Significant Differences In Lumbar Lordosis Research Articles

Imaging study on thoracic and lumbar physiological curvature in adolescent idiopathic scoliosis

To observe the alteration of thoracic and lumbar physiological curvature in adolescent idiopathic scoliosis(AIS) and the difference of physiological curvature between different types of scoliosis. A retrospective analysis was conducted on 305 adolescent patients taken full spine X-ray in our hospital from January 2017 to December 2021. The patients were divided into normal group and scoliosis group. The normal group was composed of 179 patients, 79 males and 100 females, aged 10 to 18 years old with an average of (12.84±2.10) years old, with cobb agle less than 10 degrees. The scoliosis group was composed of 126 patients, 33 males and 93 females, aged 10 to 18 years old with an average of (13.92±2.20) years old. The gender, age, Risser sign, thoracic kyphosis(TK) and lumbar lordosis(LL) in 2 groups were compared, and the TK and LL were also compared between different genders, different degrees of scoliosis and different segments of scoliosis. The female ratio(P=0.001) and age (P<0.001) in scoliosis group were higher than them in normal group; the ratio of low-grade ossification was higher in normal group than in scoliosis group(P=0.038). TK was significantly smaller in scoliosis group than in normal group(P<0.001), but there was no significant difference in LL between the 2 groups(P=0.147). There were no significant difference in TK and LL between male and female. The TK was significantly bigger in mild AIS patients than in moderate AIS patients(P<0.05), but there was no significant difference in LL between mild and moderate patients(P>0.05). The TK and LL in different segments scoliosis were not found significant difference. The physiological curvature of thoracic and lumbar spine is independent of gender. The thoracic physiological curvature becomes smaller in AIS patients, but lumbar curvature remains unchanged. The thoracic physiological curvature in mild AIS patients is greater than that in moderate AIS patients, but the lumbar curvature is almost unchanged between mild and moderate scoliosis and is similar with that in normal adolescent. The alteration of thoracic and lumbar physiological curvature in AIS patients may be related to relative anterior spinal overgrowth, and the specific detailed mechanism needs to be further studied.

The relationship between body height and plantar pressure distribution in adult handball players: A cross-sectional study

Background/purpose The relationship between a handball player's upper body posture, body weight distribution in relation to body height is poorly understood. So, this study explored the relationship between body height and sagittal spinal curvatures and plantar pressure distribution in handball players. Method According to handball player's body height, 63 male handball players were divided into two groups; group A (age, 23.54 ± 1.32 years) consisted of 30 handball players with body height above average, and group B (age, 23.40 ± 1.73 years) consisted of 33 handball players with body height below average. The thoracic and lumbar curvatures and trunk height were measured with the Formetric III 4D spine, and the DIERS Pedoscan device was used to assess the plantar pressure distribution for both groups. Results The thoracic kyphosis of group A was significantly higher than that of group B ( p = 0.001), without a significant difference in lumbar lordosis ( p = 0.086). Group A showed a significant increase in the forefeet pressure and a significant decrease in the rearfeet pressure compared to group B ( p = 0.001). There was a high positive correlation between the body height and trunk length, and body height and kyphosis angle ( r = 0.932, r = 0.665, respectively). There was a high positive correlation between the body height and forefoot plantar pressure ( r = 0.665, p &lt; 0.01). Conclusion The taller handball players have an increased thoracic kyphosis angle and forefeet pressure compared to shorter handball players.

Effects of Percutaneous Kyphoplasty for the Treatment of Thoracic Osteoporotic Vertebral Compression Fractures with or without Intravertebral Cleft in Elderly Patients.

Few studies have focused on percutaneous kyphoplasty (PKP) in the treatment of thoracic osteoporotic vertebral compression fractures (OVCFs) with intervertebral cleft (IVC). Hence, the objective of this retrospective study was to compare the clinical and radiographic outcomes of PKP in elderly patients with thoracic OVCFs, with or without IVC. A total of 106 patients were enrolled in this study and divided into two groups: the IVC group and the NIVC group (without IVC). Radiographic measures included anterior vertebral height (AVH), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Clinical function measures included Oswestry disability index (ODI) and visual analog scale (VAS) scores. There were no significant differences in the preoperative basic data between the groups classified as IVC and NIVC. However, both groups showed significant improvements in AVH and TK throughout the follow-up periods compared to the preoperative measurements (P<0.05). The recovery of AVH in the IVC group was found to be inferior to that in the NIVC group at 3 years after operation (P<0.05). There were no significant differences in LL, PI, PT and SS in both groups compared with the preoperative results and no statistically significant differences between the two groups at the same follow-up time (P>0.05). The VAS and ODI scores during all follow-up periods were significantly lower than those before operation (P<0.05). At 3 years after operation, the VAS and ODI scores of the IVC group were higher than those of the NIVC group (P<0.05). PKP is an adoptable measure to treat thoracic OVCFs with or without IVC. Our study revealed that the NIVC group was superior to the IVC group in terms of improved vertebral height and pain recovery at long-term follow-up (3 years).

