scholarly journals Global sagittal spinal alignment in patients with degenerative low-grade lumbar spondylolisthesis

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901988519
Author(s):  
Hiroto Kobayashi ◽  
Kenji Endo ◽  
Yasunobu Sawaji ◽  
Yuji Matsuoka ◽  
Hirosuke Nishimura ◽  
...  
Keyword(s):  
Sacral Slope ◽  
Low Grade ◽  
Spinal Alignment ◽  
Sagittal Spinal Alignment ◽  
Significant Difference ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis ◽  
Type 3

Purpose: Global sagittal spinal alignment undergoes changes on the basis of sagittal malalignment (trunk inclined forward) in natural degenerative progression. We hypothesized that this change would associate with the disease state of the degenerative lumbar spondylolisthesis (DS). This study aimed to evaluate the global sagittal spinal alignment of low-grade DS by classifying in accordance with sagittal vertical axis (SVA). Methods: The DS group was classified into three types according to the adult spinal deformity classification: type 1, SVA < 40 mm; type 2, 40 mm ≤ SVA < 95 mm; and type 3, 95 mm ≤ SVA. Age and sagittal spinal parameters (thoracic kyphosis, lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI)) were compared among three types. Results: There were statistically significant differences in age, LL, PI, and PT among the three types. In comparison between two types, there was a statistically significant difference between type 1 and type 2 and between type 1 and type 3, but not between type 2 and type 3 in these parameters. PI tended to increase as the type increases. Furthermore, there was significant difference between types 1 and 3. Conclusion: We evaluated the features of the DS types classified by sagittal alignment. Large PI is one of the risk factors for SVA deterioration of DS. PI may be involved in the onset and progression of DS.

scholarly journals P.231 A Quantitative Degenerative Lumbar Spondylolisthesis Instability Classification (DSIC) System to Reduce Variation in Surgical Treatment

2021 ◽  
Vol 48 (s3) ◽  
pp. S87-S87
Author(s):  
MA MacLean ◽  
C Bailey ◽  
C Fisher ◽  
R Rampersaud ◽  
A Glennie
Keyword(s):  
Invasive Surgery ◽  
Spinal Instability ◽  
Clinical Variables ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Objective System ◽  
Unstable Type ◽  
Lumbar Spondylolisthesis ◽  
Type 3

Background: The Degenerative lumbar Spondylolisthesis Instability Classification (DSIC) system categorizes spondylolisthesis (stable, potentially unstable, unstable) based on surgeon impression. It does not contain objective criteria. Objective-1: Develop a quantitative-DSIC system from predetermined radiographic/clinical variables. Objective-2: Compare qualitative (surgeon-assigned) and quantitative (objective) DSIC Types. Objective-3: Determine proportion of patients receiving more invasive surgery than warranted based on the objective system. Methods: Patients from 8 centers were enrolled prospectively (2015–2020). Radiographic/clinical variables were collected and included/excluded from the quantitative DSIC system based on prior systematic review. Scores were converted to DSIC Types: 0-2 points (“Stable”; Type 1), 3 points (“Potentially Unstable”; Type 2), 4-5 points (“Unstable”; Type 3). Surgical procedures performed were compared to those suggested by the objective system. Results: Quantitative DSIC scores were calculated (309 patients). The score includes five variables: facet effusion, disc height, translation, disc angle, and low back pain. Quantitatively, 57% were stable, 34% potentially unstable, and 9% unstable patients. Qualitatively, 30% were stable, 53% potentially unstable, and 17% unstable patients. Surgeons assigned more instability than the objective scoring system in 42% of cases. More invasive surgery was performed in 57% of cases. Conclusions: Surgeons are more likely to categorize greater degrees of spinal instability than what is objectively scored.

scholarly journals CNNM2-Related Disorders: Phenotype and Its Severity Were Associated With the Mode of Inheritance

