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Objective: Posterior and transforaminal lumbar interbody fusion (PLIF, TLIF) are among the most popular surgical options for lumbar interbody fusion. If non-union occurs with consequent pain and reduced quality of life, revision surgery should correct any previous technical errors, avoiding further complications. The aim of this study was to analyze technical advantages, radiological and clinical outcomes of anterior approaches (ALIF) in case of failed PLIF or TLIF. Methods: Retrospective analysis of consecutive patients with persistent low back pain after failed PLIF/TLIF where salvage ALIF through an anterior retroperitoneal miniopen video-assisted technique was performed. Surgical, clinical and radiological data were analysed. Uni and multivariate statistical analysis were applied. Results: Thirty-six patients (average age: 47.1 years) were included. Mean follow-up was 34.4 months. In 30 patients (83.3%) a posterior surgical step was necessary. Non-union (86.1%), cage migration (5.5%), infection (8.3%) were the causes of revision surgery. In 22 patients (61.1%) the involved level was L5-S1, in 12 patients (33.4%) L4–L5, in 1 patient (2.7%) L3–L4. One patient (2.7%) had two levels (L4–L5 and L5–S1) involved. No major intraoperative complications were recorded. Significant correlation between clinical and radiological outcomes (L4–S1 and L5–S1 lordosis improvement) were observed (postoperative VAS and L5–S1, p = 0.038). Conclusions: Salvage ALIF is a safe option that can significantly ameliorate residual pain achieving primary interbody stability with an ideal segmental lordosis according to pelvic parameters. The advantages of a naive anterior approach fulfils the main objectives of a revision surgery in order to significantly increase the chances of definitive fusion. [ABSTRACT FROM AUTHOR]

Context: Studies on adult spinal deformity have shown spinopelvic malalignment results in worse outcomes. However, it is unclear if this relationship exists in patients with single-level degenerative spondylolisthesis (DS) receiving short-segment fusions. Aims: To determine if spinopelvic alignment affects patient-reported outcome measures (PROMs) after posterior lumbar decompression and fusion (PLDF) with or without a transforaminal lumbar interbody fusion in patients with L4-5 DS. Settings and Design: A retrospective cohort analysis was conducted on patients who underwent PLDF for L4-5 DS at a single tertiary referral academic medical center. Materials and Methods: Patients were divided into groups based on preoperative cutoff values of 20° for pelvic tilt (PT) and 11° for pelvic incidence-lumbar lordosis mismatch (PI-LL) with subsequent reclassification based on correction to <20° PT or 11° PI-LL. Radiographic outcomes and PROMs were compared between the groups. Statistical Analysis Used: Multiple linear regression analyses were performed to determine whether radiographic cutoff values served as the independent predictors of change in PROMs. Statistical significance was set at P < 0.05. Results: A total of 188 patients with completed PROMs were included for the analysis. Preoperative PT >20° was associated with significantly greater reduction in PI-LL (−2.41° vs. 1.21°, P = 0.004) and increase in sacral slope (SS) (1.06° vs. −1.86°, P = 0.005) compared to patients with preoperative PT <20°. On univariate analysis, no significant differences were observed between any groups with regard to PROMs. Preoperative sagittal alignment measures and postoperative correction were not found to be independent predictors of improvement in clinical outcomes. Conclusion: A preoperative PT >20° is associated with improved PI-LL reduction and an increase in SS. However, no differences in clinical outcomes were found 1 year postoperatively for patients with preoperative PT >20° and PI-LL ≥11° compared to patients below this threshold. [ABSTRACT FROM AUTHOR]

Purpose: This study was undertaken to identify factors that affect segmental lordosis (SL) after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) by comparing patients whose postoperative SL increased with those whose decreased. Materials and Methods: Fifty-five patients underwent MIS-TLIF at our institute from January 2018 to September 2019. Demographic, pre- and postoperative radiologic, and cage-related factors were included. Statistical analyses were designed to compare patients whose SL increased with decreased after surgery. Results: After surgery, SL increased in 34 patients (group I) and decreased in 21 patients (group D). The index level, disc lordosis, SL, lumbar lordosis, proximal lordosis (PL), and Y-axis position of the cage (Yc) differed significantly between groups I and D. The cage in group I was more anterior than that in group D (Yc: 55.84% vs. 51.24%). Multivariate analysis showed that SL decreased more significantly after MIS-TLIF when the index level was L3/4 rather than L4/5 [odds ratio (OR): 0.46, p=0.019], as preoperative SL (OR: 0.82, p=0.037) or PL (OR: 0.68, p=0.028) increased, and as the cage became more posterior (OR: 1.10, p=0.032). Conclusion: Changes in SL after MIS-TLIF appear to be associated with preoperative SL and PL, index level, and Yc. An index level at L4/5 instead of L3/4, smaller preoperative SL or PL, and an anterior position of the cage are likely to result in increased SL after MIS-TLIF. [ABSTRACT FROM AUTHOR]

Objective The lordotic shape of the lumbar spine differs substantially between individuals. Measuring and recording strain during spinal biomechanical tests is an effective method to infer stresses on spinal implants and predict failure mechanisms. The geometry of the spine may have a significant effect on the resultant force distribution, thereby directly affecting rod strain. Methods Seven fresh-frozen cadaveric specimens (T12-sacrum) underwent standard (7.5 Nm) nondestructive sagittal plane tests: flexion and extension. The conditions tested were intact and pedicle screws and rods (PSR) at L1-sacrum. The posterior right rod was instrumented with strain gauges between L3–4 (index level) and the L5–S1 pedicle screw. All specimens underwent lateral radiographs before testing. Lordotic angles encompassing different levels (L5–S1, L4–S1, L3–S1, L2–S1, and L1–S1) were measured and compared with rod strain. Data were analyzed using Pearson correlation analyses. Results Strong positive correlations were observed between lordosis and posterior rod strain across different conditions. The L3–S1 lordotic angle in the unloaded intact condition correlated with peak rod strain at L3–4 with PSR during flexion (R=0.76, p=0.04). The same angle in the unloaded PSR condition correlated with peak strain in the PSR condition during extension (R=-0.79, p=0.04). The unloaded intact L2–S1 lordotic angle was significantly correlated with rod strain at L3–4 in the PSR condition during flexion (R=0.85, p=0.02) and extension (R=-0.85, p=0.02) and with rod strain at L5–S1 in the PSR condition during flexion (R=0.84, p=0.04). Conclusion Lordosis measured on intact and instrumented conditions has strong positive correlations with posterior rod strain in cadaveric testing.

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

Kyphoscoliosis is a condition that affects the spine, with adolescents accounting for 75-90% of cases of idiopathic scoliosis. Scoliosis patients may experience difficulties when receiving anaesthesia during surgical procedures. There is often multisystem involvement, including the cardiovascular, nervous, and respiratory systems. Patients who have scoliosis often have difficulties with their airways (affected airway morphology, difficult intubation with laryngoscopy), respiratory systems (hypoxia, alveolar vascular constriction, pulmonary hypertension), and cardiac systems (cardiomyopathy, right ventricular enlargement, but also cor pulmonale). Scoliosis can bring on a restrictive pulmonary disease, which can lead to a decrease in both total lung volume and functional residual capacity, as well as an increase in breathing rate. Owing to the deformities of the vertebra, subarachnoid blocks in patients with kyphoscoliosis generally constitute a special hurdle for the anaesthesiologist. Midline and paramedian approach for spinal anaesthesia has been practiced since long but a novel approach as modified paramedian technique allows the entry of the needle from far away from midline hence reducing the number of punctures taken and lesser complications. Respiratory and airway concerns are customarily addressed in kyphoscoliotic patients. Authors present a unique case of 35-year-old male with severe kyphoscoliosis with neurofibromatosis posted for right above knee amputation by spinal anaesthesia using modified paramedian technique. Authors planned for subarachnoid block for this patient with modified paramedian approach which resulted in right-sided dense block with patchy sensory and motor block on left-side. For a successful operation, scoliosis patients require a thorough preoperative evaluation, a well-equipped set-up, and a teamwork. [ABSTRACT FROM AUTHOR]

ObjectiveThe main aim of this study was to comprehensively explore the relationship among pelvic incidence (PI), inflection point (IP), and apex of lumbar lordosis (LLA), and establish a predictive formula for LLA based on individual PI and IP in asymptomatic Chinese adults.MethodsA total of 385 asymptomatic adults with average age 38.3 ± 11.9 years (range 20–73 years) were recruited between November 2020 and October 2021. Full-spine, standing x-rays were then obtained from each participant. Next, the following sagittal parameters were measured: PI, IP, LLA, the horizontal offset between the plumb line of the lumbar apex and that of the posterosuperior corner of S1 (LASO), the upper lumbar lordosis (ULL) and lower lumbar lordosis (LLL), lumbar lordosis (LL), and thoracic kyphosis (TK). Moreover, the association among PI, IP, and the other sagittal parameters was evaluated, followed by linear regression analyses. A P-value of

