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Postural assessments of the lumbar spine lack valuable information about its properties. The purpose of this study was to assess neutral zone (NZ) characteristics via in vivo lumbar spine passive stiffness and relate NZ characteristics to standing lumbar lordosis. A comparison was made between those that develop low back pain during prolonged standing (pain developers) and those that do not (nonpain developers). Twenty-two participants with known pain status stood on level ground, and median lumbar lordosis angle was calculated. Participants were then placed in a near-frictionless jig to characterize their passive stiffness curve and location of their NZ. Overall, both pain developers and nonpain developers stood with a lumbar lordosis angle that was more extended than their NZ boundary. Pain developers stood slightly more extended (in comparison to nonpain developers) and had a lower moment corresponding to the location of their extension NZ boundary. Overall, in comparison to nonpain developers, pain developers displayed a lower moment corresponding to the location of their extension NZ boundary which could correspond to greater laxity in the lumbar spine. This may indicate why pain developers have a tendency to stand further beyond their NZ with greater muscle co-contraction. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lumbar lordosis distribution has become a pivotal factor in re-establishing the foundational alignment of the lumbar spine. This can directly influence overall sagittal alignment, leading to improved long-term outcomes for patients. Despite the wide availability of hyperlordotic stock cages intended to achieve optimal postoperative alignment, there is a lack of correlation between the lordotic shape of a cage and the resultant intervertebral alignment. Recently, personalized spine surgery has witnessed significant advancements, including 3D-printed personalized interbody implants, which are customized to the surgeons treatment and alignment goals. This study evaluates the reliability of 3D-printed patient-specific interbody implants to achieve the planned postoperative intervertebral alignment. METHODS: This is a retrospective study of 217 patients with spinal deformity or degenerative conditions. Patients were included if they received 3D-printed personalized interbody implants. The desired intervertebral lordosis (IVL) angle was prescribed into the device design for each personalized interbody (IVL goal). Standing postoperative radiographs were measured, and the IVL offset was calculated as IVL achieved minus IVL goal. RESULTS: In this patient population, 365 personalized interbodies were implanted, including 145 anterior lumbar interbody fusions (ALIFs), 99 lateral lumbar interbody fusions (LLIFs), and 121 transforaminal lumbar interbody fusions. Among the 365 treated levels, IVL offset was 1.1° ± 4.4° (mean ± SD). IVL was achieved within 5° of the plan in 299 levels (81.9%). IVL offset depended on the approach of the lumbar interbody fusion and was achieved within 5° for 85.9% of LLIF, 82.6% of transforaminal lumbar interbody fusions and 78.6% of ALIFs. Ten levels (2.7%) missed the planned IVL by >10°. ALIF and LLIF levels in which the plan was missed by more than 5° tended to be overcorrected. CONCLUSIONS: This study supports the use of 3D-printed personalized interbody implants to achieve planned sagittal intervertebral alignment. CLINICAL RELEVANCE: Personalized interbody implants can consistently achieve IVL goals and potentially impact foundational lumbar alignment.

BACKGROUND: An abnormal postoperative lordosis distribution index (LDI), which quantifies the ratio between the lordosis at L4 to S1 and the lordosis at L1 to S1, contributes to the development of adjacent segment disease and increased revision rates in patients undergoing short-segment lumbar intervertebral fusions. Incorporating preoperative spinopelvic parameters and LDI into the surgical plan for short-segment fusion is important for guiding alignment restoration and preserving normal preoperative alignment in unfused segments. This study examined changes in LDI, segmental lordosis, and lordosis of the unfused levels in patients treated with personalized interbody cage (PIC) implants. METHODS: This retrospective study evaluated radiographic measurements from 111 consecutively treated patients diagnosed with degenerative spinal conditions and treated with a short-segment fusion of L4 to L5, L5 to S1, or L4 to S1 using PIC implant(s) within 6 months of the fusion procedure. Comparisons of intervertebral lordosis for treated and untreated levels as well as LDI pre- and postoperatively were performed. RESULTS: In patients with a preoperative hypolordotic distribution (LDI < 50%), statistically significant increases were found in LDI postoperatively, approaching the normal LDI range (LDI 50%-80%). Likewise, patients with hyperlordotic distribution preoperatively (LDI > 80%) experienced a decrease in LDI postoperatively, trending toward the normal range, although the changes were not statistically significant. Intervertebral lordosis for the L5 to S1 level increased significantly following the placement of a PIC in the normal and hypolordotic LDI groups. Changes in intervertebral lordosis for L5 to S1 were not significant for patients with preoperative hyperlordotic LDI. Reciprocal changes in intervertebral lordosis at L1 to L4 were not observed in any groups. CONCLUSIONS: PIC implants may provide a benefit for patients, particularly those with hypolordotic distributions preoperatively. They have the potential to further improve patient outcomes by helping surgeons to achieve patient-specific lordosis goals, which may help to reduce the risk of adjacent segment disease and revisions in patients undergoing short-segment lumbar intervertebral fusions. CLINICAL RELEVANCE: Personalized implants can help surgeons achieve patient-specific alignment goals, potentially prevent adjacent segment disease, and reduce long-term reinterventions.

STUDY DESIGN: Retrospective review of prospective database. OBJECTIVES: Vertebral pelvic angles (VPAs) account for complexity in spine shape by assessing the relative position of each vertebra with regard to the pelvis. This study uses VPAs to investigate the shape of the fused spine after T10-pelvis fusion, in patients with adult spinal deformity (ASD), and then explores its association with proximal junctional kyphosis (PJK). METHODS: Included patients had radiographic evidence of ASD and underwent T10-pelvis realignment. VPAs were used to construct a virtual shape of the post-operative spine. VPA-predicted and actual shapes were then compared between patients with and without PJK. Logistic regression was used to identify components of the VPA-based model that were independent predictors of PJK occurrence and post-operative shape. RESULTS: 287 patients were included. VPA-predicted shape was representative of the true post-operative contour, with a mean point-to-point error of 1.6-2.9% of the T10-S1 spine length. At 6-weeks follow-up, 102 patients (35.5%) developed PJK. Comparison of the true post-operative shapes demonstrated that PJK patients had more posteriorly translated vertebrae from L3 to T7 (P < .001). Logistic regression demonstrated that L3PA (P = .047) and T11PA (P < .001) were the best independent predictors of PJK and were, in conjunction with pelvic incidence, sufficient to reproduce the actual spinal contour (error

PURPOSE: The purpose of this review was to evaluate the effectiveness of patient-specific rods for adult spinal deformity. METHODS: A systematic review of the literature was performed through an electronic search of the PubMed, Scopus, and Web of Science databases. Human studies between 2012 and 2023 were included. Sample size, sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis (PI-LL), pelvic tilt (PT), operation time, blood loss, follow-up duration, and complications were recorded for each study when available. RESULTS: Seven studies with a total of 304 adult spinal deformity patients of various etiologies were included. All studies reported SVA, and PT; two studies did not report PI-LL. Four studies reported planned radiographic outcomes. Two found a significant association between preoperative plan and postoperative outcome in all three outcomes. One found a significant association for PI-LL alone. The fourth found no significant associations. SVA improved in six of seven studies, PI-LL improved in all five, and three of seven studies found improved postoperative PT. Significance of these results varied greatly by study. CONCLUSION: Preliminary evidence suggests potential benefits of PSRs in achieving optimal spino-pelvic parameters in ASD surgery. Nevertheless, conclusions regarding the superiority of PSRs over traditional rods must be judiciously drawn, given the heterogeneity of patients and study methodologies, potential confounding variables, and the absence of robust randomized controlled trials. Future investigations should concentrate on enhancing preoperative planning, standardizing surgical methodologies, isolating specific patient subgroups, and head-to-head comparisons with traditional rods to fully elucidate the impact of PSRs in ASD surgery.

