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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: Anterior lumbar interbody fusion (ALIF) or transforaminal lumbar interbody fusion (TLIF) may be used to correct the lumbosacral fractional curve (LsFC) in de novo adult (thoraco) lumbar scoliosis. Yet, the relative benefits of ALIF and TLIF for LsFC correction remain largely undetermined. PURPOSE: To compare the currently available data comparing radiographic correction of the LsFC provided by ALIF and TLIF of LsFC in adult (thoraco)lumbar scoliosis. METHODS: A systematic review was performed on original articles discussing fractional curve correction of lumbosacral spinal deformity (using search criteria: lumbar and fractional curve). Articles which discussed TLIF or ALIF for LsFC correction were presented and radiographic results for TLIF and ALIF were compared. RESULTS: Thirty-one articles were returned in the original search criteria, with 7 articles included in the systematic review criteria. All 7 articles presented radiographic results using TLIF for LsFC correction. Three of these articles also discussed results for patients whose LsFC were treated with ALIFs; 2 articles directly compared TLIF and ALIF for LsFC correction. Level III and level IV evidence indicated ALIF as advantageous for reducing the coronal Cobb angle of the LsFC. There were mixed results on relative efficacy of ALIF and TLIF in the LsFC for restoration of adequate global coronal alignment. CONCLUSIONS: Limited level III and IV evidence suggests ALIF as advantageous for reducing the coronal Cobb angle of the LsFC in de novo adult (thoraco) lumbar scoliosis. Relative efficacy of ALIF and TLIF in the LsFC for restoration of global coronal alignment may be dictated by several factors, including directionality and magnitude of preoperative coronal deformity. Given the limited and low-quality evidence, additional research is warranted to determine the ideal interbody support strategies to address the LsFC in adult (thoraco) lumbar scoliosis.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Identify optimal lumbar lordosis in adult deformity correction to achieve age-adjusted targets and sustained alignment. METHODS: Surgical adult spinal deformity patients reaching an age-adjusted ideal alignment at one year were identified. Multilinear regression analysis was used to identify the relationship between regional curvatures (LL and TK) that enabled achievement of a given global alignment (T1 pelvic angle, TPA) based on pelvic incidence (PI). RESULTS: 347 patients out of 1048 available reached their age-adjusted TPA within 5° (60-year-old, 72% women, body mass index 29 ± 6.2). They had a significant improvement in all sagittal parameters (except PI) from pre-operative baseline to 1 year following surgery (P < .001). Multilinear regression predicting L1-S1 based on TK, TPA, and PI demonstrated excellent results (R2 = .85). Simplification of the coefficients of prediction combined with a conversion to an age-based formula led to the following: LL = PI - 0.3TK - 0.5Age + 10. Internal validation of the formula led to a mean error of -.4°, and an absolute error of 5.0°. Internal validation on patients with an age-adjusted alignment revealed similar accuracy across the entire age-adjusted TPA spectrum (ranges of LL errors: ME = .2° to 1.7°, AE = 4.0° to 5.3°). CONCLUSION: This study provides a simple guideline to identify the amount of LL needed to reach a given alignment (i.e., age-adjusted target) based on PI and associated TK. Implementation of this predictive formula during pre-operative surgical planning may help to reduce unexpected sub-optimal post-operative alignment outcomes.

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. 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. 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. 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 II, diagnostic study. [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]

BACKGROUND: Up to date, there is seldom research about the correlation between the harmonious alignment degree of lumbar lordosis and pelvic incidence and the improvement of postoperative clinical symptoms in patients with lumbar stenosis fusion. OBJECTIVE: To investigate the harmonious alignment degree of lumbar lordosis and pelvic incidence in patients with lumbar spinal stenosis and fusion, and compare the differences of spinal and pelvic sagittal parameters and clinical outcomes among different harmonious alignment degrees. METHODS: The medical records of 110 patients with lumbar spinal stenosis (48 males and 62 females, aged 57±11 years) who were treated with posterior lumbar laminar decompression and internal fixation in the Department of Spinal Surgery, Tianjin Union Medical Center from December 2019 to December 2021 were retrospectively analyzed. The postoperative follow-up was more than 1 year. According to the harmonious alignment degree of lumbar lordosis and pelvic incidence, they were divided into two groups: Group A (n=47) (pelvic incidence-lumbar lordosis >10°) and group B (n=63) (pelvic incidence-lumbar lordosis ≤10°). The changes of clinical scores (low back pain visual analog scale score and Oswestry disability index) and spinal and pelvic sagittal parameters before and after surgery were compared between the two groups. The correlation between clinical symptom improvement and spinal and pelvic imaging parameters was analyzed. RESULTS AND CONCLUSION: (1) There were no significant differences in preoperative pelvic sagittal parameters and clinical function between the two groups (P > 0.05). (2) There were no significant differences in operation time and blood loss between the two groups (P > 0.05). (3) At the last postoperative followup, the visual analog scale score and Oswestry disability index in group B were significantly improved compared with group A (P=0.000, P=0.005). Lumbar lordosis and sacral slope were also significantly improved (P=0.000, P < 0.05), and pelvic tilt was more significantly recovered (P=0.000). (4) Pearson correlation coefficient method results showed that the improvement of visual analog scale score of low back pain was significantly correlated with the improvement of pelvic tilt (r=0.209, P=0.008), lumbar lordosis (r=-0.133, P=0.021) and sacral slope (r=-0.156, P=0.031). Pelvic tilt was significantly correlated with Oswestry disability index (r=0.196, P=0.014). (5) It is concluded that reconstructed lumbar lordosis and reduced pelvic tilt for the harmonious alignment (pelvic incidencelumbar lordosis ≤ 10°) can effectively improve the clinical symptoms of patients. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsSystematic review and meta-analysis to examine common static postural parameters between participants with and without low back pain (LBP).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.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, I2=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.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.Lumbo 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. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective multicenter study. Objective. Our objective was to compare the spline-based measurement of sagittal spinal curvatures to fixed landmarks in a normative population. Summary of Background Data. Recent research has stressed the importance of considering sagittal curvature in its entirety using a spline reconstruction. To date, no data supports the superiority of this method in comparison to classic measurement methods. Patients and Methods. Full-spine biplanar radiographs of subjects over 20 years old who had normal radiographs were analyzed. Thoracic kyphosis (TK) and lumbar lordosis (LL) were measured following two modalities: either using predefined landmarks (TKT1T12, TKT5T12, and LLL1S1) or spline-based measurement (TKSpline and LLspline). Results. A total of 1520 subjects were included (mean 54yo). The mean difference between TKspline and TKT1T12 was 1.4° and between TKspline and TKT5T12 was 11.7° (P<0.001). LLspline was significantly larger than LLL1S1 (55° vs. 54°, P <0.001). LLspline and LLL1S1 were correlated (R=0.950, P<0.001). Pelvic incidence had no influence on the difference between LLspline and LLL1S1 (R= -0.034, P= 0.184). Using LLL1S1 measurements, LL was underestimated in 17% of the cases. The comparison of outlier distributions according to age groups (P=0.175), sex (P= 0.937), or pelvic incidence groups (P= 0.662) found no difference. There were significantly more outliers in Roussouly type 1 compared with other types (56%, P<0.001). Conclusion. Our results suggest that the use of TKT1T12 and LLL1S1 is acceptable to assess spinal sagittal curvatures. However, TKT5T12 is not accurate for the thoracic curve and should be used with caution. LLL1S1 can be used to accurately assess the lumbar curve, except in Roussouly type 1. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to determine the effect of 8 weeks of corrective exercises with the NASM approach on movement disorders, lumbar lordosis, and genu valgum in 12–15-year-old girls. Methods Forty-five teenage girls were divided into three groups, including a movement disorder group (N=15), a lumbar lordosis group (N=15), and a genu valgum group (N=15). The corrective exercises program with the NASM approach included 24 sessions over 8 weeks with a frequency of 3 sessions per week. A flexible ruler, caliper, goniometer, and the scoring form of the NASM approach were used to measure variables. Dependent t-tests and Mann-Whitney U tests were used to analyze the data at a significance level of p

