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1.
Zhiwei Yang Fang Xie Jianxin Zhang Zhuowen Liang Zhe Wang Xueyu Hu Zhuojing Luo 《The spine journal》2017,17(12):1812-1818
Background Context
The lumbar spine latericumbent and full-length lateral standing radiographs are most commonly used to assess lumbar disorder. However, there are few literatures on the difference and correlation of the sagittal parameters between the two shooting positions.Purpose
The study aimed to investigate the difference of sagittal parameters in spine lateral radiographs between latericumbent and upright positions, identify the correlation, and establish a preliminary linear fitting formula.Study Design
The study is a prospective study on radiographic evaluation of sagittal alignment using latericumbent and upright positions.Patient Sample
One hundred fifty-seven patients were recruited from the orthopedics clinic of a single medical center.Outcome Measure
Angle measurement, the intra- and interobserver measurement reliability of measurement, and analysis of the angle measurement were carried out.Method
The sagittal alignment of 157 patients were assessed using Surgimap software from two kinds of lateral radiographs to acquire the following parameters: lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), L4–L5 intervertebral angle (IVA4–5), L4–L5 intervertebral height index (IHI4–5), and PI–LL. The Kolmogorov-Smirnov test, paired t test, Pearson correlation analysis, and multivariate linear regression analysis were used to analyze the data.Results
The results showed significantly statistical difference in LL, SS, PT, IVA4–5, and PI–LL, except for PI and IHI4–5, between the two positions. There was a significant relativity between standing LL and latericumbent LL (r=0.733, p<.01), PI (r=0.611, p<.01), and SS (r=0.626, p<.01). The predictive formula of standing LL was 12.791+0.777 latericumbent LL+0.395 latericumbent PI?0.506 latericumbent SS (adjusted R2=0.619, p<.05).Conclusion
Not all of sagittal parameters obtained from two positions are identical. Thus, the full-spine lateral standing films are difficult to be replaced. The surgeon should give sufficient consideration to the difference between the two views. We may primarily predict standing LL with the formula when we could not get whole-spine lateral standing radiographs. 相似文献2.
Andrew M. Hayden Ann M. Hayes Jennifer L. Brechbuhler Heidi Israel Howard M. Place 《The spine journal》2018,18(1):173-178
Background Context
To date, many studies have examined how pelvic position affects the spinal curvature and spinopelvic parameters. However, these studies focus on a static relationship, comparing pelvis and spine in a relaxed or baseline position only. Indeed, the spinopelvic connection is dynamic, as subjects can easily be taught to rotate their pelvis anteriorly or posteriorly on the femoral head, all while maintaining an erect posture. Therefore, for a true understanding of pelvic influence on the spinal column, it is necessary to examine spinopelvic parameters in multiple pelvic positions within the same subject.Purpose
The objective of this study was to examine the dynamic effect of pelvic motion on the spine and associated radiographic parameters.Study Design
This is a single-center, cross-sectional study of 50 healthy, asymptomatic volunteers.Patient Sample
Subjects were recruited and screened based on the following criteria: between 18 and 79 years of age; no known spinal, pelvic, or lower extremity pain lasting for >48 hours; no history of spinal, pelvic, or lower extremity dysfunction requiring medical care; no radiographic evidence of spinal or pelvic abnormality, scoliosis deformity, or other associated spinal pathologies; not currently pregnant and with no possibility of being pregnant; and a body mass index of <30. 64. The subjects were screened and 14 were excluded for a total of 50 subjects.Outcome Measures
The outcome measures included thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI).Materials and Methods
This study was funded by a Small Exploratory Research Grant from the Scoliosis Research Society. Each subject was instructed and observed to stand in three different positions: pelvic resting, anterior pelvic rotation, and posterior pelvic rotation. Lateral standing radiographs were taken in each position and each image was examined by an orthopedic spine surgeon who digitally measured the TK, LL, SVA, PT, SS, and PI. The data were then statistically examined to determine the affect of pelvic position on each parameter.Results
Subjects demonstrated a measurable, statistically significant change in each parameter with pelvic rotation. There was a clear pattern of change for LL, PT, and SS with the anterior and posterior pelvic rotations. A change in LL demonstrated a strong correlation with changes in all measured parameters with pelvic rotation.Conclusions
In asymptomatic subjects, pelvic motion affects the position of the spinal column and resultant spinopelvic parameters. The results of this study demonstrate that one can intentionally change the position of the pelvis and the adjacent spinal column in space. Knowledge of this relationship is important to the understanding of sagittal balance and could influence the treatment of patients with spinal deformity. 相似文献3.
