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Study design: Prospective concurrent cohort study. Objective: To establish the relationship between radiographic alignment parameters and functional CoE measurements at 1 week before and at 3 months after realignment surgery in ADS patients. Summary of background data: Adult degenerative scoliosis (ADS) represents a significant healthcare burden with exceedingly high and increasing prevalence, particularly among the elderly. Radiographic alignment measures and patient-reported outcomes currently serve as the standard means to assess spinal alignment, deformity, and stability. Neurological examinations have served as qualitative measures for indicating muscle strength, motor deficits, and gait abnormalities. Three-dimensional motion analysis is increasingly being used to identify and measure gait and balance instability. Recently, techniques have been established to quantify balance characteristics described by Dubousset as the “cone of economy” (CoE). The relationship between radiographic alignment parameters and CoE balance measures of ADS patients before and after realignment surgery is currently unknown. Patient sample: 29 ADS patients treated with realignment surgery. Methods: Patients were evaluated at 1 week before realignment surgery and at their 3-month follow-up examination. During each evaluation, patients completed self-reported outcomes (visual analog scales for pain, Oswestry Disability Index, SRS22r) and a functional balance test. Mean changes in dependent measures from before to after surgery were compared using paired ttests. Pearson correlations were used to test for significant correlations between changes in radiographic and CoE measures. Results: Significant improvements were found for all patient-reported outcomes, in several radiographic measures, and in CoE measures. Improvements of scoliosis Cobb angle, coronal pelvic tilt, lumbar lordosis, and thoracic kyphosis showed significant correlations with CoE sway and total distance measures at both the center of mass and center of the head. Conclusion: Improved radiographic alignment measures significantly correlated with improved CoE balance measures among ADS patients treated with realignment surgery at their three-month follow-up. These findings indicate that functional balance evaluations when used in conjunction with radiographic measurements, may provide a more robust and improved patient-specific sensitivity for postoperative assessments. CoE balance may represent a new measure of added value for surgical intervention of ADS.

Study design: A repeated-measurement, single-center, prospective study. Objective: To compare the spatiotemporal and kinematic data using gait analysis in adult degenerative scoliosis (ADS) patients using walking sticks (WS) versus rolling walkers (RW). Summary of background data: ADS patients undergo compensatory changes that can result in an altered gait pattern. RW are frequently prescribed, but result in a forward flexed kyphotic posture during ambulation. Gait using WS allows for more upright alignment in ADS patients. Methods: Fifty-three ADS patients with symptomatic degenerative scoliosis performed over-ground walking at self-selected speed with WS and with a RW. Trunk and lower extremity angles along with spatiotemporal parameters were measured and compared. Results: When using WS, patients exhibited less flexion at the head (WS: − 4.8° vs. RW: 11.0°, p= 0.001), and lumbar spine (WS: − 0.9° vs. RW: 4.2°, p= 0.001); while there was significantly more extension, of the cervical spine (WS: − 1.6° vs. RW: − 7.4°, p= 0.002) when using the RW. At the initial contact phase of gait, patients using WS showed decreased flexion at the ankle (WS 0.7° vs. RW: 3.8°, p= 0.018), knee (WS: 0.3° vs. RW: 4.8°, p= 0.001), hip (WS: 22.6° vs. RW: 27.3°, p= 0.001), and pelvis (WS: 10.2° vs. RW: 14.8°, p= 0.001). In contrast, the use of WS resulted in slower ambulation (WS: 0.6 m/s vs. RW: 0.7 m/s, p= 0.001). Conclusions: In ADS patients who have not undergone surgical correction, the use of WS resulted in a more upright posture, which may be more beneficial to the compensatory changes that lead to gait disturbance in ADS patients. Ambulation using WS resulted in slower gait versus a RW, due to the momentum induced by the forward flexed posture when using a RW. We recommend the use of WS for patients with ADS as it improves gait kinematics and may be a safer option.