Introduction: Studies describing the relationship between the hip and spine have reported that corrective spinal surgery for adult spinal deformity (ASD) affects the orientation of the acetabulum. However, the extent to which spinal correction in ASD affects acetabular anteversion in the standing position is unclear, especially after total hip arthroplasty, for which dislocation is a concern. The purpose of this study was to evaluate changes in anterior acetabular coverage in the upright position due to extensive correction surgery for ASD. Methods: Thirty-six consecutive patients who had undergone spinal corrective surgery from the thoracolumbar region to the pelvis were enrolled and evaluated. The ventral-central-acetabular (VCA) angle and anterior acetabular head index (AAHI) were measured with a false-profile view to evaluate the relationship between acetabular anteversion in the standing position and spinopelvic parameters before and after surgery. The spinopelvic parameters measured included thoracic kyphosis, pelvic incidence, pelvic tilt (PT), sacral slope, lumbar lordosis (LL), sagittal vertical axis, and global tilt. Results: The VCA angle and AAHI were significantly increased after spinal deformity correction (p

Abstract The objective of this study was to assess the thoracic kyphosis (ThKA) and lumbar lordosis (LLA) in healthy young adults and to investigate potential relationships between spinal curvatures, self-reported physical activity (PA), and somatic parameters. The study included 380 female students and 211 male students aged 20.7 ± 1.5 years. The ThKA and LLA were measured using a Plurimeter-V gravity inclinometer. The level of PA was estimated using the International Physical Activity Questionnaire. ThKA was lower in women compared to men, while LLA was higher in women than in men (p

Abstract Background Physiological thoracic kyphosis (TK) allows sagittal balance of human body. Unlike lumbar lordosis (LL), TK has been relatively neglected in the literature. EOS is an imaging technique employing high-sensitivity xenon particles, featured by low-dose exposure combined with high accuracy compared to conventional radiography. The aim of this study was to investigate predictors of TK in patients with phyiological spine morphology using EOS imaging. Methods EOS images of 455 patients without spinal anomalies were retrospectively assessed for TK (T1- T12), upper thoracic kyphosis (UTK, T1-T5), lower thoracic kyphosis (LTK, T5-T12), LL (L1-S1) and pelvic incidence (PI). The latter curves were measured by two researchers separately and the average of the two measurements was used for further analysis. Spearman non-parametric correlation was estimated for age, PI, LL, LTK, UTK and TK. Multiple robust linear regression analysis was employed to estimate TK, controlling for the effect of age, sex, LL and LTK. Results The mean age of patients was 28.3 ± 19.2 years and 302 (66.4%) of them were females. The mean TK, UTK and LTK was 45.5° ± 9.3, 16 ± 7.4° and 29.7° ± 8.9, respectively. The mean UTK in people under 40 years of age was 17.0° ± 7.2, whereas for patients 40+ years old it was 13.6° ± 7.4. At univariable analysis TK positively correlated with UTK (p

Abstract Introduction A disorder causes congenital kyphosis in the last stages of ossification and cartilage formation during embryonic development. The main treatment for this disease is surgery with various methods. The present study was performed to evaluate the results of the posterior surgery. Methods This study was a descriptive study comparing the results before and after surgery which was performed in 2022 on 14 patients with the congenital kyphosis referred to Al-Zahra Hospital in Isfahan. Initial assessments were performed, and the patient underwent surgery. The patients were re-evaluated immediately after surgery which were followed up and evaluated two years after surgery. Data were collected by a checklist and described and analyzed in SPSS software version 22. Results The mean age of the patients was 23.15 ± 13.24 years, 7 patients (50%) were male, and the mean duration of surgery was 405.85 ± 123.99 min. Seven patients (50%) were under 18 years old. No disease died and the highest T12 involvement was in 5 patients (35.8%). Sagittal Vertical Axis, Kyphosis Angle and Lumbar Lordosis decreased in two stages immediately after surgery and follow-up, which were statistically significant (P 0.05). The mean Kyphosis Angle were significantly different in adults, and children at follow-up stages (P

Abstract Background To identify the differences of lumbar lordosis (LL) and sacral slope (SS) angles between two types of postoperative lumbar disc re-herniation, including the recurrence of same level and adjacent segment herniation (ASH). Methods We searched the medical records of lumbar disc herniation (LDH) patients with re-herniation with complete imaging data (n = 58) from January 1, 2013 to December 30, 2020 in our hospital. After matching for age and sex, 58 patients with LDH without re-herniation from the same period operated by the same treatment group in our hospital were served as a control group. Re-herniation patients were divided into two groups, same-level recurrent lumbar disc herniation group (rLDHG) and adjacent segment herniation group with or without recurrence (ASHG). The preoperative, postoperative and one month after operation LL and SS were measured on standing radiographs and compared with the control group by using t-test, ANOVA, and rank-sum test. Next, we calculated the odds ratios (ORs) by unconditional logistic regression, progressively adjusted for other confounding factors. Results Compared with the control group, the postoperative LL and SS were significantly lower in LDH patients with re-herniation. However, there were no differences in LL and SS between ASHG and rLDHG at any stage. After progressive adjustment for confounding factors, no matter what stage is, LL and SS remained unassociated with the two types of re-herniation. Conclusions Low postoperative LL and SS angles are associated with degeneration of the remaining disc. Low LL and SS may be independent risk factors for re-herniation but cannot determine type of recurrence (same or adjacent disc level).

Study Design. The retrospective study included patients who underwent an L5-S1 anterior (ALIF) or transforaminal (TLIF) lumbar interbody fusion with posterior pedicle screw instrumentation for grade 1 spondylolisthesis from 2018 to 2022. Objective. To compare early reciprocal changes at the L3-L4 and L4-L5 adjacent levels 6 months after ALIF or TLIF at L5-S1. Background. Degenerative and chronic isthmic spondylolistheses often result in decreased segmental lordosis (SL) at L5-S1. This can lead to lordotic overcompensation at adjacent levels to maintain spinopelvic balance. However, the fate of adjacent angles after interbody fusion is not well understood. Patients and Methods. Preoperative and 6-month postoperative measurements of SL (L3-L4, L4-L5, and L5-S1), lumbar lordosis, and pelvic incidence (PI) were obtained from sagittal standing radiographs. Preliminary t tests were performed for descriptive purposes, and multiple regression was used for hypothesis testing. Results. Ninety-eight patients met the inclusion criteria (50 ALIF and 48 TLIF). A greater amount of lordosis achieved at L5-S1 was significantly associated with a greater reduction of SL at L4-L5 (r = -0.65, P < 0.001) or L3-L4 (r = -0.46, P < 0.001). A greater preoperative PI was associated with a greater reduction of SL at L4- L5 (r = -0.42, P < 0.001) and at L3-L4 (r = -0.44, P < 0.001) Conclusion. At 6 months after a lumbar interbody fusion at L5- S1, greater compensatory changes with lordosis reduction are observed at the supra-adjacent L4-L5 and L3-L4 levels in patients achieving greater L5-S1 SL. In addition, preoperative PI played a role in influencing lordotic correction. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the thoracic kyphosis (ThKA) and lumbar lordosis (LLA) in healthy young adults and to investigate potential relationships between spinal curvatures, self-reported physical activity (PA), and somatic parameters. The study included 380 female students and 211 male students aged 20.7 ± 1.5 years. The ThKA and LLA were measured using a Plurimeter-V gravity inclinometer. The level of PA was estimated using the International Physical Activity Questionnaire. ThKA was lower in women compared to men, while LLA was higher in women than in men (p < 0.0001). Female students reported lower PA than male students (p < 0.001). Female students with ThKA within normal values reported a significantly higher amount of low-intensity PA compared to those with ThKA below or above the norm. A correlation was found between ThKA and body mass index (BMI), body adiposity index (BAI), WC, and fat percentage (rho < 0.2), whereas LLA showed correlations with BMI, BAI, waist circumference, and fat percentage (rho < 0.2). Among male students, a correlation was found between LLA and BMI as well as WC (rho < 0.2). Maintaining a healthy body composition may be instrumental in mitigating the risk of developing spinal curvature abnormalities. [ABSTRACT FROM AUTHOR]