Seok Woo Kim Tae-Hwan Kim Do Hee Bok Chulyoung Jang Myung Ho Yang Seonjong Lee Je Hyun Yoo Yoon Hae Kwak Jae Keun Oh 《The spine journal》2018,18(5):797-810
Background context
Many studies tend to characterize cervical kyphosis as a significant clinical condition that needs to be treated. Moreover, opinions vary on whether cervical kyphosis should be considered a pathologic status or a natural occurrence in asymptomatic people.Purpose
This study aimed to determine the frequency of kyphotic posture of the cervical spine in currently asymptomatic individuals and to ascertain its relation with other spinopelvic parameters.Study Design
A cross-sectional radiographic study was carried out.Patient Sample
This study targeted 1,026 currently asymptomatic adult volunteers who agreed to participate in this study from January 2010 to March 2016. Only 958 were eligible for the study.Outcome Measures
Radiographic images, including the C-spine dynamic view and whole-spine lateral view, were measured. The sagittal parameters of the cervical spine and other parts of the spine and pelvis, such as the C2–C7 angle, C0–C2 range of motion (ROM), C2–C7 ROM, and C0–C7 ROM, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence, were measured.Methods
Based on the C-spine neutral lateral X-ray, a C2–C7 Cobb angle greater than 0 degree was defined as lordosis and an angle less than 0 degree was defined as kyphosis. Patients who showed kyphosis were further classified into the reducible or non-reducible group, depending on the ability of recovering neck motions (lordosis) in extension. The cervical and other global spine parameters between the two groups were analyzed, and the relation between the cervical alignment and other parts of the spine and pelvis were also examined. This study was not supported by any funding and had no conflicts of interest.Results
Nearly one-fourth of the asymptomatic participants (26.3%) have kyphotic cervical posture, and almost one-sixth of the kyphotic individuals (16.7%) have non-reducible kyphosis. The prevalence increases with advanced age; non-reducible cases are mostly kyphotic, kyphosis stems from the C2–C7 region, and kyphosis is not correlated with any of the radiological parameters of the other parts of the spine except lumbar lordosis.Conclusions
Cervical kyphosis can be observed in normal healthy adults. 相似文献4.
Hwee Weng Dennis Hey Kimberly-Anne Tan Shashidhar Bangalore Kantharajanna Alex Quok An Teo Chloe Xiaoyun Chan Ka-Po Gabriel Liu Hee-Kit Wong 《The spine journal》2018,18(3):422-429
Background Context
Pelvic incidence (PI)=pelvic tilt (PT)+sacral slope (SS) is an established trigonometric equation which can be expanded from studying the fixed pelvis with the spine to a fixed spinopelvic complex with the remnant spine, in scenarios of spinopelvic fusion or ankylosis. For a fixed spinopelvic complex, we propose the equation termed: lumbar incidence (LI)=lumbar tilt (LT)+lumbar slope (LS).Purpose
This study aimed to establish reference values for LI, LT, and LS at each lumbar vertebral level, and to show how LI can be used to determine residual lumbar lordosis (rLL).Study Design
This is a cross-sectional study of prospectively collected data, conducted at a single academic tertiary health-care center.Patient Sample
The study included 53 healthy patients aged 19–35 with first episode mechanical low back pain for a period of <3 months. Patients with previous spinal intervention, those with known or suspected spinal pathologies, and those who were pregnant, were excluded.Outcome Measures
Radiological measurements of LI, LT, LS, and rLL.Methods
All patients had full-body lateral standing radiographs obtained via a slot scanner. Basic global and regional radiographic parameters, spinopelvic parameters, and the aforementioned new parameters were measured. LI was correlated with rLL at each level by plotting LI against rLL on scatter plots and drawing lines-of-best-fit through the datapoints.Results
The mean value of L5I was 22.82°, L4I was 6.52°, L3I was ?0.92°, L2I was ?5.56°, and L1I was ?5.95°. LI turns negative at L3, LS turns negative at the L3/L4 apex, and LT remains positive throughout the lumbar spine. We found that the relationship of LI with its corresponding rLL follows a parabolic trend. Thus, rLL can be determined from the linear equations of the tangents to the parabolic lumbar spine. We propose the LI?rLL method for determining rLL as the LI recalibrates via spinopelvic compensation post instrumentation, and thus the predicted rLL will be based on this new equilibrium, promoting restoration of harmonized lordosis. The rLL-to-LI ratio is a simplified, but less accurate, method of deriving rLL from LI.Conclusions
This study demonstrates the extended use of PI=PT+SS proposed as LI=LT+LS. These new spinopelvic reference values help us better understand the position of each vertebra relative to the hip. In situations when lumbar vertebrae are fused or ankylosed to the sacrum to form a single spinopelvic complex, LI can be used to determine rLL, to preserve spinal harmony within the limits of compensated body balance. 相似文献5.