Background: Controversy exists regarding the ability of posterior (transforaminal) lumbar interbody fusion (PLIF/TLIF) to achieve lordosis. We hypothesized that an interbody device (IBD) designed for positioning in the anterior disc space produces greater lordosis than IBDs designed for straight-in positioning. The purpose of this study is to determine if using either an anterior-position or straight-in position IBD design were associated with successful achievement of postoperative lordosis. Methods: A consecutive series of patients undergoing a undergoing a single-level, posterior open midline (transforaminal) lumbar interbody fusion procedure for degenerative spine conditions during a time period when the two types of interbody devices were being used at surgeon discretion were identified from a multi-surgeon academic training center. Patient demographics and radiographic measures including surgical level lordosis (SLL), anterior disc height, middle disc height, posterior disc height, IBD height, and IBD insertion depth were measured on preop, immediate postop, and one-year postop standing radiographs using PACS. Group comparison and regression analysis were performed using SPSS. Results: Sixty-one patients were included (n=37 anterior, n=34 straight-in). Mean age was 59.8±8.7 years, 32 (52%) were female. There was no difference between IBD type (anterior vs. straight-in) for mean Pre-op SLL (19±7° vs. 20±6°, p=0.7), Post-op SLL (21±5° vs 21±6°, p=0.5), or Change in SLL (2±4° vs. 1±5°, p=0.2). Regression analysis showed that Pre-op SLL was the only variable associated with Change in SLL (Beta = negative 0.48, p=0.000). While the mean Change in SLL could be considered clinically insignificant, there was wide variability: from a loss of 9° to a gain of 13°. Gain of lordosis >5° only occurred when Pre-op SLL was 5° only occurred when Pre-op SLL was >21°. Conclusions: While group averages showed an insignificant change in segmental lordosis following a posterior (transforaminal) interbody fusion regardless of interbody device type, pre-operative lordosis was correlated with a clinically significant change in segmental lordosis. Preoperative hypolordotic discs were more likely to gain significant lordosis, while preoperative hyperlordotic discs were more likely to lose significant lordosis. Surgeon awareness of this tendency can help guide surgical planning and technique.

Introduction: This study aimed to investigate the immediate effect of kinesio taping (KT) over abdominal muscles with different tensions on the components of the lumbopelvic complex. Materials and Methods: This is a single-blind randomized controlled clinical trial. Participants were 44 healthy male athletes aged 18-30 years with increased anterior pelvic tilt (PT). Three intervention groups underwent 15 minutes of KT over rectus abdominis and external oblique muscles with tensions of 100, 115, and 140%, respectively, and one group was considered as the control group with no KT. The PT and lumbar lordosis angles and iliopsoas and hamstring muscle lengths were measured before and after the KT. Repeated measures ANOVA was used to compare the means in the study groups before and after the intervention. Results: The mean of right and left PT and lumbar lordosis angles in groups with 115 and 140% tensions before and after the intervention were statistically different (P

Objectives: The present study evaluated the inter-rater and intra-rater validity and reliability of posturography by Kinovea software to measure the thoracic kyphosis and lumbar lordosis. Methods: Eighteen subjects (10 females & 8 males) referring for radiographic imaging were included in this cross-sectional study. For evaluating the validity, the thoracic kyphosis and lumbar lordosis were measured according to the Cobb method and Kinovea in standing position. The inter-rater and intra-rater reliability of Kinovea were tested by 3 evaluators and one expert evaluator, respectively. Results: Pearson correlation coefficient data suggested that the validity of measuring the thoracic kyphosis depends on the evaluator’s expertise. Besides, the correlation was not significant in measuring the lumbar lordosis angle (P>0.05). The inter-rater and intra-rater repeatability revealed that the correlation was significant in all angles by the intraclass correlation coefficient (P

Study Design Retrospective cohort study. Purpose This study aimed to investigate relationships between clinical outcomes and radiographic parameters in patients with pseudoarthrosis after posterior lumbar interbody fusion (PLIF). Overview of Literature In some patients with pseudoarthrosis after PLIF, clinical symptoms improve following surgery, although pseudoarthrosis can often be one of the complications. However, there are no previous reports describing differences between patients with pseudoarthrosis after PLIF who have obtained better clinical outcomes and those who have not. Methods Twenty-seven patients who were diagnosed with pseudoarthrosis after single-level PLIF with cortical bone trajectory screw fixation (CBT-PLIF) were enrolled in this study. They were divided into two groups based on mean improvement of 22 points on the Oswestry Disability Index (ODI) at the 2-year follow-up. Group G consisted of 15 patients who showed improvement on the ODI of ≥22 points, and group P consisted of the residual 12 patients. Radiographic parameters, percentage of slip, lumbar lordosis (LL), segmental lordosis, segmental range of motion, screw loosening, and subsidence were compared between the two groups. Results There were no significant differences between the two groups on radiographic parameters except for postoperative changes in LL. Although surgery-induced changes in LL showed no significant difference between the two groups, changes in LL from before surgery to 2-year follow-up and during postoperative 2-year follow-up were significantly better in group G (mean change of LL: +3.5° and +5.1°, respectively) compared to group P (mean change of LL: −4.6° and −0.5°, respectively) (p

Objectives To evaluate the comparison between lordotic and non‐lordotic transforaminal lumbar interbody fusion (TLIF) cages in degenerative lumbar spine surgery and analyze radiological as well as clinical outcome parameters in long‐term follow up. Methods In a retrospective study design, we compared 37 patients with non‐lordotic cage (NL‐group) and 40 with a 5° lordotic cage (L‐group) implanted mono‐ or bi‐segmental in TLIF‐technique from 2013 to 2016 and analyzed radiological parameters of pre‐ and postoperative (Lumbar lordosis (LL), segmental lordosis (SL), and pelvic tilt (PT), as well as clinical parameters in a follow‐up physical examination using the Oswestry disability index (ODI), Roland–Morris Score (RMS), and visual analog scale (VAS). Results Surgery was mainly performed in lower lumbar spine with a peak in L4/5 (mono‐segmental) and L4 to S1 (bi‐segmental), long‐term follow‐up was on average 4 years postoperative. According to the literature, we found significantly better results in radiological outcome in the L‐group compared to the NL‐group: LL increased 6° in L‐group (51° preoperative to 57° postoperative) and decreased 1° in NL‐group (50° to 49° (P 0.05). Intraoperatively, we saw three dura injuries that could be sutured without problems and had no consequences for the patient. In the follow‐up, we did not find any material‐related problems, such as broken screws or cage loosening, also no pseudarthrosis. Conclusion In conclusion, we think it's not cage design but other influenceable factors such as correct indication and adequate decompression that lead to surgical success and the minimal difference in the LL therefore seemed to be of subordinate importance.

Abstract Background Degenerative cervical myelopathy (DCM) can significantly impair a patient’s quality of life (QOL). In this study, we aimed to identify predictors associated with QOL improvement after surgery for DCM. Methods This study included 148 patients who underwent surgery for DCM. The European QOL-5 Dimension (EQ-5D) score, the Japanese Orthopedic Association for the assessment of cervical myelopathy (C-JOA) score, and the Nurick grade were used as outcome measures. Radiographic examinations were performed at enrollment. The associations of baseline variables with changes in EQ-5D scores from preoperative to 1-year postoperative assessment were investigated using a multivariable linear regression model. Results The EQ-5D and C-JOA scores and the Nurick grade improved after surgery (P

Introduction: Recent research has shown that spinal sagittal alignment plays a critical role in health-related quality of life. However, most of these studies were cross-sectional in nature, and longitudinal studies of lumbar lordosis (LL) in healthy subjects were few. This study aims to evaluate the change in lumbar sagittal parameters during a 10-year period. Methods: The study population included 45 individuals (mean age, 65.7 years; male, n=20; female, n=25) who underwent sagittal lumbar radiography and a basic health checkup during a 10-year period. The radiologic parameters were LL, disc angle, sacral slope angle (SS), and pelvic incidence (PI). The change of LL during the 10-year period was defined as ΔLL. The subjects were divided into the LL maintenance group (n=33) and the LL non-maintenance group (n=12) based on their LL values. Results: The radiologic baseline/final parameters were as follows: LL, 45/34 degrees (P

BACKGROUND: The relationship between the content of paraspinal muscle and kyphotic severity in patients with degenerative thoracolumbar kyphosis has not been determined yet. Recently, a fresh concept of lumbar crossing indentation value was introduced as a simple method for the measurement of paraspinal muscle. OBJECTIVE: To identify the characteristics of lumbar paraspinal muscles in patients with degenerative thoracolumbar kyphosis, and to explore the relationship between thoracolumbar kyphosis and body mass index and between thoracolumbar kyphosis and the content of lumbar paraspinal muscles. METHODS: Totally 90 patients with degenerative thoracolumbar kyphosis (degenerative thoracolumbar kyphosis group) and 62 volunteers without spine deformity (control group) were retrospectively enrolled from June 2015 to June 2020 in the Department of Spine Surgery, Lishui District People’s Hospital with well-matched demographics. The two groups were matched in terms of demographics. Thoracolumbar kyphosis and lumbar lordosis were obtained on the X-ray of the whole spine. Lumbar crossing indentation value was introduced to evaluate the content of the lumbar paraspinal muscles, which was measured from T12-L1 to L4-L5 at T2-MRI axial imaging. Both groups were separately divided into three subgroups of normal weight, overweight and obesity according to body mass index. Degenerative thoracolumbar kyphosis patients were divided into three subgroups of increased lumbar lordosis, normal lumbar lordosis and decreased lumbar lordosis. RESULTS AND CONCLUSION: (1) The mean lumbar crossing indentation value in degenerative thoracolumbar kyphosis group was less than control group (P < 0.01). Lumbar crossing indentation value showed an increasing trend from T12-L1 in both groups (P < 0.01). (2) In control group, mean lumbar crossing indentation value in male was larger than that in female (P < 0.05) and mean lumbar crossing indentation value in normal group was less than ones with overweight or obesity (P < 0.05). (3) In the degenerative thoracolumbar kyphosis group, mean lumbar crossing indentation value was not significantly different in both sexes. Significant differences were found in lumbar crossing indentation value inT12-L1and L1-L2 at different body mass indexes (P=0.003, P=0.009). In degenerative thoracolumbar kyphosis group, mean lumbar crossing indentation value in lumbar lordosis-increased subgroup was larger than that of lumbar lordosis-normal and lumbar lordosis-decreased subgroups (P < 0.01). (4) There was no relationship between thoracolumbar kyphosis and body mass index in both groups. Body mass index was positively correlated to mean lumbar crossing indentation value in control group (P=0.003) with mean lumbar crossing indentation value=0.32×body mass index. Thoracolumbar kyphosis and mean lumbar crossing indentation value were negatively correlated (P < 0.001) in degenerative thoracolumbar kyphosis group with lumbar crossing indentation value=13.75-0.48× thoracolumbar kyphosis. For all cases, there was a relationship of mean lumbar crossing indentation value= 5.45+0.21× body mass index -0.41× thoracolumbar kyphosis. (5) It is indicated that degenerative thoracolumbar kyphosis patients had a less lumbar crossing indentation value than controls. There was no relationship between the severity of thoracolumbar kyphosis and body mass index, while lumbar crossing indentation value and thoracolumbar kyphosis were mutually predictable. [ABSTRACT FROM AUTHOR]

Introduction: Posterior lumbar interbody fusion (PLIF) is a widely used effective, safe, and established treatment for degenerative spinal disorders. Adjacent segment disease (ASD) is one of the serious concerns governing the clinical results following spinal fusion surgery. Cortical bone trajectory (CBT) is an alternative and less-invasive technique for lumbar pedicle screw placement. Its unique medial and caudal entry point has the potential to prevent an iatrogenic facet joint violence leading to the ASD; however, the incidence of ASD following PLIF using the CBT technique (CBT-PLIF) remains unknown. Methods: Among patients surgically treated with CBT-PLIF in our institute, 52 consecutive patients (13 males, 39 females) with single-level degenerative lumbar spondylolisthesis (DLS) who were followed up for at least 24 months were exclusively enrolled. Their clinical and radiological features, including the incidence of radiographical and symptomatic ASD and significantly associated factor for the developing radiographical ASD, were retrospectively measured. Results: In the present study, we could confirm significant neurological improvement and reduction of the spondylolisthesis with mean follow-up period of 43 months. Radiographical and symptomatic ASD was observed in 14 (27%) and 2 (3.8%) cases, respectively. We compared these two groups and found that the latest lumbar lordosis was significantly different between the two groups, but not in age, body mass index, and Japan Orthopaedic Association score. Two patients with symptomatic ASD required additional surgical treatment around 1 year following the initial surgery. Conclusions: The present study, even though it is preliminary, revealed that CBT-PLIF can achieve a neurological improvement and an effective reduction of spondylolisthesis for the treatment of single-level DLS. The CBT technique is capable of reducing the incidence of ASD compared with the traditional technique; however, we must keep in mind that appropriate postoperative lumbar lordosis should be achieved. Larger, longer-term follow-up studies are required to elucidate the clinical output of CBT-PLIF.

Abstract: Background: Mental exercise uses the same neuronal pathways involved in physical exercise to modify the pattern and function without the stress caused by physical exercise. This study investigated the effects of the three methods of kinesthetic imagery, active, and combined exercise (imagery and active) on the pattern of hip hyperextension and the strength of selected muscle of lumbo-pelvic in women with lumbar hyperlordosis. Method: In this semi-experimental study, 36 women with lumbar hyperlordosis (age: 34.47±3.79, height: 160.48±12.63, weight: 64.46±18.26) were sorted into three groups. The groups practiced three sessions per week for six weeks. The degree of lumbar lordosis using flexible ruler, electromyographic activity of the lumbo-pelvic muscles during hip hyperextension in the prone position using surface electromyogram, the strength of the gluteus maximus during hip hyperextention using dynamometer, the strength of abdominal muscles during lowering two legs test using goniometer, flexibility of hip flexor muscles during the Thomas test using goniometer, and flexibility of erector spine muscles during the Schober test using a meter were measured before and after the intervention. The Shapiro-Wilk test was used for normality of data, and the repeated measures variance test was used for the statistical analysis of data at a significance level of 0.05. Results: The results showed a significant difference between the three methods of kinesthetic imagery, active and combined (p -value = 0.001). There was a significant difference between the method of imagery exercise and the methods of active and combined exercise, but no significant difference was observed between the methods of active and combined exercise. Conclusion: Imagery exercises were effective in modifying the electromyographic activity of some lumbo-pelvic muscles (gluteus maximus and rectus femoris muscles); however, they did not have a significant effect on the strength, flexibility, or degree of lumbar lordosis. Combined exercise was as effective as active exercise in modifying the electromyographic activity of the lumbo-pelvic muscles, the strength of the abdominal and gluteus maximus muscles, and the flexibility of erector spine and hip flexor muscles.

Abstract Background Although pelvic incidence (PI) is a key morphologic parameter in assessing spinopelvic sagittal alignment, accurate measurements of PI become difficult in patients with severe hip dislocation or femoral head deformities. This study aimed to investigate the reliability of our novel morphologic parameters and the correlations with established sagittal spinopelvic parameters. Methods One hundred healthy volunteers (25 male and 75 female), with an average age of 38.9 years, were analysed. Whole-body alignment in the standing position was measured using a slot-scanning X-ray imager. We measured the established spinopelvic sagittal parameters and a novel parameter: the sacral incidence to pubis (SIP). The correlation coefficient of each parameter, regression equation of PI using SIP, and regression equation of lumbar lordosis (LL) using PI or SIP were obtained. The intraclass correlation coefficient (ICC) was calculated as an evaluation of the measurement reliability. Results Reliability analysis showed high intra- and inter-rater agreements in all the spinopelvic parameters, with ICCs > 0.9. The SIP and pelvic inclination angle (PIA) demonstrated strong correlation with PI (R = 0.96) and pelvic tilt (PT) (R = 0.92). PI could be predicted according to the regression equation: PI = − 9.92 + 0.905 * SIP (R = 0.9596, p

Abstract Background Thoracic scoliosis has been shown to be associated with hypokyphosis in adolescent idiopathic scoliosis (AIS). However, the relationship of sagittal spino-pelvic parameters with different coronal curve patterns and their influence on patient-perceived quality of life is unknown. This study aims to determine the association between coronal and sagittal malalignment in patients with AIS and to determine their effects on SRS-22r scores. Methods A cross-sectional study was conducted on 1054 consecutive patients with AIS. The coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PI-LL mismatch (PI-LL), pelvic tilt (PT), and sacral slope (SS) were measured on standing radiographs. The coronal Cobb angle (mild: 10–20°; moderate: > 20–40°; severe: > 40°) and PI (low: 50°) were divided into 3 sub-groups for comparison. Relationship between coronal curve magnitudes and sagittal parameters was studied as was their association with SRS-22r scores. Results Low PI had smaller SS (30.1 ± 8.3° vs 44.8 ± 7.7°; p 40°.

Two hundred people of the line (new and experienced) and staff (new and experienced) armed forces consisted of the samples. Using a flexible ruler, spinal curves (thoracic kyphosis and lumbar lordosis) were measured. The biggest kyphosis and lordosis values were seen in experienced staff and experienced line groups and the smallest kyphosis and lordosis values were seen in new staff and experienced staff groups, respectively. One-way repeated-measures analysis of variance (ANOVA) was carried out on the thoracic kyphosis and lumbar lordosis measures of the line and the staff groups to assess differences between groups and the post hoc test was carried out to define the group that was significantly distinct from the others.

ObjectiveTo establish a regression formula for LL based on individual PI and TK in asymptomatic population aged over 50 years and evaluate its predictive power for the occurrence of postoperative mechanical complications in patients with adult spinal deformity (ASD).MethodsA total of 178 asymptomatic adults were recruited for the study. The association between LL and PI, LL and TK, was investigated to establish a predictive formula for ideal LL based on PI and TK. Additionally, 93 ASD patients undergoing posterior correction surgery were retrospectively analyzed. The absolute value of the gap between postoperative actual LL and theoretical LL was defined as ΔLL. Patients were classified into two groups depending on the presence or absence of mechanical complications. The demographic and radiological data of patients were compared between the two groups.ResultsA significant association was found between LL and PI (r = 0.599, P 9.8°, the incidence of mechanical complications was 19.4% and 54.8%, respectively.ConclusionIdeal lumbar lordosis should be matched for PI and TK. The developed prediction formula for LL based on PI and TK in asymptomatic adults may help surgeons to understand the mechanisms of lumbar alignment generation and predict occurrence of mechanical complications after ASD surgery.

Objective: To explore the relationship between different sagittal parameters and identify the fitting formula of spino-pelvic parameters in patients with degenerative kyphosis (DK). Summary of Background: Sagittal balance is increasingly recognized as a predictor of clinical outcomes in patients with DK, while the relationship between different sagittal parameters in patients with DK remains unidentified. Methods: A retrospective study with 279 participants was conducted. There were 168 DK patients which were divided into a sagittal balance group (SB:52 cases) and sagittal imbalance (SIB:116 cases). Radiographic measurements included thoracolumbar kyphosis (TLK), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI), and pelvic tilt (PT). The correlations were analyzed between different sagittal parameters. Results: There were significant differences between the SB and SIB groups in terms of TLK, LL, PI-LL, PT, SVA, sacral slope (SS), and TK. For patients with DK, the LL was correlated with PT and TK. The linear regression was LL = 22.76−0.28 × PT + 0.62 × TK. In the SB group, TK was the influencing factor for LL and the linear regression analysis showed that LL = 33.57 + 0.33 × TK. While in the SIB group, PT and TK were in synergistic effect with PI-LL, the linear regression analysis showed that LL = 22.76−0.28 × PT + 0.62 × TK. Conclusion: From the present study, we can see that LL has a significant correlation with PT and TK in patients with DK, while in SB, the LL was only correlated with TK. Therefore, the correction of LL in a different group should be calculated to avoid the incidence of proximal junction kyphosis (PJK). [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous studies have reported the comparison of the sagittal parameters of the spine and pelvis between patients with lumbar spondylolisthesis and the normal population, but comparative studies on the differences in imaging parameters between patients with different subtypes of lumbar spondylolisthesis and their impact on the quality of life scores are relatively scarce. OBJECTIVE: To analyze the differences in imaging parameters between subtypes of lumbar spondylolisthesis and its relationship with quality of life. METHODS: This study retrospectively analyzed 63 patients with lumbar spondylolisthesis. These patients were divided into degenerative lumbar spondylolisthesis group (n=35) and isthmic spondylolisthesis group (n=28). Spine and pelvic imaging parameters, including sagittal vertebral axis, lumbarlordosis, pelvic incidence, pelvic tilt, sacral slope, pelvic incidence-lumbar lordosis matching, lumbar 1 plumb line, upper lumbar curve, and lower lumbar curve, and functional score (health related quality of life score) were analyzed between the two groups. The protocols were in accordance with the relevant ethical requirements of Declaration of Helsinki and Tianjin People’s Hospital. The patients signed informed consent. RESULTS AND CONCLUSION: (1) In the study of preoperative imaging parameters, sagittal vertebral axis was significantly higher in the degenerative lumbar spondylolisthesis group than that in the isthmic spondylolisthesis group. Pelvic tilt, lumbar lordosis, upper lumbar curve, and lower lumbar curve were significantly lower in the degenerative lumbar spondylolisthesis group than those in the isthmic spondylolisthesis group (all P < 0.05 or P < 0.01). The other imaging indications showed no significant differences between the two groups. (2) Pelvic tilt was significantly lower in patients with visual analogue scale (low back pain) score ≤3 than that in patients scoring > 3 (P=0.026, P=0.047). (3) There was no significant difference in imaging indexes between the two groups of patients with preoperative Oswestry disability index > 40 and those with Oswestry disability index ≤40. (4) The results have shown that there are significant differences in sagittal biomechanics between degenerative lumbar spondylolisthesis and isthmic fissure lumbar spondylolisthesis. Pelvic tilt was significantly lower in patients with visual analogue scale (low back pain) score ≤3 than that in patients scoring > 3. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Prone transpsoas lateral lumbar interbody fusion (PTP-LLIF) is a recently introduced modification to standard LLIF. To date, no study has compared the radiographic outcomes of standard LLIF and PTP-LLIF. We performed a radiographic parameter-based propensity score-matched analysis to compare postoperative clinical and radiographic outcomes between PTP-LLIF and standard LLIF for degenerative lumbar spine disease. A total of 30 consecutive patients met the inclusion criteria. The preoperative standing scoliosis radiographs were retrospectively reviewed for global and segmental sagittal alignment. Propensity score matching was calculated using the baseline radiographic parameters. One-to-one matching of patients who had undergone PTP-LLIF with those who had a similar propensity score but had undergone standard LLIF was performed to compare the radiographic (primary) and clinical (secondary) outcomes. Propensity score matching resulted in 10 pairs of PTP-LLIF and standard LLIF patients. The PTP-LLIF group had had significantly better improvement in lumbar lordosis (P = 0.047). The difference in the improvement in pelvic incidence minus lumbar lordosis mismatch approached statistical significance for the PTP-LLIF group (P = 0.05). This led to better improvement in the short-form 12-item physical score (P = 0.03) and Oswestry disability index (P = 0.1) in the PTP-LLIF group. No significant differences were found between the 2 groups in the other clinical and radiographic outcomes. The PTP-LLIF group had a shorter operative time (P = 0.4) and hospital stay (P = 0.1), without a statistically difference, and shorter radiation exposure time (P = 0.5). The standard LLIF group had experienced less intraoperative bleeding, without a statistically significant difference (P = 0.3). The mean follow-up time was 10.2 ± 5.2 months in the PTP-LLIF group and 30.9 ± 17.2 months in the standard LLIF group (P < 0.05). The PTP-LLIF group showed significantly better improvement in lumbar lordosis and short-form 12-item physical score. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective, single-center, observational study.Objective: The aim of this study was to determine the prevalence and the characteristics of adolescent idiopathic scoliosis (AIS) patients with concomitant lumbar spondylolysis.Summary Of Background Data: The prevalence and features of lumbar spondylolysis in patients with AIS are unclear.Methods: We included 357 patients with AIS who underwent correction and fusion surgery. Preoperative computed tomography (CT) images were used to assess the existence of lumbar spondylolysis. Cobb angles of the curves, parameters of spinal alignment, Lenke classification, and the presence of low back pain were compared between patients with and without spondylolysis.Results: Of the patients included in the study, 6.1% had lumbar spondylolysis. They had significantly greater lumbar lordosis (LL) and sacral slope (SS) than those without lumbar spondylolysis. Logistic regression analyses and receiver-operating characteristic curves showed that LL was a significant risk factor (odds ratio: 1.059; 95% confidence interval: 1.018-1.103; P = 0.005) of associating lumbar spondylolysis with a cut off value of 56.5 degrees (area under the curve [AUC]: 0.689; sensitivity = 63.6%, specificity = 71.0%).Conclusion: We should be vigilant for lumbar spondylolysis in AIS patients whose LL and SS are large, especially with LL larger than 56.5°.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background and Aim: Although rod bending is a universal method for maintaining lumbar lordosis (LL), its long-term efficacy in short-segment posterior fusion is still a challenge. This study aimed at evaluating the long-term effect of rod bending in patients with grade one L4/L5 spondylolisthesis with a short segment fusion. Methods and Materials/Patients: A double-blind prospective randomized clinical trial was conducted from 2016 to 2018 and patients who met the inclusion criteria were enrolled in the study. The participants were randomized into two treatment arms: open posterior fusion with rod bending and without rod bending. The baseline data, including leg and back pain scores, were evaluated before surgery. Lumbar, focal, and segmental lordosis were measured before surgery. After surgery and a one-year follow-up, pain scores and lordosis measurements were re-evaluated and compared between and within groups. Results: A total of 60 patients were analyzed. Leg and back pain scores improved significantly after the follow-up in both groups (P<0.0001). However, there was no significant difference between the two groups before and after the surgery. LL did not change in either group after surgery. Focal and segmental lordosis significantly increased in both groups but showed no difference between the groups at either time. Complications were not significantly different in either group. Conclusion: In this study, no significant difference concerning the radiological and pain outcomes was observed in either group; therefore, rod bending to reach the desired LL may be an unnecessary spend of time. [ABSTRACT FROM AUTHOR]

Background: Picture Archiving and Communication Systems (PACS) is the gold standard for the measurement of spinal parameters. The aim of this study is to evaluate the practical value of using an iPhone to rapidly measure lumbosacral spine-pelvic sagittal parameters, and compared the measurement time and accuracy between iPhone and PACS. Methods: The study group consisted of 50 patients. They were examined with a lateral x-ray of the whole spine in a standard standing position, as well as by three-dimensional CT scan of the lumbosacral area from January to September 2016. An iPhone was employed to take and observe pictures in order to measure the extent of lumbar lordosis (LL), pelvic tilt (PT), and sacral slope (SS). We compared the results with those obtained with PACS, and analyzed the reliability and measurement errors between the two acquisition methods. Results: The average measurement values obtained with PACS were as follows: (LL): 53.56 ± 15.76°, (PT): 12.60 ± 5.15°, (SS): 42.16 ± 13.29°. The average measurement values obtained by iPhone were as follows: LL: 52.20 ± 14.46°, PT: 12.48 ± 5.39°, SS: 12.48 ± 5.39°. There was no statistical significance difference found between the values obtained using the two methods, P > 0.05. The two methods of measurement of intra-class correlation coefficients (ICCs) were 0.938(De-LL), 0.812(De-PT) and 0.946(De-SS). There was no statistically significant difference in the deviation between the two measurement methods. PACS measurement time: 18.53 ± 1.44 s; iPhone measurement time: 14.02 ± 1.08 s, iPhone demonstrating statistically significant faster measurement times than PACS, P

Abstract Objective This study aimed to describe the changes in spinopelvic sagittal alignment in the sitting position after posterior lumbar fusion, and to identify the factors influencing unfused adjacent segment lordosis. Methods Consecutive patients with lumbar degenerative disease who underwent posterior lumbar interbody fusion between December 2010 and April 2012 were recruited. Lateral full spine radiographs were obtained in the standing, erect sitting, and natural sitting positions. Spinopelvic parameters were measured preoperatively and at the final follow-up. Results The data of 63 patients were analyzed in this study. The average age was 61.6 ± 11.0 years. When changing from standing to sitting at the final follow-up, all spinopelvic sagittal parameters with the exceptions of pelvic incidence and thoracic kyphosis were significantly altered. The most noticeable changes occurred in the natural sitting position, with the spine slumped toward achieving a C-shaped sagittal profile. Multiple linear regression analysis revealed that when changing to a natural sitting position, age and fusion levels reflected the changes in lumbar lordosis (ΔLL), age and lumbosacral fusion reflected the changes in upper residual lordosis (ΔURL). Conclusion The most noticeable changes in spinopelvic sagittal alignment occurred in the natural sitting position after lumbar fusion. Age, fusion levels, and lumbosacral fusion significantly influenced the differences in LL and URL between the standing and natural sitting position. These characteristics should be fully considered when planning spinal realignment surgery and investigating the etiological factors of junctional complications.

Abstract Background The impact of high dislocated dysplastic hips on spinal-pelvic alignment has not been well described. This study aims to evaluate compensatory spinal radiographic changes and presence of back pain in patients with Crowe type IV developmental dysplasia of the hip (DDH). Methods An observational study was conducted from July 2016 to December 2017, and 49 consecutive patients with Crowe IV DDH were enrolled. Forty-nine sex- and age-matched asymptomatic healthy adults were recruited as the controls. The sacral slope (SS), lumbar lordosis (LL), spino-sacral angle (SSA), C7 tilt (C7T), and sagittal vertical axis (SVA [C7]) were measured on lateral whole spine radiographs. The presence of low back pain and visual analogue scale (VAS) scores were recorded. Results The patients with Crowe IV DDH showed significantly greater SS (47.5 ± 7.5° vs. 40.4 ± 6.7°, p

Abstract Background The anatomical sacral slope is considered as an anatomical pelvic parameter independent of femoral head centers for measurement of anatomical sacral slope and was previously described to strongly correlate with pelvic incidence on a two-dimensional examination of healthy subjects. However, the correlation between anatomical sacral slope and pelvic incidence was unclear in patients with developmental dysplasia of the hip. This study aimed to examine the correlation between anatomical sacral slope and other spinopelvic parameters by analyzing plain radiographs of female patients with developmental dysplasia of the hip. Methods Eighty-four women with developmental dysplasia of the hip were examined. Lumbar lordosis, thoracic kyphosis, pelvic incidence, sacral slope, and anatomical sacral slope (the angle formed by the straight line of the S1 superior endplate and a line at a right angle to the anterior pelvic plane) were determined by analyzing plain radiographs. The correlations were examined by Pearson’s correlation coefficients, and intra- and inter-rater intraclass correlation coefficients were evaluated for reliability. Results A strong correlation was observed between pelvic incidence and anatomical sacral slope (r = 0.725, p < 0.001). In addition, the correlation between anatomical sacral slope and lumbar lordosis was similar to that between pelvic incidence and lumbar lordosis (r = 0.661, p < 0.001, and r = 0.554, p < 0.001, respectively). The intra-rater intraclass correlation coefficient values were 0.869 and 0.824 for anatomical sacral slope and pelvic incidence, respectively. Furthermore, the inter-rater intraclass correlation coefficient values were 0.83 and 0.685 for anatomical sacral slope and pelvic incidence, respectively. Conclusions We observed that the strong correlation between anatomical sacral slope and pelvic incidence in patients with developmental dysplasia of the hip was equal to that in normal healthy subjects. The correlation between anatomical sacral slope and lumbar lordosis was equal to that between pelvic incidence and lumbar lordosis. Additionally, the intraclass correlation coefficient values for the anatomical sacral slope were slightly higher than those for pelvic incidence. Thus, we conclude that anatomical sacral slope can be considered as a helpful anatomical pelvic parameter that is a substitute for pelvic incidence not only in normal healthy subjects, but also in patients with developmental dysplasia of the hip.

Abstract Background Lumbar lordosis (LL) can be restored, and screw-related complications may be avoided with the stand-alone expandable cage method. However, the long-term spinopelvic changes and safety remain unknown. We aimed to elucidate the long-term radiologic outcomes and safety of this technique. Methods Data from patients who underwent multi-level stand-alone expandable cage fusion and 80 patients who underwent screw-assisted fusion between February 2007 and December 2012, with at least 5 years of follow-up, were retrospectively analyzed. Segmental angle and translation, short and whole LL, pelvic incidence, pelvic tilt, sacral slope (SS), sagittal vertical axis, thoracic kyphosis, and presence of subsidence, pseudoarthrosis, retropulsion, cage breakage, proximal junctional kyphosis (PJK), and screw malposition were assessed. The relationship between local, lumbar, and spinopelvic effects was investigated. The implant failure rate was considered a measure of procedure effectiveness and safety. Results In total, 69 cases were included in the stand-alone expandable cage group and 150 cases in the control group. The stand-alone group showed shorter operative time (58.48 ± 11.10 vs 81.43 ± 13.75, P = .00028), lower rate of PJK (10.1% vs 22.5%, P = .03), and restoration of local angle (4.66 ± 3.76 vs 2.03 ± 1.16, P = .000079) than the control group. However, sagittal balance (0.01 ± 2.57 vs 0.50 ± 2.10, P = .07) was not restored, and weakness showed higher rate of subsidence (16.31% vs 4.85%, P = .0018), pseudoarthrosis (9.92% vs 2.42%, P = .02), cage, and retropulsion (3.55% vs 0, P = .01) than the control group. Conclusions Stand-alone expandable cage fusion can restore local lordosis; however, global sagittal balance was not restored. Furthermore, implant safety has not yet been proven.

Relevance. The development of minimally invasive surgery has led to the development of new methods for surgical treatment of the spine. Conventional surgical technique, such as vertebrotomy is accompanied by a several number of disadvantages (high blood loss, prolonged hospital stay, long intraoperative time, postoperative neurological deficit). An alternative to improve sagittal balance in the spine is to use custom-made hyperlordotic cages, which can also be used for indirect decompression of neural structures. The objective is to compare the degree of segmental and total lumbar lordosis using hyperlordotic cages through ALIF and TLIF with posterior instrumentation.Materials and Methods. A single-center retrospective cohort study using 96 patients treated from 2018 to 2019 about degenerative spinal deformities. Comparison of two groups: group 1 (A) consisted of 30 patients who were held anterior spinal fusion with individual lordotic cages from minimally invasive anterior approach (MISS ALIF) without posterior fixation. Group 2 (B) consisted of 33 patients whom were performed spinal fusion from the posterior approach (TLIF) with Smith-Peterson Osteotomy (SPO) and transpedicular fixation. Measuring segmental and lumbar lordosis, teleradiographs were used in a standing position. For an accurate assessment, the non-commercial available Surgimap software, © Nemaris, was used.Results. Segmental lordosis were superior to preoperative ones. In the intergroup comparison, the ALIF group showed an excellent increase in the enlarged lordosis segment (L3-L4 in 8 degrees; p = 0.0005, L4-L5 in 7 degrees; p = 0.0002, L5-S1 in 7 degrees; p = 0.0001). When conducting an intergroup comparison of total lumbar lordosis in the preoperative period, there was a statistically significant difference between them (p = 0.0043). At the same time, a greater degree of correction of lordosis is shown in ALIF compared to TLIF group (29,1 in comparison with 22,5; p = 0.00005).Conclusion. The results of this study confirm that the using of custom-made lordotic cages can significantly increase segmental and total lumbar lordosis for patients with degenerative scoliosis in adults.

Abstract Background Age-related height loss is a normal physical change that occurs in all individuals over 50 years of age. Although many epidemiological studies on height loss have been conducted worldwide, none have been long-term longitudinal epidemiological studies spanning over 30 years. This study was designed to investigate changes in adult spinal deformity and examine the relationship between adult spinal deformity and height loss. Methods Fifty-three local healthy subjects (32 men, 21 women) from Furano, Hokkaido, Japan, volunteered for this longitudinal cohort study. Their heights were measured in 1983 and again in 2017. Spino-pelvic parameters were compared between measurements obtained in 1983 and 2017. Individuals with height loss were then divided into two groups, those with degenerative spondylosis and those with degenerative lumbar scoliosis, and different characteristics were compared between the two groups. Results The mean age of the subjects was 44.4 (31–55) years at baseline and 78.6 (65–89) years at the final follow-up. The mean height was 157.4 cm at baseline and 153.6 cm at the final follow-up, with a mean height loss of 3.8 cm over 34.2 years. All parameters except for thoracic kyphosis were significantly different between measurements taken in 1983 and 2017 (p

Classical ballet training focuses on developing very high levels of joint mobility as it is an idiosyncrasy and aesthetic requirement of this artistic discipline. The purpose of this study was to use an inclinometer to measure sagittal spinal mobility both in general and more specifically for the degree of curvature in the thoracic and lumbar spine in both maximum trunk flexion and extension. 33 volunteer female ballet dancers were studied and compared to a control group. The Student’s t-test was used to compare both groups and analyse variance. A higher level of mobility was detected in the group of dancers than in the control group both in terms of trunk mobility (t =10.10; p

Abstract Background Adjacent segment disease (ASD) is an acknowledged problem of posterior lumbar interbody fusion (PLIF). Many studies have been reported concerning the role of lordosis distribution index (LDI) in spinal biomechanics. However, few reports have been published about the impact of LDI on ASD following L4-S1 PLIF. Methods The study enrolled 200 subjects who underwent L4-S1 PLIF for degenerative spine disease from 2009 to 2014. The average follow-up term was 84 months. Several lower lumbar parameters were measured, including lower lumbar lordosis (LLL), lumbar lordosis (LL), pelvic incidence (PI), and LDI on the pre and postoperative radiograph. Perioperative information, comorbidities, and operative data were documented. Kaplan-Meier curves were plotted for the comparisons of ASD-free survival of 3 different types of postoperative LDI subgroups. Results The incidence of ASD was found to be 8.5%. LL and LLL increased by 3.96° (38.71° vs 42.67°; P < 0.001) and 3.60° (26.22° vs 28.82°; P < 0.001) after lower lumbar fusion surgery, respectively. Lordosis distribution index (LDI) increased by 0.03 (0.66 vs 0.69, P = 0.004) postoperatively. A significant difference (P = 0.001) was observed when comparing the incidence of ASD among postoperative LDI subgroups. The Kaplan-Meier curves showed a marked difference in ASD-free survival between low and moderate LDI subgroup (log-rank test, P = 0.0012) and high and moderate LDI subgroup (log-rank test, P = 0.0005). Conclusion Patients with abnormal postoperative LDI were statistically more likely to develop ASD than those who had normal postoperative LDI. Moreover, patients with low postoperative LDI were at greater risk for developing ASD than those with high postoperative LDI over time.

ObjectiveTo explore the relationship between different sagittal parameters and identify the fitting formula of spino-pelvic parameters in patients with degenerative kyphosis (DK).Summary of BackgroundSagittal balance is increasingly recognized as a predictor of clinical outcomes in patients with DK, while the relationship between different sagittal parameters in patients with DK remains unidentified.MethodsA retrospective study with 279 participants was conducted. There were 168 DK patients which were divided into a sagittal balance group (SB:52 cases) and sagittal imbalance (SIB:116 cases). Radiographic measurements included thoracolumbar kyphosis (TLK), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI), and pelvic tilt (PT). The correlations were analyzed between different sagittal parameters.ResultsThere were significant differences between the SB and SIB groups in terms of TLK, LL, PI-LL, PT, SVA, sacral slope (SS), and TK. For patients with DK, the LL was correlated with PT and TK. The linear regression was LL = 22.76−0.28 × PT + 0.62 × TK. In the SB group, TK was the influencing factor for LL and the linear regression analysis showed that LL = 33.57 + 0.33 × TK. While in the SIB group, PT and TK were in synergistic effect with PI-LL, the linear regression analysis showed that LL = 22.76−0.28 × PT + 0.62 × TK.ConclusionFrom the present study, we can see that LL has a significant correlation with PT and TK in patients with DK, while in SB, the LL was only correlated with TK. Therefore, the correction of LL in a different group should be calculated to avoid the incidence of proximal junction kyphosis (PJK).

Background and Aim: Although rod bending is a universal method for maintaining lumbar lordosis (LL), its long-term efficacy in short-segment posterior fusion is still a challenge. This study aimed at evaluating the long-term effect of rod bending in patients with grade one L4/L5 spondylolisthesis with a short segment fusion. Methods and Materials/Patients: A double-blind prospective randomized clinical trial was conducted from 2016 to 2018 and patients who met the inclusion criteria were enrolled in the study. The participants were randomized into two treatment arms: open posterior fusion with rod bending and without rod bending. The baseline data, including leg and back pain scores, were evaluated before surgery. Lumbar, focal, and segmental lordosis were measured before surgery. After surgery and a one-year follow-up, pain scores and lordosis measurements were re-evaluated and compared between and within groups. Results: A total of 60 patients were analyzed. Leg and back pain scores improved significantly after the follow-up in both groups (P

The curvature of the lumbar spine plays a critical role in maintaining spinal function, stability, weight distribution, and load transfer. We have developed a mathematical model of the lumbar spine curve by introducing a novel mechanism: minimization of the elastic bending energy of the spine with respect to two biomechanical parameters: dimensionless lumbosacral spinal curvature c and dimensionless curvature increment along the spine CI. While most of the biomechanical studies focus on a particular segment of the spine, the distinction of the presented model is that it describes the shape of the thoracolumbar spine by considering it as a whole (non-locally) and thus includes interactions between the different spinal levels in a holistic approach. From radiographs, we have assessed standard geometrical parameters: lumbar lordosis LL, pelvic incidence PI, pelvic tilt PT, sacral slope ψ LS and dimensionless curvature increment along the spine CI. While most of the biomechanical studies focus on a particular segment of the spine, the distinction of the presented model is that it describes the shape of the thoracolumbar spine by considering it as a whole (non-locally) and thus includes interactions between the different spinal levels in a holistic approach. From radiographs, we have assessed standard geometrical parameters: lumbar lordosis LL, pelvic incidence PI, pelvic tilt PT, sacral slope ψ 0 and sagittal balance parameter SB = sagittal vertical axis (SVA)/sacrum-bicoxofemoral distance (SFD) of 42 patients with lumbar spinal stenosis (SS) or degenerative spondylolisthesis (SL) and 21 radiologically normal subjects. SB statistically significantly correlated with model parameters c L5 (r = -0.34, p = 0.009) and -CI (r = 0.33, p = 0.012) but not with standard geometrical parameters. A statistically significant difference with sufficient statistical power between the patients and the normal groups was obtained for c LS , CI, and SB but not for standard geometrical parameters. The model provides a possibility to predict changes in the thoracolumbar spine shape in surgery planning and in assessment of different spine pathologies., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Introduction: Pelvic incidence - lumbar lordosis (PI-LL) mismatch is often considered when assessing spinopelvic alignment in the sagittal plane. The mismatch is conventionally obtained by measuring 2 separate angles on lateral spinopelvic radiographs. This study describes a simplified approach for assessing spinopelvic mobility and measuring the PI-LL mismatch through the evaluation of the L1-spinopelvis angle (L1SP)., Methods: 96 standing lateral radiographs were obtained from consecutive patients presenting for total hip arthroplasty between November 2020 and July 2021. 3 operators were recruited to annotate landmarks on digital radiographs. Correlation analysis and error analysis were applied. Measurement reproducibility was assessed using intraclass correlation coefficient (ICC)., Results: The correlation coefficients of the 3 variables were respectively 0.87 for PI, 0.94 for LL, and 0.96 for L1SP. The normalised root mean square error between the 2 measurement sets was 9.96% for PI, 5.97% for LL, and 4.41% for L1SP. The absolute error was 3.49° ± 4.63° for PI, 3.23° ± 3.78° for LL, 2.68° ± 3.19° for PI-LL conventional, and 2.35° ± 2.88° for PI-LL via L1SP, respectively. In terms of reproducibility, measurement of L1SP outperformed that of PI and LL (ICC = 0.97 versus 0.83 and 0.93, respectively)., Conclusion: The simplified L1SP method, through the measurement of a single angle, produced similar measurements to the conventional PI-LL method. The measurement repeatability between operators was improved using the L1SP method. From a clinical practice perspective, both methods are equivalent. The new method is readily reproducible using commercially available PACS software during preoperative templating., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article, none of which directly relates to this study: AMB: Research support from Vivid Inc for other projects.YC: Research support from Vivid Inc for other projects.JV: Paid consultant for: Stryker, Depuy Synthes; Stock or stock options in: Intellijoint, Corin.WW: Receives royalties and paid consultant: from MatOrtho company; Paid presentations from J&J Depuy.

We present a case report of a patient suffering from chronic low back pain (CLBP) and chronic non-specific neck pain (CNSNP), both of which were caused and complicated by a physically demanding occupation, a history of mixed martial arts, and lumbar scoliosis. Improvements in patient-reported outcomes (PROs) and radiographic findings were observed following conservative spine rehabilitation. The patient, a 34-year-old male, had experienced chronic spine pain, particularly CLBP and CNSNP, for several years. He reported severe pain and increasing disability after a recent neck injury sustained while practicing jiu-jitsu. Radicular pain, along with numbness and tingling, was noted in the right upper extremity, extending to the first three digits, and there were also altered sensations and temperature changes in both feet. He described sharp, pinching mid-back pain and worsening disability due to the persistent pain, which led him to seek manual manipulative chiropractic spine therapy, though he reported little benefit from it. The patient had relied on over-the-counter pain medications for many years without achieving long-term pain and disability relief, and these medications were no longer used following treatment. Chiropractic BioPhysics® (CBP®) spinal structural rehabilitation protocols were used to improve coronal and sagittal balance, as well as paraspinal muscular strength, addressing posture, mobility, and related aspects. These protocols include postural exercises, postural Mirror Image® traction, and postural spinal manipulative therapy. All PROs improved, with a near resolution of all initial symptoms of chronic spine pain. Outcomes measured included disability indices and health-related quality of life (HRQoL) indicators. Radiographic parameter improvements were significant, demonstrating improved coronal and sagittal balance as a result of the treatment. Following 30 in-office treatments, administered three times per week for 10 weeks, initial outcomes were reassessed. The patient then received 13 in-office treatments periodically over one year, and all initial outcomes were repeated. The improvements remained stable over time. A 26-month follow-up found that the improvements were sustained over a very long period without additional treatment after the 13-month examination. Chronic spine pain, specifically CLBP and CNSNP, is a significant source of suffering and contributes substantially to the global burden of disease. Improvement in HRQoLs, PROs, and objective spine parameters are desirable clinical outcomes. Our case report documents objective improvement in lumbar scoliosis and spine pain, which is rare in conservative studies. This successful treatment of chronic pain with long-term follow-up contributes to the growing evidence supporting conservative, non-surgical treatments for CNSNP and CLBP. Successful management of chronic spine pain was observed in a patient undergoing CBP® treatment. The treatment was designed to address abnormal sagittal and coronal postural balance and radiographic abnormalities indicating spinal misalignment and reassess progress in PROs, as well as objective and subjective HRQoL measures, both following treatment and 13 months later. However, larger studies are needed to draw firm conclusions regarding the efficacy of this treatment for chronic pain., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: Dr. Miles O. Fortner (MOF) and Dr. Thomas J. Woodham (TJW) have no conflicts of interest. Dr. Paul Oakley (PAO) is a compensated consultant for CBP® NonProfit, Inc.; Dr. Jason W. Haas is a compensated instructor and researcher for CBP® NonProfit and CBP® Seminars; and Dr. Deed Harrison (DEH) is the CEO of Chiropractic BioPhysics® (CBP®) and provides post-graduate education and rehabilitation devices to health care providers/physicians. DEH is the president of CBP NonProfit, Inc., a not-for-profit spine research foundation., (Copyright © 2024, Haas et al.)

Background: Spinopelvic characteristics, including sacral slope (SS), are commonly evaluated in different positions pre-total hip arthroplasty (THA). This study aimed to: 1) investigate the change in spinopelvic parameters at 7 days (early) and 1-year post-THA; and 2) identify patient characteristics associated with a change in SS of more than 7° post-THA., Methods: We prospectively studied 250 patients who underwent unilateral THA [132 women, age 66 years (range, 32 to 88)] and underwent biplanar images preoperatively and at 7 days and 1-year post-THA. Parameters measured included pelvic incidence, standing lumbar lordosis, SS, and proximal femoral angle (PFA). A SS change ≥ 7° was considered the threshold as it would result in more than a 5° change in cup orientation., Results: Early post-THA SS standing remained within ± 6º from preoperative measurements in 75% of patients, reduced by ≥ 7° in 9%, and increased by ≥ 7° in 16%. Those that showed a reduction in SS had the lowest PFA and the highest SS pre-THA (P = .028, .107, and < 0.001, respectively). From 7 days until the 1-year mark, pelvic tilt increased, SS reduced (mean: -4º, range: -29 to 17º, P < .001), and patients stood with greater hip extension ΔPFA standing (mean 7°, range: -34 to 37°, P < .001). At 1 year, SS seated had remained within ± 6º, relative to the pre-THA value, in 49% of patients., Conclusions: Standing spinopelvic characteristics, especially SS standing, remain within ±6° in three-quarters of patients both early- and at 1-year post-THA. In the remaining cases, pelvic tilt changes significantly. In 9% of cases, SS reduces ≥ 7° early THA, probably due to the alleviation of fixed-flexion contractures. The SS seated changes by ≥ ± 7° in almost 50% of cases in this study, and its clinical value as a preoperative planning tool should be questioned., Level of Evidence: Level II, diagnostic study., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background Context: A subgroup of patients with pelvic anteversion can present with an unusually large degree of lumbar lordosis (LL), a highly sloped sacrum, and a relatively small pelvic incidence (PI). Prior to lumbar surgery, it can be important to consider such unique sagittal alignment. However, until now, there has been a lack of a predictive model considering different pelvic alignments. Furthermore, the dynamic characteristics of an anteverted pelvis (AP) subgroup have also been unclear., Purpose: To build linear predictive formulas for LL that take pelvic anteversion into consideration and to explore the dynamic characteristics of an AP subgroup., Study Design: Monocentric, cross-sectional study., Patient Sample: Five hundred sixty-five asymptomatic Chinese men and women between the ages of 18 and 80 years., Outcome Measures: Sagittal parameters including LL, lumbar lordosis minus thoracic kyphosis (LL-TK), PI, pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), sacral slope (SS), sacral slope divided by pelvic incidence (SS/PI), sagittal vertical axis (SVA), thoracic kyphosis (TK), and T1 (first thoracic vertebra) pelvic angle (TPA) were measured on whole spine radiographs obtained with participants in standing and sitting positions., Methods: All participants underwent radiography in the standing position; 235 of them underwent additional radiography in the sitting position to allow measurement of sagittal parameters. The participants with pelvic anteversion were placed in an AP (anteverted pelvis) group. Sagittal parameters were compared between the AP group and the non-AP group, and predictive formulas for LL based on PI were created in both groups. In addition, changes in sagittal parameters from standing to sitting were compared in the AP group and a PI-matched control group., Results: Of the 565 participants, 171 (30.3%) had pelvic anteversion. In comparison with the non-AP group, the AP group presented with larger LL, a larger SS, and a smaller PT, with relatively small PI. The predictive formulas for LL were LL=0.60° × PI+21.60° (R 2 =0.268; p<.001) in the whole cohort, LL=0. 83×PI+18.75° (R 2 =0.427; p<.001) in AP group, and LL=0.79°×PI+9.66° (R 2 =0.451; p<.001) in the non-AP group. In moving from standing to sitting, the AP group presented with a larger decrease in SS and LL compared with the control group, indicating different patterns of spinopelvic motion., Conclusions: In the cohort examined, 30.3% present with pelvic anteversion. Those with AP present with unique characteristics of spinopelvic alignment. In moving from standing to sitting, they exhibit different patterns of spinopelvic motion. We found that identifying the degree of anteversion in each person improves the accuracy of linear models for predicting the degree of LL, which in turn can make plans for spine surgery more accurate., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Systematic review and meta-analysis to examine common static postural parameters between participants with and without low back pain (LBP)., Methods: Systematic search on the PubMed, CINAHL, Embase and SCOPUS databases using keywords 'posture' and 'low back pain'. Observational studies comparing static postural outcomes (e.g. lumbar lordosis) between participants with and without LBP were included. Two independent reviewers conducted screening, data extraction and quality assessment. Methodological quality was assessed using Joanna Briggs Institute's critical appraisal tools., Results: Studies included in review = 46 (5,097 LBP; 6,974 controls); meta-analysis = 36 (3,617 LBP; 4,323 controls). Quality of included studies was mixed. Pelvic tilt was statistically significantly higher in participants with LBP compared to controls ( n  = 23; 2,540 LBP; 3,090 controls; SMD:0.23, 95%CI:0.10,0.35, p  < 0.01, I 2 =72%). Lumbar lordosis and sacral slope may be lower in participants with LBP; pelvic incidence may be higher in this group; both were not statistically significant and the between study heterogeneity was high. Thoracic kyphosis and leg length discrepancy showed no difference between groups., Conclusions: Lumbopelvic mechanisms may be altered in people with LBP, but no firm conclusions could be made. Pelvic tilt appeared to be increased in participants with LBP. Postural variable measurement needs standardisation. Better reporting of study characteristics is warranted.Implications for rehabilitationLumbo pelvic parameters especially pelvic tilt may be altered in people with low back pain, although no firm conclusion could be made due to the high heterogeneity between studies.Postural assessment within low back pain rehabilitation may therefore require an individualistic approach.

Purpose: Spinal flexion exposure (SFE) leads to alterations in neuromuscular and mechanical properties of the trunk. While several studies reported changes in intrinsic trunk stiffness following SFE, there is a lack of studies evaluating the effects on lumbar muscle shear modulus (SM). Therefore, the aim of our study was to investigate the effects of SFE on lumbar muscle SM and posture., Methods: Sixteen young volunteers were included in this clinical study. Passive lumbar muscle SM, lumbar lordosis, lumbar flexion range of motion and sitting height were measured prior to and following a 60-min SFE protocol., Results: For SM, our results did not show a significant muscle × time interaction effect (p = 0.40). However, we found increased SM (from 6.75 to 15.43% - all p < 0.02) and maximal lumbar flexion (15.91 ± 10.88%; p < 0.01), whereas lumbar lordosis ( - 7.67 ± 13.97%; p = 0.03) and sitting height ( - 0.57 ± 0.32%; p < 0.01) decreased following SFE. Our results showed no significant correlations between the changes in the included outcome measures (p = 0.10-0.83)., Conclusion: We hypothesized that increased lumbar muscle SM following SFE might be a compensation for decreased passive stability due to viscoelastic deformations of connective tissues, which are indicated by increased maximal lumbar flexion and decreased sitting height. However, there were no significant correlations between the changes of the included outcome measures, which implies that increased muscle SM and reduced lumbar lordosis are more likely an independent consequence of SFE., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Flatback deformity, or lumbar hypolordosis, can cause sagittal imbalance, causing back pain, fatigue, and functional limitation. Surgical correction through osteotomies and interbody fusion techniques can restore sagittal balance and relieve pain. This study investigated sagittal vertical alignment (SVA) and lumbar lordosis correction achieved through sequential procedures on human spine specimens., Methods: Human T10-sacrum specimens were stratified into 2 groups: degenerative flatback specimens had smaller L1-S1 lordosis compared to the iatrogenic group (26.1°±15.0° vs. 47.8°±19.3°, p<.05). Specimens were mounted in the apparatus in simulated standing posture with a nominal sacral slope of 45 degrees and subjected to a 400N compressive follower preload. Sequential correction of degenerative lumbar flatback deformity involved: anterior lumbar interbody fusion (ALIF) at L5-S1, ALIF at L4-5, lateral lumbar interbody fusion (LLIF) at L2-3 and L3-4, and posterior column osteotomy (PCO) at L2-3 and L3-4. In iatrogenic specimens, flatback deformity was created by performing a posterior in-situ immobilization using pedicle screw instrumentation at L4-L5-S1 followed by distraction across the pedicle screws. We then performed LLIF at L2-3 and L3-4, followed by PCO at L2-3 and L3-4., Results: Statistically significant incremental corrections were noted in SVAs and lordosis after L5-S1 ALIF, L4-5 ALIF, and PCO in degenerative flatback specimens. For the iatrogenic group, statistically significant worsening was noted in measures of standing alignment after L4-L5-S1 hypolordotic fusion. Subsequent LLIF at L2-3 and L3-4 did not significantly improve sagittal alignment. However, after PCO at L2-3 and L3-4, final alignment parameters were not significantly different than preoperative baseline values prior to hypolordotic fusion., Conclusions: ALIF cages in the lower lumbar segments significantly improved sagittal alignment in degenerative flatback specimens. In the upper lumbar segments, LLIF cages alone were ineffective at enhancing lumbar lordosis. LLIF cages in conjunction with PCO improved alignment parameters in degenerative and iatrogenic flatback deformities., Competing Interests: One or more of the authors declare financial or professional relationships on ICMJE-NASSJ disclosure forms., (© 2024 The Author(s).)

Purpose: This study aimed to describe the spinopelvic alignment of a cohort of young ambulatory individuals with cerebral palsy (CP) and compare it to published spinopelvic alignment data for the typically developing adolescents., Methods: Thirty-seven adolescents (18 females) with CP at GMFCS I-III were included in this retrospective case series. Lumbar lordosis and pelvic incidence were measured, and their mismatch was calculated. A model that calculates predicted lumbar lordosis based on pelvic incidence in normative data was utilized to calculate a predicted lumbar lordosis in this cohort with cerebral palsy., Results: At imaging, ages were mean and standard deviation 13.5 ± 3.0 years. Pelvic incidence was 46.2° ± 12.9°, pelvic tilt was 2.8° ± 9.4°, sacral slope was 43.6° ± 10.8°, and measured lumbar lordosis was 59.4° ± 11.6°. There were no differences in pelvic incidence or lumbar lordosis among the GMFCS levels; however, pelvic incidence was higher in females. Pelvic incidence-lumbar lordosis mismatch greater than 10° was found in 67% of the cohort. Mean predicted lumbar lordosis based on the model was 54.7° ± 8.5°, averaging 8° less than measured lordosis., Conclusion: PI-LL mismatch was identified in 67% of this cohort of ambulatory adolescents with CP, in part due to greater lordosis than predicted by a model based on data from adolescents without CP. The implications of this finding, such as the correlation between sagittal spinopelvic alignment and quality of life in this population, should be assessed further in ambulatory patients with cerebral palsy., Level of Evidence: Level IV-retrospective cohort study and literature comparison., (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)