Spinal sagittal alignment goals based on statistical modelling and musculoskeletal simulations

Abstract Background There is a paucity of reports clarifying the implication of knee osteoarthritis (OA) on spinal sagittal alignment of patients undergone surgery for lumbar spine. This study aimed to analyze how osteoarthritic knee affects radiographic and clinical results of degenerative lumbar disease patients undergone lumbar fusion. Methods We retrospectively reviewed the medical records and radiographs of 74 consecutive degenerative lumbar disease patients who underwent posterior instrumentation and fusion surgery between May 2016 and June 2017 and were followed up for minimum 3 years postoperatively. The patients were divided into 2 groups according to the severity of knee OA by Kellgren-Lawrence grading (KLG) scale (group I, KLG 1 or 2 [n = 39]; group II, KLG 3 or 4 [n = 35]). Patient demographic data, comorbidities, spinal sagittal parameters and clinical scores were extracted and compared at preoperative, postoperative 1 month and the ultimate follow-up between the groups. In radiographic assessment, sagittal alignment parameters and sagittal balance were used. In clinical assessment, the scores of Oswestry disability index (ODI) and Scoliosis Research Society questionnaire (SRS-22) were used. For the frequency analysis of categorical variables across the groups, chi-square test was used and student t tests was used to compare the differences of continuous variables. Results In radiographic assessment, TLK (thoracolumbar kyphosis), LL (lumbar lordosis), PT (pelvic tilt), C7 SVA (sagittal vertical axis) in both groups improved significantly after surgery (p < 0.05). However, LL, PT, C7SVA improved at postoperative 1 month in the group II were not maintained at the ultimate postoperative follow-up. In clinical assessment, preoperative Oswestry disability index (ODI, %) and all SRS-22 subscores of the group I and II were not different (p > 0.05). There were significant differences between the groups at the ultimate follow-up in ODI (− 25.6 vs − 12.1, p < 0.001), SRS total score (%) (28 vs 20, p = 0.037), function subscore (1.4 vs 0.7, p = 0.016), and satisfaction subscore (1.6 vs 0.6, p < 0.001). Conclusion Osteoarthritic knee with KLG 3 or 4 have a negative influence on maintaining postoperative spinal sagittal alignment, balance, and the clinical outcomes achieved immediately by posterior instrumentation and fusion for lumbar degenerative disease. Trial registration This study was retrospectively registered with approval by the institutional review board (IRB) of our institution (approval number: 2018–11-007).

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Spinal sagittal alignment and head control in patients with cerebral palsy

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.190160 ◽

2020 ◽

Vol 14 (1) ◽

pp. 17-23 ◽

Cited By ~ 1

Author(s):

Brice Ilharreborde ◽

Adrien de Saint Etienne ◽

Ana Presedo ◽

Anne-Laure Simon

Keyword(s):

Cerebral Palsy ◽

Sagittal Alignment ◽

Vertical Axis ◽

Sacral Slope ◽

Trunk Control ◽

Level Of Evidence ◽

Sagittal Vertical Axis ◽

Spinal Sagittal Alignment ◽

Trunk Posture ◽

Radiological Analysis

Purpose Spinal sagittal alignment restoration has been associated with improved functional outcomes and with reduced complications rates. Several limitations exist for radiological analysis in cerebral palsy (CP) patients. The goal of this study was to summarize the existing literature and report the important considerations to evaluate in a CP patient undergoing spinal surgery. Methods A retrospective radiological analysis was performed, including non-ambulant CP children with progressive scoliosis. Full-spine sitting radiographs performed pre-and postoperatively were required to measure spino-pelvic sagittal parameters. Result A total of 23 non-ambulating CP patients were included, mean age 16.0 years (standard error of the mean 0.5). Two distinct groups of patients were identified. Group 1 (61%) were patients with less trunk control (lumbar lordosis (LL) < 50°), retroverted and vertical pelvis (mean sacral slope (SS) 11.4° and pelvic tilt (PT) 38.1°) and anterior imbalance (mean sagittal vertical axis (SVA) 5.9 cm) and Group 2 (39%) were patients with better trunk control (LL > 60°, anteverted and horizontal pelvis (mean SS 49.3°, PT 9.7°) and posterior imbalance (mean SVA 5.8 cm). Postoperative measures showed significant impact of surgery with a PT reduction of 19° (p = 0.007), a mean SS increase of 15° (p = 0.04) and a LL gained of 10° (p = 0.2). Conclusion Sagittal spino-pelvic alignment in non-ambulating CP patients remains difficult to assess. The current literature is poor but our radiological study was able to define two distinct groups among Gross Motor Function Classification System (GMFCS) level V patients, based on the quality of their trunk control. All possible factors that may influence head and trunk posture should be systematically considered and optimized. Level of evidence Level IV