Caglar Yilgor Yasemin Yavuz Nuray Sogunmez Sleiman Haddad Anne F. Mannion Kadir Abul Louis Boissiere Ibrahim Obeid Frank Kleinstück Francisco Javier Sánchez Pérez-Grueso Emre Acaroglu Ferran Pellise Ahmet Alanay 《The spine journal》2018,18(10):1787-1797
Background Context
Pelvic tilt (PT) is used as an indicator of pelvic version with increased values indicating retroversion and disability. The concept of using PT solely as an absolute numerical value can be misleading, especially for the patients with pelvic incidence (PI) values near the upper and lower normal limits. Relative pelvic version (RPV) is a PI-based individualized measure of the pelvic version. Relative pelvic version indicates the individualized spatial orientation of the pelvis relative to the ideal sacral slope as defined by the magnitude of PI.Purpose
The aim of this study was to compare RPV and PT for their ability to predict mechanical complications and their correlations with health-related quality of Life (HRQoL) scores.Study Design
A retrospective analysis of a prospectively collected data of adult spinal deformity patients was carried out. Mechanical complications (proximal junctional kyphosis or proximal junctional failure, distal junctional kyphosis or distal junctional failure, rod breakage, and implant-related complications) and HRQoL scores (Oswestry Disability Index [ODI], Core Outcome Measures Index [COMI], Short Form-36 Physical Component Summary [SF-36 PCS], and Scoliosis Research Society 22 Spinal Deformity Questionnaire [SRS-22]) were used as outcome measures.Methods
Inclusion criteria were ≥4 levels fusion, and ≥2-year follow-up. Correlations between PT, RPV, PI, and HRQoL were analyzed using Pearson correlation coefficient. Pelvic incidence values and mechanical complication rates in RPV subgroups for each PT category were compared using one-way analysis of variance, Student t test, and chi-squared tests. Predictive models for mechanical complications with RPV and PT were analyzed using binomial logistic regressions.Results
A total of 222 patients (168 women, 54 men) met the inclusion criteria. Mean age was 52.2±19.3 (18–84) years. Mean follow-up was 28.8±8.2 (24–62) months. There was a significant correlation between PT and PI (r=0.613, p<.001), threatening the use of PT to quantify pelvic version for different PI values. Relative pelvic version was not correlated with PI (r=?0.108, p>.05), being able to quantify pelvic version for all PI values. Compared with PT, RPV had stronger partial correlations with ODI, COMI, SF-36 PCS, and SRS-22 scores (p<.05). Discrimination performance assessed by area under the curve, percentage accuracy in classification, true positive rate, true negative rate, and positive and negative predictive values was better for the model with RPV than for PT. For average PI sizes, the agreement between RPV and PT were moderate (0.609, p<.001), whereas the agreement in small and large PI sizes were poor (0.189, p>.05; ?0.098, p>.496, respectively). When analyzed by RPV, each PT “0,” “+,” and “++” category was further divided into two or three distinct subgroups of patients having different PI values (p=.000, p=.000, and p=.029, respectively). Relative pelvic version subgroups within the same PT category displayed different mechanical complication rates (p=.000, p=.020, and p=.019, respectively).Conclusions
Pelvic tilt may be insufficient or misleading in quantifying normoversion for the whole spectrum of PI values when used as an absolute numeric value in conjunction with previously reported population-based average thresholds of 20 and 30 degrees. Relative pelvic version offers an individualized quantification of ante-, normo-, and retroversion for all PI sizes. Schwab PT groups were found to constitute inhomogeneous subgroup of patients with different mean PI values and mechanical complication rates. Compared with PT, RPV showed a greater association with both mechanical complications and HRQoL. 相似文献6.
Hwee Weng Dennis Hey Chengyuan Gordon Wong Eugene Tze-Chun Lau Kimberly-Anne Tan Leok-Lim Lau Ka-Po Gabriel Liu Hee-Kit Wong 《The spine journal》2017,17(2):183-189
Background Context
Sitting spinal alignment is increasingly recognized as a factor influencing strategy for deformity correction. Considering that most individuals sit for longer hours in a “slumped” rather than in an erect posture, greater understanding of the natural sitting posture is warranted.Purpose
This study aimed to investigate the differences in sagittal spinal alignment between two common sitting postures: a natural, patient-preferred posture; and an erect, investigator-controlled posture that is commonly used in alignment studies.Design/Setting
This is a randomized, prospective study of 28 young, healthy patients seen in a tertiary hospital over a 6-month period.Patient Sample
Twenty-eight patients (24 men, 4 women), with a mean age of 24 years (range 19–38), were recruited for this study. All patients with first episode of lower back pain of less than 3 months' duration were included. The exclusion criteria consisted of previous spinal surgery, radicular symptoms, red flag symptoms, previous spinal trauma, obvious spinal deformity on forward bending test, significant personal or family history of malignancy, and current pregnancy.Outcome Measures
Radiographic measurements included sagittal vertical axis (SVA), lumbar lordosis (LL), thoracolumbar angle (TL), thoracic kyphosis (TK), and cervical lordosis (CL). Standard spinopelvic parameters (pelvic incidence, pelvic tilt [PT], and sacral slope) and sagittal apex and end vertebrae were also measured.Methods
Basic patient demographics (age, gender, ethnicity) were recorded. Lateral sitting whole spine radiographs were obtained using a slot scanner in the imposed erect and the natural sitting posture. Statistical analyses of the radiographical parameters were performed comparing the two sitting postures using chi-squared tests for categorical variables and paired t tests for continuous variables.Results
There was forward SVA shift between the two sitting postures by a mean of 2.9?cm (p<.001). There was a significant increase in CL by a mean of 11.62° (p<.001), and TL kyphosis by a mean of 11.48° (p<.001), as well as a loss of LL by a mean of 21.26° (p<.001). The mean PT increased by 17.68° (p<.001). The entire thoracic and lumbar spine has the tendency to form a single C-shaped curve with the apex moving to L1 (p=.002) vertebra in the majority of patients.Conclusions
In a natural sitting posture, the lumbar spine becomes kyphotic and contributes to a single C-shaped sagittal profile comprising the thoracic and the lumbar spine. This is associated with an increase in CL and PT, as well as a constant SVA. These findings lend insight into the body's natural way of energy conservation using the posterior ligamentous tension band while achieving sitting spinal sagittal balance. It also provides information on one of the possible causes of proximal junctional kyphosis or proximal junctional failure. 相似文献7.
