scholarly journals Mode of onset of dropped head syndrome and efficacy of conservative treatment

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902093888
Author(s):  
Takuya Kusakabe ◽  
Kenji Endo ◽  
Yasunobu Sawaji ◽  
Hidekazu Suzuki ◽  
Hirosuke Nishimura ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Recovery Rate ◽  
Vertical Axis ◽  
Acute Onset ◽  
Sacral Slope ◽  
Cervical Trauma ◽  
Sagittal Vertical Axis ◽  
Dropped Head Syndrome ◽  
History Of ◽  
Onset Group

Purpose: The initial treatment of dropped head syndrome (DHS) is basically nonsurgical, but the mode of onset of DHS and efficacy of conservative treatment have not been fully clarified. Methods: The subjects were 38 DHS patients without neuromuscular disease (11 men and 27 women, average age 74.5 years). Cervical collar, physical therapy, and temporary medication for cervical pain were provided for all DHS patients. The following parameters were measured on lateral global spine standing radiographs: sagittal vertical axis (SVA), cervical sagittal vertical axis, C2–C7 angle, first thoracic slope, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence. According to the mode of onset of DHS, the subjects were classified into acute-onset group (<3 months) and chronic-onset group (≥3 months). Results: Acute- and chronic-onset DHS were observed in 20 and 18 patients, respectively. A history of cervical trauma was involved in nine and two cases of acute- and chronic-onset DHS, respectively. Acute-onset DHS included more balanced-SVA (B-SVA: −30 mm <SVA ≤40 mm) than chronic-onset DHS. In conservative cases, the recovery rate was better in acute-onset DHS with B-SVA. In acute-onset DHS treated conservatively, the recovery rate was significantly poor in cervical trauma cases. Conclusions: Acute-onset DHS includes more balanced SVA and a history of cervical trauma, while acute-onset DHS without a history of cervical trauma has better prognosis by conservative treatment. Surgical indications for DHS should be carefully determined, and sufficient conservative treatment is essential.

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 The Effect of Early Mobilisation on the Sagittal Alignment and Clinical Outcome Following Conservative Treatment of the AO A3 and A4 Thoracolumbar Spine Fracture in Comparison to A1 Fractures. A Retrospective Study

2021 ◽  
Author(s):  
Mahmoud Elshamly ◽  
Stefan Toegel ◽  
Josef G Grohs
Keyword(s):  
Conservative Treatment ◽  
Clinical Outcome ◽  
Thoracolumbar Spine ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Compensatory Mechanisms ◽  
Sagittal Vertical Axis ◽  
Sagittal Malalignment ◽  
Neurologically Intact

Abstract BackgroundThe aim of the study was to correlate the clinical and radiological outcomes following the conservative treatment of neurologically intact patients with AO A4, A3, and A1 thoracolumbar (TL) fractures.MethodsRetrospective study included 3 cohorts of conservatively treated patients with AO A4, A3, and A1 TL fracture without the use of bracing or casting. At the final follow up segmental kyphotic angle (SKA), regional lordotic angle (RLA), lordosis gap (LG), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), and femoral obliquity angle (FOA), and the Oswestry disability index (ODI) were assessed. Data were analyzed using descriptive statistics, non-parametric inferential statistics, and Spearman correlation analyses.ResultsAge was significantly higher in A4 group than in A1 group (p=0.04). The median 1ry SKA of the A3 group (15 ± 3) was significantly higher than in A1 group (7 ± 7, p=0.04). The median of total ODI in the A4 group (42 ± 53) and A3 group (31.3 ± 27) was clinically higher than in A1 group (11.1 ± 25), however, this difference was not statistically significant. Age as well as SVA correlated significantly with PT, FOA, SKA at the follow up, and the total ODI.ConclusionAge of the patient is a significant confounder that has an important impact on the type of fracture, sagittal malalignment, its compensatory mechanisms, and the resulting clinical outcome following conservative treatment of AO A4 and A3 TL fracture.

