scholarly journals Peculiarities of changes in the sagittal balance of the cervical spine in cervicobrachial syndrome

2019 ◽  
Vol 16 (2) ◽  
pp. 42-48
Author(s):  
B. B. Damdinov ◽  
V. A. Sorokovikov ◽  
S. N. Larionov ◽  
Z. V. Koshkareva ◽  
O. V. Sklyarenko ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cobb Angle ◽  
Sagittal Balance ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Center Of Gravity ◽  
Sagittal Imbalance ◽  
Using Data ◽  
Mri Study ◽  
Cervicobrachial Syndrome

Objective. To analyze clinical manifestations of cervicobrachial syndrome and identify their relationship with sagittal imbalance using data of MRI and radiological examination.Material and Methods. Clinical manifestations of cervicobrachial syndrome associated with degenerative changes in the spine were studied in 22 patients. Clinical examination, radiography of the cervical spine, electroneuromyography of the upper extremities, and MRI study were performed. The intensity of the pain syndrome was assessed by VAS, and the quality of life – by the NDI questionnaire. The sagittal balance of the cervical spine was evaluated according to the following characteristics: angle of T1 slope, atlantoaxial (C1–C2) angle, degree of shift of the center of gravity of C2–C7, and Cobb angle.Results. The pain intensity in cervicobrachial syndrome correlates with sagittal balance changes in the C2–C7 Cobb angle (r = 0.656; p < 0.05), the angle of T1 vertebra slope (r = 0.520; p < 0.05), and in the degree of shift of the center of gravity of C2–C7 (r = 0.756; p < 0.02). Differences between MRI and radiological results of the sagittal balance measurement are not significant (p < 0.04).Conclusion. The study of the sagittal balance can be included in the algorithm for diagnosing osteochondrosis of the cervical spine. The MRI, along with spondylography, can be used to assess the state of sagittal balance. Understanding the identified relationships can help in determining the program of etiopathogenetic treatment of patients with cervicobrachial syndrome with obligatory including the sagittal balance correction in the program.

scholarly journals Clinical and radiological aspects of the sagittal balance of the spine in children with achondroplasia

2018 ◽  
Vol 6 (4) ◽  
pp. 6-12
Author(s):  
Oksana G. Prudnikova ◽  
Anna M. Aranovich
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Lower Limbs ◽  
Sagittal Imbalance ◽  
Compensatory Mechanisms ◽  
Lateral Instability ◽  
Hip Joints ◽  
Cross Sectional

Background. Changes in the spine with achondroplasia are represented by disorders of synostosis, the presence of wedge-shaped vertebrae, underdevelopment of the sacrum, changes in the size of the roots of the arches, stenosis of the spinal canal, and changes in the sagittal balance. Aim. To investigate the clinical and radiological features of the sagittal balance of the spine in children with achondroplasia. Materials and methods. We performed a cross-sectional clinical and radiological study of 16 patients with achondroplasia aged 6–17 years (mean, 9.2 ± 3.3 years). Radiographically, the parameters of the sagittal balance of the spine and pelvis and scoliosis were evaluated. Clinical evaluation included orthopedic and neurological status and back pain syndrome. Results. The anatomic features of patients with achondroplasia are limb shortening, O-shaped curvature of the lower extremities with lateral instability of the knee joints, and flexural contractures of the hip joints. With restriction of mobility in the hip joints, compensatory mechanisms for correcting sagittal imbalance are triggered: pelvic incline, lumbar lordosis, and thoracic kyphosis change. The clinical manifestations of sagittal imbalance in enrolled children were hypokyphosis of the thoracic spine in 100% and an increase in lumbar lordosis in 56.25% of patients. In 50% of patients, wedge-shaped deformation of vertebral bodies was diagnosed at the level of the thoracolumbar transition with the formation of local kyphosis. Neurological disorders have not been diagnosed in children. Conclusions. The anatomical features of the lower limbs and hip joints in achondroplasia reflect the biomechanical features of the relationship between the spine, pelvis, and lower limbs, which should be considered when planning for orthopedic and spinal surgery after prediction.