Aaron J. Buckland Subaraman Ramchandran Louis Day Shay Bess Themistocles Protopsaltis Peter G. Passias Bassel G. Diebo Renaud Lafage Virginie Lafage Akhila Sure Thomas J. Errico 《The spine journal》2017,17(11):1601-1610
Background Context
Patients with degenerative lumbar stenosis (DLS) adopt a forward flexed posture in an attempt to decompress neural elements. The relationship between sagittal alignment and severity of lumbar stenosis has not previously been studied.Purpose
We hypothesized that patients with increasing radiological severity of lumbar stenosis will exhibit worsening sagittal alignment.Study Design
This is a cross-sectional study.Patient Sample
Our sample consists of patients who have DLS.Outcome Measures
Standing pelvic, regional, lower extremity and global sagittal alignment, and health-related quality of life (HRQoL) were the outcome measures.Methods
Patients with DLS were identified from a retrospective clinical database with corresponding full-body stereoradiographs. Exclusion criteria included coronal malalignment, prior spine surgery, spondylolisthesis>Grade 1, non-degenerative spinal pathology, or skeletal immaturity. Central stenosis severity was graded on axial T2-weighted magnetic resonance imaging (MRI) from L1–S1. Foraminal stenosis and supine lordosis was graded on sagittal T1-weighted images. Standing pelvic, regional, lower extremity, and global sagittal alignment were measured using validated software. The HRQoL measures were also analyzed in relation to severity of stenosis.Results
A total of 125 patients were identified with DLS on appropriate imaging. As central stenosis grade increased, patients displayed significantly increasing standing T1 pelvic angle, pelvic tilt, sagittal vertical axis, and pelvic incidence-lumbar lordosis (p<.05). No significant difference wasfound in pelvic incidence, supine lordosis, thoracic kyphosis, or T1 spinopelvic inclination between central stenosis groups. Despite similar supine lordosis between stenosis groups, patients with Grades 2 and 3 stenosis had less standing lordosis, suggesting antalgic posturing. Upper lumbar (L1–L3) stenosis predicted worse alignment than lower lumbar (L4–S1) stenosis.Increasing severity of foraminal stenosis was associated with reduced lumbar lordosis; however, no significant postural difference in lordosis, thoracolumbar, or lower extremity compensatory mechanisms were noted between foraminal stenosis groups. Stenosis grading did not predict worsening HRQoLs in central or foraminal stenosis.Conclusions
Severity of central lumbar stenosis as graded on MRI correlates with severity of sagittal malalignment. These findings support theories of sagittal malalignment as a compensatory mechanism for central lumbar stenosis. 相似文献8.
Jae Hwan Cho Youn-Suk Joo Cheongsu Lim Chang Ju Hwang Dong-Ho Lee Choon Sung Lee 《The spine journal》2017,17(12):1794-1802
Background Context
Sagittal imbalance is associated with poor clinical outcomes in patients with degenerative lumbar disease. However, there is no consensus on the impact of posterior lumbar interbody fusion (PLIF) on local and global sagittal balance.Purpose
To reveal the effect of one- or two-level PLIF on global sagittal balance.Design/Setting
A retrospective case-control study.Patients Sample
This study included 88 patients who underwent a one- or two-level PLIF for spinal stenosis with spondylolisthesis.Outcome Measures
Clinical and radiological parameters were measured pre- and postoperatively.Methods
All patients were followed up for >2 years. Clinical outcomes included a visual analog scale, Oswestry Disability Index, and EuroQol 5-dimension questionnaire (EQ-5D). Radiological parameters were measured using whole-spine standing lateral radiographs. Fusion, loosening, subsidence rates, and adverse events were also evaluated. Patients were divided into two groups according to their preoperative C7–S1 sagittal vertical axis (SVA): Group N: SVA≤5?cm vs Group I: SVA>5?cm; they were also divided according to postoperative changes in C7–S1 SVA. Clinical and radiological outcomes were compared between the groups.Results
All clinical outcomes and radiological parameters improved postoperatively. C7–S1 SVA improved (?1.6?cm) after L3–L5 fusion, but it was compromised (+3.6?cm) after L4–S1 fusion (p=.001). Preoperative demographic and clinical data showed no difference except in the anxiety or depression domain of EQ-5D. No differences were found in postoperative clinical outcomes. Lumbar lordosis, pelvic tilt, and thoracic kyphosis slightly improved in Group N, whereas C7–S1 SVA decreased from 9.5?cm to 3.8?cm (p<.001) in Group I. Furthermore, all sagittal parameters improved in Group I. On comparing the postoperative changes in C7–S1 SVA, we found that the decreasing trend in the postoperative C7–S1 SVA was related to a larger preoperative C7–S1 SVA (p=.030) and a more proximal level fusion (L3–L5 vs L4–S1, p=.033).Conclusions
Global sagittal balance improved after short-level lumbar fusion surgery in patients having spinal stenosis with spondylolisthesis who showed preoperative sagittal imbalance. Restoration of sagittal balance predominantly occurred after L3–L4, L4–L5, or L3–L5 PLIF. However, no such restoration was observed after L5–S1 or L4–S1 PLIF. Thus, we could anticipate sagittal balance restoration after performing PLIF at L3–L4 or L4–L5 level. However, caution is required when planning for L5–S1 fusion if preoperative sagittal imbalance is present. 相似文献9.