Study Design: Cross-sectional observational.Background: The use of social media by providers can enhance patient education, complement offline information, facilitate patient support, stimulate brand building, and strengthen the organization’s market position. Risks of social media include, but are not limited to, a lack of quality, reliability, misrepresentation of credentials, influence of hidden and overt conflicts of interest, content that may jeopardize patient privacy, HIPAA regulations, and physicians’ credentials and licensure. Physicians’ use of social media may also expose him/her to lawsuits if providing specific medical advice on media platforms.Objective: To document the social media presence of a broad cohort of spine surgeons, and to discuss the benefits and risks of a social media presence.Methods: Cross-sectional observational of 325 Spine Surgeons from 76 institutions across the US. Description statistic and Pearson’s correlation were used to investigate the relationships between the variables.Results: Out of the 325 surgeons, 96% were male with an average age of 51.5 ± 10.7 years and 14.1 ± 9.6 years of experience. The frequency of social media use included 57.2% of surgeons had professional LinkedIn, 17.8% had professional Facebook, and less than 16% had other social media platforms. When combining all platforms together, 64.6% of all surgeons had at least one professional social media platform. 64.0% of these surgeons had no social media activity in the past 90 days, while 19.4% and 10.9% were active once and twice a month, respectively. Surgeon age (P= 0.004), years in practice (P< 0.001), and practice type (P< 0.001) were strongly correlated with social media activity.Conclusions: Given the scarcity of research on this topic and the novelty of the platforms, social media and online services continue to be utilized at a low level by spine surgeons. Issues regarding the risks of privacy issues with social media users continue to be a concern among medical professionals adopting this technology. This can largely be mitigated with the combination of physician education and informed consent from patients. The ability to connect with patients directly, and provide access to high-quality education and information will be of considerable benefit to our field well into the future.

The aging spine often presents multifaceted surgical challenges for the surgeon because it can directly and indirectly impact a patient’s spinal alignment and quality of life. Elderly and osteoporotic patients are predisposed to progressive spinal deformities and potential neurologic compromise and surgical management can be difficult because these patients often present with greater frailty.

Several assessment tools have been developed to estimate a patient's likelihood risk of falling. None of these measures estimate the contributions of the visual, vestibular, and somatosensory systems to fall risk, especially in patients with degenerative lumbar spine disease.

Study Design: Narrative review.Objective: To address the gap in the literature on specific return to play protocols and rehabilitation regimens for golfers undergoing lumbar spine surgery with a high impact swing.Methods: This review did not involve patient care or any clinical prospective or retrospective review of patient information and thus did not warrant institutional review board approval. The available literature of PubMed, Medline, and OVID was utilized to review the existing literature.Results: Studies have shown that the forces through the lumbar spine in the modern-era golf swing are like other contact sports. Methods of protecting the lumbar spine include proper swing mechanics, abdominal and paraspinal musculature strengthening and flexibility as well as physical fitness. There are a variety of treatment options available to treat lumbar spine pathology each with a different return to play recommendations from doctors in the field.Conclusions: With the introduction of a high impact, modern-era swing to the game of golf, the pathology is seen in the lumbar spine of both young, old, professional, and amateur golfers with low back pain are similar to other athletes in contact sports. Surgery is effective in returning athletes to a similar level of play even though no protocols exist for an effective and safe return. There have been many studies conducted to determine appropriate treatment and return to play for these injuries, but there is a gap in the literature on specific return to play protocols and rehabilitation regimens for golfers undergoing lumbar spine surgery with a high impact swing. As return to competitive play is important, especially with professional golfers, studies combining the use of swing mechanics changes, rehabilitation regimens and the type of surgery performed would be able to provide some insight into this topic now that golf may begin to be considered a contact sport.