Effect of spinal-pelvic sagittal balance on the clinical outcomes after lumbar fusion surgery

BackgroundSpinal-pelvic sagittal balance is important for maintaining energy-efficient posture in normal and diseased states.Few reports to date have evaluated the effect of spinal-pelvic sagittal balance on clinical outcomes after lumbar interbody fusion in patients with lumbar degenerative diseases (LDD).MethodsA total of 303 patients treated with posterior lumbar interbody fusion surgery for lumbar degenerative disease from January 2012 to December 2019 were enrolled in this retrospective study according to the inclusion criteria. Preoperative and postoperative spinal-pelvic sagittal parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL) of the patients were evaluated and compared. 163 patients whose postoperative PI-LL ≤ 10° were divided into the spinal-pelvic match group (Group M), while 140 patients were divided into the spinal-pelvic mismatch group (Group MM). Preoperative and postoperative Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back pain of both groups were compared.ResultsThere was no significant difference between the two groups in demographic and surgical data, except for blood loss in surgery. LL, PI, PT and SS of the patients at final follow-up were all statistically different from the preoperative values in the two groups(P < 0.05). There was no significant difference in LL, PI, PT and SS between the two groups before surgery. At the final follow-up, LL, PI and PT differed significantly between the two groups(P < 0.05). Compared with the preoperative results, ODI and VAS of low back in both groups decreased significantly at the final follow-up (P < 0.05). Significant differences in VAS and ODI were found between the two groups at the final follow-up (P < 0.05). The improvement rates of VAS and ODI of Group M are both significantly higher than Group MM. Regression analysis showed that age and spinal-pelvic match had significant effects on the improvement of patients’ low back pain at the final follow-up.Conclusionslumbar interbody fusion can significantly improve the prognosis of patients with LDD. In terms of outcomes with an average follow-up time of more than 2 years, the spinal-pelvic match has a positive effect on patients’ quality of life and the release of low back pain.

Clinical Outcomes and Radiologic Parameters of Endoscopic Lumbar Interbody Fusion Using a Novel Nerve Baffle with a Minimum 1-year Follow-up

Since endoscopic lumbar interbody fusion procedure has established, the insertion of cage requires a large working tube, which may lead to nerve root irritation. A novel nerve baffle was used for endoscopic lumbar interbody fusion (ELIF) and its short-term outcomes were analyzed. A total of 62 patients (32 cases in tube group, 30 cases in baffle group) with lumbar degenerative diseases who underwent endoscopic lumbar fusion surgery from July 2017 to September 2021 were retrospectively analyzed. Clinical outcomes were measured using pain visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedic Association Scores (JOA), and complications. Perioperative blood loss was calculated using the Gross formula. Radiologic parameters included lumbar lordosis, surgical segmental lordosis, cage position, and fusion rate. There were significant differences in VAS, ODI, and JOA scores postoperatively, 6 months after operation, and at the last follow-up (P < 0.05) within the 2 groups. The VAS and ODI score and hidden blood loss were significantly lower (P < 0.05) for the baffle group. There was no significant difference in lumbar lordosis and segmental lordosis (P > 0.05). Postoperative disc height was significantly higher than preoperative and follow-up disc heights (P < 0.05) for both groups. There was no statistical difference in fusion rate and cage position parameters or subsidence rate. Endoscopic lumbar interbody fusion using the novel baffle has more advantages in nerve protection and hidden blood loss reduction than traditional ELIF with working tube. Compared with the working tube procedure, it has similar or even better short-term clinical outcomes.

Influence of posterior instrumented correction with pedicle screw dual rod systems on thoracic kyphosis in Lenke 1 and 2 curves: minimum 2years follow-up.

Adolescent idiopathic scoliosis (AIS) often correspond with hypo thoracic kyphosis (TK) or even lordosis. The aim of this study was to analyze the influence of posterior instrumentation in thoracic AIS. Analysis of prospectively collected AIS-data with structural thoracic curves (Lenke type 1 & 2), operated 2010-2019 with pedicle screw dual rod systems in one scoliosis center. Follow-up (FU) minimum 24months. Coronal and sagittal angles measured based on standing long-cassette-X-rays: thoracic major (MC), proximal thoracic (PC) and lumbar curve (LC), TK, lumbar lordosis (LL). values as mean ± SD, differences by student's t-test (significancy a = 0.05), Pearson's correlation, sub-analysis with sagittal modifier (-, N, +). A total of 127 AIS could be identified (63% type 1, 37% type 2). Mean FU 32.2 ± 16.6months, mean age 14 ± 1.5years. Mean Correction of MC 73 ± 12%, PC 51 ± 17%, LC 69 ± 21% with a significantly better correction of PC in Lenke 2 curves(p < 0.05). On average, TK (FU-preop) decreased by -2.1 ± 12.1°(p < 0.05) in all AIS. Whereas TK in type 1 was unchanged (p = 0.9), TK significantly decreased by - 6.0 ± 12.7°(p < 0.05) in type 2. No significant difference in LL. TK in hypokyphotic cases increased by 9.5 ± 5.5°(p < 0.05), stayed almost unchanged (- 1.4 ± 9.1°,p = 0.2) in normokyphotic, decreased by - 17.2 ± 14.2°(p < 0.05) in hyperkyphotic cases. Only hypokyphotic cases had a moderately strong correlation between correction of LC (r = 0.6) and PC (r = - 0.4) (frontal plane) and change from pre- to postoperative TK (sagittal plane) (r = 0.6). No relevant correlations for normo- and hyperkyphotic AIS. Postoperative hypokyphosis was significantly more often in Lenke 2 (16.3% vs. 2.6%, p < 0.05). Rod diameter (5,5mm versus 6mm) had no significant influence. Significant correction of hypo- and hyperkyphosis can be achieved with posterior spinal fusion (pedicle screw dual rod systems), whereas normokyphotic spines stay unchanged. However, Lenke 2 curves have a significantly higher risk for a postoperative thoracic hypokyphosis.

Is spinal sagittal alignment of diffuse idiopathic skeletal hyperostosis relevant to thoracolumbar pain? A controlled study

ObjectivesThe extension of diffuse idiopathic skeletal hyperostosis (DISH) from the low thoracic spine to the lumbar spine result in adjustment of spinal sagittal alignment in surgical patients. The aim of this study was to investigate changes in sagittal alignment and back pain in the thoracolumbar spine in nonsurgical DISH and control participants selected from a radiological database.MethodsParticipants in the DISH and the control group were selected by searching for “DISH or degenerative changes in the thoracic spine” in the radiology database of Taizhou Hospital between 2018 and 2021 using Resnick and Niwayama’s criteria. The subjects with spinal tumors, previous spinal surgery, vertebral fractures, inflammatory diseases, poor-quality radiographs, or loss of follow-up were excluded. Demographic and clinical characteristics were recorded retrospectively via the hospital information system and telephone follow-up. Segmental disc angles (SDAs), lumbar lordosis (LL), and bridge scores were analyzed using images of three-dimensional CT.ResultsThe final participants consisted of 51 individuals with DISH (DISH group) and 102 individuals without DISH (control group). Depending on the presence of thoracolumbar pain, the DISH group was divided into the DISH group with thoracolumbar pain (DISH+Pain) and the DISH group without thoracolumbar pain (DISH-Pain). The LL and SDAs of T11-T12 and T12-L1 were significantly greater in the DISH group than in the control group. In addition, the SDA of L1-L2 was significantly smaller in the DISH+Pain group than in the DISH-Pain group, whereas there was no significant difference in lumbar lordosis between the DISH+Pain group and the DISH-Pain group. The bridge scores in DISH+Pain group was larger in T10-T11 (p = 0.01) and L1-L2 (p < 0.01) spine segments than those in DISH-Pain group.ConclusionThe extension of DISH from thoracic to lumbar spine may increase lumbar lordosis and SDAs in the thoracolumbar spine. The DISH patients with more bony bridging and small L1-L2 SDA may be more likely have thoracolumbar pain. Adjustment of sagittal alignment of the spine in the development of DISH may be of clinical importance.

Oblique lumbar interbody fusion combined with stress end plate augmentation and anterolateral screw fixation for degenerative lumbar spinal stenosis with osteoporosis: a matched-pair case-controlled study

BACKGROUND CONTEXTOblique lumbar interbody fusion (OLIF) has been proven to be effective in treating degenerative lumbar spinal stenosis (DLSS). Whether OLIF is suitable for treating patients with DLSS with osteoporosis (OP) is still controversial. Bone cement augmentation is widely used to enhance the internal fixation strength of osteoporotic spines. However, the effectiveness of OLIF combined with bone cement stress end plate augmentation (SEA) and anterolateral screw fixation (AF) for DLSS with OP have not confirmed yet. PURPOSETo evaluate the clinical, radiological, and functional outcomes of OLIF-AF versus OLIF-AF-SEA in the treatment of DLSS with OP. STUDY DESIGNRetrospective case-control study. PATIENT SAMPLEA total of 60 patients with OP managed for DLSS at L4–L5. OUTCOME MEASURESVisual analog scale (VAS) score of the lower back and leg, Oswestry Disability Index (ODI), disk height (DH), lumbar lordosis (LL), segmental lordosis (SL), cage subsidence and fusion rate. METHODSThe study was performed as a retrospective matched-pair case‒controlled study. Patients with OP managed for DLSS at L4–L5 between October 2017 and June 2020 and completed at least 2 years of follow-up were included, which were 30 patients treated by OLIF-AF and 30 patients undergoing OLIF-AF-SEA. The demographics and radiographic data, fusion status and functional outcomes were therefore compared to evaluate the efficacy of the two approaches. RESULTSPain and disability improved similarly in both groups at the 24-month follow-up. However, the SEA group had lower pain and functional disability at 3 months postoperatively (p<.05). The mean postoperative disc height decrease (△DH) was significantly lower in the SEA group than in the control group (1.17±0.81 mm vs 2.89±2.03 mm; p<.001). There was no significant difference in lumbar lordosis (LL) or segmental lordosis (SL) between the groups preoperatively and 1 day postoperatively. However, a statistically significant difference was observed in SL and LL between the groups at 24 months postoperatively (p<.05). CS was observed in 4 cases (13.33%) in the SEA group and 17 cases (56.67%) in the control group (p<.001). A nonsignificant difference was observed in the fusion rate between the SEA and control groups (p=.347) at 24 months postoperatively. CONCLUSIONSThis study revealed that OLIF-AF-SEA was safe and effective in the treatment of DLSS with OP. Compared with OLIF-AF, OLIF-AF-SEA results in a minor postoperative disc height decrease, a lower rate of CS, better sagittal balance, and no adverse effect on interbody fusion.