Louis Boissière Mitsuru Takemoto Anouar Bourghli Jean-Marc Vital Ferran Pellisé Ahmet Alanay Caglar Yilgor Emre Acaroglu Francisco Javier Perez-Grueso Frank Kleinstück Ibrahim Obeid 《The spine journal》2017,17(4):480-488
Background Context:
Many radiological parameters have been reported to correlate with patient's disability including sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence minus lumbar lordosis (PI?LL). European literature reports other parameters such as lumbar lordosis index (LLI) and the global tilt (GT). If most parameters correlate with health-related quality of life scores (HRQLs), their impact on disability remains unclear.Purpose
This study aimed to validate these parameters by investigating their correlation with HRQLs. It also aimed to evaluate the relationship between each of these sagittal parameters and HRQLs to fully understand the impact in adult spinal deformity management.Study Design
A retrospective review of a multicenter, prospective database was carried out.Patient Sample
The database inclusion criteria were adults (>18 years old) presenting any of the following radiographic parameters: scoliosis (Cobb ≥20°), SVA ≥5?cm, thoracic kyphosis ≥60° or PT ≥25°. All patients with complete data at baseline were included.Outcome Measures
Health-related quality of life scores, demographic variables (DVs), and radiographic parameters were collected at baseline.Methods
Differences in HRQLs among groups of each DV were assessed with analyses of variance. Correlations between radiographic variables and HRQLs were assessed using the Spearman rank correlation. Multivariate linear regression models were fitted for each of the HRQLs (Oswestry Disability Index [ODI], Scoliosis Research Society-22 subtotal score, or physical component summaries) with sagittal parameters and covariants as independent variables. A p<.05 value was considered statistically significant.Results
Among a total of 755 included patients (mean age, 52.1 years), 431 were non-surgical candidates and 324 were surgical candidates. Global tilt and LLI significantly correlated with HRQLs (r=0.4 and ?0.3, respectively) for univariate analysis. Demographic variables such as age, gender, body mass index, past surgery, and surgical or non-surgical candidate were significant predictors of ODI score. The likelihood ratio tests for the addition of the sagittal parameters showed that SVA, GT, T1 sagittal tilt, PI?LL, and LLI were statistically significant predictors for ODI score even adjusted for covariates. The differences of R2 values from Model 1 were 1.5% at maximum, indicating that the addition of sagittal parameters to the reference model increased only 1.5% of the variance of ODI explained by the models.Conclusion
GT and LLI appear to be independent radiographic parameters impacting ODI variance. If most of the parameters described in the literature are correlated with ODI, the impact of these radiographic parameters is less than 2% of ODI variance, whereas 40% are explained by DVs. The importance of radiographic parameters lies more on their purpose to describe and understand the malalignment mechanisms than their univariate correlation with HRQLs. 相似文献10.
Chang Ju Hwang Choon Sung Lee Hyojune Kim Dong-Ho Lee Jae Hwan Cho 《The spine journal》2018,18(10):1822-1828
Background Context
Coronal imbalance is a complication of corrective surgeries in adolescent idiopathic scoliosis (AIS). However, few studies about immediate coronal decompensation in Lenke-5C curves have reported its incidence, prognosis, and related factors.Purpose
To evaluate the development of coronal imbalance after selective thoracolumbar-lumbar (TL/L) fusion (SLF) in Lenke-5C AIS, and to reveal related factors.Study Design
Retrospective comparative study.Patient Sample
This study included 50 consecutive patients with Lenke-5C AIS who underwent SLF at a single center.Outcome Measures
Whole-spine anteroposterior and lateral radiographs were used to measure radiological parameters.Methods
Patients were divided into two groups according to the presence or absence of coronal imbalance (distance between C7 plumb line and central sacral vertical line >2?cm) in the early (1 month) postoperative period. Various radiological parameters were statistically compared between groups.Results
Of the patients, 28% (14 of 50) showed coronal imbalance in the early postoperative period; however, most of them (13 of 14) showed spontaneous correction during follow-up. The development of coronal imbalance was related to less flexibility of the TL/L curve (51.3% vs. 52.6%, p=.040), greater T10–L2 kyphosis (11.7° vs. 6.4°, p=.034), and greater distal junctional angle (6.0° vs. 3.7°, p=.025) in preoperative radiographs. Lowermost instrumented vertebra (LIV) tilt was greater in the decompensation [+] group in the early postoperative period (8.8° vs. 4.4°, p=.009). However, this difference disappeared in final follow-up with the decrease of LIV tilt in the decompensation [+] group.Conclusions
Less flexibility of the TL/L curve, greater TL kyphosis, and greater distal junctional angle preoperatively were predictive factors for immediate coronal imbalance in Lenke-5C curves. Although coronal imbalance was frequently detected in the early postoperative period after SLF, it was mostly corrected spontaneously with a decrease of LIV tilt. Thus, SLF for Lenke-5C curves can be a good option regardless of the possible coronal imbalance in the early postoperative period. 相似文献11.