scholarly journals Chronic infectious lesions of the cervical spine in adults: monocentric cohort analysis and literature review

2021 ◽  
Vol 18 (3) ◽  
pp. 68-76
Author(s):  
D. G. Naumov ◽  
S. G. Tkach ◽  
A. Yu. Mushkin ◽  
M. E. Makogonova
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Sagittal Balance ◽  
Cohort Analysis ◽  
Pain Syndrome ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
Comorbidity Index ◽  
Anterior Reconstruction ◽  
Infectious Spondylitis

Objective. To analyze the results of surgical treatment of chronic infectious cervical spondylitis and literature data.Material and Methods. Design: retrospective monocentric cohort study for 2017–2020. The study included medical history and clinical and instrumental data of 25 patients who underwent 28 reconstructive surgeries on the suboccipital (n1 = 3) and subaxial (n2 = 25) spine. The average follow-up period was 1 year 2 months ± 4 months. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 22.0.Results. The effect of the duration of the therapeutic pause (p = 0.043) and the T1 slope (T1S) (p = 0.022) on the intensity of vertebrogenic pain syndrome was established. When assessing the parameters of the sagittal balance a direct relationship between the age of patients and the value of cervical sagittal vertical axis (CSVA) (p = 0.035) was revealed, while CSVA (p = 0.514) and neck tilt angle (NTA) (p = 0.617) did not significantly affect the intensity of vertebral pain syndrome. The extent of vertebral destruction did not affect either the intensity of vertebral pain (p = 0.872) or the indices of the sagittal balance: CSVA (p = 0.116), T1S (p = 0.154), and NTA (p = 0.562). A significant predictor of postoperative complications is the level of comorbidity with an index of 7 or more (p = 0.027) according to the Charlson scale.Conclusion. The leading predictors of complications of surgical treatment of cervical infectious spondylitis are the Charlson comorbidity index (7 points or more) and the variant of anterior reconstruction (the use of a blocked extraspinal plate). The factors influencing the intensity of vertebrogenic pain syndrome in this pathology are the duration of the therapeutic pause and the magnitude of T1S compensation. Anterior reconstruction of the cervical spine in the presence of infectious spondylitis provides a correction of the sagittal balance parameters, with the possibility of long-term maintaining the achieved values.

scholarly journals Outcomes of Surgical Treatment of High-Grade Spondylolisthesis (Monocenter Cohort and Literature Review)

2019 ◽  
Vol 25 (3) ◽  
pp. 100-111
Author(s):  
S. O. Ryabykh ◽  
D. M. Savin ◽  
E. Yu. Filatov ◽  
A. O. Kotelnikov ◽  
M. S. Sayfutdinov
Keyword(s):  
Surgical Treatment ◽  
Sagittal Balance ◽  
Life Quality ◽  
Pain Syndrome ◽  
Lower Limbs ◽  
Sagittal Imbalance ◽  
High Grade ◽  
X Rays ◽  
Level Of Evidence ◽  
Severity Grade