Study Design: Prospective cohort study.Objective: Evaluate changes in gait, pain, and psychosocial factors among degenerative lumbar spondylolisthesis (DLS) patients before and 3 months after surgical intervention.Methods: Forty-four symptomatic DLS patients performed clinical gait analysis 1 week before surgery and 3 months after surgery. Patients performed a series of over-ground gait trials at a self-selected speed. Twenty-two matched asymptomatic controls underwent the same battery of tests. Three-dimensional motion tracking was used to analyze gait kinematics. Patient-reported outcomes, gait range of motion, and spatiotemporal parameters compared before and after lumbar decompression with fusion.Results: Surgical intervention resulted in significant improvements in walking speed (P= .021), stride time (P= .020), step time (P= .014), and single-support time (P= .038). Significant improvements in joint range-of-motion were found for knee (P= .002) and hip flexion (P= .006). Degenerative lumbar spondylolisthesis patients reported significant reductions in pain, disability, and improved psychological perceptions for fear-avoidance of pain and motion (all P< .001).Conclusions: Surgical treatment of DLS resulted in a faster, more efficient gait in addition to significant reductions in pain, disability, and psychological fear associated with pain and motion. These beneficial changes that we identified early in the postoperative period indicate that patients return to the quality of life they seek early on. Clinical gait analysis provides objective, quantifiable measures of gait parameters that provide new insight into both the preoperative disability associated with DLS and into the early postoperative function of patients during their rehabilitation.

Study Design: Prospective, concurrent-cohort study.Objectives: To determine the effects of volitional preemptive abdominal contraction (VPAC) on trunk control during an asymmetric lift in patients with recurrent low back pain (rLBP) and compare with matched controls.Methods: Thirty-two rLBP patients and 37 healthy controls performed asymmetric lifting with and without VPAC. Trunk, pelvis, and hip biomechanical along with neuromuscular activity parameters were obtained using 3-dimensional motion capture and electromyography system. Hypotheses were tested using analysis of variance.Results: The VPAC resulted in significantly reduced muscle activity across all trunk extensor muscles in both groups (M ± SD, 6.4% ± 8.2% of maximum contraction; P≤ .005), and reduced trunk side flexion (1.4° ± 5.1° smaller; P≤ .005) and hip abduction (8.1° ± 21.1° smaller; P≤ .003). rLBP patients exhibited reduced muscle activity in external oblique (12.3% ± 5.5% of maximum contraction; P≤ .012), as well as decreased hip flexion (4.7°, P≤ .008) and hip abduction (5.2°, P≤ .001) at the final position of lifting in comparison with healthy controls.Conclusions: The results of this study defend the recommendation that the use of a VPAC increase spine stability during an asymmetrical loading task. Our results provide an indication that a VPAC strategy that is achieved during an asymmetric lifting decreases exposure for lumbar spine injury and instability. Spine care providers and ergonomists can use this information when designing neuromuscular control training programs, both for healthy individuals aimed at prevention of injury, as well as those with a history of rLBP, aimed at full functional recovery and protection from future injury.

Study Design: Pre-post cohort finite elements (FE). Objectives: To investigate the effect of adjacent load transfer pre and post fusion surgery of lumbar scoliotic spines using FE models. Summary of Background Data: Adult degenerative scoliosis (ADS) results from age-related changes, leading to segmental instability, deformity, and stenosis. FE study is capable of capturing the biomechanical parameters internal to the bones and connective soft tissues of the spine, which is difficult to measure by experimental approaches. Literature that describes the underlying mechanisms responsible for spinal fusion in scoliosis patients is limited, and FE study with larger subject sample size should be conducted. Methods: Twenty three-dimensional nonlinear FE models of the lumbosacral spine were created from pre (Cobb angle: 28.1° ± 10.5°) and post scoliosis surgery in vivo CT scans. During surgery, pedicle screws and rods were implanted at lumbar and sacral levels. A compressive load and six different moments (flexion, extension, right lateral bending, left lateral bending, right axial rotation, left axial rotation) were applied to the top level of each model. Outcome measures were range of motion (RoM), intradiscal pressure (IDP), and facet joint forces (FJF). Spinal fusion did alter the mechanical function of the scoliotic spine. Results: Scoliotic spine presented abnormal and asymmetrical kinetic and kinematic behavior. RoM: At the adjacent level, spinal fusion surgery produced a statically significantly increased left and right later bending intersegmental rotation (p &lt; .006) in comparison to presurgical scoliosis models. At the fused level, spinal fusion surgery produced a statically significantly reduced intersegmental rotation in all the loading conditions (p = .001) in comparison to presurgical scoliosis models. IDP: At the fused level, spinal fusion surgery produced a much lower IDP in all of the loading conditions (p = .001). FJF: At the adjacent level, spinal fusion surgery produced a considerably larger left lateral rotation FJF (p = .001) in comparison to presurgical scoliosis models. At the fused level, spinal fusion surgery produced considerably lower FJF in all the loading conditions (p = .001) in comparison to presurgical scoliosis models. Conclusions: This study was the first to investigate the effect of adjacent load transfer before and after fusion surgery using in vivo CT scans of 10 scoliotic spines. A posterior fusion has only a minor effect on mechanical behavior and a large effect on pressure and forces at the adjacent level. As expected, a large effect in the kinematics and kinetics was found at the fused level. Level of Evidence: Level 3.