Background: Prolonged hours of sitting in sustained posture is a common job requirement of desk job workers. Potential risk of iliopsoas muscle shortening leading to lumbar hyperlordosis, which in turn may cause low-back pain was identified. Thus, this study determined association between iliopsoas muscle length and lumbar lordosis in desk job workers. Methods and Material: This cross-sectional study was conducted on forty-six desk job workers working for 5 hrs/day for at least 5 years. Workers were assessed for iliopsoas muscle length using Modified Thomas test and flexi-ruler was used to measure lumbar lordosis. Pearson's correlation was operated for association of iliopsoas length with lumbar lordosis. Results: Lumbar lordosis demonstrated moderate positive correlation with both right (r = 0.628) and left Iliopsoas muscle length (r = 0.647). Conclusion: This study concluded workers with higher degree of lumbar lordosis presented with shorter iliopsoas length. Timely intervention to maintain the length of this muscle will ensure low incidence of low-back pain among desk job workers thereby safeguarding their spine due to cumulative trauma. Keywords: Desk-job-workers, ilio-psoas-length, lumbar-lordosis, work-related musculoskeletal disorders, Author(s): Prachi M. Singhvi [1]; Juhi K. Bharnuke (corresponding author) [1] INTRODUCTION Low-back pain (LBP) has a high prevalence among desk job workers and is one of the most common [...]

Study Design. Retrospective cohort study. Objective. The purpose of this study is to determine which demographic, surgical, and radiographic preoperative characteristics are most associated with the need for subsequent fusion after decompression lumbar spinal surgery. Summary of Background Data. There is a relatively high rate of the need for repeat decompression or fusion after an index decompression procedure for degenerative spine disease. Nevertheless, there is a dearth of literature identifying risk factors for lumbar fusion following decompression surgery Methods. Patients 18 years or older receiving a primary lumbar decompression surgery within the levels of L3-S1 between 2011 and 2020 were identified. All patients had preoperative radiographs and 2 years of follow-up data. Chart review was performed for surgical characteristics and demographics. The sagittal parameters included lumbar lordosis (LL), segmental lordosis (SL), anterior disk height (aDH), posterior disk height (pDH), sacral slope (SS), and pelvic tilt (PT). Pelvic incidence (PI = PT+SS) and pelvic incidence minus lumbar lordosis (PI-LL) were calculated. In addition, the Roussouly classification was determined for each patient. Bivariant and multivariant analyses were performed. Results. Of the 363 patients identified in this study, 96 patients had a fusion after their index decompression surgery. Multivariable analysis identified involvement of L4-L5 level in the decompression [odds ratio (OR) = 1.83 (1.09-3.14), P = 0.026], increased L5-S1 segmental lordosis [OR = 1.08 (1.03-1.13), P = 0.001], decreased SS [OR = 0.96 (0.93-0.99), P = 0.023], and decreased endplate obliquity [OR = 0.88 (0.77-0.99), P = 0.040] as significant independent predictors of fusion after decompression surgery. Conclusions. This is one of the first studies to assess preoperative sagittal parameters in conjunction with demographic variables to determine predictors of the need for fusion after index decompression. We demonstrated that decompression at L4-L5, greater L5-S1 segmental lordosis, decreased sacral slope, and decreased endplate obliquity were associated with higher rates of fusion after decompression surgery. [ABSTRACT FROM AUTHOR]

Objective: When implanting the Zero‐P device, the screws of Zero‐P form a bone wedge with a 40 ± 5° cranial and caudal angle (CCA). However, no study has been performed in the optimal CCA of the Zero‐P implant. To investigate whether the cranial/caudal angles (CCA) of the screws affect the clinical and radiological outcomes in patients undergoing ACDF with the Zero‐P implant. Methods: From January 2016 to December 2023, we retrospectively analyzed 186 patients who underwent 1‐level ACDF with the Zero‐P device. The patients were divided into four groups: group A (cranial angle ≤40°, caudal angle ≤40°); group B (cranial angle ≤40°, caudal angle >40°); group C (cranial angle >40°, caudal angle ≤40°); and group D (cranial angle >40°, caudal angle >40°). The clinical outcomes, including Japanese Orthopaedic Association (JOA), neck disability index (NDI), and visual analogue scale (VAS) scores, the radiological parameters, including cervical lordosis (CL), cervical lordosis of operated segments (OPCL), intervertebral space height (ISH) and fusion rate (FR), and the complications, were evaluated and compared. Parametric tests, non‐parametric tests, and chi‐square tests were conducted to analyze the data. Results: The OPCL of group A was significantly less than that of the other groups at the final follow‐up (p < 0.05). The ISH of group D was significantly less than that of group A at the final follow‐up (p < 0.05). The subsidence rate of group A was significantly less than that of group D at the final follow‐up (p < 0.05). At the final follow‐up, the upper adjacent‐level degeneration (ASD) of group D was significantly less severe than that of groups A and B (p < 0.05). The clinical outcomes do not differ among groups (p > 0.05). Conclusion: A larger CCA of the screws (cranial angle >40°, caudal angle >40°) was better for maintaining OPCL and reducing the incidence of ASD. A smaller CCA of the screws (cranial angle ≤40°, caudal angle ≤40°) was better for maintaining ISH and reducing the rate of subsidence. [ABSTRACT FROM AUTHOR]

Summary: Designing appropriate diagnostic and treatment methods to reduce fall risk and improve quality of life, as well as reduce the cost of care in elderlies. Our findings have potential for early diagnosis of those with a high probability of falling based on fairly simple clinical measures of hyperkyphosis, forward head, and lordosis. Introduction: Poor balance is an underlying cause of falling in the elderly, for which a change in the natural curvature of the spine plays a major role. Little is known about the relationship between spinal curvatures and fall incidence in this population. We primarily aimed to investigate the relationship between sagittal plane spinal curvatures and fall incidence over 1 year among nursing facility residents. Secondarily, we aim to determine associations of sagittal plane spinal curvatures with participants' perception of fall risk and balance capability. Methods: Participants (100 residents mean age 70.17 ± 6.01 years) underwent standing measures of sagittal plane spinal curvatures (flexible ruler technique) and forward displacement of the head relative to the cervical spine. The Tinetti Performance Oriented Mobility Assessment (POMA) and Fall Efficacy Scale assessed participants' perception of balance and fear of falling. Incident falls were self-reported monthly and tracked across 1 year. Spearman's correlations and logistic regression evaluated associations between fall incidence and spinal curvature. Predictive performance of spinal curvature and fall risk was determined by the corresponding ROC for defining a cut-off for variables of spinal curvature and fall risk indicators. Results: Predictive performance of spinal curvature and fall risk factors indicated 84% and 77% of participants were correctly classified using models of kyphosis and head angle, respectively. Conclusions: Our study adds new data on spinal curvatures and incident falls among nursing facility residents. Efforts are needed to intervene to counter progression of spinal curvatures and improve fall prevention practices. [ABSTRACT FROM AUTHOR]

