of the spine is hypothesized to play an important role in induction of spinal deformities in adolescent idiopathic scoliosis. We previously showed an S shaped flexible rod, with the same curvature as the pediatric sagittal spinal curve, produces scoliotic-like deformities under physiologic loading. Yet, detailed characteristics of the pediatric sagittal spinal curves associated with higher risk of scoliosis are not well defined. A total of 32 patients in a population with a high prevalence of idiopathic-like scoliosis, 22q11.2 deletion syndrome (22q), were included and followed up for at least two-years. We developed a reduced order finite element model (FEM) of the sagittal profile of these 32 patients where the spine was modeled as an S shaped elastic rod. We related the geometrical parameters of the sagittal curves and the deformed FEM of the corresponding S shaped rods to the risk of scoliosis development at two-year follow-up in this cohort. Variations in the sagittal curvature in the cohort of 22q patients resulted in five different deformity patterns shown by finite element analyses. Two sagittal plane deformity pattern groups had high rate of scoliosis development (86% and 100%) whereas the other 3 groups had less than 50% rate of scoliosis development (40%, 33%, and 0%). The pre-scoliotic position of the inflection point (where lordosis turns into kyphosis), the ratio of the spinal curvatures above and below the inflection point, and the length of the spinal curve above and below the inflection point were significantly different between the five deformity patterns groups, p < 0.05. Combination of geometrical parameters of the sagittal profile prior to onset of scoliosis can relate to the development of spinal deformity in pediatric population.

Comparison of different strategies on three-dimensional correction of AIS: which plane will suffer?

PurposeThere are distinct differences in strategy amongst experienced surgeons from different ‘scoliosis schools’ around the world. This study aims to test the hypothesis that, due to the 3-D nature of AIS, different strategies can lead to different coronal, axial and sagittal curve correction.MethodsConsecutive patients who underwent posterior scoliosis surgery for primary thoracic AIS were compared between three major scoliosis centres (n = 193). Patients were treated according to the local surgical expertise: Two centres perform primarily an axial apical derotation manoeuvre (centre 1: high implant density, convex rod first, centre 2: low implant density, concave rod first), whereas centre 3 performs posteromedial apical translation without active derotation. Pre- and postoperative shape of the main thoracic curve was analyzed using coronal curve angle, apical rotation and sagittal alignment parameters (pelvic incidence and tilt, T1–T12, T4-T12 and T10-L2 regional kyphosis angles, C7 slope and the level of the inflection point). In addition, the proximal junctional angle at follow-up was compared.ResultsPre-operative coronal curve magnitudes were similar between the 3 cohorts and improved 75%, 70% and 59%, from pre- to postoperative, respectively (P < 0.001). The strategy of centres 1 and 2 leads to significantly more apical derotation. Despite similar postoperative T4-T12 kyphosis, the strategy in centre 1 led to more thoracolumbar lordosis and in centre 2 to a higher inflection point as compared to centre 3. Proximal junctional angle was higher in centres 1 and 2 (P < 0.001) at final follow-up.ConclusionCurve correction by derotation may lead to thoracolumbar lordosis and therefore higher risk for proximal junctional kyphosis. Focus on sagittal plane by posteromedial translation, however, results in more residual coronal and axial deformity.

Evaluation methods of sagittal curvatures in invasive examinations of the spine: a systematic review

Introdução: A avaliação das curvaturas sagitais da coluna vertebral auxilia na determinação dos padrões posturaisdos indivíduos. Objetivo: Revisar sistematicamente os métodos de avaliação das curvaturas sagitais da coluna vertebralno exame de Raios-X descritos em estudos observacionais. Métodos: Foi realizada uma busca sistemática nasbases de dados Scopus, Science, Bireme e Pubmed. Os principais desfechos extraídos foram os métodos utilizadospara avaliar as curvaturas torácica e lombar da coluna vertebral no plano sagital através do exame de Raios-X. Paraavaliação da qualidade metodológica foi utilizado o checklist de Brink, Louw. Resultados: Nos 23 artigos incluídosnessa revisão, encontramos nove métodos diferentes para avaliar as curvaturas sagitais, tais como Cobb (2 ou 4 linhas),Cobb alternativo, Cobb máximo ou não constricto, Raio da curvatura, TRALL, Círculos tangenciais, Tangentesposteriores, Centroides e PR. Os métodos não dependentes dos platôs vertebrais, tais como Centroides, Círculostangenciais, Cobb alternativo, Raio da curvatura para a coluna torácica; Centroide, Tangente posterior, TRALL e PRpara a lombar apresentam iguais ou melhores valores de reprodutibilidade e menor variabilidade de medidas quequando comparados ao ângulo Cobb. Conclusão: Os métodos encontrados mostraram grande correlação com o padrãoouro (ângulo Cobb), tanto para coluna torácica, quanto para a lombar, e podem ser utilizados, em ambos osâmbitos, da pesquisa e da prática clínica, já que apresentam iguais ou melhores valores de reprodutibilidade e menorvariabilidade de medidas que quando comparados ao ângulo Cobb.

Defining the effective deformation of the vertebral column

Summary The Cobb angle is calculated in the coronal plane, irrespective of vertebral rotation, lordokyphosis and local wedge properties of individual verte-brae other than the end plates used for the measurement. Rigorous three-dimensional generalizations of the Cobb angle are complicated for at least two reasons. Firstly, the vertebral column is segmented, not continuous, making the choice of rigorous model ambiguous. Secondly, there exists an inherent curvature (in terms of thoracic kyphosis and lumbar lordosis) that may be considered physiologically healthy or ’normal’. When attempting to find a three-dimensional deviation measure, such normal sagittal curvature must be compensated for. In this paper we introduce a three-dimensional local deformation parameter (which we call the local effective deformation) motivated by both biomechanics and the basic theory of spatial curves, and simultaneously introduce a technical procedure to estimate the parameter from CT scans using MPR (multi-phase reconstruction) in PACS (IDS-7). A detailed description of the proposed modelling of vertebral column deformation is given, together with a stepwise procedure to estimate the three-dimensional deformation (in terms of local effective deformation). As a deformation measure it requires knowledge about the natural healthy kypholordosis. A method is described by which such knowledge may be incorporated in future work.

Revisiting thoracic kyphosis: a normative description of the thoracic sagittal curve in an asymptomatic population.

Thoracic kyphosis (TK) remained in the shadow of lumbar lordosis. Based on Berthonnaud and Roussouly segmentation, TK is divided into two arches: upper TK (UTK) and lower TK (LTK). The purpose of this study is to propose a normative description of the TK arches in an asymptomatic adults' population and their correlation with spinal and pelvic parameters. This is an observational study performed on asymptomatic healthy Caucasians volunteers aged between 18 and 45years. Each patient had a standardized standing biplanar full spine X-rays. Using KEOPS®, sacropelvic parameters and global spinal parameters (LL, TK) as well as the inflexion point location were measured. The upper lumbar lordosis angle (ULL) as well as LTK and UTK was calculated. Patients were classified according to Roussouly morphotypes of normal spine. A total of 373 adults (F/M = 1.4/1) were enrolled with mean age of 27years. Mean UTK averaged 25.8°, while mean LTK averaged 19.8° (p < 0.001). UTK angle values were statistically the same in the five different Roussouly spinal shapes (p > 0.05), while LTK values were variable among different Roussouly spine subtypes (p < 0.05). Finally, TK showed the highest correlation with the LL mainly with the ULL (Pearson = 0.66). In asymptomatic young adults, thoracic kyphosis is composed by two unequal arches, a stable UTK and a variable LTK, with an apex around T8 and T9 vertebra, depending on the spinal morphotype according to Roussouly classification. This should be taken into consideration when analyzing spine sagittal compensation and preparing corrections to minimize risk of mechanical complications.

Kickboxers and crossfitters vertebral column curvatures in sagittal plane: Crossfit practice influence in kickboxers body posture

BackgroundIn combat sports, long-term training load can lead to sport-specific functional and body posture adaptations. The most often observed changes are in the shape of the anterior-posterior spinal curvatures. The abnormal inclination of the thoracic and lumbar regions of the spine may lead to an additional overload of the musculoskeletal system and spinal pain or decrease sports performance. Therefore it is crucial to prevent disadvantageous body posture features. AimThe aim was to examine differences in vertebral column's sagittal curves parameters between kickboxing fighters, kickboxing fighters who also trained CrossFit and CrossFit athletes and evaluate these parameters' predictive ability to predict sport disciplines. Received results show if CrossFit training influences vertebral column curvatures in the sagittal plane among Kickboxers is an effective method in proper body posture shaping. MethodsThe study involved 45 men aged 25.2 years divided into three groups depending on the sport they practiced: group kickboxing (KB), kickboxing and CrossFit (KBCF), and CrossFit (CF). The body posture was observed using the photogrammetric method. The parameters of the sagittal plane were analyzed. ResultsAmong the kickboxers, it was observed that the angle of the thoracolumbar region, the angle of inclination of the thoracolumbar and lumbosacral regions significantly increased compared to other groups of athletes (p < 0.05). ConclusionPracticing kickboxing can be a factor in increasing the risk of postural defects. It was found that CrossFit training has a beneficial effect on the shape of physiological curvatures of the spine in combat sports athletes.

A Semi-Analytic Elastic Rod Model of Pediatric Spinal Deformity.

The mechanism of the scoliotic curve development in healthy adolescents remains unknown in the field of orthopedic surgery. Variations in the sagittal curvature of the spine are believed to be a leading cause of scoliosis in this patient population. Here, we formulate the mechanics of S-shaped slender elastic rods as a model for pediatric spine under physiological loading. Second, applying inverse mechanics to clinical data of the subtypes of scoliotic spines, with characteristic 3D deformity, we determine the undeformed geometry of the spine before the induction of scoliosis. Our result successfully reproduces the clinical data of the deformed spine under varying loads, confirming that the prescoliotic sagittal curvature of the spine impacts the 3D loading that leads to scoliosis.

A bi-radial approach to define the sagittal geometry of the healthy ankle

BackgroundPrevious descriptions of the sagittal geometry of the tibia and talus have involved single radius curves. The purpose of this investigation was to: determine if the sagittal curvature of the medial and lateral sides of the talus and tibia can be described by dividing the condyles into anterior and posterior regions, determine tibiotalar congruency, and categorize the morphological configurations of the talus and tibia. MethodsEighteen subjects underwent weightbearing CT scans and the osseous curvature was analyzed. ResultsFor the talus, the medial anterior radius was smaller than the lateral anterior radius. For the distal tibia, the lateral posterior radius was smaller than the medial posterior radius. Tibiotalar congruency varied by region. The most common geometric configuration was two cones, one anterior and one posterior, pointed in opposite directions. ConclusionThe sagittal profiles of the tibia and talus can be more accurately described using a bi-radial approach as compared to a single radius.

Evaluation of the association between postural control and sagittal curvature of the spine.

Balance is key to controlling body posture. Balance is typically assessed by measures of the body's vertical orientation, obtained by balancing out the forces acting on different body segments. The ability to maintain balance is assessed by evaluating centre of pressure (CoP) displacement; such assessments are typically used to evaluate responses to a treatment process. This study evaluated the efficiency of compensatory reactions in children according to the extent of thoracic kyphosis and lumbar lordosis. The study enrolled 312 children aged 8‒12 years, including 211 patients with postural disorders: thoracic kyphosis outside the 47‒50-degree range and lordosis outside the 38‒42-degree range (study group). A control group was also recruited and comprised 101 children without postural disorders. The DIERS formetric 4D system was used to assess posture and CoP displacement. Children in the study group showed a significantly greater range of CoP displacement than children in the control group. The kyphosis angle correlated with the maximum CoP displacement in the coronal plane and the maximum CoP displacement in the sagittal plane during gait. The kyphosis angle also correlated with the maximum CoP displacement back in the static test. The size of the lordosis angle correlated with the maximum displacement of CoP in the coronary plane during gait, and with the maximum displacement of CoP toward the left, forward, and backward in the static test. The correlation coefficient of the lordosis angle with displacement of the CoP in the sagittal plane was 0.999. We found an association between kyphosis and lordosis and the amplitude of CoP displacement, which may reflect the postural control system's response to biomechanical destabilisation caused by changes in kyphosis and lordosis.The lordosis angle correlation strength for displacement of CoP in sagittal plane is 0.999 and adopts a linear value.

Single vs dual rod constructs in early onset scoliosis treated with magnetically controlled growing rods.

Non-invasive distractions of recently introduced magnetically controlled growing rods (MGCRs) spare multiple operations in the surgical treatment of early onset scoliosis (EOS). Since the costs of the implants are high, concerns have been raised regarding cost-effective, optimal but safe MGCR options: single or dual constructs. To report deformity control, spinal growth and complication incidence in EOS patients treated with MCGR singleor dual-rod constructs. The study involved 47 patients with MCGRs inserted at Great Ormond Street Hospital, London (UK) in 2013-2014, who were followed up for at least 1 year. In 32 patients, T1-S1 distances, and coronal and sagittal curves were measured on preoperative and postoperative X-rays, and at a one-year follow-up. All complications were recorded. The patients were analyzed in 2 groups: those with single-rod constructs (24 patients) and those with dual-rod constructs (23 patients). Comparing postoperative with one-year follow-up measurements, T1-S1 length increase was better in the dual-rod group (3.29%) than in the single-rod group (0.34%) (p = 0.031). In the whole series, mean scoliosis magnitude dropped by 27.5% at the one-year follow-up. The dual-rod group showed better mean curve correction: 36.5% compared to 15.3% in the single-rod group (p = 0.0076). Overall, 34.04% of the patients had complications: 45.8% in the single-rod group and 30.4% in the dual-rod group (p = 0.0413). Metalwork failure was observed in 8 patients, lengthening problems in 5 and wound infections in 2; there was also 1 case of proximal junctional kyphosis (PJK). Preoperative hyperkyphosis was associated with more complications (75%, p = 0.037), most of which were metalwork failure (41.6%). The MCGRs are efficient at controlling EOS; however, the complication rate is high, particularly in single-rod constructs. The use of dual-rod constructs allows for better curve control, greater T1-S1 length increase and a lower complication rate.

A reduced-order model of the spine to study pediatric scoliosis.

The S-shaped curvature of the spine has been hypothesized as the underlying mechanical cause of adolescent idiopathic scoliosis. In earlier work, we proposed a reduced-order model in which the spine was viewed as an S-shaped elastic rod under torsion and bending. Here, we simulate the deformation of S-shaped rods of a wide range of curvatures and inflection points under a fixed mechanical loading. Our analysis determines three distinct axial projection patterns of these S-shaped rods: two loop (in opposite directions) patterns and one Lemniscate pattern. We further identify the curve characteristics associated with each deformation pattern, showing that for rods deforming in a Loop1 shape the position of the inflection point is the highest and the curvature of the rod is smaller compared to the other two types. For rods deforming in the Loop2 shape, the position of the inflection point is the lowest (closer to the fixed base) and the curvatures are higher than the other two types. These patterns matched the common clinically observed scoliotic curves-Lenke 1 and Lenke 5. Our S-shaped elastic rod model generates deformations that are similar to those of a pediatric spine with the same sagittal curvature characteristics and it can differentiate between the clinically observed deformation patterns.

Korelasi antara Berat Badan, Tinggi Badan, Indeks Massa Tubuh dan Rasio Lingkar Pinggang-Panggul dengan Hiperkifosis Torakal dan Hiperlordosis Lumbar pada Pelajar Sekolah Menengah Atas

Pendahuluan: Perubahan gaya hidup pada remaja berpotensi menyebabkan masalah pada pola berat badan, tinggi badan, dan berdampak pada indeks massa tubuh serta rasio lingkar pinggang-panggul. Perubahan ini disertai pula dengan perubahan pada kelengkungan sagital tulang belakang berupa hiperkifosis torakal dan hiperlordosis lumbar. Hiperkifosis torakal dan hiperlordosis lumbar merupakan suatu penyakit yang tidak hanya menyebabkan ketidaknyamanan pada siswa-siswi, namun juga pada dampak psikologis berupa gangguan citra diri. Tindakan preventif merupakan tindakan yang dapat dilakukan, yaitu mengetahui korelasi antar variabel dengan lengkung kifosis torakal dan lordosis lumbar.Metode: Penelitian ini merupakan penelitian cross-sectional dan dilakukan dalam 1 hari. Penelitian dilakukan di 2 sekolah, yaitu SMAN 2 Jakarta dan SMA Katolik Diakonia. Penelitian dilakukan dengan menggunakan timbangan untuk mengukur berat badan dan pita ukur untuk tinggi badan. Pengukuran tulang belakang sagital menggunakan flexicurve.Hasil: Dari 154 responden, 49,35% berjenis kelamin pria dan 50,65% berjenis kelamin wanita. Siswa-siswi yang mempunyai lengkung tulang belakang hiperkifosis adalah 24.68%, sedangkan untuk hiperlordosis lumbar adalah 24.02%. Ditemukan korelasi bermakna positif lemah didapatkan antara Indeks Massa Tubuh (IMT) dengan hiperlordosis lumbar, namun tidak ditemukan korelasi bermakna lainnya antar variabel. Korelasi bermakna lemah juga ditemukan antara lingkar pinggang dan li¬ngkar panggul dengan hiperlordosis lumbar.Kesimpulan: Terdapat korelasi lemah antara IMT dengan hiperlordosis lumbar pada siswa siswi SMA. Tidak terdapat korelasi antara rasio lingkar pinggang panggul terhadap hiperlordosis lumbar, namun terdapat korelasi lemah antar lingkar pinggang dan lingkar panggul dengan hiperlordosis lumbar. Tidak terdapat korelasi antara variabel yang diteliti dengan hiperkifosis torakal.

The heritability of coronal and sagittal phenotype in idiopathic scoliosis: a report of 12 monozygotic twin pairs

PurposeOne of the pathways through which genetics may act in the causation of idiopathic scoliosis is inheritance of a specific sagittal profile that predisposes for its development. In this study, coronal and sagittal parameters were compared in an international collection of monozygotic twins with idiopathic scoliosis.MethodsTwelve monozygotic twin pairs who underwent biplanar radiography for idiopathic scoliosis were systematically identified in existing scoliosis databases in The Netherlands, Sweden, and Denmark. On the first available radiographs, the coronal and sagittal curve parameters (Roussouly and Abelin types, thoracic kyphosis, lumbar lordosis and length of the posteriorly inclined segment) were determined.ResultsIn all 12 monozygotic twin pairs, both twins were affected by AIS. Four (33%) twin pairs had similar coronal and sagittal spinal phenotype, whereas two (17%) had different coronal phenotype and similar sagittal profiles, and six (50%) pairs had different coronal as well as sagittal phenotype.ConclusionsAnalysis of biplanar curve characteristics in monozygotic twins showed that all twin pairs were affected by idiopathic scoliosis. However, only 33% of the pairs had similar coronal and sagittal spinal phenotypes. Based on this limited dataset, the hypothesis can be formulated that besides genetic pre-disposition, the individual (inherited) sagittal profile plays a role in the development of different coronal curve type.

Effect of 9-month Pilates program on sagittal spinal curvatures and hamstring extensibility in adolescents: randomised controlled trial

The percentage of spine misalignment increases during the childhood and adolescence stages. The Pilates method has been associated with an improvement in the sagittal spine disposition, but no studies have been conducted on adolescents. Therefore, the present study aimed to evaluate the effectiveness of a 9-month Pilates exercise program (PEP) on hamstring extensibility and sagittal spinal curvatures on adolescents. This randomised controlled trial included 236 adolescents. The experimental group (EG) received a PEP (9 months, 2 sessions/week, 15 minutes/session). The control group (CG) did not receive any intervention. Hamstring extensibility was measured with the passive and active straight leg raise and toe-touch tests. Sagittal spinal curvatures and pelvic tilt was assessed in relaxed standing, active alignment and toe-touch test positions. The EG had significant changes in hamstring extensibility, lumbar curvature and pelvic tilt in standing sagittal curvature. The CG became significantly worse in thoracic kyphosis in standing. This study provides evidence of nine-months of a PEP increased the hamstring extensibility; averted the increase of the thoracic curvature, and decreased the curvature of the lumbar lordosis and pelvic tilt in standing position; avoided a greater increase of thoracic curvature in active alignment in standing position; and avoided the increase of thoracic curvature in trunk flexion.

Analysis of Lumbar Sagittal Curvature in Spinal Decompression and Fusion for Lumbar Spinal Stenosis Patients under Roussouly Classification.

To evaluate the clinical significance of spinal decompression and fusion for lumbar spinal stenosis in old patients under Roussouly classification, 160 old patients (>60 year old) with lumbar spinal stenosis underwent spinal decompression, and fusion were retrospectively studied. According to Roussouly classification, patients were divided into 4 groups, in which Roussouly types I, II, and IV were the nonstandard group and Roussouly type III was the standard group. Visual analog scale (waist, leg) and Oswestry disability index (ODI) scores were recorded before operation and at the final follow-up. All patients improved the sagittal curvature: for patients in Roussouly types I and II, there were statistically significant differences in terms of postoperative global lordosis (GL), global kyphosis (GK), sacral slope (SS), sagittal vertical axis (SVA), and pelvic tilt (PT) compared with that before surgery (all P < 0.001); patients in Roussouly type IV obtained similar results with type III after surgery. The four groups showed significant improvement in ODI and VAS scores at final follow-up (all P < 0.001). After regrouping at the final follow-up, the proportion of the standard type (Roussouly type III) patients was increased compared with preoperative. In conclusion, Roussouly classification has important guiding significance in spinal decompression and fusion for old patients (>60 years) with lumbar spinal stenosis.

The validity of the kinect sensor for the measurement of sagittal spine curvature against the gold standard lateral spinal radiograph

The validity of the kinect sensor for the measurement of sagittal spine curvature against the gold standard lateral spinal radiograph

Characterization of Sagittal Spine Alignment With Reference to the Gravity Line and Vertebral Slopes: An Analysis of Different Roussouly Curves.

Prospective study. To map the healthy standing alignment of the adult spine, grouped according to Roussouly curve types, using both horizontal offset distance from the gravity line (GL), as well as vertebral slope measurements. Spinal sagittal realignment requires a reference posture, and this has been defined in the literature via horizontal offsets from the GL. While useful, this does not provide information on the orientation of each vertebral segment, or distinguish between the various physiological curve types. A total of 169 consecutive young adult subjects with healthy spines were recruited over a year. (EOS Imaging, Paris, France) whole body radiographs were performed. Radiographic measurements collected included sagittal vertical axis (SVA), T1-slope, global cervical angle (GCA), global thoracic angle (GTA), global lumbar angle (GLA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), apical and inflection vertebrae. Outcome measures comprised slope measurements, and distance offsets relative to the GL for individual vertebrae from T3 to S1. GLA, PI, PT, SS, apex of lordosis, and inflection vertebra were significantly different across groups, while SVA, T1-slope, GCA, GTA, and apex of kyphosis were not. Mean PI to LL discrepancy for Type I to IV groups were 8.0°, 2.3°, 4.8°, and 3.0°, respectively. Between groups, T3, T7 to T12, and L2 to S1 slopes and T9 to L3 offset distances from GL were significantly different, while the distance of the hip center from the GL was not. GLA was significantly different between curve types except between Type 1 and 2 curves, while the inflection vertebrae were not significantly different between Type 1 and 2 curves, as well as Type 3 and 4 curves. This study demonstrates normative sagittal spatial orientation of each vertebra in healthy adults, for each Roussouly type. Comparison across groups suggests the possibility of further refining the sagittal curve patterns described by Roussouly. 3.

Comparison of Spinal Sagittal Curvatures, Functional Status and Quality of Life of Medical Secretaries with or without Upper or Low Back Pain

Amaç: Tıbbi sekreterlerde sırt ve/veya bel ağrısı sık görülmektedir. Bu çalışmanın amacı, sırt veya bel ağrısı olan sekreterler ile olmayan sekreterlerin omurga eğriliği, omurga hareketliliği, disabilite ve yaşam kalitesi düzeylerini karşılaştırmaktır. Materyal ve Metod: Çalışmaya aynı hastanede çalışan 111 tıbbi sekreter dahil edildi. Tıbbi sekreterler sırt ağrısı olan ve olmayan olarak iki gruba; bel ağrısı olan ve olmayan olarak diğer iki gruba ayrıldılar. Omurganın sagittal düzlemdeki şekli ve hareketliliği “Spinal Mouse™” isimli non-invaziv bir alet kullanılarak ölçüldü. Ölçümler ayakta dururken ve oturma pozisyonunda ayrı ayrı tekrarlandı. Ağrı şiddeti Vizüel Analog Skala (VAS) ile; fonksiyonel durum Oswestry Disabilite Ölçeği (ODÖ) ile; yaşam kalitesi ise Notthigham Sağlık Profili (NSP) kullanılarak değerlendirildi. Bulgular: Çalışmaya dahil edilen tıbbi sekreterlerin (75 kadın/36 erkek) yaş ortalaması 30.73±5.74 yıl idi. Sırt ağrısı olan 51 sekreterin VAS ortalaması 5.47±2.67; bel ağrısı olan 63 sekreterin VAS ortalaması 5.52±2.66 idi. Sırt ağrısı olan sekreterlerin oturur pozisyonda ve ayakta iken ölçülen torakal kifoz açısı, sırt ağrısı olmayan sekreterlere göre daha yüksekti (p˂0.032, p˂0.001). Her iki grup arasında oturur pozisyonda ve ayakta iken ölçülen torakal vertebra hareketliliği açısından anlamlı fark yoktu. İki grup arasında NSP-total, NSP-enerji, NSP-ağrı, NSP-duygusal reaksiyonlar ve NSP-fiziksel hareketlilik alt grupları arasında anlamlı fark vardı (p˂0.001, p=0.001, p˂0.001, p=0.001, p=0.001). Bel ağrısı olan sekreterlerin ayakta duruşta ölçülen lomber lordoz açısı, bel ağrısı olmayanlara göre daha düşüktü (p˂0.001). Her iki grup arasında oturur pozisyonda iken ölçülen lomber lordoz açısı ile oturur pozisyonda ve ayakta iken ölçülen lomber vertebra hareketliliği açısından anlamlı fark yoktu. İki grup arasında ODÖ, NSP-total, NSP-enerji, NSP-ağrı ve NSP-fiziksel hareketlilik alt grupları arasında anlamlı fark vardı (p˂0.001, p=0.025, p=0.042, p=0.039, p=0.019). Sonuç: Spinal Mouse™ kullanılarak yapılan ölçümlerde omurga hareketliliğinde fark olmamasına rağmen; sırt ağrısı olan sekretelerde torakal omurgada kifoz artışı, bel ağrısı olanlarda da lomber omurgada lordoz azalması olduğu görülmüştür. Sırt ve bel ağrısının varlığı fonksiyonel durumu ve yaşam kalitesini olumsuz etkilemektedir.