scholarly journals Sagittal profile modifications in hybrid versus all screw technique in adolescent idiopathic scoliosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Laura Scaramuzzo ◽  
Antonino Zagra ◽  
Giuseppe Barone ◽  
Stefano Muzzi ◽  
Leone Minoia ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Thoracic Kyphosis ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Sagittal Profile ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Lenke Classification

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

scholarly journals Lumbar Level Significantly Influences Postoperative Global Sagittal Balance Following Pedicle Subtraction Osteotomy

2021 ◽  
pp. 219256822110325
Author(s):  
Athan G. Zavras ◽  
T. Barrett Sullivan ◽  
Navya Dandu ◽  
Howard S. An ◽  
Christopher J. DeWald ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Vertical Axis ◽  
Pedicle Subtraction Osteotomy ◽  
Current Evidence ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Lumbar Level ◽  
Global Sagittal Alignment

Study Design: Retrospective cohort study. Objectives: The current evidence regarding how level of lumbar pedicle subtraction osteotomy (PSO) influences correction of sagittal alignment is limited. This study sought to investigate the relationship of lumbar level and segmental angular change (SAC) of PSO with the magnitude of global sagittal alignment correction. Methods: This study retrospectively evaluated 53 consecutive patients with adult spinal deformity who underwent lumbar PSO at a single institution. Radiographs were evaluated to quantify the effect of PSO on lumbar lordosis (LL), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), T1-spinopelvic inclination (T1SPI), T1-pelvic alignment (TPA), and sagittal vertical axis (SVA). Results: Significant correlations were found between PSO SAC and the postoperative increase in LL ( r = 0.316, P = .021) and PT ( r = 0.352, P = .010), and a decrease in TPA ( r = −0.324, P = .018). PSO level significantly correlated with change in T1SPI ( r = −0.305, P = .026) and SVA ( r = −0.406, P = .002), with more caudal PSO corresponding to a greater correction in sagittal balance. On multivariate analysis, more caudal PSO level independently predicted a greater reduction in T1SPI (β = −3.138, P = .009) and SVA (β = −29.030, P = .001), while larger PSO SAC (β = −0.375, P = .045) and a greater number of fusion levels (β = −1.427, P = .036) predicted a greater reduction in TPA. Conclusion: This study identified a gain of approximately 3 degrees and 3 cm of correction for each level of PSO more caudal to L1. Additionally, a larger PSO SAC predicted greater improvement in TPA. While further investigation of these relationships is warranted, these findings may help guide preoperative PSO level selection.

scholarly journals Sagittal spinal-pelvic alignment in patients with Crowe type IV developmental dysplasia of the hip

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Peng Ren ◽  
Xiangpeng Kong ◽  
Wei Chai ◽  
Yan Wang
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Vertical Axis ◽  
Developmental Dysplasia ◽  
Sacral Slope ◽  
Low Back ◽  
Sagittal Vertical Axis ◽  
Type Iv ◽  
The Impact ◽  
Dysplasia Of The Hip

Abstract Background The impact of high dislocated dysplastic hips on spinal-pelvic alignment has not been well described. This study aims to evaluate compensatory spinal radiographic changes and presence of back pain in patients with Crowe type IV developmental dysplasia of the hip (DDH). Methods An observational study was conducted from July 2016 to December 2017, and 49 consecutive patients with Crowe IV DDH were enrolled. Forty-nine sex- and age-matched asymptomatic healthy adults were recruited as the controls. The sacral slope (SS), lumbar lordosis (LL), spino-sacral angle (SSA), C7 tilt (C7T), and sagittal vertical axis (SVA [C7]) were measured on lateral whole spine radiographs. The presence of low back pain and visual analogue scale (VAS) scores were recorded. Results The patients with Crowe IV DDH showed significantly greater SS (47.5 ± 7.5° vs. 40.4 ± 6.7°, p < 0.05), LL (− 63.7 ± 9.2° vs. − 53.3 ± 11.5°, P < 0.05), SSA (141.8° ± 7.2° vs. 130.6 ± 7.9°, p < 0.05), C7T (93.9 ± 3.6° vs. 91.1 ± 3.7°, P < 0.05), and lower SVA(C7) (− 16 mm[− 95–45] vs. 6.4 mm[− 52–47], p < 0.05) compared to the controls. The patients with bilateral Crowe IV DDH also exhibited larger SS, LL, SSA, and C7T and a smaller SVA (C7) than those with unilateral Crowe IV DDH. Sixty-three percent of the patients with Crowe IV DDH reported low back pain. Conclusion The patients with Crowe IV DDH exhibited abnormal spinal-pelvic alignment characterized by anterior pelvic tilt, lumbar hyperlordosis, and a backward-leaning trunk. Bilateral Crowe IV DDH had a greater impact on spinal-pelvic alignment than unilateral Crowe IV DDH.

scholarly journals Spinal sagittal alignment and head control in patients with cerebral palsy

2020 ◽  
Vol 14 (1) ◽  
pp. 17-23 ◽  
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

scholarly journals Long-term effects of the Chêneau brace on coronal and sagittal alignment in adolescent idiopathic scoliosis

2015 ◽  
Vol 23 (4) ◽  
pp. 505-509 ◽  
Author(s):  
Ming-Qiao Fang ◽  
Chong Wang ◽  
Guang-Heng Xiang ◽  
Chao Lou ◽  
Nai-Feng Tian ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Long Term Effects ◽  
Sagittal Vertical Axis ◽  
Pelvic Parameters

OBJECT The aim of the present study was to retrospectively evaluate progressive correction of coronal and sagittal alignment and pelvic parameters in patients treated with a Chêneau brace. METHODS Thirty-two patients with adolescent idiopathic scoliosis (AIS) were assessed before initiation of bracing treatment and at the final follow-up. Each patient underwent radiological examinations, and coronal, sagittal, and pelvic parameters were measured. RESULTS No statistically significant modification of the Cobb angle was noted. The pelvic incidence remained unchanged in 59% of the cases and increased in 28% of the cases. The sacral slope decreased in 34% of the cases but remained unchanged in 50%. Thoracic kyphosis and lumbar lordosis were significantly decreased, whereas the sagittal vertical axis was significantly increased from a mean of -44.0 to -30.2 mm (p = 0.02). The mean pelvic tilt increased significantly from 4.5° to 8.3° (p = 0.002). CONCLUSIONS The Chêneau brace can be useful for preventing curvature progression in patients with AIS. However, the results of this study reveal high variability in the effect of brace treatment on sagittal and pelvic alignment. Treatment with the Chêneau brace may also influence sagittal global balance.

scholarly journals Increasing pelvic incidence is associated with more global sagittal imbalance in ankylosing spondylitis with thoracolumbar kyphosis

2019 ◽  
Author(s):  
Diyu Song ◽  
Guoquan Zheng ◽  
Tianhao Wang ◽  
Dengbin Qi ◽  
Yan Wang
Keyword(s):  
Ankylosing Spondylitis ◽  
Pelvic Incidence ◽  
Vertical Axis ◽  
Control Group ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Thoracolumbar Kyphosis ◽  
Spinopelvic Parameters ◽  
Sagittal Vertical Axis ◽  
The Relationship