2021 ◽  
Vol 9 ◽  
Author(s):  
Han Zhang ◽  
Ye Wu ◽  
Yuwu Jiang
Keyword(s):  
De Novo ◽  
Serum Magnesium ◽  
Brain Magnetic Resonance Imaging ◽  
Functional Studies ◽  
Pathogenic Variants ◽  
Significant Difference ◽  
Domain Variations ◽  
Type 3

CNNM2 (Cystathionine-β-synthase-pair Domain Divalent Metal Cation Transport Mediator 2) pathogenic variants have been reported to cause hypomagnesemia, epilepsy, and intellectual disability/developmental delay (ID/DD). We identified two new cases with CNNM2 novel de novo pathogenic variants, c.814T&gt;C and c.976G&gt;C. They both presented with infantile-onset epilepsy with DD and hypomagnesemia refractory to magnesium supplementation. To date, 21 cases with CNNM2-related disorders have been reported. We combined all 23 cases to analyze the features of CNNM2-related disorders. The phenotypes can be classified into three types: type 1, autosomal dominant (AD) inherited simple hypomagnesemia; type 2, AD inherited hypomagnesemia with epilepsy and ID/DD; and type 3, autosomal recessive (AR) inherited hypomagnesemia with epilepsy and ID/DD. All five type 1 cases had no epilepsy or ID/DD; they all had hypomagnesemia, and three of them presented with symptoms secondary to hypomagnesemia. Fifteen type 2 patients could have ID/DD and seizures, which can be controlled with antiseizure medications (ASMs); their variations clustered in the DUF21 domain of CNNM2. All three type 3 patients had seizures from 1 to 6 days after birth; the seizures were refractory, and 1/3 had status epilepticus; ID/DD in these AR-inherited cases was more severe than that of AD-inherited cases; they all had abnormalities of brain magnetic resonance imaging (MRI). Except for one patient whose serum magnesium was the lower limit of normal, others had definite hypomagnesemia. Hypomagnesemia could be improved after magnesium supplement but could not return to the normal level. Variations in the CBS2 domain may be related to lower serum magnesium. However, there was no significant difference in the level of serum magnesium among the patients with three different types of CNNM2-related disorders. The severity of different phenotypes was therefore not explained by decreased serum magnesium. We expanded the spectrum of CNNM2 variants and classified the phenotypes of CNNM2-related disorders into three types. We found that DUF21 domain variations were most associated with CNNM2-related central nervous system phenotypes, whereas hypomagnesemia was more pronounced in patients with CBS2 domain variations, and AR-inherited CNNM2-related disorders had the most severe phenotype. These results provide important clues for further functional studies of CNNM2 and provide basic foundations for more accurate genetic counseling.

scholarly journals Variations of Sagittal Alignment in Standing Versus Sitting Positions Under the Roussouly Classification in Asymptomatic Subjects

2020 ◽  
pp. 219256822096243
Author(s):  
Zhuoran Sun ◽  
Siyu Zhou ◽  
Shuai Jiang ◽  
Da Zou ◽  
Miao Yu ◽  
...  
Keyword(s):  
Sacral Slope ◽  
Healthy Population ◽  
Sitting Position ◽  
Spinopelvic Alignment ◽  
Roussouly Classification ◽  
Asymptomatic Subjects ◽  
Type 3 ◽  
Parameter Values

Study Design: Prospective radiological analysis. Objective: To investigate the characteristics of the sagittal spinopelvic alignment in the standing and sitting positions under the Roussouly classification in a healthy population. Methods: This study using standing and sitting lateral radiographs included 143 volunteers whose spinopelvic parameters were measured. The parameters were compared in the standing and sitting positions. The lumbo-pelvic profile was identified according to the Roussouly classification. The differences in the values of the parameters between the standing and sitting positions were analyzed. The different frequencies of the unchanged apex were assessed. Results: All parameter values except the thoracolumbar angle (TLK) were significantly altered. With regard to the classification of the lumbopelvic profile, 15 (10.5%) subjects were excluded because they were evaluated as not belonging to any of the Roussouly types. The remaining 128 subjects were evaluated and classified as follows: 19 (14.8%), type 1; 53 (41.4%), type 2; 9 (7.0%), type 3 + anteverted pelvis (AP); 33 (25.8%), type 3; and 14 (10.9%), type 4. The differences in the pelvic tilt (PT), sacral slope (SS), and thoracic pelvic angle (TPA) values were significantly lower in types 1 and 2 than in other Roussouly types. Corresponding variations in the apical vertebra for the sagittal lumbar curves in the sitting position were observed. Conclusions: Subjects with Roussouly type 1 and type 2 sagittal alignments were found to be less capable of performing changes in alignment when changing to the sitting position. The characteristics of the apical movement were also different.

scholarly journals Analysis of the Characteristics and Number of Bicycle–Passenger Conflicts at Bus Stops for Improving Safety

2019 ◽  
Vol 11 (19) ◽  
pp. 5263 ◽  
Author(s):  
Xingchen Yan ◽  
Tao Wang ◽  
Jun Chen ◽  
Xiaofei Ye ◽  
Zhen Yang ◽  
...  
Keyword(s):  
Video Recording ◽  
Longitudinal Direction ◽  
Percentage Error ◽  
Significant Difference ◽  
Conflict Duration ◽  
Passenger Volume ◽  
Bus Stops ◽  
Type 3

This study aimed to analyze the characteristics of bicycle–passenger conflicts at bus stops and develop a model to predict the number of conflicts accurately. This paper investigated the traffic flow operation at bus stops by video recording. Duration and distribution characteristics of bicycle–passenger conflicts were statistically analyzed. Then four types of conflicts defined based on evasive behavior (cyclist yielding as Type 1, cyclist bypassing as Type 2, passenger yielding as Type 3, and passenger bypassing as Type 4) were compared. A generalized event count (GEC) model was established for bicycle–passenger conflict estimation and analysis. The main results indicated that: (1) The average conflict duration was 1.716 s, whilst 60.9% of conflicts existed near the accesses of bus stops in longitudinal direction; (2) Type 1 conflict was significantly different from Type 2, 3, and 4 conflicts in duration, whilst the three had no significant difference; (3) the proposed GEC model showed good performance in predicting bicycle–passenger conflicts, with 15.71% of mean-absolute-percentage-error and 0.8772 of R2; and (4) bicycle volume, bus passenger volume, and passenger crossing time were critical factors impacting the number of bicycle–passenger conflicts. Finally, transport agencies may consider installing separations and crosswalks to improve the safety of the stop area.

scholarly journals Serum IL-17, IL-23, and TGF-βLevels in Type 1 and Type 2 Diabetic Patients and Age-Matched Healthy Controls

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Azam Roohi ◽  
Mina Tabrizi ◽  
Farzaneh Abbasi ◽  
Asal Ataie-Jafari ◽  
Behrouz Nikbin ◽  
...  
Keyword(s):  
Serum Levels ◽  
Diabetic Patients ◽  
Low Grade ◽  
Healthy Controls ◽  
Type 2 Diabetic Patients ◽  
Significant Difference ◽  
Type 1 Diabetic Patients ◽  
Type 2 Diabetic

Type 1 diabetes is recognized as an autoimmune inflammatory disease and low grade inflammation is also observed in type 2 diabetic patients. Interleukin 17 (IL-17) is a new player in inflammation. Th17 cells, as the main source of IL-17, require transforming growth factorβ(TGF-β) and interleukin 23 (IL-23). The aim of this study was to investigate serum IL-17, IL-23 and TGF-βlevels in diabetic patients and controls. In this case-control study, serum levels of IL-17, IL-23, and TGF-βwere measured in 24 type 1 diabetic patients and 30 healthy controls using the ELISA method. Simultaneously, the same methodology was used to compare serum concentration of these three cytokines in 38 type 2 diabetic patients and 40 healthy controls. There was no significant difference between serum levels of IL-17 and IL-23 cytokines between cases and controls. However, TGF-βwas significantly lower in type 1 diabetic patients (P<0.001). Serum IL-17 and IL-23 levels demonstrate no association with type 1 and type 2 diabetes, but, in line with previous studies, TGF-βlevels were lower in type 1 diabetic patients.

