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Study Design: Retrospective comparative study., Objective: The aim of this study was to evaluate the changes in global spinal sagittal alignment (GSSA) following selective anterior spinal fusion (ASF) in patients with Lenke type 5 adolescent idiopathic scoliosis (AIS)., Summary of Background Data: Few studies have assessed the changes in postoperative GSSA, including cervical, thoracic, and lumbosacral sagittal alignment in AIS patients with major thoracolumbar/lumbar (TL/L) curve who underwent selective ASF., Methods: Fifty-two patients with Lenke type 5 AIS (two males and 50 females, mean age at surgery of 16.4 ± 3.1 years) were included in this study. The average final follow-up was 8.3 ± 3.1 years after surgery. The variations of outcome variables were analyzed in various spinal sagittal profiles using radiographic outcomes (pre-operation, immediate post-operation, and final follow-up). The clinical outcomes at the final follow-up were assessed using Scoliosis Research Society (SRS)-22 and Oswestry Disability Index (ODI) questionnaires., Results: The mean Cobb angle of the main TL/L and minor thoracic curve was significantly improved after selective ASF, which was maintained up to the final follow-up. However, in all cases, the various sagittal parameters examined (sagittal vertical axis [SVA], C2-7 SVA, C2-7 lordosis, T1 slope, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope), did not significantly change in the immediate postoperative period, and all GSSA parameters were maintained up to the final follow-up. Furthermore, the magnitude of coronal curve correction and fused levels did not affect each GSSA parameter postoperatively. During the period up to the final follow-up, no significant clinical symptoms were observed. The final SRS-22 global score was 4.5 ± 0.3, and ODI scored 0.8 ± 2.4., Conclusion: Selective ASF did not influence various GSSA parameters postoperatively and could maintain excellent correction for coronal deformity with satisfactory final functional and clinical outcomes confirmed by long-term follow-up.Level of Evidence: 4., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background Context: The relationship between gait pattern and the level of upper instrumented vertebra (UIV) in surgically treated patients with adult spinal deformity (ASD) has not been fully documented., Purpose: This study aimed to assess the effect of UIV level for the gait pattern in ASD., Study Design/setting: A prospective case series was carried out., Patient Sample: Thirty surgically treated consecutive female ASD with lumbosacral fusion (age 67.0±8.4 years; body mass index 22.7±2.4 kg/m 2 ; Cobb angle 49.9°±21.3°; coronal vertical axis 1.5±3.6 cm; C7 sagittal vertical axis [C7SVA] 9.3±5.3 cm; pelvic incidence-lumbar lordosis 35.4°±25.8°; and lean volume of the lower leg 5.5±0.9 kg) were categorized into upper thoracic [UT] group or lower thoracic [LT] group based on the level of UIV (UT; UIV T2-T5, LT; UIV T9-T11), and the gait pattern were compared before and after corrective spine surgery., Outcome Measures: Scoliosis Research Society Patient Questionnaire, Oswestry Disability Index, and force plate analysis were the outcome measures., Methods: All subjects underwent gait analysis on a custom-built force plate. Dual-energy X-ray absorptiometry. Subjects were followed-up for at least 2 years postoperation., Results: The UT group had larger baseline Cobb angle, whereas the LT group had larger C7SVA (UT vs. LT; Cobb angle: 59.2±22.9 vs. 44.6±17.4°, p=.03, C7SVA: 10.9±8.7 vs. 12.0±7.1 cm, p=.03). Preoperatively, no difference was found in gait velocity and stride between UT and LT group, whereas the right and left difference of step length was significantly large in UT group (velocity: 55.0±12.5 vs. 53.6±9.0 m/min, stride: 99.7±13.0 vs. 97.8±13.6 cm, step length; 10.4±4.9 vs. 5.6%±3.3%). Coronal and sagittal alignments were significantly improved in both groups (total; Cobb angle: 19.4°±10.6°, C7SVA: 5.3±2.9 cm, PI-LL: 12.1°±5.1°). Gait pattern, stride, and velocity all improved significantly after surgery (total; velocity: 62.3±8.9m/min, stride: 106.8±12.3 cm, p=.01). The knee angle at the heel contact phase and hip range of motion (ROM) were also significantly improved at postoperation (total; hip ROM: preoperation: 29.2°±9.1°, postoperation: 36.2°±4.8°, knee angle; preoperation: 10.6°±6.6°, postoperation: 4.4°±2.8°). No difference was observed for the pelvis and shoulder rotation on the horizontal plane at postoperation in both groups (total; pelvis rotation; preoperation: 7.4°±3.4°, postoperation: 7.9°±2.4°, shoulder rotation; preoperation: 7.4°±2.9°, postoperation: 8.7°±3.6°). The head vertical deviation was also not changed postoperatively in both groups (preoperation: 3.1±0.9 cm, postoperation: 3.1±0.8 