Aim: To examine factors associated with lower urinary tract symptoms (LUTS) and lower urinary tract dysfunction (LUTD) in children with Duchenne muscular dystrophy (DMD). Methods: This cross‐sectional study included 45 individuals diagnosed with DMD between the ages of 5 and 18 years. LUTS were evaluated with the Dysfunctional Voiding and Incontinence Scoring System, functional levels with the Brooke Upper Extremity Functional Classification and the Vignos Scale, lumbar lordosis angle with a bubble inclinometer, pelvic inclination angles with a digital inclinometer, and muscle strength with a hand‐held dynamometer. Results: The mean age of the children was calculated as 9.00 ± 3.32 years, body weight as 31.10 ± 12.59 kg, and height as 125.87 ± 18.46 cm. LUTD was detected in 20 children (44.44%). There was an association between high LUTD severity and low strength of the following muscles: bilateral hip flexor (Dominant: r = −0.338, p = 0.023; nondominant: r = −0.411, p = 0.005), quadriceps femoris (Dominant: r = −0.445, p = 0.002; nondominant: r = −0.504, p < 0.001), elbow flexor (Dominant: r = −0.461, p = 0.001; nondominant: r = −0.455, p = 0.002), and elbow extensor (Dominant: r = −0.442, p = 0.002; nondominant: r = −0.450, p = 0.002). Upper extremity functionality level was significantly higher in the LUTD‐negative group (p = 0.004). There was no relationship between lumbar lordosis and pelvic inclination angles and LUTS symptoms (p > 0.05). Conclusion: To provide the adequate care for bladder health in children with DMD, it is essential to focus on parameters that will increase functionality and independence in this population. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective study. Objective: To investigate whether lumbar apex position had an impact on the development of adjacent segment disease (ASD) following transforaminal lumbar interbody fusion (TLIF). Summary of Background Data. Previous studies have demonstrated that solely concentrating on lumbar lordosis value is not suitable, and neglecting the significance of lumbar apex can lead to mechanical complications. However, the relationship between lumbar apex and ASD is still not well understood. Methods. In this retrospective study, 234 consecutive patients who underwent L3-5 or L4-5 TLIF for degenerative diseases were reviewed. The study evaluated the associations between sagittal parameters and pelvic incidence (PI). Patients were labeled "matched" when lumbar apex position aligned with the theoretical target, and "mismatched" when it did not. Multivariate analysis was applied to find the independent risk factors of ASD. In addition, a focused subanalysis was performed based on the lumbar apex position (ideal match, cranial from ideal, and caudal from ideal). Results. After an average follow-up period of 70.6 months, 68 cases were identified as having ASD. Postoperatively, 64.7% (44 of 68) of the patients with ASD exhibited a mismatched lumbar apex, compared with 41%(68 of 166) of those without ASD(P < 0.001). PI correlated significantly with proximal lordosis (PL) and lordosis distribution index (LDI) but not with distal lordosis (DL). Multivariate analysis identified age, L3--5 fusion, postoperative DL, and postoperative mismatched lumbar apex as independent risk factors of ASD. Upon the subanalysis, it was discovered that there were unique compensatory strategies in the cranial and caudal groups, with notable variations in postoperative DL, PL, and LDI among three groups (all P value of <0.05). Conclusion. Lumbar apex position significantly influenced the risk of ASD. To restore the lumbar apex to its ideal position, a proper value and distribution of DL should be attained. [ABSTRACT FROM AUTHOR]

Herein, we describe a novel posterior lumbar interbody fusion (PLIF) technique with annulus fibrosus (AF) release and the use of expandable cages (called "anterior-release PLIF" [ARPLIF]). In this technique, posterior column osteotomy (PCO) and AF release provide excellent intervertebral mobility. AF release involves circumferentially peeling off the AF above or below the endplate between the fixed vertebrae under radiographic guidance without cutting the AF and anterior longitudinal ligament. Subsequently, high-angle variable-angle expandable cages are used to simultaneously expand both sides before inserting the percutaneous pedicle screws and correcting to achieve good local lumbar lordosis. PCO and AF release achieve excellent intervertebral mobility. Intervertebral mobility and simultaneous expansion of both cages disperse the force on the endplates, reducing cage subsidence, and the high-angle cages facilitate high intervertebral angle creation. The novel ARPLIF intervertebral manipulation technique can promote good local lumbar lordosis formation. [ABSTRACT FROM AUTHOR]

Spinal alignment can be assessed without radiation using three-dimensional ultrasound imaging (3DUS). Reliable measurements could inform the ideal arm position for scoliosis radiographs. This study determined the inter-evaluator reliability of axial vertebral rotation (AVR) measurements and sagittal curve angles in healthy females from 3DUS spinal images in standing with two common radiograph arm positions: Chin and abduction (Abd). Three novice evaluators (R1, R2, and R3) measured images once. The Bland–Altman bias and limits of agreement (LOA) were calculated. T5-T12 kyphosis measurements met our bias and LOA error threshold only for R1 vs R2 in the Chin position [−0.53° (−10.7,9.7)]. The distance between the bias and the LOA also met our acceptable threshold of 5° for all mean AVRTwist, and all but one AVRTwist measurements (R1-R2_Chin = 5.9°). Three lordosis measurements did not meet our acceptable threshold (R1-R2_Chin, R1-R3_Chin, and R2-R3_Abd). The inter-evaluator reliability of novice evaluators was adequate and did not differ significantly between positions. [ABSTRACT FROM AUTHOR]

The article in the Journal of Fish Diseases discusses the prevalence and typology of skeletal abnormalities in fish from the Eastern Mediterranean. The study reports on various types of skeletal abnormalities found in specimens of 10 fish species from the Aegean Sea, with rates ranging from 3.3% to 28.6%. The research highlights the impact of anthropogenic pressures, pollution, and other factors on the occurrence of skeletal abnormalities in wild fish populations. The study emphasizes the need for further monitoring programs to understand the effects of fish abnormalities on natural stocks and mortality rates. [Extracted from the article]

To elucidate the effect of global spinal alignment on cervical degeneration in patients with degenerative lumbar scoliosis (DLS). This study included 117 patients with DLS and 42 patients with lumbar spinal stenosis as a control group. Patients with DLS (study group) were categorized according to the Scoliosis Research Society–Schwab classification. Spinopelvic parameters were measured in cervical and full-length spine radiographs. Cervical degeneration was assessed using the cervical degeneration index (CDI) scoring system. There were significant differences in C2-C7 sagittal vertical axis, T1 slope, thoracic kyphosis, lumbar lordosis (LL), and pelvic tilt between DLS and control groups. Although the DLS and control groups did not differ significantly with regard to CDI scores, a striking difference was noted when sagittal spinopelvic modifiers were considered individually. Patients with a pelvic incidence (PI)–LL mismatch modifier grade of ++ had significantly higher CDI scores than patients with grade 0, and patients with a PI-LL or sagittal vertical axis modifier grade of ++ had significantly higher CDI scores than the control group. Disk narrowing scores were highest in patients with a PI-LL modifier grade of ++ followed by patients with a grade of +. Additionally, CDI scores were more associated with LL rather than cervical lordosis. Patients with DLS may be at greater risk of cervical spine degeneration, especially patients with a PI-LL or sagittal vertical axis modifier grade of ++. A surgical strategy for patients with DLS should be carefully selected considering the restoration of LL. [ABSTRACT FROM AUTHOR]

This study evaluates the impact of L4-L5 minimally invasive surgery (MIS)– transforaminal lumbar interbody fusion (TLIF) on adjacent-level parameters. This is a retrospective study performed on consecutive patients between January 2015 and December 2019. The index- and adjacent-level segmental lordosis (SL) and disc angle (DA) were measured. Patient-reported outcomes (PROs) were collected preoperatively and at 3–24 months postoperatively. Factors influencing changes in adjacent-level parameters and the occurrence of adjacent segment degeneration (ASDeg) were assessed. A total of 117 adult patients, averaging 65.5 years of age and slight preponderance of female (56.4%), were analyzed. L4-L5 SL decreased at 2 years (P < 0.05), but L4-L5 DA significantly increased at all timepoints (P < 0.05). While L3-L4 SL and DA significantly decreased at all timepoints (P < 0.05), L5-S1 SL decreased at 3 and 12 months (P < 0.05) and L5-S1 DA only significantly decreased at 2 years (P < 0.05). All PROs improved significantly (P < 0.0001). The ASDeg rate was 19.7% at 2.2 years. Cephalad and caudal ASDeg rates were 12.0% and 10.3%, respectively. Eight patients (6.8%) required adjacent-level reoperations, mainly at L3-L4 (6 cases). The use of expandable cage significantly reduced the odds of caudal ASDeg (OR 0.15, P = 0.037), but had no significant effect on cephalad ASDeg. L4-L5 MIS-TLIF had a more consistent effect on L3-L4 than L5-S1. Although adjacent-level SL and DA decreased over time, their association with ASDeg appears limited, suggesting a multifactorial etiology. L4-L5 MIS-TLIF provides demonstrable clinical benefits with lasting PRO improvements and low adjacent-level reoperations. [ABSTRACT FROM AUTHOR]