scholarly journals Characteristics and Clinical Significance of Spondylolisthetic and Spino-pelvic Sagittal Parameters in Kyphotic Low-grade Degenerative Lumbar Spondylolisthesis

2020 ◽  
Author(s):  
Chongqing Xu ◽  
Mengchen Yin ◽  
Wen Mo
Keyword(s):  
Life Quality ◽  
Observer Agreement ◽  
Common Disease ◽  
Low Grade ◽  
Significant Difference ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Sagittal Parameters ◽  
Lumbar Spondylolisthesis ◽  
The Impact

Abstract Background: Degenerative lumbar spondylolisthesis (DLS) has been a common disease that make increasing patients suffer from different degrees of low back pain and radicular symptoms. At present, the incidence of kyphosis in DLS and the differences in spinal sagittal morphology between kyphotic and non-kyphotic DLS still remain unclear. Our study aimed to determine the incidence of kyphosis in DLS, explore the characteristics of spondylolisthetic and spino-pelvic sagittal parameters, and evaluate the impact of kyphosis on the life quality of patients with DLS.Methods/Design: All 108 patients with L4/5 low-grade DLS were enrolled and divided into kyphotic and non-kyphotic group. 2 spine surgeons who have certain clinical experience were selected to measure the spondylolisthetic and spino-pelvic parameters, as well as visual analogue scale (VAS) and Oswestry disability index (ODI). Differences between the 2 groups and characteristics of measurements were analyzed.Results: The inter-observer agreement of all parameters between the 2 spine surgeons were excellent with each ICC > 0.75. Kyphotic group had higher SA, SD, SDM, SAM, PDH, PT and SVA, and lower ADH, SS and LL than those in non-kyphotic group (p < 0.01). There was no significant difference in PI and TK between the two groups (p > 0.05).Conclusion: The incidence of kyphotic spondylolisthesis in patients with L4/5 low-grade DLS is 16.7%. Compared with those in non-kyphotic group, patients with kyphosis show inferior results of spondylolisthetic parameters, more severe loss of LL, more obvious pelvic retroversion and trunk anteversion, which indicates worse spino-pelvic sagittal balance. In addition, their quality of life was significantly lower than that of patients in non-kyphotic group.

Lactoseries carbohydrate antigen, Gal beta 1-4GlcNAc-R, is expressed by a subpopulation of capsaicin-sensitive rat sensory neurons

1996 ◽  
Vol 76 (4) ◽  
pp. 2192-2199 ◽  
Author(s):  
L. P. Del Mar ◽  
R. S. Scroggs
Keyword(s):  
Carbohydrate Antigen ◽  
Current Amplitude ◽  
Membrane Properties ◽  
High Threshold ◽  
Outer Cell ◽  
Inward Current ◽  
Significant Difference ◽  
Type 3