Pre-post cohort finite elements (FE).

A repeated measurement, single-center, prospective study.

Study Design: A repeated measurement, single-center, prospective study. Objective: The purpose of this study is to compare and contrast the benefits of walking sticks versus a walker on the trunk and lower extremity muscular control in patients with adult degenerative scoliosis (ADS). Summary of Background Data: ADS patients demonstrate an altered gait pattern. Walking aids help maintain mobility in those patients. Whereas a walker forces patients into kyphosis, the higher grips of walking sticks allows for more upright posture, arm swing, and improved sagittal alignment. Methods: Twenty ADS patients with symptomatic degenerative scoliosis performed over-ground walking at self-selected speed under 3 testing conditions: 1) with walking sticks (WS); 2) with walker (WR); and 3) without any device (ND). Trunk and lower extremity peak muscle activation, time to peak muscle activity, muscle duration, muscle onset, and integrated electromyography (iEMG) were measured and compared. Results: The use of WS produced increases in muscle activity in the external oblique (WS: 44.3% vs. WR: 7.4% of submaximum voluntary contraction [sMVC], p = .007) and medial gastrocnemius (WS: 78.8% vs ND: 43.7% of sMVC, p = .027) in comparison to the walker and no device, respectively. When using WS, shorter muscle activity time was observed for rectus femoris (WS: 62.9% vs. WR: 88.8% of gait cycle, p = .001), semitendinosus (WS: 64.3% vs. WR: 93.0% of gait cycle, p = .003), tibialis anterius (WS: 59.4% vs. WR: 85.1% of gait cycle, p = .001), and medial gastrocnemius (WS: 67.3% vs. WR: 98.0% of gait cycle, p = .006) in comparison to the walker. Conclusions: The use of walking sticks can potentially promote trunk and lower extremity neuromuscular control and gait mechanics comparable to gait without any assistive devices. Although the differences in magnitudes between comparisons were small and should be cautiously interpreted on a case-by-case basis, based on this study’s results and our anecdotal experience treating patients with ADS, we recommend the use of walking sticks to assist with their gait prior to and after surgical intervention. Level of Evidence: Level III.

Context:Volitional preemptive abdominal contraction (VPAC) during dynamic activities may alter trunk motion, but the role of the core musculature in positioning the trunk during landing tasks is unclear.Objective:To determine whether volitional core-muscle activation incorporated during a drop vertical jump alters lower extremity kinematics and kinetics, as well as trunk and lower extremity muscle activity at different landing heights.Design:Controlled laboratory study.Setting:Clinical biomechanics laboratory.Patients or Other Participants:Thirty-two young healthy adults, consisting of 17 men (age 25.24 ± 2.88 years, height 1.85 ± 0.06 m, mass 89.68 ± 16.80 kg) and 15 women (age 23.93 ± 1.33 years, height 1.67 ± 0.08 m, mass 89.68 ± 5.28 kg).Intervention(s):Core-muscle activation using VPAC.Main Outcome Measure(s):We collected 3-dimensional ankle, knee, and hip motions, moments, and powers; ground reaction forces; and trunk and lower extremity muscle activity during 0.30- and 0.50-m drop vertical-jump landings.Results:During landing from a 0.30-m height, VPAC performance increased external oblique and semitendinosis activity, knee flexion, and knee internal rotation and decreased knee-abduction moment and knee-energy absorption. During the 0.50-m landing, the VPAC increased external oblique and semitendinosis activity, knee flexion, and hip flexion and decreased ankle inversion and hip-energy absorption.Conclusions:The VPAC performance during landing may protect the anterior cruciate ligament during different landing phases from different heights, creating a protective advantage just before ground contact and after the impact phase. Incorporating VPAC during high injury-risk activities may enhance pelvic stability, improve lower extremity positioning and sensorimotor control, and reduce anterior cruciate ligament injury risk while protecting the lumbar spine.