Hwee Weng Dennis Hey Gordon Chengyuan Wong Chloe Xiaoyun Chan Leok-Lim Lau Naresh Kumar Joseph Shantakumar Thambiah John Nathaniel Ruiz Ka-Po Gabriel Liu Hee-Kit Wong 《The spine journal》2017,17(6):830-836
Background Context
Knowledge of sagittal radiographic parameters in adolescent idiopathic scoliosis (AIS) patients has not yet caught up with our understanding of their roles in patients with adult spinal deformity. It is likely that more emphasis will be placed in restoring sagittal parameters for AIS patients in the future. Therefore, we need to understand how these parameters may vary in AIS to facilitate management plans.Purpose
This study aimed to determine the reproducibility of sagittal spinal parameters on lateral film radiographs in patients with AIS.Study Design/Setting
This was a retrospective, comparative study conducted in a tertiary health-care institution from January 2013 to February 2016 (3-year period).Patient Sample
All AIS patients who underwent deformity correction surgery from January 2013 to February 2016 and had two preoperative serial lateral radiographs taken within the time period of a month were included in the study.Outcome Measures
Radiographic sagittal spinal parameters including sagittal vertical axis (SVA), cervical lordosis (CL), thoracic kyphosis (TK), thoracolumbar alignment (TL), lumbar lordosis (LL); standard spinopelvic measurements such as pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS); as well as end and apical vertebrae of cervical, thoracic, and lumbar curves were the outcome measures.Methods
All patient data were pooled from electronic medical records, and X-ray images were retrieved from Centricity Enterprise Web. Averaged X-ray measurements by two independent assessors were analyzed by comparing two radiographs of the same patients performed within a 1-month time period. Chi-squared and Wilcoxon signed-rank tests were used for categorical and continuous variables.Results
The study cohort comprised 138 patients, 28 men and 110 women, with a mean age of 15 years (range 11–20). Between the two lateral X-rays, there was a mean difference of 0.79?cm in SVA (p<.001), 0.70° in LL (p=.033), and 0.73° in PT (p=.010). In the combined Lenke 1 and 2 subgroup, there was a similar 0.77?cm (p=.002), 0.79° (p=.009), and 1.49° (p=.001) mean difference in SVA, LL, and PT, respectively. Additionally, there was also a 1.85° (p=.009) and 1.76° (p=.006) mean difference seen in TL and SS, respectively. The overall profile of the sagittal curves remained largely similar, with only the lumbar apex shifting from L3 to L4 during the first and the second X-rays, respectively (p<.001). This occurred for the combined Lenke 1 and 2 subgroup as well (p<.001).Conclusion
Most radiographic sagittal spinal parameters in AIS patients are generally reproducible with some variations up to a maximum of 4°. This natural variation should be taken into account when interpreting these radiographic sagittal parameters so as to achieve the most accurate results in surgical planning. 相似文献12.
Background Context
Acute fixed cervical kyphosis may be a rare presentation of conversion disorder, psychogenic dystonia, and potentially as a side effect from typical antipsychotic drugs. Haldol has been associated with acute dystonic reactions. In some cases, rigid deformities ensue. We are reporting a case of a fixed cervical kyphosis after the use of Haldol.Purpose
To present a case of a potential acute dystonic reaction temporally associated with Haldol ingestion leading to fixed cervical kyphosis.Study design
This is a case report.Methods
A patient diagnosed with bipolar disorder presented to the emergency room several times with severe neck pain and stiffness. The neck appeared fixed in flexion with extensive osteophyte formation over a 3-month period.Results
The patient's condition was resolved by a posterior-anterior-posterior surgical approach. It corrected the patient's cervical curvature from 88° to 5°.Conclusions
Acute dystonic reactions have the potential to apply enough pressure on bone to cause rapid osteophyte formation. 相似文献13.
Benlong Shi Qinghua Zhao Liang Xu Zhen Liu Xu Sun Zezhang Zhu Yong Qiu 《The spine journal》2018,18(11):2059-2064
Background Context
Several osteotomy techniques including pedicle subtraction osteotomy and vertebral column resection have been employed in the correction of congenital kyphosis (CK) and satisfying outcomes have been demonstrated. However, the Scoliosis Research Society (SRS)-Schwab Grade 4 osteotomy, defined as resection of posterior elements, partial vertebral body, and superior adjacent disc, is rarely reported in the treatment of CK.Purpose
The present study aimed to evaluate the efficiency and safety of SRS-Schwab Grade 4 osteotomy in patients with CK, and to propose its optimal indication.Study Design
This is a retrospective analysis of clinical and radiographic outcomes of patients with CK undergoing SRS-Schwab Grade 4 osteotomy.Patients Sample
Patients with thoracolumbar CK undergoing SRS-Schwab Grade 4 osteotomy from January 2010 to May 2015 followed up for at least 2 years were retrospectively reviewed.Outcome Measures
The thoracic kyphosis, lumbar lordosis, segmental kyphosis (SK), sagittal vertical axis (SVA), pelvic incidence, pelvic tilt, and sacral slope were measured on lateral spinal x-rays. Patients were required to fulfill the SRS-22 questionnaire at preoperation and the last follow-up.Materials and Methods
The sagittal spinal-pelvic parameters were assessed at preoperation, postoperation, and last follow-up. The comparison between preoperation and postoperation was performed by paired samples t test.Results
A total of 38 patients with CK (17 male and 21 female) with an average age of 16.5±9.9 years were included. The mean operating time was 242.7±88.1 minutes and blood loss was 634.5±177.8?mL. The mean follow-up was 38.8±20.3 months. The SK was 49.5±11.7° at preoperation, 6.8±7.4° at postoperation (p<.001), and 8.0±8.1° at the last follow-up. No significant correction loss during follow-up was found in SK (p=.125). The SVA was improved from ?36.0±18.3?mm at preoperation to 3.7±17.8?mm at postoperation (p<.001), and the correction was well maintained during follow-up (p=.113). Compared with preoperation, the mean postoperative scores of each domains of SRS-22 questionnaire improved at different levels. Intraoperative complications included one case with incidental dural tear and another with transient root injury. Proximal junctional kyphosis occurred in three patients at 6 months after operation and remained stable during the follow-up. At the last follow-up, all patients were identified to have achieved solid bony fusion.Conclusions
The SRS-Schwab Grade 4 osteotomy, if selected appropriately, could provide satisfying correction of congenital kyphosis. The correction could be well maintained during the longitudinal follow-up. 相似文献14.