cm)., Conclusions: Both UT and LT groups achieved similar improvement of gait ability and pattern after surgery. Additional studies will be needed to further define the effect of UIV for the activity of daily living such as fast walking, stepping the stairs, or standing from the chair in ASDs., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background Context: The effect of corrective spine surgery on standing stability in adult spinal deformity (ASD) has not been fully documented., Purpose: To compare pre- and postoperative standing balance and posture in patients with ASD., Study Design/setting: This study is a prospective case series., Patient Sample: Standing balance before and after corrective spine surgery was compared in 35 consecutive female patients with ASD (65.6±6.9 years, body mass index 22.3±2.7 kg/m 2 , Cobb angle 50.2±19.2°, C7 plumb line 9.3±5.6 cm, and pelvic incidence-lumbar lordosis mismatch 40.8±23.3°)., Outcome Measures: The Scoliosis Research Society Patient Questionnaire, the Oswestry Disability Index, and force-plate analysis were used to evaluate the patient outcomes., Materials and Methods: We reviewed patient charts and X-rays and compared standing balance before and after corrective spine surgery. All subjects were assessed by force-plate analysis using optical markers while standing naturally on a custom-built force platform. The spinal tilt, pelvic obliquity, pelvic tilt, and joint angle were calculated. The lower leg lean volume was obtained by whole-body dual X-ray absorptiometry to assess muscle strength., Results: ASD patients showed significant differences between the left and right sides in ground reaction force (dGRFs), hip (dHip), and knee angle (dKnee) while standing (dGRF 15.1±8.7%, dHip 7.1±6.6°, dKnee 5.9±5.5°). The recorded center-of-gravity (CoG) area was not improved after surgery, whereas the dGRF, dHip, and dKnee all decreased. The spinal tilt, pelvic obliquity, and pelvic tilt were all significantly improved after surgery. We found significant correlations between the radiographic trunk shift and the postoperative coronal CoG distance and recorded CoG area, and between the sagittal CoG distance and the age and the lean volume of the lower extremities (trunk shift R=0.33, 0.45; age R=0.32; lean volume R=0.31)., Conclusions: Corrective spinal surgery improved the spinal alignment and joint angles in patients with ASD but did not improve the standing stability. A correlation found between the sagittal CoG distance and the lean volume of the lower extremities indicated the importance of the leg muscles for stability when standing, whereas a correlation found between the coronal CoG distance and trunk shift reflected the attenuated postural response in the ASD patients., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background Context: Gait patterns and their relationship to demographic and radiographic data in patients with adult spinal deformity (ASD) have not been fully documented., Purpose: This study aimed to assess gait pattern in patients with ASD and the effect of corrective spinal surgery on gait., Design/setting: This is a prospective case series., Patient Sample: The gait patterns of 33 consecutive women with ASD (age 67.1 years; body mass index [BMI] 22.5±2.5 kg/m 2 , Cobb angle 46.8±18.2°, coronal vertical axis [CVA] 1.5±3.7 cm, C7 sagittal vertical axis [SVA] 9.1±6.4 cm, pelvic incidence minus lumbar lordosis [PI-LL] 38.2±22.1°, and lean volume of the lower leg, 5.5±0.6 kg) before and after corrective surgery were compared with those of 33 age- and gender-matched healthy volunteers., Outcome Measures: Scoliosis Research Society Patient Questionnaire (SRS22r), Oswestry Disability Index (ODI), and forceplate analysis., Methods: All subjects underwent gait analysis on a custom-built forceplate using optical markers placed on all joints and spinal processes. Dual X-ray absorptiometry scores were used to calculate the lean composition of the lower legs. Subjects with ASD were followed for at least 2 years post operation., Results: Preop mean values showed that patients with ASD had a significantly worse gait velocity (54±10 m/min vs. 70.7±12.9 m/min, p<.01) and stride (97.8±13.4 cm vs. 115.3±15.1 cm, p<.01), but no difference was observed in the stance-to-swing ratio. The right and left ground reaction force vectors were also discordant in the ASD group (vertical direction; r=0.84 vs. r=.97, p=.01). The hip range of motion (ROM) was also significantly decreased in ASD. Correlation coefficient showed moderate correlations between the preoperative gait velocity and the gravity line (GL), PI, ROM of the lower extremity joints, and lean volume, and between the stride and the lean volume, GL, and PI-LL. Gait pattern, stride, and velocity all improved significantly in the patients with ASD after surgery, but were still not as good as in healthy volunteers. The SRS22r satisfaction domain correlated moderately with postoperative gait velocity (r=0.34)., Conclusions: The patients with ASD had an asymmetric gait pattern and impaired gait ability compared with healthy volunteers. Gait ability correlated significantly with the GL, spinopelvic alignment, lower extremity joint ROM, and lean volume. The surgical correction of spinopelvic alignment and exercises to build muscle strength may improve the gait pattern and ability in patients with ASD., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Study Design: A multicenter retrospective case series of patients treated surgically for adult spinal deformity (ASD).Objective: The aim of this study was to compare clinical outcomes between propensity score matched ASD patients with or without drop body syndrome (DBS).Summary Of Background Data: DBS is an extreme primary sagittal-plane deformity often seen in Asian countries. Although the importance of sagittal alignment is widely recognized, surgical outcomes for deformities purely in the sagittal plane are poorly understood.Methods: This study included 243 consecutive patients (age 66 ± 17 years; range 22-78) who were treated surgically for ASD and were followed at least 2 years (mean follow-up 3.7 ± 2.3 years). DBS was defined as a primary lumbar kyphosis with PI-LL >40°, Cobb angle <30°, and multifidus cross-sectional area <300 mm. DBS patients were matched with non-DBS patients by propensity scores for age, gender, lowest instrumented vertebra (LIV) level, and number of levels fused. Demographics, radiographic findings, and clinical outcomes were compared between DBS and non-DBS patients.Results: Of 243 patients with ASD, 34 had DBS (14%); 28 of these were propensity-matched with ASD patients without DBS. Baseline bone mineral density (BMD), body mass index (BMI), and frailty were similar in DBS and non-DBS patients. Baseline sagittal alignment was worse in DBS than in non-DBS patients [C7SVA 14 ± 5 vs. 8 ± 5 cm; pelvic incidence (PI) - lumbar lordosis (LL) 60 ± 14 vs. 36 ± 20°], and scoliosis research society (SRS)22 scores were also worse for DBS patients (2.5 ± 0.6 vs. 2.9 ± 0.8). Although DBS patients had more complications (20 DBS vs. 16 non-DBS), the clinical outcomes were similarly improved in both groups after surgery. At the 2-year follow-up, the spinopelvic malalignment was worse in DBS than non-DBS patients (PI-LL 17 ± 16° vs. 8 ± 13°, P < 0.05).Conclusion: DBS affected 14% of 234 ASD patients. Although DBS patients had inferior baseline SRS22 scores than non-DBS patients, ASD surgery resulted in similar clinical improvement in both groups. Future studies should examine the influence of lifestyle and genetics on clinical outcomes after surgery for DBS.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective observational study.Objective: This study examined the role of skeletal muscles in the spinal alignment of lumbar degenerative kyphosis (LDK).Summary Of Background Data: Adult spinal deformity (ASD) may present as LDK, which is unusual in that it typically lacks any coronal deformity.Methods: This retrospective study included 367 female patients with ASD. Demographic and radiographic data from LDKs were compared with those with other ASD. The LDK multifidus was also subjected to histological analysis. The muscle volume and strength were analyzed using whole-body dual x-ray absorptiometry and pulmonary function tests. Magnetic resonance images were used to determine the cross-sectional area (CSA) and fatty infiltration area (FIA) of the psoas and multifidus.Results: A total of 52 patients (15%) were classified as LDK. Compared with other ASDs, those with LDK had a significantly larger sagittal vertical axis (16.3 ± 5.0 cm), and pelvic incidence minus lumbar lordosis (52.8° ± 9.2°). The LDK had significantly lower CSA and higher FIA of the multifidus, but not in the psoas (multifidus CSA 223 ± 96 vs. 477 ± 129 mm, P < 0.001; FIA 82% vs. 31%, P < 0.001). Eighty-six percent of LDK had a multifidus CSA of less than 300 mm, and 82% had an FIA of more than 80%. Whole-body dual x-ray absorptiometry showed no significant difference in the other body sections between LDK and other ASDs. The percent-predicted peak expiratory flow was within normal range in 82% of the LDK. LDK multifidus specimens revealed diffuse, nonuniform muscular fibers and growth of the interstitium and adipose tissue, with no muscular inflammation. We redefined LDK as drop body syndrome, a distinct form of ASD.Conclusion: Significantly decreased CSA and increased FIA of the multifidus were observed in LDK, whereas the muscle strength and volume of the other body sections were normal. These findings strongly suggest the presence of isolated lumbar extensor myopathy in LDK.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]