Clinical observation of chiropractic manipulation in the treatment of degenerative scoliosis

To observe clinical efficacy of chiropractic manipulation in the treatment of degenerative scoliosis (DS). From June 2017 to September 2019, 120 patients with degenerative scoliosis were randomly divided into treatment group (60 cases) and control group(60 cases). The patients in treatment group were treated with chiropractic manipulation once every other day for 4 weeks. The patients in control group were treated with eperisone hydrochloride tablets combined with thoracolumbar orthopedic(TSLO)brace, oral eperisone hydrochloride tablets 50 mg three times a day, wearing TSLO brace for not less than 8 hours a day. The course of treatment was 4 weeks. After the patients were selected into the group, visual analogue scale (VAS) and Oswestry Disability Index (ODI) were recorded before treatment, 1, 2, 3, 4 weeks after treatment and 1 month after treatment. The full length X-ray of the spine was taken before and 4 weeks after treatment, and the scoliosis Cobb angle, sagittal vertical axis (SVA) and lumbar lordosis (LL) were measured and compared. The adverse reactions during the treatment were recorded. There were significant differences in VAS and ODI between two groups at each time point after treatment (P<0.001), VAS and ODI at 2 weeks after treatment (PVAS=0.025, PODI=0.032) and 3 weeks after treatment(PVAS=0.040, PODI=0.044) in treatment group were significantly different from those in control group, but there was no significant difference in VAS and ODI at other time points between treatment group and control group (P>0.05). There was significant difference in Cobb angle between treatment group(P=0.010) and control group(P=0.017) after treatment, but there was no significant difference in LL and SVA between treatment group and control group. There was no significant difference in Cobb angle, LL and SVA between two groups before and after treatment. During the treatment, there were 4 mild adverse reactions in the control group and no adverse reactions in the treatment group. Chiropractic manipulation can effectively relieve pain and improve lumbar function in patients with degenerative scoliosis. The onset of action is faster than that oral eperisone hydrochloride tablets combined with TSLO brace, and it has better safety and can improve Cobb angle of patients with degenerative scoliosis.

Efficiency of various options for surgical treatment and prevention of proximal junctional kyphosis in patients with lumbar spine deformities and concomitant osteoporosis

Objective. To conduct a comparative analysis of the effectiveness of various options for the prevention of proximal junctional kyphosis (PJK) in the surgical treatment of adult patients with deformities of the lumbar spine, including taking into account the degree of correction of the lumbar lordosis.Material and Methods. The results of instrumental fixation of the spine performed in 140 adult patients with severe frontal spinal deformity and/or sagittal imbalance corresponding to types III and IV according to Berjano and Lamartina were studied. The patients were divided into 4 clinical groups depending on the methods of surgical treatment: in 36 cases, correction of lumbar lordosis of no more than 30° was performed without the use of PJK prevention methods (Group I); in 24 – the same correction was supplemented with laminar fixation of the vertebra above the fusion zone (Group II); 20 patients underwent complete restoration of the sagittal and frontal balance with prophylactic vertebroplasty of the superjacent vertebra above the zone of instrumental fixation (Group III); and in 60 – the same intervention was performed without the use of the PJK prevention methods (Group IV).Results. Statistically significant differences in lumbar lordosis, difference in the pelvic angle and lumbar lordosis, and displacement of the sagittal vertical axis were found between the pairs of groups I and II, and III and IV. Postoperative values of the index of the proximal junctional angle (PJA) in patients of Group II differed significantly from the corresponding indicators of other groups. A statistically significant increase in the PJA after surgery was found in patients of groups III and IV. There was a statistically significant decrease in PJK cases in Group II in comparison with other groups (p = 0.001), as well as more pronounced trend to decrease in pain intensity and ODI score. Laminar fixation of the superjacent vertebra leads to a decrease in local kyphosis over the area of instrumental fixation and reduces the load on the ventral parts of the vertebra. Prophylactic vertebroplasty (Group III) provides better results compared to a comparable cohort (Group IV).Conclusion. Partial correction of lumbar lordosis (no more than 30°) and preventive laminar fixation of the superjacent vertebra showed significantly better clinical results (by more than 50 %; p = 0.001) compared with the other three clinical groups in terms of reducing the level of pain and improving the quality of life, as well as of decrease in number of cases of PJK development – by 16–28 % (p = 0.001).

Computed Tomographic Assessment of Age- and Gender-Specific Sagittal Lumbopelvic Alignment in a Japanese Population.

Introduction Previous studies have reported differences in lumbopelvic alignment between standing and supine positions. Computed tomography (CT) images taken in the supine position are often used for clinical studies in addition to standing radiographs, although not frequently. Our study aims to clarify normative values of CT-evaluated lumbopelvic parameters and the characteristics of age- and gender-related lumbopelvic alignment in the supine position. Methods Patients undergoing CT scans of abdominal or lumbar regions for reasons other than low back disorders were included (n=581). Sagittal multiplanar reconstruction CT images were obtained, and lumbar lordosis (LL), L5-S1 angle, and sacral slope (SS) were measured. Mean values of the parameters in patients aged 59 years and under, 60-69, 70-79, and 80 and over, and in males and females, were calculated. Age- and gender-related differences in these parameters were statistically analyzed. Results Among the four age groups, patients 80 years and over showed significantly lower LL and SS than patients aged 70-79. Females 80 years and over showed significantly lower LL and SS than all other age groups, but those in males did not. The comparison between males and females showed no significant differences in LL and SS; however, the L5-S1 angle was significantly higher in males than in females. In patients 80 years and over, females showed significantly lower LL and SS than in males. Conclusions This study provides normative CT-evaluated lumbopelvic parameters, such as LL, L5-S1 angle, and SS, which will be utilized for comparisons in future studies. The present study first revealed that pelvic retroversion and lumbar kyphosis occur in elderly females in the supine position, which raised a possibility that age-related decrease of LL and SS in females occurs at an older age in the supine position than in the standing position.

Effect of Posterior Pelvic Tilt Taping on Abdominal Muscle Thickness and Lumbar Lordosis in Individuals With Chronic Low Back Pain and Hyperlordosis: A Single-Group, Repeated-Measures Trial

ObjectiveThe purpose of this study was to investigate the effect of posterior pelvic tilt taping (PPTT) on lumbar lordosis, pain, disability, and abdominal muscle thickness in individuals with nonspecific chronic low back pain with hyperlordosis. MethodsA prospective, single-group, repeated-measures design was conducted with 31 individuals with nonspecific chronic low back pain (16 men, 15 women) with hyperlordosis (mean ± SD = 59.3° ± 2.9°). Participants’ mean age, pain, disability, and lumbar lordosis were, respectively, 35.7 ± 9.9 years, 5.1 ± 1.3, 26.8 ± 11.5, and 59.3° ± 2.9°. The thickness of the abdominal muscles on both sides was measured in the crook lying position by ultrasound imaging. PPTT was performed on both sides. Pain intensity, functional disability, lumbar lordosis angle, and abdominal muscle thickness were measured before PPTT (W0), 1 week after PPTT (W1), and 1 week after PPTT removal (W2). ResultsAnalysis revealed significant reductions in lumbar lordosis, pain, and disability, and increased abdominal muscle thickness, at W1 and W2 compared with W0 (P < .001). There were no significant differences in lumbar lordosis or abdominal muscle thickness between W1 and W2. ConclusionThe current study showed in a small group of participants that 1 week of PPTT may improve lumbar lordosis, pain, disability, and abdominal muscle thickness in individuals with nonspecific chronic low back pain with hyperlordosis.

Treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis by transintervertebral release, bone impaction grafting, and posterior column compressed-closing

To explore the safety and preliminary effectiveness of transintervertebral release, bone impaction grafting, and posterior column compressed-closing in the treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis. The clinical data of 21 elderly patients with osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis were retrospectively analyzed between March 2016 and November 2017. There were 1 male and 20 females, aged 55-75 years, with an average of 64.8 years. The disease duration was 8-24 months, with an average of 13.1 months. The bone density T value ranged from -3.4 to -2.1, with an average of -2.3. Lesion segments: T 11 in 2 cases, T 12 in 6 cases, L 1 in 8 cases, L 2 in 1 case, T 11, 12 in 1 case, T 12, L 1 in 2 cases, and T 12, L 2 in 1 case. Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA): 5 cases of grade D and 16 cases of grade E. All patients underwent transintervertebral release, bone impaction grafting, and posterior column compressed-closing. The effectiveness was evaluated by visual analogue scale (VAS) score and Oswestry dysfunction index (ODI) score before operation, at 3 months after operation, and at last follow-up. The neurological function was assessed by ASIA at last follow-up. Local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertebral axis (SVA) were measured on the X-ray films of the full-length lateral spine of the patient before operation, at 1 week after operation, and at last follow-up. No complication such as fracture of internal fixator or nerve injury occurred. LKCA, TK, and SVA were significantly improved at 1 week after operation and at last follow-up ( P<0.05). There was no significant difference between at 1 week after operation and at last follow-up ( P>0.05). There was no significant difference in LL before and after operation ( F=3.013, P=0.057). The VAS and ODI scores were significantly improved at 3 months after operation and at last follow-up, and further improved at last follow-up when compared with the scores at 3 months after operation, showing significant differences between time points ( P<0.05). Five patients with ASIA grade D neurological function recovered to grade E at 6 months after operation. Transintervertebral release, bone impaction grafting, and posterior column compressed-closing for treating osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis has definite effectiveness, strong orthopaedic ability, and minimal trauma, which can effectively restore the sagittal balance of the spine, alleviate pain, and improve the patients' quality of life.

Patients with Modic type 2 change have a severe radiographic representation in the process of lumbar degeneration: a retrospective imaging study

BackgroundThere are few studies to investigate changes in imaging parameters of Modic changes (MCs). The imaging studies examining the distinctions in the lumbar sagittal parameters between MCs and lumbar disc degeneration (LDD) are still lacking. The purpose of this study was to identify the differences in the lumbar sagittal parameters among patients for LDD with/without Modic type 2 change (MII).MethodsA total of 208 patients with lumbar degenerative disease from January 2017 to August 2018 volunteered for this study. Sixty-two patients with MII were used as the MC group. The other 146 patients served as the disc degeneration (DD) group. The DD scores and sagittal parameters were measured on magnetic resonance imaging (MRI) and X-ray by using Surgimap software.ResultsThe prevalence of MII for patients with degenerative lumbar diseases in this study was 29.81%, primarily located at L5/S1. There were significant differences in lumbar lordosis (LL) and sacral slope (SS) between these two groups (P < 0.05). Similarly, the significant decrease in intervertebral height index (IHI) was found at L3-S1 in the MC group, compared with the DD group (P < 0.05). However, a significant difference in intervertebral angle (IVA) was observed only at L5/S1 (P < 0.05). The MC group had the smaller endplate concave angle (ECA) than the DD group from L3 caudal endplate to S1 cranial endplate (P < 0.05).ConclusionsMII has a severe radiographic representation in the process of lumbar degeneration than patients without MII, and the overconcentration of load caused by the smaller LL, SS, and IVA may be a reasonable explanation to answer why MCs are more common at the L5/S1.

Calculation of Intervertebral Disc Pressure in the Thoracic and Lumbar Spine in Elderly Women with Kyphosis Using a Novel Musculoskeletal Model with Isolated Thoracic Vertebrae and Rib Cage

Background: Degeneration of the intervertebral disc is one of the causes of kyphosis. Several biomechanical studies have investigated the mechanisms of development of spinal deformity using simulation models. Realistic musculoskeletal models are helpful for investigating the pathophysiology and changes in internal forces in patients with kyphosis. However, the association between intervertebral disc pressure and kyphosis has not been fully elucidated to date. Purpose: To calculate intervertebral disc pressure in elderly women with kyphosis using a novel and precise thoracolumbar three-dimensional musculoskeletal model. Materials and Method: Ten female patients with a mean age of 80.0 ± 6.5 years who visited our hospital for medical examination of osteoporosis were included. The subjects were divided into the normal and kyphosis groups depending on their sagittal vertical axis. Intervertebral disc pressures in the thoracic and lumbar spines of subjects were analyzed by inverse dynamics analysis using a novel three-dimensional musculoskeletal model, and were compared between the groups. Result: Significant differences in lumbar lordosis (LL) were observed between the two groups. Furthermore, the kyphosis group was older and shorter. In the kyphosis group, the upper thoracic vertebrae (T1 - T6) showed significantly higher intervertebral pressure than the normal group. Conclusion: Intervertebral disc pressure in the thoracic and lumbar spines of patients with spinal deformities was evaluated using a novel thoracolumbar three-dimensional musculoskeletal model. Using this novel model with separated thoracic spine and modified muscle path reflecting actual physiological curvature, disc pressure closer to the realistic condition was obtained. Intervertebral disc pressure in the upper thoracic spine in the kyphosis group was significantly increased compared with that in the normal group. Moreover, intervertebral disc pressures in the upper thoracic spine correlated negatively with LL.

The Ratio of Lumbar to Hip Motion during the Trunk Flexion in Patients with Mechanical Chronic Low Back Pain According to O'Sullivan Classification System: A Cross-sectional Study.