George M. Ghobrial Daniel G. Eichberg John Paul G. Kolcun Karthik Madhavan Nathan H. Lebwohl Barth A. Green Joseph P. Gjolaj 《The spine journal》2017,17(10):1499-1505
Background Context
Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common problems after long-segment (>5 levels) thoracolumbar instrumented fusions in the treatment of adult spinal deformity (ASD). No specific surgical strategy has definitively been shown to lower the risk of PJK as the result of a multifactorial etiology.Purpose
The study aimed to assess the incidence of PJK and PJF in patients treated with prophylactic polymethylmethacrylate (PMMA) cement augmentation at the uppermost instrumented vertebrae (UIV) and rostral adjacent vertebrae (UIV+1).Study Design/Setting
This is a retrospective cohort-matched surgical case series at an academic institutional setting.Patient Sample
Eighty-five adult patients over a 16-year enrollment period were identified with long-segment (>5 levels) posterior thoracolumbar instrumented fusions for ASD.Outcome Measures
Primary outcomes measures were PJK magnitude and PJF formation. Secondary outcomes measures were spinopelvic parameters, as well as global and regional sagittal alignment.Methods
The impact of adjunctive PMMA use in long-segment (≥5 levels) fusion for ASD was assessed in adult patients aged 18 and older. Patients were included with at least one of the following: lumbar scoliosis >20°, pelvic tilt >25°, sagittal vertical axis >5?cm, central sacral vertical line >2?cm, and thoracic kyphosis >60°. The frequency of PJF and the magnitude of PJK were measured radiographically preoperatively, postoperatively, and at maximum follow-up in controls (Group A) and PMMA at the UIV and UIV+1 (Group B).Results
Eighty-five patients (64±11.1 years) with ASD were identified: 47 control patients (58±10.6) and 38 patients (71±6.8) treated with PMMA at the UIV and UIV+1. The mean follow-up was 27.9 and 24.2 months in Groups A and B, respectively (p=.10). Preoperative radiographic parameters were not significantly different, except the pelvic tilt which was greater in Group A (26.6° vs. 31.4°, p=.03). Postoperatively, the lumbopelvic mismatch was greater in Group B (14.6° vs. 7.9°, p=.037), whereas the magnitude of PJK was greater in controls (9.36° vs. 5.65°, p=.023). The incidence of PJK was 36% (n=17) and 23.7% (n=9) in Groups A and B, respectively (p=.020). The odds ratio of PJK with vertebroplasty was 0.548 (95% confidence interval=0.211 to 1.424). Proximal junctional kyphosis was observed in 6 (12.8%) controls only (p=.031). The UIV+1 angle, a measure of PJK, was significantly greater in controls (10.0° vs. 6.8°, p=.02). No difference in blood loss was observed. No complications were attributed to PMMA use.Conclusions
The use of prophylactic vertebral cement augmentation at the UIV and rostral adjacent vertebral segment at the time of deformity correction appears to be preventative in the development of proximal junctional kyphosis and failure. 相似文献15.
Background Context
Arthrodesis of the lumbosacral junction continues to be a challenge in pediatric and adult spinal deformity surgery.Purpose
To evaluate the biomechanical rigidity of two types of lumbosacral fixation. Our hypothesis was that the use of S2 alar-iliac (S2AI) fixation will result in statistically similar biomechanical fixation as compared with use of an iliac screw with a 95% confidence interval.Study Setting
Controlled biomechanical laboratoryMethods
Ten human cadaveric lumbosacral specimens were separated into two test groups: (1) S2AI (n=5) and (2) iliac screw (n=5). S2AI and iliac screws were placed according to current clinical practice techniques. Specimens were mounted in an unconstrained dual leg stance configuration for testing in flexion, extension, lateral bending, and axial rotation. These loads were induced by moving the offset loading arm 10?mm in the respective direction from the point of neutral motion with displacement control up to a 10 N-m moment, except axial rotation which used a 4 N-m moment. Optical tracking was used to monitor motion of the vertebra, pelvis, and fixation instrumentation during testing. Specimens were tested in intact and instrumented states. The stiffness values between S2AI and iliac screw configurations were compared.Disclosure
The present study received external research support (>$50,000 –<$75,000) from Stryker Spine (Allendale, NJ, USA).Results
There was a consistent trend of increased construct stiffness for all S2AI samples compared with the iliac screw group. However, none of the groups tested reached statistical significance for a 95% confidence interval.Conclusions
S2AI screws are just as stable as iliac screws with biomechanical testing in flexion, extension, rotation, lateral bending, and axial rotation. Given the similarities of biomechanical testing to human movements, these findings support S2AI screws as a viable option for lumbosacral fixation. 相似文献16.