1. The membrane properties of dorsal root ganglion (DRG) cells expressing the lactoseries carbohydrate antigen Gal beta 1-4GlcNAc-R were studied and compared with those of DRG cells lacking this antigen. Acutely dissociated rat DRG cells that expressed Gal beta 1-4GlcNAc-R on their outer cell membranes were detected with the use of a primary monoclonal mouse IgM antibody (A5), directed against Gal beta 1-4GlcNAc-R, and a fluorescent secondary antibody (fluorescein-conjugated goat anti-mouse IgM). We found 12.8 micrograms/ml of A5 to be a saturating concentration of primary antibody that labeled approximately 19% of the DRG cells. A battery of membrane properties including action potential (AP) duration; sensitivity to capsaicin; expression of H current (IH), A current (IA), and Ca2+ current subtypes (L, N, and T); and inhibition of high-threshold Ca2+ currents by serotonin (5HT) or 8-hydroxy-2-(di-N-propylamino)-tetralin (8-OH-DPAT) was measured in DRG cells labeled (A5+) and unlabeled (A5-) by a saturating concentration of A5. 2. There was a significant difference in the number of capsaicin-sensitive DRG cells and a significant difference in the magnitude of the capsaicin-induced inward current in A5+ versus A5- DRG cells. Of 35 A5+ cells tested, 33 were sensitive to 1 microM capsaicin, which produced an inward current averaging 4 +/- 0.46 (SE) nA (n = 33). In contrast, only 12 of 33 A5- cells were sensitive to 1 microM capsaicin, which produced an inward current averaging 1.2 +/- 0.52 nA (n = 12). 3. There were also significant differences between A5+ and A5- cells regarding average AP duration, N- and T-type Ca2+ current amplitude, and number of cells that expressed IH and IA. A5+ cells had significantly larger N-type Ca2+ currents and expressed IA more frequently than A5- cells. Conversely, A5- cells had significantly longer AP duration and larger T-type Ca2+ currents, and expressed IH more frequently compared with A5+ cells. 4. A5+ and A5- cells differed regarding the inhibition of high-threshold Ca2+ currents by maximal concentrations of 5HT1A agonists (10 microM 5HT or 1 microM 8-OH-DPAT). Inhibition of Ca2+ currents in A5+ cells by 1 microM 8-OH-DPAT (n = 15) or 10 microM 5HT (n = 18) averaged 4 +/- 0.9%. In contrast, inhibition of Ca2+ currents in A5- cells by 10 microM 5HT (n = 33) averaged 20 +/- 3.8%. 5. Cells for which sufficient data were collected were categorized as type 1, 2, 3, or 4 on the basis of sensitivity to capsaicin and expression of IH, IA, and T-type Ca2+ current amplitude, and the distribution of A5+ and A5- cells among the various groups was observed. The categories were defined as follows: type 1 (capsaicin sensitive, no IH or IA); type 2 (capsaicin sensitive, significant IA); type 3 (capsaicin insensitive, T-type Ca2+ currents < 1 nA, significant IH but no IA); and type 4 (capsaicin insensitive, T-type Ca2+ currents > 2.4 nA). On the basis of this criteria, 6 of 15 type 1 cells and all type 2 cells (n = 19) were A5+. All type 3 cells (n = 8) and all type 4 cells (n = 11) were A5-. 6. As indicated above, the expression of the Gal beta 1-4GlcNAc-R antigen differentiated two subgroups of DRG cells in the type 1 category (A5+, n = 6 and A5-, n = 9). These two groups varied regarding the sensitivity of Ca2+ currents to maximally effective concentrations of 5HTIA agonists. In type 1 A5+ DRG cells, high-threshold Ca2+ currents were not significantly inhibited by 1 microM 8-OH-DPAT (average inhibition = 1.2 +/- 0.8%, n = 6). However, in type 1 A5- cells, high-threshold Ca2+ currents were reduced 47 +/- 6.0% (n = 9) by 10 microM 5HT. 7. The several significant differences in membrane properties between A5+ and A5- DRG cells suggest that the Gal beta 1-4GlcNAc-R antigen is expressed by a distinct subset of DRG cells, consisting predominately of type 1 and type 2 cells. The observation that most A5+ DRG cells were capsaicin sensitive suggests that the Gal beta 1-4GlcNAc-R antigen is expressed primarily by n

scholarly journals Global sagittal spinal alignment at cervical flexion in patients with dropped head syndrome