Static and dynamic postures of lumbopelvic in low back pain (LBP) are considered as two important aspects of clinical assessment and management of LBP. Thus, the focus of the current study was to compare the posture and compensatory strategy of hip and lumbar region during trunk flexion between LBP subgroupsand health subjects. LBP cases are subdivided into active extension pattern (AEP) and flexion pattern (FP) based on O'Sullivan's classification system (OCS). This work was a cross-sectional study involving 72 men, 21 low back pain patients with FP and 31 low back pain patients with AEP and 20 healthy groups. Lumbar and hip angles during trunk flexion were measured by a 3D motion analysis system in neutral standing posture and end-range of trunk flexion. The participants were asked to full bend without any flexion of the knees. The bending speed was preferential. Hip and lumbar ranges of motion were divided into four quartiles (Q). The quartiles were compared between groups. Data analysis was performed using one-way analysis of variance (ANOVA) and independent t-test. There was no statistically significant difference in lumbar lordosis in standing and full trunk flexion positions between the healthy groups and heterogeneous LBP groups. In addition, there was not any statistically significant difference between the healthy group and the homogenous LBP group (FP and AEP). Moreover, no statistically significant difference was observed in hip angles during standing between the healthy group and the heterogeneous LBP group, and between the healthy group and the homogenous LBP group (FP and AEP). In full trunk flexion position, there was statistically significant difference in hip angles between the healthy group and the heterogeneous LBP group (P=0.026). In this position, the difference in hip angles between the healthy group and FP group was statistically significant (P<0.05). In the second Q, there was no significant difference between the healthy group and the heterogeneous LBP group (P=0.062), however, there was a significant difference between FP group and the healthy group in the fourth Q of the total hip range of motion. There was no statistically significant difference between the healthy group and the heterogeneous LBP group (P=0.054) but there was a difference between FP group and the healthy group. Lumbar/hip motion ratio (L/H ratio) was different between and within the subgroups in the second Q. This study supported the subgrouping of LBP and showed that the difference between subgroups could be determined effectively through subdividing the total range of lumbar and hip motions into smaller portions. It is possible that the neuromuscular system selects different strategies to compensate and prevent further injury of the chain components (muscle, joint, nerve and etc.). IV.

Impact of lumbar hypolordosis on the incidence of symptomatic postoperative spinal epidural hematoma after decompression surgery for lumbar spinal canal stenosis.

Potential associations between radiographic parameters and the incidence of symptomatic postoperative spinal epidural hematoma (PSEH) have not been identified. This study aimed to identify risk factors including radiographic parameters for symptomatic PSEH after posterior decompression surgery for lumbar spinal canal stenosis (LSS). We retrospectively reviewed 1007 consecutive patients who underwent lumbar decompression surgery for lumbar spinal canal stenosis (LSS) at our institution. We identified 35 cases of symptomatic PSEH, defined by clinical symptoms and MRI findings, and selected 3 or 4 age- and sex-matched control subjects for each PSEH subject (124 controls). We compared radiographic parameters and previously reported risk factors between PSEH and control subjects. Compared to the control group, PSEH patients had significantly higher preoperative systolic (p = .020) and diastolic (p = .048) blood pressure, and more levels of decompression (p = .001). PSEH and control subjects had significant differences in lumbar lordosis (PSEH 24.8° ± 14.6°, control 34.8° ± 14.5°), pelvic tilt (25.1° ± 11.7° vs. 20.8° ± 8.4°), sacral slope (23.4° ± 9.4° vs. 27.6° ± 8.3°), and pelvic incidence minus lumbar lordosis (23.7° ± 15.0° vs. 13.7° ± 14.6°). Multivariate analysis revealed two significant risk factors for PSEH: decompression of two or more levels and lumbar lordosis < 25°. Multilevel decompression and hypolordosis are significant risk factors for symptomatic PSEH after decompression surgery for LSS. LSS patients with lumbar hypolordosis or multilevel stenosis should be carefully observed for PSEH after decompression surgery. These slides can be retrieved under Electronic Supplementary Material.

Immediate effect of application of the pressure technique to the psoas major on lumbar lordosis.

[Purpose] To demonstrate immediate alteration in lumbar lordosis and the lumbar angle in each segment after the application of the mechanical pressure technique to the psoas major muscle (PM). [Participants and Methods] In all, 34 participants were assigned to either the PM pressure technique group (n=17) or control group (n=17). Three dimensional (3D) coordinates of the 12th thoracic spinous process and lumbar spinous processes were measured with a 3D digitizer in the prone position with 15° bilateral hip extension to compare the changes in lumbar lordosis and the lumbar extension angle in each segment in both the PM pressure technique group and control group. [Results] Mann-Whitney’s U test revealed no significant differences in lumbar lordosis in either group. However, the lumbar extension angle at L4 decreased significantly after the PM pressure technique compared with that before the pressure technique. Additionally, the lumbar extension angle at L4 also decreased significantly after the PM pressure technique compared with the control group. Conversely, lumbar extension angle at L1 increased significantly after the PM pressure technique compared with that before. There was no significant difference in the lumbar extension angle at L2, L3 and L5 after the PM pressure technique. [Conclusion] This study suggests that the PM pressure technique possibly attenuates PM stiffness while reducing lumbar extension in each segment.