Purpose — to evaluate outcomes of surgical treatment for high-grade spondylolisthesis using bone-disc-bone osteotomy, reduction and fixation through the dorsal approach. Materials and Methods. The authors retrospectively examined a monocenter five-year cohort (IV level of evidence). The study included 10 patients aging from 7 to 22 years (Me — 12 years, M±m — 13.1±4.1 years) who underwent surgery due to high-grade spondylolysis antelisthesis in the period from 2012 to 2017. Displacement was located in L5-S1 segments and corresponded to types 4-6 by AO Spine SDSG classification in all patients. Catamnesis was followed for the period from 1 to 5 years. Surgical procedures included bone-disc-bone osteotomy, L5 reduction and dorsal instrumental multi-bearing (from 2 to 5 spinal motion segments) using reduction transpedicular screws. The following parameters were evaluated: pain syndrome prior and after surgery, sagittal balance, spondylolisthesis mobility on the functional x-rays or CYs, severity grade of anterior spondylolysis, criteria of spontaneous muscular activity and MEPs as well as structure of postoperative complications. Results. L5 displacement prior to surgery was 92.6±25.2%, after surgery — 25.4±16.6% (Z = -2.805, p = 0.005). Patients with sagittal imbalance demonstrated normalization after the surgery allowing to re-classify pathology as “balanced spondylolisthesis”: PI from 67.9±8.6 to 67.5±8.7 (Z = 0,000, p = 1,000), PT from 26.8±13.3 to 20.1±7.1 (Z = -2,090, p = 0.037), SS from 41.3±8.7 to 47.3±9.7 (Z = -1.886, p = 0.059), SA from 34.9±36.3° to 8.6±7.1° (Z = -2.803, p = 0.005). 3 cases of transient L5 radiculopathy with full regress after conservative 6 months’ treatment were reported in the early follow up period (on day 3 after procedure). Pain syndrome dynamics on VAS scale prior to and after the surgery were as follows: spine 8.1±1.0 and 0.5±0.5 (Z = -2.814, p = 0.005), lower limbs 6.8±1.5 and 0.4±0.7 (Z = -2.812, p = 0.005), respectively. Life quality indices by SRS-24 score prior to and after the surgery were 62.6±7.9 and 90.7±12.4 (Z = -2.803, p = 0.005). Mobility of spondylolisthesis was observed in 9 patients. Spondylolisthesis severity by Bridwell classification in late period scored from 1 to 3 points. Conclusion. Use of AO Spine SDSG classification along with assessment of sagittal balance as well as severity of neurological deficit and pain syndrome allow to define the severity grade of spondylolisthesis, while normalization of parameters after the surgery speaks for positive treatment outcome. Extensive release during bone-disc-bone osteotomy at L5-S1 level along with altering tilt angle of the sacrum is the key factor for mobilization and radical correction of pelvic balance in high-grade spondylolisthesis. Outcomes of surgical treatment in the analyzed cohort demonstrate significant improvement in life quality (by SRS-24 score) and reduced pain syndrome (by VAS) in patients. At the same time precise compliance to the procedure protocol and intraoperative neuro-monitoring of MEPs allow to decrease risk of complications. 

scholarly journals The dynamics of quality of life in young patients with vertebrobasilar insufficiency and pathobiomechanical changes in the musculoskeletal system against the background of complex non-drug therapy

2018 ◽  
Keyword(s):  
Cervical Spine ◽  
Drug Therapy ◽  
Musculoskeletal System ◽  
Affective Disorders ◽  
Myofascial Pain ◽  
Young Patients ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Sf 36

The main reason for the development of dysgemic disorders in the vertebrobasilar system in young people is pathobiomechanical changes in the cervical spine and myofascial pain syndrome of the cervico-brachial localization. The aim of the study was to study the dynamics of life quality in young patients withVBI, biomechanical disorders of the cervical spine and myofascial pain syndrome of the neck and shoulder localization on the background of complex non-drug therapy (biomechanical correction of the musculoskeletal system, medical exercises, acupuncture and the dry needling). 83 patients (mean age – 37,4 ± 4,8 years) with clinical manifestations of VBI on the background of pathobiomechanical changes of the cervical spine and myofascial pain syndrome of the neck-brachial localization were investigated. They were divided into 2 groups depending on the chosen treatment strategy: 1 group - 42 patients, in the treatment of which were used complex non-drug therapy, 2 group - 41 patients, in the treatment of which were used drug therapy (nicergoline 30 mg / day, meloxicam 15 mg / day). The control group consisted of 20 healthy individuals (37 ± 3,7 years). Evaluation of the severity of VBI according to the VBI scale, vertebro-neurological examination with the calculation of the muscle syndrome index, pain syndrome assessment (VAS), affective disorders (HADS), quality of life (MOS SF-36) in the dynamics - before the start of therapy, at 11 and on the 31st day after the start of therapy. The results of evaluating QOL using the MOS SF-36 questionnaire in young patients with VBI on the background of pathobiomechanical changes in the musculoskeletal system showed a significant decrease in all indicators of the questionnaire scales, which is associated with the presence of clinical manifestations of VBI in these patients, as well as painful , musculo-tonic syndrome of neck and shoulder localization and affective disorders. The use of complex non-drug therapy in the treatment of these patients, aimed at the biomechanical correction of the musculoskeletal system and the elimination of myofascial pain of neck and shoulder localization, has contributed to a more effective regression of manifestations of VBI, affective disorders, pain and musculo-tonic syndrome, leading to a significant increase in all indicators of QOL and had advantages over traditional treatment with the use of vasoactive drugs and non-steroidal anti-inflammatory drugs.