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Comparison of Sagittal Spinal Alignment on Standing Plain X-Rays and Supine MRI in Degenerative Lumbar Disease

10.21203/rs.3.rs-26627/v1 ◽

2020 ◽

Author(s):

Yulu Wang ◽

Jinwu Bai ◽

Zhijun Pan ◽

Deting Xue

Keyword(s):

Sagittal Alignment ◽

Correlation Coefficients ◽

Sacral Slope ◽

X Rays ◽

Degenerative Lumbar Diseases ◽

Angle Measurements ◽

Sagittal Spinal Alignment ◽

Spinal Sagittal Alignment ◽

Degenerative Lumbar Disease ◽

Magnetic Resonance Imaging Mri

Abstract Background:The purpose of present study is to examine the possible correlation between standing plain X-rays and supine MRI for evaluating spinal sagittal alignment in degenerative lumbar disease.Methods: The characteristics and images of 64 patients with degenerative lumbar diseases were reviewed retrospectively. The thoracolumbar junction kyphosis (TJK), lumbar lordosis (LL), and sacral slope (SS) were measured on lateral plain X-rays and by magnetic resonance imaging (MRI). Inter- and intra-observer reliability were tested using intra-class correlation coefficients. Results: The results suggested that TJK measurements obtained from MRI tended to underestimate the radiographic measures by 2°, whereas SS measurements obtained from MRI tended to overestimate the radiographic measures by 2°. The LL measurements obtained from MRI were approximately equal to the radiographic measures. The X-ray and MRI measurements were linearly related. Conclusions:In conclusion, supine MRI can be directly translated into sagittal alignment angle measurements obtained from standing X-rays with an acceptable degree of accuracy. This can avoid the impaired view caused by the overlapping ilium, while reducing the patient’s exposure to radiation.

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Validation of spinal sagittal alignment with plain radiographs and the Debrunner Kyphometer

Medical Research Archives ◽

10.18103/mra.v2i1.319 ◽

2015 ◽

Vol 2 (1) ◽

Cited By ~ 2

Author(s):

Carl Todd

Keyword(s):

Sagittal Alignment ◽

Plain Radiographs ◽

Spinal Sagittal Alignment

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Spinous Process-Splitting Laminectomy Approach for Tumor Excision at Conus Medullaris or Cauda Equina Level Results in Satisfactory Clinical Outcomes Without Affecting Global Spinal Sagittal Alignment

Global Spine Journal ◽

10.1177/21925682211047460 ◽

2021 ◽

pp. 219256822110474

Author(s):

Toshiki Okubo ◽

Narihito Nagoshi ◽

Osahiko Tsuji ◽

Soraya Nishimura ◽

Satoshi Suzuki ◽

...

Keyword(s):

Clinical Outcomes ◽

Sagittal Alignment ◽

Spinous Process ◽

Tumor Resection ◽

Cauda Equina ◽

Conus Medullaris ◽

Sagittal Profile ◽

Significant Group ◽

Age At Surgery ◽

Spinal Sagittal Alignment

Study design Retrospective comparative study. Objectives The present study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes following tumor resection using spinous process-splitting laminectomy (SPSL) approach without fixation in patients with conus medullaris (CM) or cauda equina (CE) tumor. Methods Forty-one patients with CM or CE tumor (19 males, 22 females, mean age at surgery of 52.9 ± 13.0 years) were included in this study. The variations of outcome variables were analyzed in various GSSA profiles using radiographic outcomes. The clinical outcomes were assessed using Japan Orthopaedic Association (JOA) score and JOA back pain evaluation questionnaire (JOABPEQ). Results In all cases, the various GSSA parameters (sagittal vertical axis, C2–7 lordosis, T1 slope, thoracic kyphosis, T10–L2 kyphosis, lumbar lordosis [LL; upper, middle, and lower], sacral slope, pelvic incidence, and pelvic tilt) did not significantly change in the 2-years postoperative period. Moreover, age at surgery, the number of resected laminae, preoperative T12–L2 kyphosis, or LL did not affect the postoperative changes in T12–L2 kyphosis or LL, and had no statistically significant correlation among them. The scores of each postoperative JOA domain and the Visual Analogue Scale included in the JOABPEQ were significantly improved. There was no statistical significant group difference in each sagittal profile or clinical outcomes between CM and CE groups postoperatively. Conclusions Tumor resection using SPSL approach did not affected the various GSSA parameters examined and resulted in satisfactory clinical outcomes, indicating that SPSL approach is a suitable surgical technique for patients with CM or CE tumor.

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Effects of total hip arthroplasty on spinal sagittal alignment and static balance: a prospective study on 28 patients

European Spine Journal ◽

10.1007/s00586-016-4696-9 ◽

2016 ◽

Vol 25 (11) ◽

pp. 3615-3621 ◽

Cited By ~ 7

Author(s):

Kamil Eyvazov ◽

Bahruz Eyvazov ◽

Selda Basar ◽

Luigi Aurelio Nasto ◽

Ulunay Kanatli

Keyword(s):

Total Hip Arthroplasty ◽

Prospective Study ◽

Hip Arthroplasty ◽

Sagittal Alignment ◽

Static Balance ◽

Total Hip ◽

Spinal Sagittal Alignment ◽

A Prospective Study

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Spinal sagittal alignment and trapezoidal deformity in patients with degenerative cervical spondylolisthesis

Scientific Reports ◽

10.1038/s41598-019-41079-3 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Kazuma Murata ◽

Kenji Endo ◽

Hidekazu Suzuki ◽

Yuji Matsuoka ◽

Taichiro Takamatsu ◽

...

Keyword(s):

Sagittal Alignment ◽

Spinal Sagittal Alignment

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The Effect of Lumbar Spinal Muscle on Spinal Sagittal Alignment

Neurosurgery ◽

10.1227/neu.0000000000001269 ◽

2016 ◽

Vol 79 (6) ◽

pp. 847-855 ◽

Cited By ~ 27

Author(s):

Hyo Sub Jun ◽

Ji Hee Kim ◽

Jun Hyong Ahn ◽

In Bok Chang ◽

Joon Ho Song ◽

...

Keyword(s):

Magnetic Resonance ◽

Elderly Patients ◽

Thoracic Kyphosis ◽

Pelvic Tilt ◽

Sagittal Alignment ◽

Vertical Axis ◽

Magnetic Resonance Images ◽

Paraspinal Muscle ◽

Sagittal Vertical Axis ◽

Spinal Sagittal Alignment

Abstract BACKGROUND: The majority of earlier studies of the parameters of sagittal balance did not consider the influence of spinal muscles on spinal sagittal alignment. OBJECTIVE: To analyze the relationship between the paraspinal muscle (quantity and quality) and sagittal alignment in elderly patients. METHODS: We reviewed 50 full-spine lateral standing radiographs and lumbar magnetic resonance images of elderly patients at a single center. The radiographic parameters examined were thoracic kyphosis, lumbar lordosis (LL), sagittal vertical axis, pelvic tilt, sacral slope, and pelvic incidence (PI). The lumbar muscularity (LM; quantity) and fatty degeneration ratio (FD; quality) in the paraspinal muscle were measured at the L3 level on magnetic resonance images. The relationships between the parameters, LM, and FD were analyzed with the Pearson correlation coefficient and multiple linear regression. RESULTS: Pearson analysis demonstrated that the FD had significant correlations with age (r = 0.393), thoracic kyphosis (r = −0.559), pelvic tilt (r = 0.430), sagittal vertical axis (r = 0.488), and PI − LL (r = 0.479, P < .05), and a close negative correlation was found between the FD and LL (r = −0.505, P < .01). The LM had significant correlations with the LL (r = 0.342) and PI − LL (r = −0.283, P < .05). Regression models that controlled for confounding factors such as body mass index confirmed the correlations between the above parameters and FD (P < .05). CONCLUSION: The quality of the paraspinal muscle could be one of the various factors that influence sagittal balance.

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