Background: Physiological thoracic kyphosis (TK) allows sagittal balance of human body. Unlike lumbar lordosis (LL), TK has been relatively neglected in the literature. EOS is an imaging technique employing high-sensitivity xenon particles, featured by low-dose exposure combined with high accuracy compared to conventional radiography. The aim of this study was to investigate predictors of TK in patients with phyiological spine morphology using EOS imaging. Methods: EOS images of 455 patients without spinal anomalies were retrospectively assessed for TK (T1- T12), upper thoracic kyphosis (UTK, T1-T5), lower thoracic kyphosis (LTK, T5-T12), LL (L1-S1) and pelvic incidence (PI). The latter curves were measured by two researchers separately and the average of the two measurements was used for further analysis. Spearman non-parametric correlation was estimated for age, PI, LL, LTK, UTK and TK. Multiple robust linear regression analysis was employed to estimate TK, controlling for the effect of age, sex, LL and LTK. Results: The mean age of patients was 28.3 ± 19.2 years and 302 (66.4%) of them were females. The mean TK, UTK and LTK was 45.5° ± 9.3, 16 ± 7.4° and 29.7° ± 8.9, respectively. The mean UTK in people under 40 years of age was 17.0° ± 7.2, whereas for patients 40+ years old it was 13.6° ± 7.4. At univariable analysis TK positively correlated with UTK (p<0.001), LTK (p<0.001) an LL (p<0.001). At multivariable linear regression TK increased with LTK (RC = 0.67; 95%CI: 0.59; 0.75) or LL (RC = 0.12; 95%CI: 0.06; 0.18), whereas it decreased with age (RC = -0.06; 95%CI: -0.09;—0.02). Conclusion: If EOS technology is available, the above linear regression model could be used to estimate TK based upon information on age, sex, LL and LTK. Alternatively, TK could be estimated by adding to LTK 17.0° ± 7.4 for patients < 40 years of age, or 13.6° ± 7.4 in patients 40 + years old. The evidence from the present study may be used as reference for research purposes and clinical practice, including spine examination of particular occupational categories or athletes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Lumbar lordotic curvature (LLC), closely associated with low back pain (LBP) when decreased, is infrequently assessed in clinical settings due to the spatiotemporal limitations of radiographic methods. To overcome these constraints, this study used an inertial measurement system to compare the magnitude and maintenance of LLC across various sitting conditions, categorized into three aspects: verbal instructions, chair type, and desk task types. Methods: Twenty-nine healthy participants were instructed to sit for 3 min with two wireless sensors placed on the 12th thoracic vertebra and the 2nd sacral vertebra. The lumbar lordotic angle (LLA) was measured using relative angles for the mediolateral axis and comparisons were made within each sitting category. Results: The maintenance of LLA (LLAdev) was significantly smaller when participants were instructed to sit upright (−3.7 ± 3.9°) compared to that of their habitual sitting posture (−1.2 ± 2.4°) (p = 0.001), while the magnitude of LLA (LLAavg) was significantly larger with an upright sitting posture (p = 0.001). LLAdev was significantly larger when using an office chair (−0.4 ± 1.1°) than when using a stool (−3.2 ± 7.1°) (p = 0.033), and LLAavg was also significantly larger with the office chair (p < 0.001). Among the desk tasks, LLAavg was largest during keyboard tasks (p < 0.001), followed by mouse and writing tasks; LLAdev showed a similar trend without statistical significance (keyboard, −1.2 ± 3.0°; mouse, −1.8 ± 2.2°; writing, −2.9 ± 3.1°) (p = 0.067). Conclusions: Our findings suggest that strategies including the use of an office chair and preference for computer work may help preserve LLC, whereas in the case of cueing, repetition may be necessary. [ABSTRACT FROM AUTHOR]

Purpose: Transitional lumbosacral vertebrae (TLSV) are a congenital anomaly of the lumbosacral region that is characterized by the presence of a vertebra with morphological properties of both the lumbar and sacral vertebrae, with a prevalence of up to 36% in asymptomatic patients and 20% in adolescent idiopathic scoliosis patients. In patients with TLSV, because of these morphological changes and the different numbers of lumbar vertebrae, there are two optional reference sacral endplates that can be selected intently or inadvertently to measure the spinopelvic parameters: upper and lower endplates. The spinopelvic parameters measured using the upper and lower endplates are significantly different from each other as well as from the normative values. Therefore, the selection of a reference endplate changes the spinopelvic parameters, lumbar lordosis (LL), and surgical goals, which can result in surgical over- or under-correction. Because there is no consensus on the selection of sacral endplate among these patients, it is unclear as to which of these parameters should be used in diagnosis or surgical planning. The present study describes a standardization method for measuring the spinopelvic parameters and LL in patients with TLSV. Methods: Upper and lower endplate spinopelvic parameters (i.e., pelvic incidence [PI], sacral slope [SS], and pelvic tilt) and LL of 108 patients with TLSV were measured by computed tomography. In addition, these parameters were measured for randomly selected subjects without TLSV. The PI value in the TLSV group, which was closer to the mean PI value of the control group, was accepted as valid and then used to create an optimum PI (OPI) group. Finally, the spinopelvic parameters and LL of the OPI and control groups were compared. Results: Except for SS, all spinopelvic parameters and LL were comparable between the OPI and control groups. In the OPI group, 60% of the patients showed valid upper endplate parameters, and 40% showed valid lower endplate parameters. No difference was noted in the frequency of valid upper or lower endplates between the sacralization and lumbarization groups. Both the OPI and control groups showed nearly comparable correlations between their individual spinopelvic parameters and LL, except for PI and LL in the former. Conclusions: Because PI is unique for every individual, the endplate whose PI value is closer to the normative value should be selected as the reference sacral endplate in patients with TLSV. [ABSTRACT FROM AUTHOR]

Purpose: Intra-Discal Vacuum phenomenon (IDVP) is well-recognised, yet poorly visualised and poorly understood radiological finding in disc degeneration, particularly with regard to its role in spinal alignment. CT analysis of the lumbar spine in an aging population aims to identify patterns associated with IDVP including lumbopelvic morphology and associated spinal diagnoses. Methods: An analysis was performed of an over-60s population sample of 2020 unrelated abdominal CT scans, without acute spinal presentations. Spinal analysis included sagittal lumbopelvic reconstructions to assess for IDVP and pelvic incidence (PI). Subjects with degenerative pathologies, including previous vertebral fractures, auto-fusion, transitional vertebrae, and listhesis, were also selected out and analysed separately. Results: The prevalence of lumbar spine IDVP was 50.3% (955/1898) and increased with age (125 exclusions). This increased in severity towards the lumbosacral junction (L1L2 8.3%, L2L3 10.9%, L3L4 11.5%, L4L5 23.9%, and L5S1 46.3%). A lower PI yielded a higher incidence of IDVP, particularly at L5S1 (p < 0.01). A total of 292 patients had IDVP with additional degenerative pathologies, which were more likely to occur at the level of isthmic spondylolisthesis, adjacent to a previous fracture or suprajacent to a lumbosacral transitional vertebra (p < 0.05). Conclusions: This study identified the prevalence and severity of IDVP in an aging population. Sagittal patterns that influence the pattern of IVDP, such as pelvic incidence and degenerative pathologies, provide novel insights into the function of aging spines. [ABSTRACT FROM AUTHOR]