Abstract Background: Ankylosing spondylitis (AS) patients with kyphosis have an abnormal spinopelvic alignment and pelvic morphology. Most of them focus on the relationship of pelvic tilt (PT) or sacral slope (SS) and deformity, and relatively few studies have addressed the relationship between pelvic incidence (PI) and kyphosis in AS patients. The purpose of this study is to analyze the correlation between pelvic incidence (PI) and the spinopelvic parameters describing local deformity or global sagittal balance in AS patients with thoracolumbar kyphosis. Methods: A total of 94 patients with AS (91 males and 3 females) and 30 controls were reviewed. Sagittal spinopelvic parameters, including PI, PT, SS, thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis(LL), sagittal vertical axis(SVA), T1 pelvic angle(TPA), spinosacral angle(SSA) and spinopelvic angle(SPA) were measured. Statistical analysis was performed to identify the correlation of PI with other parameters. Results: Compared with the control group, the AS patients had significantly higher PI(47.4˚ vs. 43.2˚, P<0.001). PI in AS patients was found to be significantly positively correlated with TPA(r=0.533, R 2 =0.284, P<0.001), and negatively correlated with SPA(r=-0.504, R 2 =0.254, P<0.001). However, no correlations were found between PI and SVA, SSA, TK, TLK or LL in AS patients. Conclusion: The value of PI in AS patients with kyphosis was significantly higher than that of controls. Correlation analysis revealed that increasing PI was significantly correlated with more global sagittal imbalance, not with the local deformity in AS patients with thoracolumbar kyphosis.

The change of sagital balance after PKP for patients with osteoporotic vertebral compression

2020 ◽  
Author(s):  
Jingkun Li ◽  
Kaining Zhang ◽  
Yanjun Ren ◽  
Yingguang Wu ◽  
Yun Yang ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Vertebral Compression Fracture ◽  
Body Height ◽  
Compression Fracture ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Vertebral Body Height ◽  
Sagittal Vertical Axis ◽  
Before And After

Abstract Purpose To detect the postoperative change in total spinal alignment in 0VCF patients after PKP. Methods A total of 130 patients with vertebral compression fracture was involved in this study. The entire spine radiographs of every patients were taken pre and postoperatively. The parameters including vertebral body height, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), and spinosacral angle (SSA). All the parameters were compared before and after PKP. Results In the patients, the VAS score was decreased from 8.26±1.12 preoperative to 2.70±0.90 postoperative. And SVA decreased from 6.82±3.30 cm to 4.07±2.77cm. The change in sagittal balance is related to the recovery of vertebral body height. Conclusion PKP plays a role not only in improving the vertebral body height but also in rebuilding sagittal imbalance in the treatment of vertebral compression fracture.

scholarly journals Sagittal alignment based on inflection point and its differences according to age groups

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902090461
Author(s):  
Moon Soo Park ◽  
Seong-Hwan Moon ◽  
Tae-Hwan Kim ◽  
Jae Keun Oh ◽  
Seung Jin Lee ◽  
...  
Keyword(s):  
Pelvic Incidence ◽  
Sagittal Plane ◽  
Sagittal Alignment ◽  
Age Groups ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Inflection Points ◽  
Lumbar Segment ◽  
Cervical Segment

Purpose: We have always used the standard anatomical landmark vertebrae to measure the sagittal alignment. Instead, scoliosis has been evaluated by the end vertebrae in the coronal plane. There have been clinical studies to investigate sagittal alignment on the end vertebrae of inflection points (IPs). The purpose is to determine sagittal alignment based on IPs and to elucidate the changes while considering age groups. Methods: We identified the most titled vertebrae in the sagittal plane to define the end vertebrae of S1, thoracolumbar and cervicothoracic IPs and to measure the Cobb angles of sacral slope, functional lumbar, thoracic, cervical segment between them, and the McGregor’s line, and the IP distances from the C2 plumb line to the point bisecting the upper end plate of the IPs, in addition to S1. Results: The most common thoracolumbar and cervicothoracic IPs were L2 and T1, respectively. However, the next most common cervicothoracic IP changed from T2 in the youngest to C7 in the oldest age group. The sagittal angles decreased at the sacral slope and functional lumbar segment but not the functional thoracic segment and functional cervical segment. Similarly, the distance increased at the C2 sagittal vertical axis (SVA) distance to S1 and thoracolumbar IP distance but not at the cervicothoracic IP distance. There was no difference in the pelvic incidence among age groups. Conclusion: The sagittal Cobb angles based on the IPs decreased at the sacral slope and functional lumbar segment in the older adults. Consequently, the C2 SVA distance to S1 and thoracolumbar IP distance increased.

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