Hwee Weng Dennis Hey Alex Quok An Teo Kimberly-Anne Tan Li Wen Nathaniel Ng Leok-Lim Lau Ka-Po Gabriel Liu Hee-Kit Wong 《The spine journal》2017,17(6):799-806
Background Context
The current prevailing school of thought in spinal deformity surgery is to restore sagittal balance with reference to the alignment of the spine when the patient is standing. This strategy, however, likely accounts for increased rates of proximal junctional failure.Purpose
The purpose of this study was to investigate the differences between the spine in standing and sitting positions as these may elucidate reasons for deformity correction failure.Study Design/Setting
A prospective, comparative study of 58 healthy patients presenting to a tertiary hospital over a 6-month period was carried out.Patient Sample
All patients presenting with a less than 3-month history of first episode lower back pain were included. Patients who had radicular symptoms, red flag symptoms, previous spine surgery, or visible spinal deformity during forward bending test were excluded. Pregnant patients were also excluded.Outcome Measures
Radiographic measurements including sagittal vertical axis (SVA), lumbar lordosis (LL), thoracolumbar angle (TL), thoracic kyphosis (TK), cervical lordosis (CL), pelvic incidence (PI), and pelvic tilt (PT) were collected. The sagittal apex and end vertebrae of all radiographs were also recorded.Methods
Basic demographic data (age, gender, and ethnicity) was recorded. Lateral standing and sitting radiographs were obtained using EOS technology. Statistical analysis was performed to compare standing and sitting parameters using chi-square tests for categorical variables and paired t tests for continuous variables.Results
Taking the standing position as the reference point, forward displacement of the SVA occurred during sitting by a mean of 6.39±3.87?cm (p<.001). This was accompanied by a reduction of LL and TK by a mean of 24.63±12.70° (p<.001) and 8.56±7.21°(p<.001), respectively. The TL became more lordotic by a mean of 3.25±7.30° (p<.001). The CL only reached borderline significance (p=.047) for increased lordosis by a mean of 3.45±12.92°. The PT also increased by 50% (p<.001). Despite relatively constant end vertebrae, the apex vertebra moved inferiorly for the thoracic curve (p<.006) and superiorly for the lumbar curve (p<.001) by approximately one vertebral level each.Conclusions
Sagittal spinal alignment changes significantly between standing and sitting positions. Understanding these differences is crucial to avoid overcorrection of LL, which may occur if deformity correction is based solely on the spine's standing sagittal profile. 相似文献17.
Background Context
L5-S1 transforaminal percutaneous endoscopic lumbar discectomy (PELD) is a demanding procedure because of structures such as iliac crest, L5 transverse process, hypertrophic L5-S1 facet joint, and sacral ala. There has been no definite preoperative evaluation method to evaluate the surgical validity of L5-S1 transforaminal PELD.Purpose
The authors report a new preoperative trajectory evaluation method for L5-S1 transforaminal PELD using magnetic resonance imaging (MRI) or computed tomography (CT) examinations.Study Design/Setting
This is a technical report study.Patient Sample
Patients who were diagnosed L5-S1 soft disc herniation were included in the present study.Outcome Measures
Success rate of transforaminal PELD according to height of iliac crest was measured.Methods
Twelve patients who were diagnosed L5-S1 disc herniation were preoperatively evaluated with this new method. A skin marker is attached to patient's back as a tentative skin entry point, which was determined by usual preoperative MRI or CT. A new tilted axial and coronal MRI or CT scan is performed according to axis of L5-S1 transforaminal working channel. The images show good relationship between working channel and iliac crest.Results
Six patients underwent a transforaminal PELD, and the results were successful. The other six patients were considered to be “unsuitable” for transforaminal PELD because of the probable blockade by iliac crest.Conclusions
The tilted MRI or CT provides precise evaluation for L5-S1 transforaminal PELD trajectory and may achieve good outcome. 相似文献18.
Background Context
Epidural steroid injection is commonly used in patients with chronic low back pain. Applying a mixture of a local anesthetic (LA) and steroid using the interlaminar (IL), transforaminal, and caudal techniques is a preferred approach.Purpose
The present study aims to investigate the efficacy of interlaminar epidural steroid administration in patients with multilevel lumbar disc pathology (LDP) and to assess the possible correlation of the procedure's success with age and body mass index (BMI).Study Design
A randomized controlled trial was performed.Patient Sample
We administered interlaminar epidural steroid to a total of 98 patients with multilevel LDP.Outcome Measures
The visual analog scale (VAS) and Oswestry Disability Index (ODI) scoring were performed on the study population at pretreatment (PRT), posttreatment, and 1, 3, 6, and 12 PRT months. A possible correlation of BMI and age with the procedure success was evaluated.Methods
The LA group (Group L, n=50) received 10?mL 0.25% bupivacaine, whereas the steroid+LA group (Group S, n=48) received 10?mL 0.25% bupivacaine+40?mg methylprednisolone at L4–L5 intervertebral space in prone position under the guidance of C-arm fluoroscopy.Results
There was no statistical difference in the PRT VAS and ODI scores between the groups (p<.05), whereas the VAS and ODI scores at 1, 3, 6, and 12 posttreatment months were higher in Group L, compared with Group S (p<.05). Age and BMI were not found to be related with the success of the procedure.Conclusions
Our study results showed that the VAS and ODI scores were lower in patients with multilevel LDP receiving steroid, following the administration of IL epidural injection. However, further studies are required to establish a robust conclusion on the dispersion of IL epidural injections in the epidural area and the dose of steroid. 相似文献19.
Yoshitaka Matsubayashi Hirotaka Chikuda Yasushi Oshima Yuki Taniguchi Yoh Fujimoto Takachika Shimizu Sakae Tanaka 《The spine journal》2017,17(5):622-626