Background: Patients with lumbar spinal stenosis (LSS) sometimes have lower lumbar lordosis (LL), and the incidence of LSS correlates closely with the loss of LL. The few studies that have evaluated the association between LL and clinical outcomes after non-instrumented surgery for LSS show conflicting results. This study investigates the association between preoperative LL and changes in PROMs 2 years after decompressive surgery. Method: This prospective cohort study obtained preoperative and postoperative data for 401 patients from the multicenter randomized controlled spinal stenosis trial as part of the NORwegian degenerative spondylolisthesis and spinal STENosis (NORDSTEN) study. Before surgery, the radiological sagittal alignment parameter LL was measured using standing X-rays. The association between LL and 2-year postoperative changes was analyzed using the oswestry disability index (ODI), a numeric rating scale (NRS) for low back and leg pain, the Zurich claudication questionnaire (ZCQ), and the global perceived effect (GPE) score. The changes in PROMs 2 years after surgery for quintiles of lumbar lordosis were adjusted for the respective baseline PROMs: age, sex, smoking, and BMI. The Schizas index and the Pfirrmann index were used to analyze multiple regressions for changes in PROMs. Results: There were no associations in the adjusted and unadjusted analyses between preoperative LL and changes in ODI, ZCQ, GPE, and NRS for back and leg pain 2 years after surgery. Conclusion: LL before surgery was not associated with changes in PROMs 2 years after surgery. Lumbar lordosis should not be a factor when considering decompressive surgery for LSS. [ABSTRACT FROM AUTHOR]

Background: The goal of this study was to better understand the variation of femoral neck version according to spinopelvic and lower limb 3D alignment using biplanar X-rays in standing position. Methods: This multicentric study retrospectively included healthy subjects from previous studies who had free-standing position biplanar radiographs. Subjects were excluded if they presented spinal or any musculo-skeletal deformity, and reported pain in the spine, hip or knee. Age, sex, and the following 3D-reconstructed parameters were collected: spinal curvatures, pelvic parameters, sagittal vertical axis (SVA), T1 pelvic angle (TPA), spino-sacral angle (SSA), femoral torsion angle (FTA), sacro-femoral angle (SFA), knee flexion angle (KA), ankle angle (AA), pelvic shift (PS) and ankle distance. Femoral neck version angle (FVA) was calculated between horizontal plane projection of the bi-coxo-femoral axis and the line passing through the femoral neck barycenter and femoral head center. Analysis according to age subsets was performed. Results: A total of 400 subjects were included (219 females); mean age was 29 ± 18 years (range: 4–83). Subjects with high pelvic tilt values presented significantly higher FVA than average and low-PT individuals, respectively, 7.8 ± 7.1°, 2 ± 9° and 2.1 ± 9.5° (p < 0.001). These subjects also presented lower lumbar lordosis values and higher acetabulum anteversion in the horizontal plane than the two other groups. SVA correlation with FVA was weaker (r = 0.1, p = 0.03) than SSA and TPA (r = − 0.3 and r = 0.3, respectively, p < 0.001). A strong correlation was found with femoral torsion (r = 0.5, p < 0.001). SFA (r = − 0.3, p < 0.001), pelvic shift (r = 0.2, p < 0.001) and ankle distance (r = 0.3, p < 0.001) were also significantly correlated. Multivariate analysis confirmed significant association of age, pelvic tilt, lumbar lordosis, pelvic shift, ankle distance and femoral torsion with FVA. Conclusion: Patients with lower lumbar lordosis present pelvic retroversion which induces a higher femoral neck version. This finding may help positioning implants in total hip replacement procedures. Higher pelvic shift, age, male gender and increased femoral torsion were also correlated with higher FVA. Level of evidence: II (Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding). [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study were to explore the correlations between thoracic kyphosis (TK) and lumbar lordosis (LL) parameters and to build corresponding linear regressions to predict TK morphology and the thoracolumbar inflection point (IP) determined by individual LL parameters in asymptomatic adults. Methods: A total of 280 adult healthy volunteers were recruited, and full-spine X-rays were performed for each subject in a standing posture. The following sagittal parameters were measured: cumulative TK, LL, proximal LL (PLL), the apices of TK (TKA) and LL (LLA), the IP and the distance from the plumb line of the thoracic apex (TAPL) and the lumbar apex (LAPL) to the gravity line. The correlations between TK and LL parameters were analyzed, and the corresponding linear regressions were conducted. Results: Extensive variations existed in TK alignment, including angular and morphological parameters. In addition, there were statistical correlations of all cumulative TK angles with LL (r values from − 0.173 to − 0.708) and PLL (r values from − 0.206 to − 0.803), TKA and IP with LLA (rs = 0.359 and 0.582, respectively) and TAPL with LAPL (rs = 0.335). The common predictive formulas employed in ASD surgery could include T10-L1 = − 3.6–0.2*LL (R2 = 0.201), T4-L1 = 3.4–0.5*LL (R2 = 0.457), TKA = − 10.3 + 1.1*LLA (R2 = 0.180) and IP = − 12.7 + 1.6*LLA (R2 = 0.330). Conclusion: There were intimate associations between TK and LL parameters in asymptomatic adults. Moreover, predictive models for thoracic alignment, particularly cumulative TK, based on LL parameters were proposed, which could better delineate anatomical relationships, guide thoracic construction during adult spinal deformity surgery and may help preventing proximal junctional failure. [ABSTRACT FROM AUTHOR]

Introduction: A disorder causes congenital kyphosis in the last stages of ossification and cartilage formation during embryonic development. The main treatment for this disease is surgery with various methods. The present study was performed to evaluate the results of the posterior surgery. Methods: This study was a descriptive study comparing the results before and after surgery which was performed in 2022 on 14 patients with the congenital kyphosis referred to Al-Zahra Hospital in Isfahan. Initial assessments were performed, and the patient underwent surgery. The patients were re-evaluated immediately after surgery which were followed up and evaluated two years after surgery. Data were collected by a checklist and described and analyzed in SPSS software version 22. Results: The mean age of the patients was 23.15 ± 13.24 years, 7 patients (50%) were male, and the mean duration of surgery was 405.85 ± 123.99 min. Seven patients (50%) were under 18 years old. No disease died and the highest T12 involvement was in 5 patients (35.8%). Sagittal Vertical Axis, Kyphosis Angle and Lumbar Lordosis decreased in two stages immediately after surgery and follow-up, which were statistically significant (P < 0.05). No associated neurologic abnormalities was found during a physical examination or magnetic resonance imaging. In three phases (before, immediately after surgery, and follow-up), the mean of the Sagittal Vertical Axis, and Lumbar Lordosis in adults (over 18 years) and children (under 18 years) was not substantially different (P > 0.05). The mean Kyphosis Angle were significantly different in adults, and children at follow-up stages (P < 0.05). Because one of the children had a device filler in the follow-up stage. Conclusions: PSO can be used as a safe and effective technique to treat and correct Sagittal Vertical Axis, Kyphosis angle, Lumbar lordosis. [ABSTRACT FROM AUTHOR]

Background: To identify the differences of lumbar lordosis (LL) and sacral slope (SS) angles between two types of postoperative lumbar disc re-herniation, including the recurrence of same level and adjacent segment herniation (ASH). Methods: We searched the medical records of lumbar disc herniation (LDH) patients with re-herniation with complete imaging data (n = 58) from January 1, 2013 to December 30, 2020 in our hospital. After matching for age and sex, 58 patients with LDH without re-herniation from the same period operated by the same treatment group in our hospital were served as a control group. Re-herniation patients were divided into two groups, same-level recurrent lumbar disc herniation group (rLDHG) and adjacent segment herniation group with or without recurrence (ASHG). The preoperative, postoperative and one month after operation LL and SS were measured on standing radiographs and compared with the control group by using t-test, ANOVA, and rank-sum test. Next, we calculated the odds ratios (ORs) by unconditional logistic regression, progressively adjusted for other confounding factors. Results: Compared with the control group, the postoperative LL and SS were significantly lower in LDH patients with re-herniation. However, there were no differences in LL and SS between ASHG and rLDHG at any stage. After progressive adjustment for confounding factors, no matter what stage is, LL and SS remained unassociated with the two types of re-herniation. Conclusions: Low postoperative LL and SS angles are associated with degeneration of the remaining disc. Low LL and SS may be independent risk factors for re-herniation but cannot determine type of recurrence (same or adjacent disc level). [ABSTRACT FROM AUTHOR]

Background: Lumbrosacral spondylolisthesis is a common spinal ailment affecting 4-6% of the population. It occurs when the morphology of the neural foramen changes, trapping nerve roots in a restricted area. Lower back pain can range from moderate to severe and can present with or without radiculopathy. Surgical methods like posterior instrumented interbody fusion (PLF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF) are commonly used. However, high-level evidence on the best surgical method is still lacking. The primary focus of this study is to evaluate the surgical outcomes and documenting any complications. Methods: This prospective observational study enrolled 40 consecutive patients at a tertiary care hospital in Ongole, Andhra Pradesh, who were scheduled for surgical intervention for a low-grade degenrative spondylolisthesis. The study excluded patients with long-term medications, facet tenderness, previous spinal surgery, diabetic neuropathy, or vascular claudication. Data was collected through radiological assessments, operative time, blood loss, technique, and intraoperative complications, with post-operative normalization assessed using VAS scores and Oswestry Disability Index. Results: The study involved 11 men and 29 women with low-back pain, neurological claudication, and radiating pain in the lower extremities. The most common radiographic finding was decreased disc space (72.5%) and loss of lumbar lordosis (17.5%). Surface-level wound infection was seen in 11 patients, but it was effectively treated with oral antibiotics. The mean follow-up period was 8.5 months. The neurological and functional recovery of patients showed significant improvement throughout the follow-up period. Lower grades of radiological fusion were associated with higher VAS scores for pain. Conclusion: Surgery for symptomatic low- and midgrade spondylolisthesis has demonstrated superior functional clinical outcomes and enhanced pain control. Opting for posterior decompression and spinal fusion can result in a successful fusion process with few complications. A higher pelvic incidence may be crucial in the progression of developing spondylolisthesis. [ABSTRACT FROM AUTHOR]

Pelvic incidence and lumbar lordosis have only normative values for spines comprising five lumbar and five sacral vertebrae. However, it is unclear how pelvic incidence and lumbar lordosis are affected by the common segmentation anomalies at the lumbo‐sacral border leading to lumbosacral transitional vertebrae, including lumbarisations and sacralisations. In lumbosacral transitional vertebrae it is not trivial to identify the correct vertebral endplates to measure pelvic incidence and lumbar lordosis because ontogenetically the first sacral vertebra represents the first non‐mobile sacral segment in lumbarisations, but the second segment in sacralisations. We therefore assessed pelvic incidence and lumbar lordosis with respect to both of these vertebral endplates. The type of segmentation anomaly was differentiated using spinal counts, spatial relationship with the iliac crest and morphological features. We found significant differences in pelvic incidence and lumbar lordosis between lumbarisations, sacralisations and the control group. The pelvic incidence in the sacralised group was mostly below the range of the lubarisation group and the control group when measured the traditional way at the first non‐mobile segment (30.2°). However, the ranges of the sacralisation and lubarisation groups were completely encompassed by the control group when measured at the ontogenetically true first sacral vertebra. The mean pelvic incidence of the sacraliation group thus increased from 30.2° to 58.6°, and the mean pelvic incidence of the total sample increased from 45.6° to 51.2°, making it statistically indistinguishable from the control sample, whose pelvic incidence was 50.2°. Our results demonstrate that it is crucial to differentiate sacralisations from lumbarisation in order to assess the reference vertebra for pelvic incidence measurement. Due to their significant impact on spino‐pelvic parameters, lumbosacral transitional vertebrae should be evaluated separately when examining pelvic incidence and lumbar lordosis. [ABSTRACT FROM AUTHOR]

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

Introduction: Posterior lumbar interbody fusion (PLIF) is a common treatment for nerve root disease associated with lumbar foraminal stenosis or lumbar spondylolisthesis. At our institution, PLIF is usually performed with high-angle cages and posterior column osteotomy (PLIF with HAP). However, not all patients achieve sufficient segmental lumbar lordosis (SLL). This study determined whether the location of PLIF cages affect local lumbar lordosis formation. Methods: A total of 59 patients who underwent L4/5 PLIF with HAP at our hospital, using the same titanium control cage model, were enrolled in this cohort study. The mean ratio of the distance from the posterior edge of the cage to the posterior wall of the vertebral body/vertebral length (RDCV) immediately after surgery was 16.5%. The patients were divided into two groups according to RDCV

Transitional lumbosacral vertebra presents in 2 forms based on its origin: sacralization and lumbarization. These patients have 2 options for sacral endplates (upper and lower) and consequently, 2 sets of values for spinopelvic parameters and lumbar lordosis (LL). This study aimed to evaluate these parameters in asymptomatic patients with sacralization and lumbarization and compare them with each other and normative values. Spinopelvic parameters and LL according to upper and lower endplate were measured using abdominal computed tomography in 1420 asymptomatic patients, of which 108 had Transitional lumbosacral vertebra. These parameters were compared among patients with lumbarization and sacralization and with normal controls. In addition, correlations between the upper and lower endplate parameters were determined. As compared to the control group, upper endplate measurements yielded lower spinopelvic parameters and LL values while lower endplate values yielded higher values. While these values were significantly different from normative values, these parameters were similar in both lumbarization and sacralization groups. Furthermore, most spinopelvic parameters of both upper and lower endplates were strongly correlated, and the differences between the upper and lower PI and LL values are relatively constant (27° and 14°, respectively. Upper and lower endplate parameters are comparable in patients with sacralization and lumbarization; therefore, the average spatial position of a sacralized L5 and a lumbarized S1 within the pelvis is similar and either parameter can be used for radiological measurements. Further studies with symptomatic patients are warranted to confirm these results. [ABSTRACT FROM AUTHOR]

Preoperative difference in lumbar lordosis (DiLL) was associated with surgical outcomes after single-level transforaminal lumbar interbody fusion (TLIF). Patients with DiLL>0 (DiLL (+)) tended to show worse clinical outcomes and postoperative greater restoration of lumbar lordosis (LL). However, some patients with DiLL (+) showed relatively good outcomes and no postoperative LL restration. This study aimed to elucidate whether the lumbar intervertebral disc vacuum phenomenon (VP) influences clinical course after single-level TLIF in patients with DiLL (+) and DiLL (−). Patients with lumbar spinal stenosis and degenerative spondylolisthesis treated with single-level TLIF were included. Pre- and postoperative LL were measured, and postoperative LL improvement was calculated. Preoperative DiLL was calculated as preoperative supine LL minus standing LL. Severity of VP at the non-fused discs (SVP (non-FS)) was evaluated using preoperative reconstructed computed tomography imaging. Clinical outcomes were assessed using the Oswestry disability index, visual analogue scale (VAS; low back pain (LBP), lower-extremity pain, numbness, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Patients were stratified by the median preoperative SVP (non-FS) score into severe and mild VP groups in patients with DiLL (+) or DiLL (−), and their surgical outcomes were compared. Overall, 89 patients were included. In patients with DiLL (+) (n = 37), patients with severe VP showed worse clinical outcomes, particulary for LBP and DiLL (+) patients with mild VP showed greater LL improvement (6.5° ± 10.0°). In patients with DiLL(−) (n = 52), patients with severe VP showed worse clinical outcomes, particularly for LBP and no differences in preoperative, postoperative, and improvement of LL were observed between two groups. Patients with DiLL (+) and DiLL (−) showed different clinical courses depending on VP severity at the non-fused discs after single-level TLIF. [ABSTRACT FROM AUTHOR]

The aim of our study is to investigate the effect of acute low back pain on spinopelvic parameters. Pre-pain and post-pain scoliosis radiographs of the patients who applied with the complaint of low back pain of acute onset (less than 12 weeks) were taken. Measurements of the spinopel-vic parameters were performed for each patient, including pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), and the sagittal vertical axis (SVA). 65 patients were included in the study. In the statistical study in acute low back pain, changes in SVA, PT, LL, and SS were found to be significant (p = 0.014, 0.006, 0.003, 0.003) Lumbar lordosis decreases as a result of pathologies, such as asymmetric disc degeneration and facet joint hypertrophy that occur in a chronic process, and the sagittal imbalance appears as a consequence of all these. After that, the mechanisms utilized to compensate for the resulting sagittal imbalance led to low back pain. However, differently, in the case of acute low back pain, the patient changes the sagittal alignment first, to yield a less painful posture. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this research was to establish a link between direction of a prolapsed intervertebral disc (PIVD) and lumbar vertebral alignment. Methods: This cross-sectional study included 102 participants with prolapsed intervertebral discs in the lumbar segment and lumbar vertebral mal-alignment of both sexes between the ages of 30 and 50 who had undergone MRI and X-ray for the lumbo-sacral spine. The Numerical Pain Rating Scale (NPRS) was used to assess outcome, MRI scans were used to determine the direction and amount of PIVD, and lumbar spinal alignment was assessed using X-rays in the AP and lateral views. SPSS version 26.0 was used for statistical analysis. Findings: Among the 102 participants, The study found that only 2.94% of 102 participants had Prolapsed Intracranial Disc Disease (PID) at the L1-2 level, with many on multiple levels. Prolapsed intervertebral discs were prevalent in 46.07% of individuals, with scoliosis in 33.33%, exaggerated lumbar lordosis in 4 subjects, and anterolisthesis in 20.59%. The study found a significant correlation between posterocentral and anterolisthesis, biforaminal and flatback, right paracentral and left paracentral prolapse and scoliosis (p<0.0001), with biforaminal direction being particularly significant for anterolisthesis and retrolisthesis (p=0.0050, 0.0014). The lumbosacral angle had a mean value of 31.79, and the mean of pain on rest was 1.99±1.38 and during activity was 5.51±1.66. Conclusion: It concluded that there was a significant relationship between the direction of prolapsed intervertebral disc (PIVD) and lumbar vertebral alignment. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective Cohort Study Objectives: To determine the effect of interbody cages inserted via posterior approach on segmental lordosis in the setting of preoperative lordotic vs kyphotic discs in patients with lumbar degenerative spondylolisthesis (LDS). Methods: Retrospective analysis of prospectively collected data on assessment and management of LDS patients from 2 contributing centres. Patients were analyzed preoperatively and at 12-month follow-up with standing lumbar radiographs. Index level segmental lumbar lordosis (SLL), disc angle and global lumbar lordosis was measured. Patients were stratified into 4 groups based on index level disc angle and procedure: preoperative lordotic posterolateral fusion (group L-PLF); preoperative kyphotic PLF (group K-PLF); preoperative lordotic interbody fusion (IF) (group L-IF); preoperative kyphotic IF (group K-IF). Results: A total of 100/111 (90%) patients completed follow-up with 40 in group L-IF and 48 in group K-IF. There were 18 patients in group L-PLF and 5 in group K-PLF. Among patients with preoperatively lordotic disc angles who had a worsening of SLL, group L-IF had worse SLL than group L-PLF patients, with differences persisting at one-year (mean difference 2.30, 95% CI,.3, 4.3, P =.029). Patients in group K-IF achieved improvement in SLL at one-year more frequently than group L-IF (67% vs 44%, P =.046), with similar mean improvement magnitude between groups L-IF and K-IF (−1.1, 95% CI, −3.7, 1.6, P =.415). Conclusion: Segmental lordosis worsening was greater with preoperative index lordotic disc angles when an interbody cage was used. Patients who have a kyphotic disc preoperatively gain more lordosis with interbody cage use. [ABSTRACT FROM AUTHOR]

To identify variables that may contribute to the development of proximal junctional failure (PJF) in patients with long lumbo-sacral and thoraco-lumbo-pelvic constructs undergoing anterior column realignment (ACR) with anterior longitudinal ligament release (ALLR). Data of patients with adult spinal deformity who underwent ACR with ALLR at L3-4 were collected retrospectively from medical records and a prospectively maintained spine research database between 2016 and 2022. Eleven (41%) developed PJF at a mean of 24 ± 21 months from the index surgery. The cohort was then divided into 2 groups for analysis, 13 subjects in the high pelvic incidence (PI) group (defined as PI ≥ 55°) and 14 subjects in the low PI group (defined as PI < 55°). Visual Analog Scale for back pain and Oswestry Disability Index decreased from 9.5 to 2.1 and 61 to 10 in the high PI group, and from 8.9 to 2.4 and 60.9 to 10.3 in the low PI group, respectively. PI (P = 0.004), sacral slope (P = 0.005), and postoperative PI-lumbar lordosis mismatch (P = 0.02) were found to be significant predictors of PJF. The receiver operator curve revealed a cutoff PI value ≤ 53° (95% confidence interval: 52°–64°), below which the risk of PJF becomes significantly higher in patients undergoing ACR with ALLR at L3-4. PI may be a predictor of PJF and highly correlates with ACR-ALLR levels. In patients undergoing L3-4 ACR-ALLR, a PI value of ≤53° is associated with a significantly elevated risk of PJF. Preoperative planning of ACR-ALLR level based on normal sagittal alignment in otherwise healthy individuals may mitigate the risk of PJF development in patients with adult spinal deformity treated with ACR-ALLR. [ABSTRACT FROM AUTHOR]

To evaluate any mismatch between rod bending and actual lordosis during posterior lumbar instrumentation and its effects on the quality of life (QOL) of patients. Patient records for posterior lumbar fusion in 2018–2023 were retrospectively reviewed. The radiologic parameters consisted of pelvic incidence, sacral slope, L1S1 lumbar lordosis, lumbosacral angle, the distance between the posterior wall of the vertebra and the rod, lordosis of the rod. The postoperative QOL of patients was assessed using Oswestry Disability Index. The patients were grouped postoperative into Group-1 (minimal/moderate disability) and Group-2 (severe disability/crippled/bed bound). Total of 133 patients were included; 99 women, 34 men. The difference was significant for patients with diabetes to be presented in the more disabled Group-2. The distance between the posterior vertebral wall and the rod was found to be short in Group-2. Preoperative and postoperative sagittal lumbar Cobb angles were significantly higher in Group-2. The changing degree of pain was found to score high in Group-2. The postoperative visual analog scale was high in Group-2. The difference between the preoperative and postoperative lumbar sagittal Cobb and rod Cobb-angles was found to be high in Group-2. The results of our study confirm the importance of considering the preoperative actual lumbar lordosis during bending and maintaining it as much as possible. To our knowledge, this is the first study that evaluated the effect of rod bending on quality of life (QOL) and supports that this might be affected in case of any mismatches. [ABSTRACT FROM AUTHOR]

Purpose: Three-column osteotomies (TCOs) and minimally invasive techniques such as anterior column realignment (ACR) are powerful tools used to restore lumbar lordosis and sagittal alignment. We aimed to appraise the differences in construct and global spinal stability between TCOs and ACRs in long constructs. Methods: We identified consecutive patients who underwent a long construct lumbar or thoracolumbar fusion between January 2016 and November 2021. "Long construct" was any construct where the uppermost instrumented vertebra (UIV) was L2 or higher and the lowermost instrumented vertebra (LIV) was in the sacrum or ileum. Results: We identified 69 patients; 14 (20.3%) developed PJK throughout follow-up (mean 838 days). Female patients were less likely to suffer PJK (p = 0.009). TCO was more associated with open (versus minimally invasive) screw/rod placement, greater number of levels, higher UIV, greater rate of instrumentation to the ilium, and posterior (versus anterior) L5-S1 interbody placement versus the ACR cohort (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.005, respectively). Patients who developed PJK were more likely to have undergone ACR (12 (32.4%) versus 2 (6.3%, p = 0.007)). The TCO cohort had better improvement of lumbar lordosis despite similar preoperative measurements (ACR: 16.8 ± 3.78°, TCO: 23.0 ± 5.02°, p = 0.046). Pelvic incidence–lumbar lordosis mismatch had greater improvement after TCO (ACR: 14.8 ± 4.02°, TCO: 21.5 ± 5.10°, p = 0.042). By multivariate analysis, ACR increased odds of PJK by 6.1-times (95% confidence interval: 1.20–31.2, p = 0.29). Conclusion: In patients with long constructs who undergo ACR or TCO, we experienced a 20% rate of PJK. TCO decreased PJK 6.1-times compared to ACR. TCO demonstrated greater improvement of some spinopelvic parameters. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the acute and long-term effects of karate kata training on body posture (range of motion (ROM)) and musculoskeletal pain in elite karate athletes. Twelve kata athletes from the Polish national team participated in the study. A cross-sectional study protocol was used, with direct participatory observation (NMQ-7/6 questionnaire, spinal curvatures and spinal ROM testing, ROM of joints) and natural experiment (225 min of kata training) methods of assessment. Age and number of weekly kata sessions were found to correlate with ROM of the lumbar spine (R = (−0.6), p < 0.05). High increase in the prevalence of lumbar hypolordosis and posterior pelvic tilt was noted after karate training sessions. ROM of the inclination in the sagittal plane differed significantly between the first and second trials, by 10.0 degrees on average. Kata stances and their movement pattern seem to be related to the occurrence of disturbances in the ROM of the internal and external rotations of the hip joints and decreased depth of the lumbar lordosis, pelvic tilt, and their ROM. The locations of the long-term musculoskeletal complaints (NMQ-6) seem to result from compensatory changes that occur in the musculoskeletal structures as a result of elite-level kata training. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Urinary incontinence (UI) is a common public health problem and postural changes may be crucial in women presenting with UI. This study was aimed at evaluating the relationship between low back pain (LBP), pelvic tilt (PT), and lumbar lordosis (LL) in women with and without UI using the DIERS formetric 4D motion imaging system. To date no study has to our knowledge compared postural changes and LBP in women with UI using the DIERS 4D formetric system. Methods: This was a case–control study. We included 33 women with UI and 33 without incontinence. The severity of urogenital symptoms was assessed by the IIQ-7 (Incontinence Impact Score) and UDI-6 (Urogenital Distress Inventory), and disability owing to LBP was evaluated using the Oswestry Disability Index (ODI). Posture and movement assessment, LL angle, thoracic kyphosis, and PT assessment were performed with the DIERS Formetric 4D motion imaging system. Results: The LL angle and pelvic torsion degree were higher in the incontinence group than in the control group (53.9 ± 9.5° vs 48.18 ± 8.3°; p = 0.012, 3.9 ± 4.1 vs 2.03 ± 1.8 mm; p = 0.018 respectively). The LBP visual analog scale value was also significantly higher in the incontinence group (5.09 ± 2.3 vs 1.7 ± 1.8 respectively, p < 0.0001). The LL angle showed a positive correlation with pelvic obliquity, (r = 0.321, p < 0.01) and fleche lombaire (r = 0.472, p < 0.01) and a negative correlation with lumbar range of motion measurements. Pelvic obliquity correlated positively with pelvic torsion (r = 0.649, p < 0.01), LBP (r = 0.369, p < 0.01), and fleche lombaire (r = 0.269, p < 0.01). Conclusions: Women with UI were more likely to have lumbopelvic sagittal alignment changes and a higher visual analog scale for LBP. These findings show the need for assessment of lumbopelvic posture in women with UI. [ABSTRACT FROM AUTHOR]

Introduction: Lumbar lordosis is important for the spine and pelvis to work in harmony in providing trunk control and maintaining sagittal balance. Children with cerebral palsy (CP) have difficulties in providing trunk postural control and balance, which is critical for independence in daily living activities. This study was planned to examine the immediate effect of a lower-trunk orthosis supporting physiological lumbar lordosis on trunk control and upper-limb functionality in children with CP. Objectives and Methods: A total of 30 children with CP, 13 diparetic, 11 hemiparetic, and 6 ataxic, 21 ambulatory (GMFCS I/II), and 9 nonambulatory (GMFCS III/IV) aged 3-16 years were included in the study. The Pediatric Functional Reach Test (PFRT) and the Seated Postural Control Measure (SPCM) were used to assess trunk control; the Pediatric Berg Balance Scale (PBBS) was used to assess balance; and the Box and Block Test (BBT) and the Nine-Hole Peg Test (9HPT) were used to evaluate upper-limb functions. All tests were performed with and without a soft lumbosacral brace. The braces were made of soft, elastic fabric with steel, and weremade by the orthotic technician in four different sizes. The angle of lordosis was adjusted with steel underwires according to each child. The existing physiological lordosis of the child is supported by the brace. It is not intended to increase or decrease. Results: In the study, the results of all evaluations with a brace were better than those without a brace (P < 0.05). No significant difference was found only in the functional part of the SPCM test (P > 0.05). Conclusions: Our study revealed that soft lumbosacral orthosis, which supports physiological lordosis, has a positive effect on trunk stability and upper-limb functionality in children with CP. Clinical Relevance: In children's trunk stability and upper-limb functionality studies, the use of soft lumbosacral orthosis that supports physiological lordosis can be added to rehabilitation programs and daily living activities as a support. [ABSTRACT FROM AUTHOR]

BACKGROUND: According to previous studies, the relationship between lumbar lordosis and thoracic kyphosis or that between pelvic parameters and thoracic kyphosis have been inconsistent. OBJECTIVE: The purpose of this study was to investigate spinal sagittal alignment and its relationship to global and regional lumbar and thoracic angles, pelvic and sway angles, and C7–S1 distance measurements, followed by a detailed subgroup analysis using an inertial measurement unit system. METHODS: A total of 51 asymptomatic volunteers stood in a comfortable posture with inertial measurement units attached to the T1, T7, T12, L3, and S2 vertebrae. T1, T7, T12, L3, and S2 sagittal angles were acquired during standing posture using the Eulerian angle coordinate system. All angles are reported as the mean of three 5-s measurements. Following the measurement of lumbar lordosis angles (T12 relative S2), participants were divided into the flat lumbar and normal lordosis groups. RESULTS: There were different correlation patterns between groups because of spinal sagittal imbalance, which was greater in the flat lumbar group than in the normal lordosis group. In addition, sacral inclination proved the ideal parameter to evaluate reciprocal balance in lumbar lordosis, showing a stronger correlation with lower than with upper lumbar lordosis. T1 was the key element in assessing thoracic kyphosis, which showed a stronger correlation with upper than with lower thoracic kyphosis. CONCLUSION: We suggest that when assessing posture, it is necessary to identify the global and regional angles and it is useful to classify spinal sagittal alignment into subgroups according to lumbar lordosis and evaluate the groups separately. [ABSTRACT FROM AUTHOR]

Abstract Background Anterior column realignment (ACR) is a novel surgical method for correcting spinal sagittal balance. meanwhile, oblique lumbar interbody fusion (OLIF) and anterior lumbar interbody fusion (ALIF) are considered minimally invasive surgical methods through natural anatomical space. This study aimed to explore the corrective effects and clinical outcomes of OLIF or ALIF combined with ACR technology in patients with adult spinal deformity (ASD). Methods We retrospectively analyzed patients with sagittal imbalance who received OLIF and/or ALIF and ACR treatment from 2018 to 2021. Surgical time and intraoperative bleeding volume are recorded, the corrective effect is determined by the intervertebral space angle (IVA), lumbar lordosis (LL), the sagittal vertical axis (SVA), clinical outcome is evaluated by preoperative and final follow-up visual analog pain score (VAS), Japanese orthopedic association scores (JOA) and complications. Results Sixty-four patients were enrolled in the study, average age of 65.1(range, 47–82) years. All patients completed 173 fusion segments, for 150 segments of ACR surgery. The operation time of ALIF-ACR was 50.4 ± 22.1 min; The intraoperative bleeding volume was 50.2 ± 23.6 ml. The operation time and intraoperative bleeding volume of single-segment OLIF-ACR was 66.2 ± 19.4 min and 70.2 ± 31.6 ml. At the follow-up of 6 months after surgery, the intervertebral space angle correction for OLIF-ACR and ALIF-ACR is 9.2° and 12.2°, the preoperative and postoperative lumbar lordosis were 16.7° ± 6.4°and 47.1° ± 3.6° (p

Study Design This study adopted a retrospective study design. Purpose Our study aimed to investigate the impact of central canal stenosis severity on surgical outcomes and lumbar sagittal correction after lumbar decompression. Overview of Literature Studies have evaluated sagittal correction in patients with central canal stenosis after lumbar decompression and the association of stenosis severity with worse preoperative sagittal alignment. However, none have evaluated the impact of spinal stenosis severity on sagittal correction. Methods Patients undergoing posterior lumbar decompression (PLD) of ≤4 levels were divided into severe and non-severe central canal stenosis groups based on the Lee magnetic resonance imaging (MRI) grading system. Patients without preoperative MRI or inadequate visualization on radiographs were excluded. Surgical characteristics, clinical outcomes, and sagittal measurements were compared. Multivariate logistic regression was performed to determine the predictors of pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and pelvic incidence minus lumbar lordosis (PI–LL). Results Of the 142 patients included, 39 had severe stenosis, and 103 had non-severe stenosis. The mean follow-up duration for the cohort was 4.72 months. Patients with severe stenosis were older, had higher comorbidity indices and levels decompressed, and longer lengths of stay and operative times (p0.05). On multivariate regression, severe stenosis was a significant predictor of a lower preoperative LL (estimate=−5.243, p=0.045) and a higher preoperative PI–LL mismatch (estimate=6.192, p=0.039). No differences in surgical or clinical outcomes were observed (p>0.05). Conclusion Severe central lumbar stenosis was associated with greater spinopelvic mismatch preoperatively. Sagittal balance improved in both patients with severe and non-severe stenosis after PLD to a similar degree, with differences in sagittal parameters remaining after surgery. We also found no differences in postoperative outcomes associated with stenosis severity.

Abstract Background Transforaminal lumbar interbody fusion (TLIF), a commonly used procedure in spine surgery, has the advantage of a lower incidence of nerve lesions compared to the posterior lumbar interbody fusion (PLIF) technique. The intersomatic arthrodesis has always been carried out with a single tantalum cage normally used for PLIF. Tantalum is a metal that is particularly used in orthopedic surgery. It has a modulus of elasticity similar to marrow and leads to high primary stability of the implant. Materials and methods Our study was a retrospective monocentric observational study evaluating clinical and radiological outcomes of tantalum cages in a modified TLIF technique with posterior instrumentation and autologous and/or homologous posterolateral bone grafting. The aim of the study was to evaluate clinical outcomes and the increase in or redistribution of lumbar lordosis. The intersomatic arthrodesis was always carried out with a single tantalum cage normally used for PLIF to reduce the neurological risk. We retrospectively studied 105 patients who were treated with a modified unilateral TLIF approach by two surgeons between 2013 and 2018. We evaluated the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for back pain, global lumbar lordosis, lordosis of L4–sacrum, segmental lordosis of functional motion units that underwent arthrodesis, pelvic tilt, pelvic incidence, and the sacral slope in 77 patients. All patients were suffering from grade III or IV Pfirrmann, instability, or foraminal post-laminectomy stenosis and/or grade I–II degenerative spondylolisthesis or low-grade isthmic spondylolisthesis. They had no significant sagittal imbalance, with a sagittal vertical axis (SVA) of

Abstract Purpose The purpose of the study was to evaluate the clinical efficacy and safety of using Ponte osteotomy combined with posterior lumbar interbody fusion in the treatment of patients with degenerative scoliosis. Method The medical records and imaging data of degenerative scoliosis patients in our department from 2013 to 2022 were retrospectively collected. A total of 47 patients were included, including 16 male patients and 31 female patients. The mean follow-up was 47.8 months. Whole spine X-rays in the standing position were performed on all patients preoperatively, postoperatively, and at the latest follow-up. The length of hospital stay, complications, operative duration, estimated blood loss, instrumented segment, fused segment, clinical scores, and various radiological indicators were recorded. Results The coronal vertical axis improved from 3.1 ± 1.9 cm preoperatively to 1.2 ± 1.0 cm postoperatively with an average reduction of 1.9 ± 1.7 cm. The preoperative coronal Cobb angle was 18.1 ± 10.6°, the immediate postoperative Cobb angle was 6.6 ± 3.9°, and the Cobb angle at the last follow-up was 5.8 ± 3.7°. The sagittal vertical axis decreased from 5.6 ± 3.7 cm preoperatively to 2.7 ± 1.9 cm immediately after the operation and was well maintained at the last follow-up (3.1 ± 2.5 cm). Lumbar lordosis increased from 22.2 ± 10.2° preoperatively to 40.4 ± 8.3° postoperatively and 36.0 ± 8.8° at the last follow-up. The ODI score, VAS low back pain score, and VAS leg pain score were also improved to varying degrees. Conclusion Ponte osteotomy combined with posterior lumbar interbody fusion can significantly improve coronal and sagittal plane deformities and postoperative functional scores in patients with adult degenerative scoliosis.