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902094826 ◽  
Author(s):  
Takamitsu Konishi ◽  
Kenji Endo ◽  
Takato Aihara ◽  
Hidekazu Suzuki ◽  
Yuji Matsuoka ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Vertical Axis ◽  
Control Group ◽  
Sacral Slope ◽  
Neutral Position ◽  
Spinal Alignment ◽  
Sagittal Vertical Axis ◽  
Dropped Head Syndrome ◽  
Sagittal Spinal Alignment ◽  
Significant Difference

Purpose: Dropped head syndrome (DHS) is characterized by the passively correctable chin-on-chest deformity. The characteristic feature is emphasized in the cervical flexion position. The purpose of this study was to analyze the influence of cervical flexion on sagittal spinal alignment in patients with DHS. Methods: The study included 15 DHS subjects and 55 cervical spondylosis (CS) subjects as the control group. The following parameters were analyzed: cervical sagittal vertical axis (C-SVA), occipitoaxial angle (O–C2A), C2 slope (C2S), C2–C7 angle (C2–C7A), T1 slope (T1S), sagittal vertical axis, T1–T4 angle (T1–T4A), T5–T8 angle (T5–T8A), T9–T12 angle, lumbar lordosis, sacral slope, and pelvic tilt, in cervical flexion and neutral positions. Results: The values of C-SVA, O–C2A, C2S, and T1S were significantly different between CS and DHS at cervical neutral and flexion positions. C2–C7A showed significant difference in cervical neutral position, but the difference disappeared in flexion position. T1–T4A did not present a significant difference, but T5–T8A showed a difference in neutral and flexion positions. Conclusions: Malalignment of DHS extended not only to cervical spine but also to cranio-cervical junction and thoracic spine, except T1–T4. It is known that global sagittal spinal alignment is correlated with adjacent parameters, although in DHS the reciprocal change was lost from cranio-cervical junction to the middle part of thoracic spine at cervical flexion.

scholarly journals Failed Dermal Allograft Procedures in Irreparable Rotator Cuff Tears Can Still Improve Pain and Function. The “Biologic Tuberoplasty Effect”

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0009
Author(s):  
Raffy Mirzayan ◽  
Michael Allan Stone ◽  
Michael Batech ◽  
Daniel Acevedo ◽  
Anshu Singh
Keyword(s):  
Rotator Cuff ◽  
Average Length ◽  
Rotator Cuff Tears ◽  
Double Row ◽  
Significant Difference ◽  
Goutallier Classification ◽  
And Function ◽  
Type 3