Purpose: Previous work comparing ASD to a normative population demonstrated that a large proportion of lumbar lordosis is lost proximally (L1-L4). The current study expands on these findings by collectively investigating regional angles and spinal contours. Methods: 119 asymptomatic volunteers with full-body free-standing radiographs were used to identify age-and-PI models of each Vertebra Pelvic Angle (VPA) from L5 to T10. These formulas were then applied to a cohort of primary surgical ASD patients without coronal malalignment. Loss of lumbar lordosis (LL) was defined as the offset between age-and-PI normative value and pre-operative alignment. Spine shapes defined by VPAs were compared and analyzed using paired t-tests. Results: 362 ASD patients were identified (age = 64.4 ± 13, 57.1% females). Compared to their age-and-PI normative values, patients demonstrated a significant loss in LL of 17 ± 19° in the following distribution: 14.1% had "No loss" (mean = 0.1 ± 2.3), 22.9% with 10°-loss (mean = 9.9 ± 2.9), 22.1% with 20°-loss (mean = 20.0 ± 2.8), and 29.3% with 30°-loss (mean = 33.8 ± 6.0). "No loss" patients' spine was slightly posterior to the normative shape from L4 to T10 (VPA difference of 2°), while superimposed on the normative one from S1 to L2 and became anterior at L1 in the "10°-loss" group. As LL loss increased, ASD and normative shapes offset extended caudally to L3 for the "20°-loss" group and L4 for the "30°-loss" group. Conclusion: As LL loss increases, the difference between ASD and normative shapes first occurs proximally and then progresses incrementally caudally. Understanding spinal contour and LL loss location may be key to achieving sustainable correction by identifying optimal and personalized postoperative shapes. [ABSTRACT FROM AUTHOR]

Purpose: Pelvic incidence (PI) is commonly used to determine sagittal alignment. Historically, PI was believed to be a fixed anatomic parameter. However, recent studies have suggested that there is positionally-dependent motion that occurs through the sacroiliac joint (SIJ) resulting in changes in PI. Methods: We reviewed 100 consecutive adult spinal deformity (ASD) patients seen at our academic tertiary referral center. Two reviewers measured pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) on standing radiographs and scout computed tomography scans (CT). Unilateral, bilateral, or absent SIJ vacuum sign (VS) was determined using CTs. Results: Eighty-six patients (42 M:44 F) were included with an average age of 64.1 years and BMI of 28.8 kg/m2. Standing PI was low (< 50°) in 35 patients (40.7%), average (50°-60°) in 22 (25.6%), and high (> 60°) in 29 (33.7%). Average and high PI patients had significant PI changes of 3.0° (p = 0.037) and 4.6° (p = 0.005), respectively. Bilateral SIJ VS was seen in 68 patients, unilateral VS in 9, and VS was absent in 9. The average change in PI between standing and supine was 2.1° in bilateral SIJ VS patients (p = 0.045), 2.2° in unilateral SIJ VS (p = 0.23), and − 0.1° in patients without SIJ VS (p = 0.93). The average absolute difference in PI between supine and standing was 5.5° ±5.5° (p < 0.001). Conclusion: There is a change in PI from supine to standing. In patients with high PI and bilateral VS on CT, the change from supine to standing is significant, perhaps representing instability of the SIJ. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to clarify the relation between global spinal alignment and the necessity of walking aid use in patients with adult spinal deformity (ASD) and to investigate the impact of spinal fixation on mobility status after surgery. Methods: In total, 456 older patients with ASD who had multi-segment spinal fixation surgery and were registered in a multi-center database were investigated. Patients under 60 years of age and those unable to walk preoperatively were excluded. Patients were classified by their mobility status into the independent, cane, and walker groups. Comparison analysis was conducted using radiographic spinopelvic parameters and the previously reported global spine balance (GSB) classification. In addition, preoperative and 2 years postoperative mobility statuses were investigated. Results: Of 261 patients analyzed, 66 used walking aids (canes, 46; walkers, 20). Analysis of preoperative radiographical parameters showed increased pelvic incidence and pelvic incidence-lumbar lordosis mismatch in the walker group and increased sagittal vertebral axis in the cane and walker groups versus the independent group. Analysis of GSB classification showed a higher percentage of walker use in those with severe imbalance (grade 3) in the sagittal classification but not in the coronal classification. While postoperative radiographical improvements were noted, there was no significant difference in the use of walking aids before and 2 years after surgery (P = 0.085). Conclusion: A significant correlation was found between "sagittal" spinal imbalance and increased reliance on walking aids, particularly walkers. However, the limitation of improvement in postoperative mobility status suggested that multiple factors influence the mobility ability of elderly patients with ASD. [ABSTRACT FROM AUTHOR]

Objective: For degenerative diseases accompanied by cervical malalignment, the starting and ending points of fixation for better cervical sagittal alignment and clinical results are not as clear as the thoracolumbar region. In this study we aimed to compare the effects of posterior subaxial cervical fixation (PSCF), posterior cervical fixation extending to the upper thoracic region and posterior upper cervical fixation extending to the upper thoracic region on cervical sagittal alignment. Methods: Sixty‐three patients who underwent posterior cervical and cervical‐up thoracic fixation were retrospectively analyzed in a comparative study. The procedures that we performed from May 2019 to March 2022 on these 63 patients were: (1) C3‐C6 group—posterior subaxial cervical fixation; (2) Subaxial‐T2 group—posterior subaxial cervicothoracic fixation (PSCTF); (3) C2‐T2 upper thoracic posterior fixation group. The C3‐C6 group had 27 patients, Subaxial‐T2 group had 24, and C2‐T2 group had 12. We determined the minimum follow‐up period as 12 months. C0‐2, C2‐7 lordosis angle, sagittal vertical axis (SVA), C2 slope, C7 slope, T1 slope, cervical slope, neck slope, and thoracic inlet angle (TIA) measurements were made in three patient groups. Comparatively, cervical sagittal alignment was evaluated. Result: In the C2‐T2 group, a significant increase in C2‐C7 lordosis, decrease in C2 slope, and increase in TS‐CL were observed. Significant C2‐C7 lordosis decrease, C2 slope increase, and TS‐CL decrease were observed in the C3‐C6 group. A significant increase in C2‐C7 lordosis and a decrease in C2 slope were observed in the subaxial‐T2 group. No significant change was observed in the TS‐CL angle. Conclusion: In cervical degenerative disorders accompanied by cervical malalignment, we recommend the C2‐T2 fixation method, which provides the desired C2‐C7 lordosis, SVA within the normal range, and the best Neck Disability Index results. [ABSTRACT FROM AUTHOR]

Purpose: Proper posture is essential for maintaining musculoskeletal health. The stability of the spine depends largely on the curvature of the human upright spine, and deviations in sagittal arches may signify a displacement in the body's center of gravity. This study aims to investigate the relationship between spinal curvature and postural... [ABSTRACT FROM AUTHOR]

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Background: In order to restore the individual's health in lumbar stabilization surgeries, it is aimed to bring the sagittal alignment closer to normal values, to eliminate the findings, and thus to increase the quality of life of the individual by reducing the disability level. The aim of this study is to measure the effects of lumbar region stabilization surgeries performed in our clinic on some angular values in the spine, disability and quality of life. Preoperative (preop) and postoperative (postop) radiographs of 30 individuals over the age of 40 who applied to our clinic with various lumbar region complaints and underwent lumbar stabilization surgery between the years 2020–2022 were taken. Lumbar lordosis, pelvic tilt, sacral slope and pelvic inclination angles were measured from the images obtained. The Visual Analog Scale was used to measure the pain of individuals, the Oswestry Disability Index to measure the disability level, and the Nottingham Health Profile questionnaire to measure the quality of life. Preop and postop data were analyzed with the SPSS 23.0 program and p < 0.05 was considered significant. Results: The lumbar lordosis angles of individuals who underwent lumbar stabilization surgery approached normal values and the difference between preop–postop lumbar lordosis angle averages was significant (p < 0.05); It was observed that the harmony between the lumbar lordosis and pelvic inclination angles increased, the pain decreased and the difference between preop–postop pain values was significant (p < 0.05), disability levels decreased and quality of life increased. Conclusions: The decrease in the level of disability and the increase in the quality of life seen in individuals who underwent lumbar stabilization surgery were associated with the decrease in pain; The changes in angular values are considered to be clinically significant. [ABSTRACT FROM AUTHOR]

Lateral lumbar interbody fusion (LLIF), developed by Dr. Luiz Pimenta in 2006, allows access to the spinal column through the psoas major muscle. The technique has many advantages, such as reduced bone and muscular tissue damage, indirect decompression, larger implants, and lordosis correction capabilities. However, this technique also has drawbacks, with the most notorious being the risk of spinal pathologies due to indirect injury of the lumbar plexus, but with low rates of persistent injuries. Therefore, several groups have proposed classifications to help identify patients at a greater risk of presenting with neurological deficits. The present work proposes a classification system that relies on simple observation of easily identifiable key structures to guide lateral L4-L5 LLIF decision-making. Patients aged > 18 years who underwent preoperative magnetic resonance imaging (MRI) between 2022 and 2023 were included until 50 high-quality images were acquired. And excluded as follow Anatomical changes in the vertebral body or major psoas muscles prevent the identification of key structures or poor-quality MRIs. Each anatomy was classified as type I, type II, or type III according to the consensus among the three observers. Fifty anatomical sites were included in this study. 70% of the L4-L5 anatomy were type I, 18% were type II, and 12% were type III. None of the type 3 L4-L5 anatomies were approached using a lateral technique. The proposed classification is an easy and simple method for evaluating the feasibility of a lateral approach to–L4-L5. [ABSTRACT FROM AUTHOR]

Introduction: Degenerative spondylolisthesis causes translational and angular malalignment, resulting in a loss of segmental lordosis. This leads to compensatory adjustments in adjacent levels to maintain balance. Lateral lumbar interbody fusion (LLIF) and transforaminal lumbar interbody fusion (TLIF) are common techniques at L4-5. This study compares compensatory changes at adjacent L3-4 and L5-S1 levels six months post LLIF versus TLIF for grade 1 degenerative spondylolisthesis at L4-5. Methods: A retrospective study included patients undergoing L4-5 LLIF or TLIF with posterior pedicle screw instrumentation (no posterior osteotomy) for grade 1 spondylolisthesis. Pre-op and 6-month post-op radiographs measured segmental lordosis (L3-L4, L4-L5, L5-S1), lumbar lordosis (LL), and pelvic incidence (PI), along with PI-LL mismatch. Multiple regressions were used for hypothesis testing. Results: 113 patients (61 LLIF, 52 TLIF) were studied. TLIF showed less change in L4-5 lordosis (mean = 1.04°, SD = 4.34) compared to LLIF (mean = 4.99°, SD = 5.53) (p = 0.003). L4-5 angle changes didn't correlate with L3-4 changes, and no disparity between LLIF and TLIF was found (all p > 0.16). In LLIF, greater L4-5 lordosis change predicted reduced compensatory L5-S1 lordosis (p = 0.04), while no significant relationship was observed in TLIF patients (p = 0.12). Conclusion: LLIF at L4-5 increases lordosis at the operated level, with compensatory decrease at L5-S1 but not L3-4. This reciprocal loss at adjacent L5-S1 may explain inconsistent improvement in lumbar lordosis (PI-LL) post L4-5 fusion. [ABSTRACT FROM AUTHOR]

Purpose: The prone transpsoas approach is a single-position alternative to traditional lateral lumbar interbody fusion (LLIF). Earlier prone LLIF studies have focused on technique, feasibility, perioperative efficiencies, and immediate postoperative radiographic alignment. This study was undertaken to report longer-term clinical and radiographic outcomes, and to identify learnings from experiential evolution of the prone LLIF procedure. Methods: All consecutive patients undergoing prone LLIF for any indication at one institution were included (n = 120). Demographic, diagnostic, treatment, and outcomes data were captured via prospective institutional registry. Retrospective analysis identified 31 'pre-proceduralization' and 89 'post-proceduralization' prone LLIF approaches, enabling comparison across early and later cohorts. Results: 187 instrumented LLIF levels were performed. Operative time, retraction time, LLIF blood loss, and hospital stay averaged 150 min, 17 min, 50 ml, and 2.2 days, respectively. 79% of cases were without complication. Postoperative hip flexion weakness was identified in 14%, transient lower extremity weakness in 12%, and sensory deficits in 10%. At last follow-up, back pain, worst-leg pain, Oswestry, and EQ-5D health state improved by 55%, 46%, 48%, and 51%, respectively. 99% improved or maintained sagittal alignment with an average 6.5° segmental lordosis gain at LLIF levels. Only intra-psoas retraction time differed between pre- and post-proceduralization; proceduralization saved an average 3.4 min/level (p = 0.0371). Conclusions: The largest single-center prone LLIF experience with the longest follow-up to-date shows that it results in few complications, quick recovery, improvements in pain and function, high patient satisfaction, and improved sagittal alignment at an average one year and up to four years postoperatively. [ABSTRACT FROM AUTHOR]

Objectives: Single position lateral fusion with robotic assistance eliminates the need for surgical staging while harnessing the precision of robotic adjuncts. We expand on this technique by demonstrating the technical feasibility of placing bilateral pedicle screws with S2-alar-iliac (S2AI) fixation while in the lateral position. Methods: A cadaveric study was performed using 12 human specimens. A retrospective clinical series was also performed for patients who had undergone robot-assisted placement of S2AI screws in lateral decubitus between June 2020 and June 2022. Case demographics, implant placement time, implant size, screw accuracy, and complications were recorded. Early postoperative radiographic outcomes were reported. Results: In the cadaveric series, a total of 126 screws were placed with robotic assistance in 12 cadavers of which 24 screws were S2AI. There were four breaches from pedicle screws and none with S2AI screws for an overall accuracy rate of 96.8%. In the clinical series, four patients (all male, mean age 65.8 years) underwent single position lateral surgery with S2AI distal fixation. Mean BMI was 33.6 and mean follow-up was 20.5 months. Mean radiographic improvements were lumbar lordosis 12.3 ± 4.7°, sagittal vertical axis 1.5 ± 2.1 cm, pelvic tilt 8.5 ± 10.0°, and pelvic incidence—lumbar lordosis mismatch 12.3 ± 4.7°. A total of 42 screws were placed of which eight screws were S2AI. There were two breaches from pedicle screws and none from S2AI screws for an overall accuracy rate of 95.2%. No repositioning or salvage techniques were required for the S2AI screws. Conclusions: We demonstrate here the technical feasibility of single position robot-assisted placement of S2-alar-iliac screws in the lateral decubitus position for single position surgery. [ABSTRACT FROM AUTHOR]

Objectives: Cervical spinal canal-expanding laminoplasty has been recognized as an alternative to cervical laminectomy, especially in multilevel cervical myelopathy due to spinal stenosis. This study aimed to determine the effects of En-block laminoplasty on cervical sagittal balance, cervical spine biomechanics and whether it is sufficient to preserve cervical canal diameter and lordosis and whether it causes additional lordosis or kyphosis in cases of cervical narrow spinal canal. Methods: Thirty-eight cervical narrow canal patients operated on between 2008 and 2020 were retrospectively evaluated and the results of 24 laminoplasty patients were evaluated. Spinal tomography results for the evaluation of canal diameter changes and X-ray results for cervical sagittal balance evaluation were compared with each other in the early postoperative period and 3 years later. For cervical lordosis assessment, Cobb and C2-C7sagital vertical axis measurements were performed using the PACS system. Results: Fifteen patients were male and 9 were female. The mean age was 65.55±11.56 years (min-max: 58-84) and the mean follow-up period was three years. Two patients had one level stenosis, 4 had two levels, 7 had three levels, and 11 had four or more levels. Radiculopathy was present in 17 patients (71.8%) and myelopathy in 7 patients (29.1%). There was no statistically significant difference in the frequency of myelopathy/radiculopathy between genders. When all distances were considered, no statistical difference was observed in the early postoperative period (median ten days) and late postoperative period (median 3 years) in terms of canal diameters. No measurement value could be obtained for any level diagnosed as restenosis or requiring reoperation. Loss of lordosis was measured in only one patient. Otherwise, lordosis was preserved in all cases at late conversion. Conclusions: The results of our study showed that en-block laminoplasty after the cervical narrow spinal canal was sufficient to maintain the cervical canal diameter in the long term with appropriate patient and surgical technique. [ABSTRACT FROM AUTHOR]

To put forward a new index of cervical curvature evaluation - relative cervical curvature area, and a new classification of cervical spine was proposed according to the relative cervical curvature area. A total of 167 subjects with cervical spondylosis were included in the study. Firstly, 119 subjects were selected to measure C2-C7 lordosis angle by Cobb angle method, Harrison posterior tangent method, and Jackson physiological stress line method, and then their relative cervical curvature area, C1-C7 Cobb angle, C7 slope, and T1 slope were measured. The correlation between relative cervical curvature area and 3 measurement methods and common sagittal parameters was analyzed. According to the angle classification method, we calculated the diagnostic boundary value of the relative cervical curvature area classification, and selected 48 subjects to evaluate its diagnostic efficacy. Finally, 119 subjects were re-evaluated according to the diagnostic threshold and the number of intersections to verify the feasibility of the new classification. The results showed that the relative cervical curvature area index had good intraobserver and interobserver repeatability. Relative cervical curvature area was correlated with Harrison posterior tangent method (r = 0.930), Cobb angle method (r = 0.886), and Jackson physiological stress line method (r = 0.920), and correlated with C1-C7 Cobb angle, C7 slope, and T1 slope. The relative cervical curvature area has a good diagnostic performance for distinguishing patients with lordosis, straightening, and kyphosis. According to the new classification of cervical spine, 119 subjects were divided into 57 simple lordosis, 11 simple straightening, 4 simple kyphosis, 26 S-type, and 21 RS-type. The relative cervical curvature area uses the area parameter instead of the original angle parameter and distance parameter to incorporate the change of segmental curvature, which makes up for the shortcomings of the Cobb angle method that only evaluates the curvature of 2 vertebrae, and better reflects the cervical curvature. Studies have shown that relative cervical curvature area has good repeatability and diagnostic value, and found that it has a good correlation with common cervical sagittal parameters. The new classification of cervical spine makes up for the disadvantage that the angle classification method cannot distinguish between S-type and RS-type, and initially proposes to use the number of intersections and the relative absolute value area to reflect the severity of S-type. [ABSTRACT FROM AUTHOR]

Minimally invasive hemilaminectomy is a safe and effective alternative to open laminectomy for treating intradural extramedullary tumors. There are no reports of postoperative kyphosis after this approach. This study aims to determine whether performing minimally invasive spine surgery hemilaminectomy for intradural extramedullary tumors can prevent the development of postlaminectomy kyphosis (PLK) or lordosis loss. Sixty-five patients with spinal intradural extramedullary tumors who underwent minimally invasive hemilaminectomy surgery and complete pre and postoperative radiologic imaging were included. The effect of the surgical approach on the spinal sagittal axis was assessed by comparing pre- versus postoperative segmental and local Cobb angles at different spinal levels, considering anatomical localization (cervical, thoracic, lumbar, and transition segments) and functional features (mobile, semi-rigid, and transition segments), as well as the extent of the surgical approach (1, 2, or 3 levels) and follow-up. None of the patients had an increase in thoracic kyphosis nor a loss of cervical or lumbar lordosis greater than or equal to 10° after undergoing the minimally invasive spine surgery hemilaminectomy approach. More than 5° of increase in kyphosis was detected on 7.4% and 11.1%, for the segmental and the local angles, respectively; meanwhile, for patients with loss of lordosis, this deviation was detected in 5.3%, for both angles. The occurrence of PLK was more common than that of lordosis loss, but mainly manifested in postoperative angle impairment of less than 5°. No significant differences were evidenced, considering the approach length. Hemilaminectomy represents a promising approach for preventing PLK and postlaminectomy lordosis loss following intradural extramedullary tumor resection. [ABSTRACT FROM AUTHOR]

To investigate the characteristics of the spinal-pelvic sagittal sequence in patients with lumbar vertebral posterior ring apophysis separation (PRAS). A retrospective analysis was conducted on 119 hospitalized patients with PRAS, and 119 adults without symptoms of low back and leg pain were selected as the control. General data and spinal-pelvic sagittal parameters were collected and analyzed. Compared to the control group, the pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis of the PRAS group were significantly lower, while the pelvic tilt (PT), sagittal vertical axis, and PI minus LL were significantly higher. There was no significant difference in thoracolumbar kyphosis between the 2 groups. In patients with PRAS, the LL value of lumbar curvature was moderately correlated with thoracic kyphosis and SS, while PI, PT, and SS were pairwise correlated, indicating that the change in one parameter is often accompanied by simultaneous changes in other parameters if PRAS happens. The correlation between different parameters could provide guidance for the diagnosis of PRAS. In terms of LL type, the PRAS group was mainly of Roussouly type I, while the control group was mainly of type II, and the difference in the composition ratio was statistically significant. As reflected by the spinal-pelvic sagittal parameters, the patients with PRAS exhibited reduced thoracic and lumbar curvature, posterior PT, and fewer vertebral bodies involved in LL. These morphological characteristics indicate the changes of the mechanical structure of the spine. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective analysis of prospectively collected data. Objective. Evaluate the impact of correcting normative segmental lordosis values on postoperative outcomes. Background. Restoring lumbar lordosis magnitude is crucial in adult spinal deformity surgery, but the optimal location and segmental distribution remain unclear. Patients and Methods. Patients were grouped based on offset to normative segmental lordosis values, extracted from recent publications. Matched patients were within 10% of the cohort's mean offset, less than or over 10% were undercorrected and overcorrected. Surgical technique, patient-reported outcome measures, and surgical complications were compared across groups at baseline and two years. Results. In total, 510 patients with a mean age of 64.6, a mean Charlson comorbidity index 2.08, and a mean follow-up of 25 months. L4-5 was least likely to be matched (19.1%), while L4-S1 was the most likely (24.3%). More patients were overcorrected at proximal levels (T10-L2; undercorrected, U: 32.2% vs. matched, M: 21.7% vs. overcorrected, O: 46.1%) and undercorrected at distal levels (L4-S1: U: 39.0% vs. M: 24.3% vs. O: 36.8%). Postoperative Oswestry disability index was comparable across correction groups at all spinal levels except at L4-S1 and T10-L2/L4-S1, where overcorrected patients and matched were better than undercorrected (U: 32.1 vs. M: 25.4 vs. O: 26.5, P=0.005; U: 36.2 vs. M: 24.2 vs. O: 26.8, P=0.001; respectively). Patients overcorrected at T10-L2 experienced higher rates of proximal junctional failure (U: 16.0% vs. M: 15.6% vs. O: 32.8%, P<0.001) and had greater posterior inclination of the upper instrumented vertebrae (U: -9.2±9.4° vs. M: -9.6±9.1° vs. O: -12.2±10.0°, P<0.001), whereas undercorrection at these levels led to higher rates of revision for implant failure (U: 14.2% vs. M: 7.3% vs. O: 6.4%, P=0.025). Conclusions. Patients undergoing fusion for adult spinal deformity suffer higher rates of proximal junctional failure with overcorrection and increased rates of implant failure with undercorrection based on normative segmental lordosis. [ABSTRACT FROM AUTHOR]

• The evaluation and restoration of sagittal balance is important for accurate spinal surgery. • People with pelvic anteversion was focused due to their relatively large lumbar lordosis and sacral slope based on relatively small pelvic incidence. • In movement from standing to sitting, different patterns of spine and pelvis motion can be observed in asymptomatic people with pelvic anteversion and in people without it. • Considering the special characteristics of anteverted-pelvis subgroup would help to improve the accuracy of predictive formulas based on pelvic incidence for determining lumbar lordosis. 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. To build linear predictive formulas for LL that take pelvic anteversion into consideration and to explore the dynamic characteristics of an AP subgroup. Monocentric, cross-sectional study. Five hundred sixty-five asymptomatic Chinese men and women between the ages of 18 and 80 years. 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. 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. 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° (R2=0.268; p<.001) in the whole cohort, LL=0. 83×PI+18.75° (R2=0.427; p<.001) in AP group, and LL=0.79°×PI+9.66° (R2=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. 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. [ABSTRACT FROM AUTHOR]

Study Design: Systematic review and meta-analysis. Objectives: To assess the radiographic risk factors for adjacent segment disease (ASD) following anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine pathologies. Methods: PubMed, Embase and the Cochrane Library databases were searched up to December 2023. The primary inclusion criteria were degenerative spinal conditions treated with ACDF, comparing radiological parameters in patients with and without postoperative ASD. The radiographic parameters included intervertebral disc height, cervical sagittal alignment, sagittal segmental alignment, range of motion, segmental height, T1 slope, sagittal vertical axis (SVA), thoracic inlet angle (TIA), and plate to disc distance (PPD). Risk of bias was assessed for all studies. The Cochrane Review Manager was utilized to perform the meta-analysis. Results: From 7044 articles, 13 retrospective studies were included in the final analysis. Three studies had "not serious" bias and the other 10 studies had serious or very serious bias. The total number of patients in the included studies was 1799 patients. Five studies included single-level ACDF, 2 studies included multi-level ACDF, and 6 studies included single or multi-level ACDF. On meta-analysis, the significant risk factors associated with ASD development were reduced postoperative cervical lordosis (mean difference [MD] = 3.35°, P =.002), reduced last-follow-up cervical lordosis (MD = −3.02°, P =.0003), increased preoperative to postoperative cervical sagittal alignment change (MD = −3.68°, P =.03), and the presence of developmental cervical canal stenosis (Odds ratio [OR] = 4.17, P <.001). Conclusions: Decreased postoperative cervical lordosis, greater change in cervical sagittal alignment and developmental cervical canal stenosis were associated with an increased risk of ASD following ACDF. [ABSTRACT FROM AUTHOR]

Purpose: Proper posture is essential for maintaining musculoskeletal health. The stability of the spine depends largely on the curvature of the human upright spine, and deviations in sagittal arches may signify a displacement in the body’s center of gravity. This study aims to investigate the relationship between spinal curvature and postural stability to promote optimal spinal health. Methods: In this cross-sectional study, 120 recreationally active university students (60 men and 60 women) were selected and grouped by gender. Postural stability was assessed using the balance error scoring system (BESS), and the craniovertebral angle (CVA) was evaluated through photographic methods. Kyphosis and lordosis angles were also measured using specific anatomical landmarks. Correlation analyses were performed using Pearson’s and Spearman’s tests, with a statistical significance of P≤0.05, to explore the relationship between the variables Results: The study’s results showed no significant correlations between thoracic kyphosis, lower back lordosis, and the CVA with BESS scores, except within the male group, where a significant correlation was found between BESS and kyphosis (P=0.01). Conclusion: This study suggests that evaluating thoracic kyphosis can be crucial to enhance postural stability in recreationally active adults. Further research can investigate interventions aimed at improving postural stability among individuals with kyphosis.

OBJECTIVE: Generally, anterior lumbar interbody fusion (ALIF) was believed superior to transforaminal lumbar interbody fusion (TLIF) in induction of fusion. However, many studies have reported comparable results in lumbosacral fusion rate between the two approaches. This study aimed to evaluate the realistic lumbosacral arthrodesis rates following ALIF and TLIF in patients with degenerative spondylolisthesis as measured by CT and radiology. METHODS: Ninety-six patients who underwent single-level L5-S1 fusion through ALIF (n = 48) or TLIF (n = 48) for degenerative spondylolisthesis at the Spine Center, University of California San Francisco, between October 2014 and December 2017 were retrospectively evaluated. Fusion was independently evaluated and categorized as solid fusion, indeterminate fusion, or pseudarthroses by two radiologists using the modified Brantigan-Steffee-Fraser (mBSF) grade. Clinical data on sex, age, body mass index, Meyerding grade, smoking status, follow-up times, complications, and radiological parameters including disc height, disc angle, segmental lordosis, and overall lumbar lordosis were collected. The fusion results and clinical and radiographic data were statistically compared between the ALIF and TLIF groups by using t-test or chi-square test. RESULTS: The mean follow-up period was 37.5 (ranging from 24 to 51) months. Clear, solid radiographic fusions were higher in the ALIF group compared with the TLIF group at the last follow-up (75% vs 47.9%, p = 0.006). Indeterminate fusion occurred in 20.8% (10/48) of ALIF cases and in 43.8% (21/48) of TLIF cases (p = 0.028). Radiographic pseudarthrosis was not significantly different between the TLIF and ALIF groups (16.7% vs 8.3%; p = 0.677). In subgroup analysis of the patients without bone morphogenetic protein (BMP), the solid radiographic fusion rate was significantly higher in the ALIF group than that in the TLIF group (78.6% vs 45.5%; p = 0.037). There were no differences in sex, age, body mass index, Meyerding grade, smoking status, or follow-up time between the two groups (p > 0.05). The ALIF group had more improvement in disc height (7.8 mm vs 4.7 mm), disc angle (5.2° vs 1.5°), segmental lordosis (7.0° vs 2.5°), and overall lumbar lordosis (4.7° vs 0.7°) compared with the TLIF group (p  0.999). CONCLUSIONS: With a minimum 2-year radiographic analysis of arthrodesis at lumbosacral level by radiologists, the rate of solid radiographic fusions was higher in the ALIF group compared with the TLIF group, whereas the TLIF group had a higher rate of indeterminate fusion. Radiographic pseudarthrosis did not differ significantly between the TLIF and ALIF groups.

Study Design. A multicentric retrospective study. Objective. The study of center of mass (COM) locations (ie, barycentremetry) can help us understand postural alignment. The goal of this study was to determine relationships between COM locations and global postural alignment x-ray parameters in healthy subjects. The second objective was to determine the impact on the spinopelvic alignment of increased distance between the anterior body envelope and spine at the lumbar apex level. Summary of Background Data. Unexplored relationship between COM location and spinopelvic parameters. Methods. This study included healthy volunteers with full-body biplanar radiographs, including body envelope reconstruction, allowing the estimation of COM location. The following parameters were analyzed: lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), pelvic tilt (PT), sacro-femoral angle (SFA), knee flexion angle (KFA), and sagittal odontoid-hip axis angle (ODHA). The following COM in the sagittal plane were located: whole body, at a thoracolumbar inflection point, and body segment above TK apex. The body envelope reconstruction also provided the distance between the anterior skin and the LL apex vertebral body center ("SV-L distance"). Results. This study included 124 volunteers, with a mean age of 44 ±19.3. Multivariate analysis confirmed the posterior translation of COM above TK apex with increasing LL (P=0.002) through its proximal component and posterior shift of COM at the inflection point with increasing TK (P=0.008). Increased SV-L distance was associated with greater ODHA (r= 0.4) and more anterior body COM (r=0.5), caused by increased TK (r=0.2) and decreased proximal and distal LL (both r= 0.3), resulting in an augmentation in SFA (r=0.3) (all P< 0.01). Conclusions. Barycentremetry showed that greater LL was associated with a posterior shift of COM above the thoracic apex, while greater TK was correlated with more posterior COM at inflection point. Whole-body COM was strongly correlated with ODHA. This study also exhibited significant alignment disruption associated with increased abdominal volume, with compensatory hip extension. Level of Evidence. Level-II. [ABSTRACT FROM AUTHOR]

The prevalence of phone use has become a major concern for pedestrian safety. Using smartphones while walking reduces pedestrians' ability to perceive the environment by increasing their cognitive, manual, and visual demands. The purpose of this study was to investigate the effect of common phone tasks (i.e., reading, tapping, gaming) on walking behaviors during outdoor walking. Nineteen young adults were instructed to complete four walking conditions (walking only, walking-reading, walking-tapping, and walking-gaming) along an open corridor. Results showed that all three phone tasks increased participants' neck flexion (i.e., neck kyphosis) during walking. Meanwhile, the reading task showed a greater influence on the temporal aspect during the early phases of a gait cycle. The tapping task lowered the flexion angles of the middle and lower back (i.e., torso lordosis) and induced a longer terminal double support. And the gaming task resulted in a decrease in middle back flexion, a shorter stride length, and a longer terminal double support while walking. Findings from the study confirmed our hypothesis that phone tasks changed pedestrians' physical responses to smartphone distraction while walking. To avoid potential risks caused by the observed posture and gait adaptations, safety precautions (e.g., roadside/electronic warning signals) might be imposed depending on the workload expected by different phone tasks. [ABSTRACT FROM AUTHOR]

Objective: Cervical spine posture is related to craniofacial morphology, airway, gait and body posture. This posture may be influenced by the changes in the mandibular position brought about by functional appliance therapy. Therefore, this systematic review aimed to assess the changes in the cervical spine posture with functional appliance treatment in Skeletal Class II subjects. Methods: A search of studies in six electronic databases - Medline (via Pubmed), the Cochrane Library, OVID, LILACS, Scopus and Web of Science were performed until January 18, 2024 without any restriction in date or language of publication. Eligibility screening, study selection, and data extraction were performed by two reviewers independently. The risk of bias assessment of the included studies was performed with the Newcastle Ottawa scale and Cochrane RoB 2.0. Meta-analysis was performed using random effects model for assessment of changes in the cervical spine with removable and fixed functional appliances. Results: Twelve articles that satisfied the eligibility criteria were included for systematic review and nine articles for meta-analysis. Five studies showed a low risk of bias, one as moderate and six as high risk of bias. GRADE assessment revealed a low quality evidence. Meta-analysis revealed a decrease of the upper cervical inclination by 1.16° (95 % CI of −2.68 to 0.35, I2 = 6 %), an increase of the middle cervical inclination by 2.20° (95 % CI of 0.46–3.94, I2 = 49 %), an increase in cervical curvature angle by 1.60° (95 % CI of 0.12–3.09, I2 = 89 %) and a decrease in cervical lordosis angle by 1.54° (95 % CI of −4.16 to 1.08, I2 = 0 %). Conclusions: Minimal uprighting of the cervical spine was noted with functional appliances. Fixed functional appliances exerted a greater effect than removable functional appliances. Cervical hyperlordosis was reduced with removable functional appliance treatment. Though these changes are minimal, the clinical orthodontist should be aware that functional therapy also influences cervical spine posture. Due to the heterogeneity and low quality of evidence, the results are to be considered critically.

The present work aims to demonstrate the importance of physical therapy in a lumbar disc herniation rehabilitation program. Due to its frequency and the problems it creates, related to the inability to work, the condition is starting to become a social disease. This is becoming more and more common in society, making it impossible for the subject to perform various activities from an early age.[1,3,5,11] The aim pursued in this work is to recover the patient with lumbar disc herniation. The general goal of rehabilitation is to help the patient recover as quickly as possible, to prevent physical discomfort and, in particular, to stop the worsening of the disease.[2,7,9] After performing the initial and final tests, we managed to collect the results presented in the paper and draw up the final conclusions of the study.

Background: Non-contiguous two-level Anterior Cervical Discectomy and Fusion (ACDF) may be a viable option for patients with degenerative cervical myelopathy and imaging-evident spine and radicular compression at two non-contiguous cervical levels. The risk of hastening degeneration and triggering Adjacent Segment Disease at the spine levels located between the fused levels is a putative adverse event, which was assessed in a few studies. The aim of this study is to investigate the clinical outcomes of patients undergoing non-contiguous two levels ACDF and to assess biomechanical modifications at non-fused segments. Method: We retrospectively reviewed all patients with noncontiguous two-level spine and radicular compression, who underwent simultaneous noncontiguous two-level ACDF at our center. We analyzed clinical and radiological outcomes and investigated the rate of adjacent segment disease. Radiographic parameters were calculated on pre- and postoperative images. Results: Thirty-two patients underwent simultaneous noncontiguous two-level ACDF for cervical myelo-radiculopathy between 2015 and 2021 and were followed up for a mean period of 43.3 months. For all patients, the mJOA score significantly improved from 14.57 ± 2.3 to 16.5 ± 2.1 (p<0.01) and the NDI score significantly decreased from 21.45 ± 4.3 to 12.8 ± 2.3 (p<0.01) postoperatively. Cervical lordosis increased after surgery (from 9.65° ±9.47 to 15.12° ± 6.09); intermediate disc height decreased (5.68 mm ± 0.57 to 5.27 mm ±0.98); the ROMs of intermediate (from 12.45 ± 2.33 to 14.77 ± 1.98), cranial (from 14.63 ± 1.59 to 15.71 ± 1.02), and caudal (from 11.58 ± 2.32 to 13.33 ± 2.67) segments slightly increased. During follow-up assessment, in one patient the myelopathy worsened due to spine compression at the intermediate level. Conclusions: Simultaneous and non-contiguous two-level ACDF is a safe and effective procedure. The occurrence of postoperative adjacent and intermediate segment disease is rare. [ABSTRACT FROM AUTHOR]