Relationship between anthropometric measures and sagittal spinal curvatures in adult male handball players

PurposeIncreasing anthropometric measures bring considerable spinal loads during sports practice, which inversely affects the adaptation abilities of the spinal structures; this in turn influences the spinal curvatures. The study was conducted to explore the relationship between anthropometric measures and sagittal spinal curvatures in handball players.MethodThe total of 83 male handball players were divided into 2 groups, depending on their body height: group 1 (age, 23.62 ± 2.07 years) consisted of 40 handball players with height above average, group 2 (age, 24.63 ± 2.58 years) consisted of 43 handball players with height below average. The thoracic and lumbar curvatures and trunk height were measured with the Formetric III 4D spine and posture analysis system.ResultsThe thoracic kyphosis of group 1 was significantly higher than that of group 2 (&lt;i&gt;p&lt;/i&gt; = 0.038), without a significant difference in lumbar lordosis (&lt;i&gt;p&lt;/i&gt; = 0.312), and significant difference in the coefficient of compensation between thoracic kyphosis and lumbar lordosis (&lt;i&gt;p&lt;/i&gt; = 0.026). Group 1 showed strong positive correlation between body height and kyphotic angle (&lt;i&gt;r&lt;/i&gt; = 0.897), and moderate positive correlation with lordosis angle (&lt;i&gt;r&lt;/i&gt; = 0.496). In group 2, there was weak positive correlation with kyphotic angle (&lt;i&gt;r&lt;/i&gt; = 0.381), and weak negative correlation with lumbar lordosis angle (&lt;i&gt;r&lt;/i&gt; = –0.355).ConclusionsIncreasing body height of handball players is associated with bigger kyphotic and lordotic angles. Owing to frequent sagittal asymmetric overloading of the spine during handball training, exercises that help maintain good posture and correct the thoracic kyphosis are required, especially for taller players.

Radiological Analysis of Thoracolumbar Junctional Degenerative Kyphosis in Patients with Lumbar Degenerative Kyphosis.

Background:Thoracolumbar junction (TLJ) is the transitional area between the lower thoracic spine and the upper lumbar spine. Vertebral compression fractures and proximal junctional kyphosis following spine surgery often occur in this area. Therefore, the study of development and mechanisms of thoracolumbar junctional degeneration is important for planning surgical management. This study aimed to review radiological parameters of thoracolumbar junctional degenerative kyphosis (TLJDK) in patients with lumbar degenerative kyphosis and to analyze compensatory mechanisms of sagittal balance.Methods:From January 2016 to March 2017, patients with lumbar degenerative kyphosis were enrolled in this radiographic study. Patients were divided into two groups according to thoracolumbar junctional angle (TLJA): the non-TLJDK (NTLJDK) group (TLJA <10°) and the TLJDK group (TLJA ≥10°). Complete spinopelvic radiographic parameters were analyzed and compared between two groups. Pearson or Spearman correlation coefficients and independent two-sample t-test or Mann-Whitney U-test were used.Results:A total of 77 patients with symptomatic sagittal imbalance due to lumbar degenerative kyphosis were enrolled in this study. There were 34 patients in NTLJDK group (TLJA <10°) and 43 patients in TLJDK group (TLJA ≥10°). The median angle of lumbar lordosis (LL) in the NTLJDK or TLJDK groups was 23.40° (18.50°, 29.48°) or 19.50° (13.30°, 24.55°), respectively. The median TLJAs in all patients and both groups were −11.20° (−14.60°, −4.80°), −3.70° (−7.53°, −1.73°), and −14.30° (−17.45°, −13.00°), respectively. In the NTLJDK group, LL was correlated with thoracic kyphosis (TK; r = −0.400, P = 0.019), sacral slope (SS; r = 0.681, P < 0.001), and C7-sagittal vertical axis (r = −0.402, P = 0.018). In the TLJDK group, LL was correlated with TK (r = −0.345, P = 0.024), SS (r = 0.595, P < 0.001), and pelvic tilt (r = −0.363, P = 0.017). There were significant differences in LL, TLJA, TK, SS, and pelvic incidence (PI) between two groups.Conclusions:Although TLJDK is common in patients with lumbar degenerative kyphosis, it might be generated by special characteristics of morphology and biomechanics of the TLJ. To maintain sagittal balance, pelvis back tilt might be more important in patients with TLJDK, whereas thoracic curve changes might be more important in patients without TLJDK.