While the 21stcentury has seen major advances in evidence-based medicine to improve health, athletic performance, and injury prevention, our inability to implement these best practices across underserved American communities has limited the impact of these breakthroughs in Sports Medicine. Rochester, New York is stereotypical of American communities in which an economically challenged racially diverse urban center with grossly underperforming public schools is surrounded by adequately resourced predominantly Caucasian state-of-the-art education systems. As these great disparities perpetuate and further degrade our society in the absence of interventions, the need for community engagement initiatives is self-evident. However, what interventions could have a positive effect, and how they could be administered remain open questions. Here we describe the Center for Human Athleticism, Musculoskeletal Performance and Prevention (CHAMPP) pilot program at the University of Rochester, whose goal is improved health for all participants through Fitness Science. Current efforts are focused on adding psychosocial and nutritional wellness components, as well as providing wearable devices to enhance participation and engagement offering a unique data analytics platform.

Context: Low back pain and lower extremity injuries affect athletes of all ages. Previous authors have linked a history of low back pain with lower extremity injuries. Fatigue is a risk factor for lower extremity injuries, some of which are known to affect female athletes more often than their male counterparts.Objective: To determine the effects of lower extremity fatigue and sex on knee mechanics, neuromuscular control, and ground reaction force during landing in people with recurrent low back pain (LBP).Design: Cross-sectional study.Setting: A clinical biomechanics laboratory.Patients or Other Participants: Thirty-three young adults with recurrent LBP but without current symptoms.Intervention(s): Fatigue was induced using a submaximal free-weight squat protocol with 15 body weight until task failure was achieved.Main Outcome Measure(s): Three-dimensional knee motion, knee and ankle moments, ground reaction force, and trunk and lower extremity muscle-activity measurements were collected during 0.30-m drop vertical-jump landings.Results: Fatigue altered landing mechanics, with differences in landing performance between sexes. Women tended to have greater knee-flexion angle at initial contact, greater maximum knee internal-rotation angle, greater maximum knee-flexion moment, smaller knee-adduction moment, smaller ankle-inversion moment, smaller ground reaction force impact, and earlier multifidus activation. In men and women, fatigue produced a smaller knee-abduction angle at initial contact, greater maximum knee-flexion moment, and delays in semitendinosus, multifidus, gluteus maximus, and rectus femoris activation.Conclusions: Our results provide evidence that during a fatigued 0.30-m landing sequence, women who suffered from recurrent LBP landed differently than did men with recurrent LBP, which may increase women's exposure to biomechanical factors that can contribute to lower extremity injury.

Finite element analysis was used to investigate the responses of five adult degenerative scoliosis (ADS) subjects to cyclic vibration before and after surgical alignment (SA). The dynamic responses of the healthy and presurgical scoliotic spines to the sinusoidal cyclic vibrations have been investigated in previous studies by computational and experimental approaches. However, no computational or experimental results were available for the pre- and postsurgical scoliosis subjects. The effect of the SA on the vibrational response of the postsurgical scoliosis subjects remained unknown. The objective of this study was to compare differences of the dynamic responses to the cyclic vibration input among the scoliotic spines for pre- and post-SA. Previous studies suggested that untreated scoliotic spines especially at the apical vertebrae are more sensitive to the vibration than spinal segments with normal anatomies. Results of this study showed that the SA was able to reduce the vibrational response of the scoliotic spines to the whole body vibrations (WBV) at the fused level while not significantly increase the response at the superior adjacent level, which suggested that SA is able to reduce the risk of further degeneration in the scoliotic spines.

Engineering has been playing an important role in serving and advancing healthcare. The term “Healthcare Engineering” has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of “Healthcare Engineering” remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects.