Slump Sitting Research Articles

Forced Straightening of the Back Does Not Improve Body Shape

Background: Sitting for a long time causes various postural problems, such as slump sitting. It has been reported that employing a corrected sitting position while lifting the sternum is effective in improving this form of posture. We investigated how a corrected sitting posture with the lifting of the sternum is different from a forced position that is applied through the command and passive positions. Materials and methods: The postural angle of 270 subjects aged 19–23 years was measured in the passive, forced, and corrected positions using a Saunders inclinometer and a Formetric 4D system. Results: As a result, the corrected position had a small range (min–max) at all angles, but the forced position and passive position had a large range (min–max). The lumbar lordosis angle in the corrected position showed positive values throughout its range (min–max), while the other groups showed negative values, which indicates the kyphotic position of the lumbar section. In addition, the percentage error in the corrected position was small, but it presented high values in the other groups. When comparing the average angles between the groups, there were substantial changes observed between the corrected position and the other groups. It was found that the corrected position with the sternum lifted, which is applied to improve slump sitting in the clinical environment, exhibited an angle that differed from that of the forced position and the passive position. Conclusions: Our results suggest that a forced position on the command “scapular retraction” does not meet the clinical assumptions of posture correction, in contrast to the corrected position with the lifting of the sternum for the improvement of slump sitting. The accurate correction of the position of the sternum and sacrum improves the position of the spine in the sagittal plane, enabling physiological values for the kyphosis and lordosis angle parameters to be obtained. This approach combines the ease of execution and precision of the effect. The fact that this method does not require complex tools to accurately correct the body encourages the implementation of this solution in clinical practice.

The biomechanical consequence of posterior interventions at the thoracolumbar spine on the passively stabilized flexed posture

In the flexed end-of-range position (e.g., during slumped sitting), the trunk is passively stabilized. Little is known about the biomechanical consequence of posterior approaches on passive stabilization. The aim of this study is to investigate the effect of posterior surgical interventions on local and distant spinal regions. While being fixed at the pelvis, five human torsos were passively flexed. The change in spinal angulation at Th4, Th12, L4 and S1 was measured after level-wise longitudinal incisions of the thoracolumbar fascia, the paraspinal muscles, horizontal incisions of the inter- & supraspinous ligaments (ISL/SSL) and horizontal incision of the thoracolumbar fascia and the paraspinal muscles. Lumbar angulation (Th12-S1) was increased by 0.3° for fascia, 0.5° for muscle and 0.8° for ISL/SSL-incisions per lumbar level. The effect of level-wise incisions at the lumbar spine was 1.4, 3.5 and 2.6 times greater compared to thoracic interventions for fascia, muscle and ISL/SSL respectively. The combined midline interventions at the lumbar spine were associated with 2.2° extension of the thoracic spine. Horizontal incision of the fascia increased spinal angulation by 0.3°, while horizontal muscle incision resulted in a collapse of 4/5 specimens. The thoracolumbar fascia, the paraspinal muscle and the ISL/SSL are important passive stabilizers for the trunk in the flexed end-of-range position. Lumbar interventions needed for approaches to the spine have a larger effect on spinal posture than thoracic interventions and the increase of spinal angulation at the level of the intervention is partially compensated at the neighboring spinal regions.

Prolonged slumped sitting causes neck pain and increased axioscapular muscle activity during a computer task in healthy participants – A randomized crossover study

IntroductionSitting posture may contribute to spinal pain. Effects of postures on pain, sensitivity and muscle activity during computer tasks were investigated. MethodsTwenty-five healthy participants, seated at a workstation without backrest, completed four, 15-min typing tasks: A)Upright with forearm-support; B)Upright without forearm-support; C)Slumped with forearm-support; D)Slumped without forearm-support. Participants rated pain every minute on a numerical rating scale (NRS). RMS-EMG was recorded from upper/lower trapezius (UT, LT), serratus anterior and anterior/middle deltoid. At baseline and after tasks, pressure pain thresholds (PPTs) were recorded bilaterally over the head, UT, and leg. ResultsAll tasks caused clinically relevant increased NRS (≥2/10) compared to baseline (P < 0.001). NRS was higher in Task-D (P < 0.003) and lower in Task-B (P < 0.005) than others. PPTs did not change from baseline. Task-D caused higher UT and LT RMS-EMG (P < 0.02) than other tasks. ConclusionA 15-min task caused pain irrespective of posture with some causing larger changes than others.

Effect of Spinal Sagittal Alignment in Sitting Posture on Swallowing Function in Healthy Adult Women: A Cross-Sectional Study.

Swallowing function is both directly and indirectly related to postures, such as head and cervical angle and body position. However, the effects of different sitting postures on oropharyngeal swallowing have not been investigated. This study aimed to investigate whether the change in thoracolumbar alignment affected the oropharyngeal swallowing. A total of 58 healthy adult women (mean age 22.2 ± 1.67years) without dysphagia were enrolled in this cross-sectional study. Participants were positioned in three sitting postures: comfortable sitting (CS), thoracic upright sitting (TUS), and slump sitting (SS). In each sitting posture, the kyphosis index (using a flexicurve), head and cervical angles (using a digital camera), swallowing speed (100-ml water swallowing test), and oral and articulatory function [by maximum tongue pressure (MTP) and oral diadochokinesis (ODK)] were evaluated. SS showed the largest kyphosis index and was associated with a greater anterior translation of the head. Swallowing speed was significantly decreased in SS compared with CS (p = 0.002) and TUS (p = 0.020) and ODK was significantly decreased in SS compared with other postures, for both /ta/ (p = 0.004) and /ka/ (p < 0.001) syllables. Further, MTP tended to decrease in SS compared with TUS (p = 0.064). Our results suggest that changes in sitting posture with different thoracolumbar alignments affect swallowing speed and oral and articulatory function. Consequently, adjustments to reduce sitting postural kyphosis may improve swallowing speed and oral and articulatory function.

Lower-Limb Range of Motion Predicts Sagittal Spinal Misalignments in Children: A Case-Control Study

The main objective of this study was to determine lower-limb range of motion (ROM) as a risk factor associated with sagittal spinal misalignments in children. Two hundred and one children (10.9 ± 0.7 years old) from five different primary schools were recruited for this retrospective case—control study. Anthropometric variables, sagittal spinal alignment in habitual everyday postures, and lower-limb ROM, such as ankle dorsiflexion with the knee flexed (ADF-KF), hip extension with the knee relaxed (HE), and hip flexion with the knee extended (HF-KE) were measured. Multivariate and univariate analyses revealed differences between the means of HE and HF-KE ROM, and the thoracic and lumbar curves (p ≤ 0.034; η2 ≥ 0.052). The HE (p ≤ 0.028; OR ≥ 1.066) predicted sagittal thoracic misalignment in the slump sitting (SSP) and relaxed standing (RSP) postures in males and the sagittal lumbar misalignment in the RSP in female children; while HF-KE (p ≤ 0.006; OR ≥ 1.089) predicted sagittal thoracic misalignment in the maximum trunk forward flexion posture (MTFP) and sagittal lumbar misalignment in SSP and MTFP in males. In this study, the reference values for restricted HE and HF-KE were significantly associated with sagittal spinal misalignment in male children but not for the ankle ROM. Physical education teachers should include stretching exercises in the ISQUIOS programme to increase the extensibility of the iliopsoas (HE) and hamstrings (HF-KE) and prevent sagittal spinal misalignments in habitual everyday postures.

Slump Sitting X-ray

Study Design: This was a prospective study. Purpose: The aim of this study was to introduce a new slump sitting method radiographs and to compare the angular range of motion (ROM) and displacement between conventional flexion view method and slump sitting radiograph. Overview of Literature: Most patients have mechanical low back pain and lumbar instability is considered to be responsible for most chronic and recurrent pain. Dynamic radiographs have been used to identify spinal instability. Methods: After ethics committee permission, this study was initiated. Sixty patients were enrolled in the study after obtaining written informed consent. Patients were randomly allocated into two groups: the first group underwent slump view then conventional view, and the second group underwent conventional view then slump view followed all patient’s extension radiographs taken. Angular and displacement measurements of the lumbar spine were carried out and compared. Results: Of 60 patients, 40 patients and 26 patients were found instability with slump radiographs and conventional flexion radiographs, respectively. When slump and conventional method were compared, the lumbar flexions were larger in slump radiographs. There were 22.35° of additional global flexion (L1/S1) (P &lt; 0.0001) in slump radiographs when compared with conventional radiographs. Greater global flexion using slump method was found at all lumbar segments with L1/L2 contributing 1.15°; P = 0.009, L2/L3 contributing 3.41°; P &lt; 0001, L3/L4 contributing 5.25°; P &lt; 0.001, L4/L5 5.23°; P &lt; 0.001 with the main contributor being L5/S1 7.41°; P &lt; 0001. When slump and conventional method were compared in terms of displacement, there were no significant differences. Conclusion: The slump siting radiographs in lumbar spine instability effectively show the increase in global flexion with significant improvement in segmental flexion. Slump siting radiograph produces more stress in the entire lumbar spine, especially in lower lumbar spine to diagnose lumbar spine instability. Hence, slump sitting dynamic radiograph was shown to be superior to the conventional forward flexion method in measuring the angular ROM and noninferior to the conventional method in the measurement of displacement

The Sagittal Integral Morphotype in Male and Female Rowers.

The goal of this study was to describe the integrated spinal assessment of the sagittal morphotype in rowers to determine whether the intense practice of rowing causes a modification of the sagittal curvatures of the spine, its relationship with the rowing technique, and training background. The second goal was to analyse how the dorsal and lumbar curves behave in the three phases of the rowing gesture, and to determine which phases can be detrimental to the correct development of the spine during growth. We analysed the spine curvatures in the sagittal plane of 29 females and 82 males, which were measured with an inclinometer in standing, slump sitting, maximal trunk flexion and during rowing performance. The average value of thoracic kyphosis in the rowers was 30° (mean, 30 + 8.27°). Thoracic hyperkyphosis was found in only two rowers (1.8%). Lumbar lordosis was within normal range in 84.1% of the males (mean, 27 + 9.57°) and 75.9% of female rowers (mean, 33°). Functional thoracic hyperkyphosis was observed in 57.4% of the males and 17.1% of the females. Functional lumbar hyperkyphosis was observed in 28 of the 69 males (40.5%) and five of 22 females (17.2%). Rowing seems to provide adequate spine alignment in the sagittal plane on standing. The integrated spinal assessment of the sagittal morphotype showed that half or our rowers presented with functional thoracic hyperkyphosis, and 43.2% presented with functional lumbar hyperkyphosis. Spine behaviour during the rowing technique shows that the thoracic kyphosis (98.2%) and lumbar spine (91%) perform within normative ranges and could explain the adequate positioning of the spine in the sagittal plane on standing. Years of rowing training tend to reduce thoracic kyphosis in males.

Understanding the Pathophysiology of L5-S1 Loss of Lordosis and Retrolisthesis: An EOS Study of Lumbopelvic Movement Between Standing and Slump Sitting Postures

To understand the pathophysiology of L5-S1 loss of lordosis and retrolisthesis by comparing 2 commonly assumed physiological weight-bearing postures. This was a prospective comparative study of whole-body standing and slump sitting EOS radiographs in clinic patients presenting with back pain or lower limb radicular pain. Patients with prior spinal intervention, malignancy, trauma, inflammatory diseases, transitional lumbosacral vertebra, pregnancy, and L5-S1 retrolisthesis or spondylolisthesis from nondegenerative causes were excluded. C7 sagittal vertical axis, global cervical angle, global thoracic angle, global lumbar angle, thoracolumbar angle, T1-slope, pelvic incidence, pelvic tilt, sacral slope, L5-S1 angle, L5-S1 vertebral translation, L5-S1 disc height, and presence of L4-5 vertebral translation were measured. Univariate and multivariate analyses were performed to identify predictors of L5-S1 lordosis loss and retrolisthesis. L5-S1 loss of lumbar lordosis (7.02 ± 9.90°, P < 0.001), retrolisthesis (0.07 ± 0.411 cm, P < 0.001), and loss of disc height (0.10 ± 0.23 cm, P < 0.001) occurred when changing from standing to slump sitting along with other sagittal profile changes (P < 0.001). Taller L5-S1 disc height (odds ratio [OR] 2.57, P= 0.04), larger lumbar range-of-motion change (OR 3.82, P= 0.012), lower sacral slope on sitting (OR 2.50, P= 0.043), and presence of L4-5 spondylolisthesis (OR 2.75, P= 0.032) were predictive of larger L5-S1 lordosis loss (>7°) on multivariate analysis, while larger lumbar range-of-motion change (OR 2.21, P= 0.050) and presence of L4-5 spondylolisthesis (OR 3.08, P= 0.023) were predictive of greater L5-S1 retrolisthesis (>0.07 cm). Degenerative L5-S1 loss of lordosis and retrolisthesis likely result from long-standing lower lumbar spine bending forces against the posterior ligamentous complex with slump sitting, predisposed by a negatively sloped sacrum and increased lumbar flexibility.

Sagittal Integral Morphotype of Female Classical Ballet Dancers and Predictors of Sciatica and Low Back Pain.

The aims of this study were to describe the sagittal integral morphotype (SIM) of classical ballet (CB) dancers, and to establish predictor factors and their cut off values for high risk of experiencing sciatica or low back pain (LBP). This retrospective cohort study was performed in 33 female professional CB dancers. Data related to anthropometric parameters, CB dance experience, sciatica or LBP history, and sagittal spine curvatures were collected. A binary logistic regression and receiver-operating characteristic analysis were performed. The main spine misalignments observed in the SIM of CB dancers were thoracic functional hyperkyphosis, hypomobile kyphosis, and hypokyphosis, and those for the lumbar curvature were hyperlordotic attitude and functional hyperkyphosis. The lumbar curvature in slump sitting and trunk forward bending positions, together with the stature, were significant predictor factors of sciatica history, while the years of dance experience was a significant predictor factor of LBP history. The cut off values analysis revealed that dancers with a stature of 161 cm or less, and those with 14 years of experience or more, have a greater probability of experiencing sciatica or LBP history, respectively.

The relation between the flexion relaxation phenomenon onset angle and lumbar spine muscle reflex onset time in response to 30 min of slumped sitting

Viscoelastic creep of spine tissue, induced by submaximal spine flexion in sitting, can delay the onset of the flexion-relaxation phenomenon (FRP) and low back reflexes (LBR). Theoretically, these two outcome measures should be correlated; however, no studies have investigated this. This study aims to determine whether 30 min of near-maximal spine flexion will affect the onset of FRP and LBR in the lumbar erector spinae (LS) and lumbar multifidus (LM), and to examine the relation between these parameters. 15 participants were recruited (9F, 6M). Spine angle (between L1 and S2) was monitored synchronously with bilateral muscle activity in the LS (L1) and the LM (L4). FRP onset and LBR were measured in a randomized order before and after 30 min of slouched sitting. No significant difference was found for any muscle LBR onset time between pre and post-sitting (p > 0.05). A significant increase in FRP onset was found in the RLM (p = 0.016) following sitting. No significant correlation was found between the FRP and the LBR for any muscle. These results suggest that the LBR onset might not be as sensitive as an outcome measure to investigate shorter exposures of sitting as FRP.

Differences in regional and global lumbar angle during slumped sitting and upright sitting among global three subgroups.

The purpose of this study was to investigate differences in regional lumbar lordosis (RLL) and global lumbar lordosis (GLL) angle during slumped sitting and upright sitting among three global subgroups. A total of 48 young asymptomatic volunteers stood in a comfortable posture, sat upright, and sat in a slumped position for 5 seconds, with inertial measurement units attached to the T10, L3, and S2 vertebrae. According to standing measurement, the participants were categorized into flat-back (GLL < 20∘), normal lordosis (20∘⩽ GLL < 30∘), and hyper-lordosis (30∘⩽ GLL < 40∘) groups. Both the GLL and RLL in the flat-back group were reduced lumbar lordosis in the upright sitting posture and increased lumbar kyphosis in the slumped sitting postures compared to the other groups (p< 0.05), but the range of motion during the transition from upright sitting to slumped sitting was lower than that of the normal and hyper-lordosis groups (p< 0.05). GLL in standing was a moderate correlation with GLL and RLL during upright sitting (p< 0.05). However, there was a strong correlation between GLL and RLL kinematics during upright and slumped sitting (p< 0.05). Flat-back posture is a potential source of low back pain during both upright and slumped sitting compared to the normal and hyper-lordosis groups. Posture measurements in a standing and sitting position conducted to assess lordosis should consider the relationship between GLL and RLL.

Relationship between muscle thickness and spinal column alignment in the standing and sitting positions

The trunk muscles play a role in posture maintenance, but whether they are related to spinal alignment in different postures has only been investigated in young adults and not in the elderly who show age-related changes in the spine. This study aimed to determine the relationship between changes in spinal alignment and muscle thickness in three postures in healthy elderly subjects. Spinal mouse measurements of Spinal alignment and ultrasound measurements of the trunk muscles were performed in the standing, upright and slump sitting positions on healthy elderly individuals living in the community. Results showed significant differences in the sacral tilt, lumbar curvature, and overall tilt angles in the slump sitting position for spinal alignment, and significant differences were noted in muscle thickness between standing and upright sitting, standing and slump sitting, and standing and slump sitting, and upright and slump sitting for the spinal proprioceptive muscle (second lumbar level). In conclusion, there was no correlation between the two changes. It was suggested that the spine be viewed as a whole and not in parts, with muscle thickness changes. Keywords: Spine, postural difference, posture holding muscle.

Effect of low back pain on the muscles controlling the sitting posture.

[Purpose] The purpose of the current study was to reveal the association between posture control and muscle activity by measuring the trunk and hip joint muscle activities in the upright and slump sitting positions in both the healthy participants and patients with recurrent lower back pain. [Participants and Methods] We recruited eleven patients of recurrent lower back pain and ten healthy participants. During the maintenance of the two types of posture, upright and slump, we collected the surface electromyography data. We assessed the following muscles: rectus abdominis, external oblique, thoracic erector spinae, lumbar erector spinae, internal oblique, lumbar multifidus, iliacus, serratus anterior, rectus femoris, tensor fascia latae, and gluteus maximus. We studied the differences in spinal–pelvic curvature and muscle activity between the upright and slump positions in each group. [Results] In the healthy group, comparison of the muscle activity in upright and slump positions for both the trunk (external oblique, internal oblique, lumbar erector spinae, and lumbar multifidus), and the hip muscles (iliacus and gluteus maximus) showed a significant decrease in activity in the slump position. In the group with recurrent lower back pain, although the external oblique, lumbar erector spinae and lumbar multifidus showed reduced activity in slump position, these values were smaller when compared to those in the healthy group. [Conclusion] This study aimed to clarify the relationship between posture (upright and slump) and the activity of the trunk and hip joint muscles in the healthy participants and the patients with recurrent lower back pain. The results indicated that postural changes caused by recurrent lower back pain significantly affected the activity of the muscles involved in controlling the posture.

The effectiveness of cement augmentation in kyphosis correction of dynamically loaded osteoporotic vertebral fractures: A retrospective case series

BackgroundOsteoporotic fracture of vertebrae is the presentation of osteoporosis, in most elderly patients and treatment of these fractures aims in pain relief, correction of kyphosis and management of osteoporosis. The purpose of the study is to evaluate the clinical usefulness of cement augmentation and the ability of cement augmented vertebrae to withstand physiological axial load. Materials and methodsWe did a retrospective analysis of all patients (62 patients and 67 vertebrae) from 2015 to 2019 in whom a stand-alone percutaneous cement augmentation was done for primary osteoporotic vertebral fractures. The kyphotic angle (KA), wedge angle (WA) and anterior vertebral height (AVH) were measured in radiographs taken pre-operatively and post-operatively in slump sitting and supine position. The mobility of the vertebra was determined radiologically by the difference in KA, WA and AVH in two positions (slump sitting and supine) and were compared. Functional outcome was analyzed using VAS scores for back pain. ResultsThe mean age group was 67.66 + 11.49 years, with thoracolumbar region being the most commonly involved. There was a significant improvement in back pain scores post cement augmentation from a pre-operative VAS of 6.91 ± 1.7 to a post-operative VAS score of 1.74 ± 1.1. The kyphotic deformity parameters like KA, WA and AVH also improved post cement augmentation. The difference of KA, WA and AVH between sitting and supine position preoperatively were 4.85 ± 6.87degrees, 2.61 ± 6.35 degrees and 0.26 ± 0.47 cm. The difference of post-operative KA, WA and AVH in two different positions was 1.02 ± 0.76 degrees, 0.05 ± 0.21 degrees and 0.03 ± 0.04 and were statistically significant than pre-operative measurements. ConclusionThe cement augmentation technique in addition to pain relief, it also improves the kyphotic deformity of the fractured vertebrae. The kyphotic deformity correction achieved by the procedure remain sustained even in physiological axial loading of the cement augmented vertebra.

Classification System of the Sagittal Integral Morphotype in Children from the ISQUIOS Programme (Spain).

The sagittal spinal morphology presents 4 physiological curvatures that increase endurance to axial compression forces and allow adequate postural balance. These curves must remain within normal ranges to achieve a static and dynamic balance, a correct functioning of the muscles and an adequate distribution of the loads, and thus minimize the injury risk. The purpose of this study was to categorize the sagittal spinal alignment according to the different morphotypes obtained for each curve in standing, slump sitting, and trunk forward bending positions in schoolchildren. It was a cross-sectional study. Sagittal spinal curvatures were assessed in 731 students from 16 elementary schools. In the sagittal standing position assessment, 70.45% and 89.06% of schoolchildren presented a “normal” morphotype for both dorsal and lumbar curves, respectively. After the application of the “Sagittal Integral Morphotype” protocol according to the morphotypes obtained in the three positions assessment (standing, slump sitting, and trunk forward bending), it was observed how the frequency of normal morphotypes for the dorsal and lumbar curve decreased considerably (only 32% and 6.6% of children obtained a “normal sagittal integral morphotype” for the thoracic and lumbar curvatures, respectively). These results show how it is necessary to include the slump sitting and trunk forward bending assessment as part of the protocol to define the “integral” sagittal alignment of the spine and establish a correct diagnosis. The use of the diagnostic classification presented in this study will allow early detection of misalignment not identified with the assessment of standing position.

Sagittal Radiographic Parameters of the Spine in Three Physiological Postures Characterized Using a Slot Scanner and Their Potential Implications on Spinal Weight-Bearing Properties

Study DesignProspective radiographic comparative study.PurposeTo compare and understand the load-bearing properties of each functional spinal unit (FSU) using three commonly assumed, physiological, spinal postures, namely, the flexed (slump sitting), erect (standing) and extended (backward bending) postures. Overview of LiteratureSagittal spinal alignment is posture-dependent and influences the load-bearing properties of the spine. The routine placement of intervertebral cages “as anterior as possible” to correct deformity may compromise the load-bearing capabilities of the spine, leading to complications.MethodsWe recruited young patients with nonspecific low back pain for <3 months, who were otherwise healthy. Each patient had EOS images taken in the flexed, erect and extended positions, in random order, as well as magnetic resonance imaging to assess for disk degeneration. Angular and disk height measurements were performed and compared in all three postures using paired t-tests. Changes in disk height relative to the erect posture were caclulated to determine the alignment-specific load-bearing area of each FSU.ResultsEighty-three patients (415 lumbar intervertebral disks) were studied. Significant alignment changes were found between all three postures at L1/2, and only between erect and flexion at the other FSUs. Disk height measurements showed that the neutral axis of the spine, marked by zones where disk heights did not change, varied between postures and was level specific. The load-bearing areas were also found to be more anterior in flexion and more posterior in extension, with the erect spine resembling the extended spine to a greater extent.ConclusionsLoad-bearing areas of the lumbar spine are sagittal alignment-specific and level-specific. This may imply that, depending on the surgical realignment strategy, attention should be paid not just to placing an intervertebral cage “as anterior as possible” for generating lordosis, but also on optimizing load-bearing in the lumbar spine.

Sagittal Spinal Morphotype Assessment in Dressage and Show Jumping Riders.

Previous research has analyzed how the sport influences sagittal spinal curvatures in young athletes and has found that spinal curves may be modified as a consequence of repeated movement patterns and postures of each discipline. To analyze sagittal spinal alignment by equestrian discipline and its relation to training load, and to describe "sagittal integrative morphotype" in young riders. Observational descriptive study. Training room. A total of 23 riders (aged 9-17y)-13 dressage riders (3 males and 10 females) and 10 show jumping riders (5 males and 5 females)-participated voluntarily. Mann-Whitney U test was applied to determine differences between riders' characteristics (gender, discipline, and training load) and spine variables. According to normality ranges for spinal curves, females showed an increase for lumbar curvature in standing position. It was found that show jumping riders manifested an increment in thoracic and lumbar curves while standing and an increase in the thoracic curvature in slump sitting. Statistically significant differences were found when lumbar curvature, "sit and reach" distance, and lumbo-horizontal angle in flexion were analyzed by gender in "sit and reach" test. No statistical significant differences were found when spinal curves in each position were analyzed depending on the training load. With regard to "sagittal integrative morphotype," all riders presented a hyperkyphotic dorsal morphotype no matter what their discipline. As for the lumbar curve, dressage and show jumping riders presented a functional hyperkyphotic morphotype. It is important to note that many riders presented a sagittal imbalance for the thoracic and lumbar curves. Therefore, as the sagittal spinal misalignments persist and worsen over time, exercise programs to prevent or rehabilitate these imbalances in young riders will be needed. The "sagittal integrative morphotype" assessment is an essential tool in order to identify the spinal misalignment.