Objectives: Massive rotator cuff tears (MRCT) are a challenging problem. Dermal allografts have been used in “bridging” procedures and superior capsule reconstruction (SCR). Both have led to clinical improvement, but without correlation with post-operative imaging. The purpose of this study is to examine graft integrity on MRI in patients who underwent an SCR or bridging procedure to determine if graft integrity correlates with functional outcome. We also propose a new classification of dermal allograft re-tear on MRI. Methods: This study was approved by our IRB. Between 2006 and 2016, 11 patients (12 shoulders) underwent a bridging procedure and 10 patients underwent an SCR for MRCT with a dermal allograft by a single surgeon. The grafts were secured to the tuberosity in a double-row, trans-osseous equivalent (DR-TOE) fashion. Pre- and post-operative VAS, acromiohumeral distance (AHD), and ASES scores, and pre-operative Hamada grade and Goutallier classification were prospectively collected and retrospectively reviewed. An MRI was obtained on all patients post-operatively to assess graft integrity. The status of the graft was divided into three types based on MRI findings: Type 1- Graft intact medially (rim of cuff or glenoid) AND laterally (greater tuberosity); Type 2- Graft intact laterally but torn medially; Type 3- Graft torn laterally. The shoulders were then grouped based on these types for further analysis. Results: The average age was 61 (range: 49-73). Average follow-up was 21.6 months (range: 8-80). Average length from surgery to MRI was 13.9 months (range: 6-80). There was a significant improvement in VAS (pre-8.1 to post-1.3) and ASES (pre-26.3 to post-84.6) in Type 1 (P<0.01) and in VAS (pre-7.0 to post-0.7) and ASES (pre-32.6 to post-91.2) in Type 2 (P<0.01). There was no difference in post-operative VAS (1.3 vs 0.7) and ASES (84.6 vs 91.2) between Type 1 and Type 2 (P=0.8). There was no improvement in VAS (pre-7.3 vs post-5.7) and ASES (pre-30.6 vs post-37.2) in Type 3. There was a significant difference in post-operative VAS (5.7 vs 1) and ASES (37.2 vs 88.1) between Type 3 versus Types 1+2, respectively (P<0.01). The AHD decreased in type 3 (pre-7.8 mm to post-3.2 mm, P=0.02) but did not change in Types 1+2 (pre-7.8 mm to post-8.0 mm, P=0.7). Conclusion: In patients who have SCR or “bridging” procedures for MRCT with a dermal allograft, there is significant improvement in VAS and ASES scores if the graft heals to the tuberosity, regardless if it is still intact to the glenoid (in SCR) or the rim of rotator cuff tendon (“bridging”). Individuals whose graft is torn from the tuberosity did not have improvement in VAS or ASES scores versus baseline. There was no significant difference in AHD in all groups. We believe that the dermal graft acts as a “biologic (interpositional) tuberoplasty,” preventing bone-to-bone contact between the tuberosity and the acromion, thus eliminating pain and improving function. We still recommend performing an SCR when indicated because it has been shown to restore the normal kinematics of the shoulder in a laboratory setting. However, careful attention should be paid to the repair of the graft to the tuberosity, so that in case the primary procedure fails medially, the graft can still improve pain and function.

scholarly journals Novel Method for Evaluation of Sagittal Spinal Alignment Using Cluster Analysis of Slope of Each Vertebra.

2021 ◽  
Author(s):  
Yoshitaka Matsubayashi ◽  
Yasushi Oshima ◽  
Yuki Taniguchi ◽  
Toru Doi ◽  
So Kato ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Sagittal Alignment ◽  
Thoracolumbar Junction ◽  
Sacral Slope ◽  
Spinal Alignment ◽  
Sagittal Spinal Alignment ◽  
Significant Difference ◽  
Novel Method ◽  
And Cluster Analysis ◽  
Whole Spine

Abstract Background: The parameters of sagittal spinal alignment proposed to date measure only the specific sectional angle or the specific sectional distance of the entire spine. To evaluate the alignment of the entire spine without segmentation, we sought to measure and analyze the slope of each vertebral body from skull to pelvis. The purpose of this study was to confirm the effectiveness of this novel analytic method for the evaluation of spinal alignment that considers the slope of each spinal vertebra using graph and cluster analysis.Methods: Every spinal slope from McGregor’s slope to the sacral slope of 88 patients who underwent standing whole spine radiography was measured. Subsequently, we conducted cluster analysis of each spinal slope to understand the characteristics of sagittal alignment.Results: Cluster analysis of whole spinal slopes did not provide useful results in this study because the number of cases per cluster was small due to the large number of parameters. Therefore, we focused the cluster analysis on only the cervical spine slopes. Then, we categorized cervical alignment into four groups (named Normal, Mismatch, Straight, and Sigmoid) based on the results of the cluster analysis. Patients in the Normal and Mismatch groups were older and had lower lumbar apex (L4), apparent lordo-kyphosis around the thoracolumbar junction, and high thoracic kyphosis (TK). Patients in the straight and sigmoid groups were younger, had a higher lumbar apex (L3), flat thoracolumbar junction, and low TK. There was no significant difference between the four groups with respect to pelvic incidence (PI) or pelvic tilt (PT).Conclusion: We proposed a novel method for visually understanding sagittal alignment. Using this analysis method, differences and similarities of sagittal alignment between each group can be easily identified. More detailed analysis of the whole spine may be possible by increasing the number of cases.

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