201. Utility of neutral sitting lateral radiographs for assessment of lumbar segmental instability in lumbar spondylolisthesis: a prospective study

BACKGROUND CONTEXT Degenerative lumbar spondylolisthesis (DLS) is a common disease and often results in back pain and neurogenic claudication, which frequently requires surgical intervention. However, segmental instability is a key factor in determining the treatment algorithm. PURPOSE To investigate the listhesis of the involved segments in DLS through slump sitting radiograph, and to determine the most useful diagnostic modalities in the evaluation of instability. STUDY DESIGN/SETTING This study prospectively recruited a consecutive series of patients with L4/5 DLS who underwent surgical intervention at our center between September 2018 and January 2019. PATIENT SAMPLE A total of 29 patients (9 men, 20 women), with a mean age of (59.6±8.2) years (3yr) were included. OUTCOME MEASURES Slip parameters were measured on all the sagittal images. Maximal translational and angular range of motion (ROM) was determined by comparing slip parameters between the above radiographs. METHODS All subjects had X-ray studies performed in slump sitting (Si), upright standing (U), flexion (F), extension (E) and supine MRI (Su). Slip parameters were measured on all the sagittal images. Maximal translational and angular range of motion (ROM) was determined by comparing slip parameters between the above radiographs. RESULTS A total of 29 patients (9 men, 20 women), with a mean age of (59.6±8.2) years (3yr) were included. Maximal vertebral reduction could be detected on Si, U and F radiograph, and maximal vertebral reduction could be determined on Su and E radiograph. In all, Si radiograph was detected with the maximal SP and minimum SA (P CONCLUSIONS Si radiograph demonstrated maximal anterior listhesis than U and F radiograph, and minimum intervertebral lordosis than E radiograph. Incorporation of Si lateral radiographs can improve our understanding of segmental mobility when evaluating DLS. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The Relationship between Cervical Tilt Angle and Upper Body Position in Upright and Slump Sitting

The Relationship between Cervical Tilt Angle and Upper Body Position in Upright and Slump Sitting

Patient and radiographer assessment of slump sitting flexion compared to conventional standing forward bending flexion.

A comparative survey from patients and radiographers of the new slump sitting flexion posture and the conventional standing forward bending posture. This study was performed to compare the technical and logistical aspects of the slump sitting versus the forward bending posture. Slump sitting flexes the lumbar spine more than the forward bending and increases the diagnosis rate of sagittal spinal instability up to 40% depending on the diagnostic criteria used. This should not come at the expense of patient safety and comfort nor burden the radiographers. Sixty patients were recruited from a single tertiary spine centre. Patients were block randomised into two groups with either the forward bending or the slump sitting being performed first. Feedback was obtained through self-administered questionnaires from patients regarding perceived safety, convenience and comfort, plus from radiographers regarding the imaging process, proxy measures of radiographer ability and scan difficulty. There was no significant difference between the baseline characteristics in both groups. Majority (63%) of patients preferred slump sitting and felt that forward bending caused pain (P=0.025). Overall, slump sitting was equivalent in comfort, perceived safety and ease to forward bending. Despite requiring more logistics (P=0.031), more effort to set up (P=0.002) and explain (P=0.012), the majority of radiographers (83%) preferred slump sitting. This method was felt to be less dangerous (P=0.015) and easier to maintain (P<0.001). This study showed that the superiority of slump sitting in allowing more lumbar flexion compared to the forward bending comes with patient safety or comfort. The technical demands of the learning curve can be offset with training. As such, slump sitting flexion views should be adopted as the standardized method for assessing spinal instability.