RADIOGRAPHIC RESTORATION OF LUMBAR ALIGNMENT AFTER TRANSFORAMINAL LUMBAR INTERBODY FUSION

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 955-964 ◽  
Author(s):  
Jay Jagannathan ◽  
Charles A. Sansur ◽  
Rod J. Oskouian ◽  
Kai-Ming Fu ◽  
Christopher I. Shaffrey
Keyword(s):  
Surgical Technique ◽  
Cobb Angle ◽  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Sagittal Imbalance ◽  
X Rays ◽  
Lumbar Interbody Fusion ◽  
Spinal Alignment

Abstract OBJECTIVE Restoration of lumbar lordosis is a critical factor in long-term success after lumbar fusions. Transforaminal lumbar interbody fusion (TLIF) is a popular surgical technique in the lumbar spine, but few data exist on change in spinal alignment after the procedure. METHODS Eighty patients who underwent TLIF surgery were retrospectively reviewed (minimum follow-up period, 2 years). Standing x-rays were assessed for changes in focal and segmental kyphosis, and restoration of lumbar lordosis. Improvement in spondylolisthesis, sagittal balance, and scoliosis were also assessed. Fusion was assessed as well. RESULTS Eighty operations were performed at 107 levels. Mean presenting lumbar Cobb angle measurement (L1–S1) was 36.3 ± 4.5 degrees (range, 12–77 degrees). Forty patients (50%) had sagittal imbalance. Mean postoperative Cobb angle (L1–S1) was 55.1 ± 6.6. Thirty-three of 36 patients with segmental kyphosis (92%) had restoration of lordosis. Improvement in alignment was most prominent at the surgical level (mean increase in lordosis, 20.2 ± 4.2 degrees). The improvement in lumbar lordosis among patients undergoing multilevel TLIFs (27.3 ± 3.4 degrees) was significantly higher compared with patients undergoing single-level operations (17.4 ± 4.4) (Student's t test, P = 0.0004). Thirty of the 40 patients with sagittal imbalance (75%) achieved immediate restoration of normal sagittal balance. The ability to restore normal sagittal balance was correlated with a sagittal imbalance of less than 10 cm (P = 0.0001). Spondylolisthesis was completely corrected at the TLIF site in 90 of 99 levels (91%). Three patients (4%) required reoperation, 2 for implant disengagement and 1 for worsening kyphoscoliosis above the original surgical levels. Two of the 80 patients had pseudoarthrosis; hence, the rate of pseudoarthrosis was 2.5%. CONCLUSION The TLIF operation is highly effective in improving spinal alignment in patients with degenerative spinal disorders when the appropriate surgical technique is implemented.

scholarly journals The Sagittal Balance of the Cervical Spine: Radiographic Analysis of Interdependence between the Occipitocervical and Spinopelvic Alignment

2020 ◽  
Vol 14 (3) ◽  
pp. 287-297 ◽  
Author(s):  
Babak Alijani ◽  
Javid Rasoulian
Keyword(s):  
Cobb Angle ◽  
Sagittal Balance ◽  
Sagittal Alignment ◽  
Surgical Reconstruction ◽  
Sagittal Imbalance ◽  
Sagittal Vertical Axis ◽  
Asymptomatic Patients ◽  
Significant Difference ◽  
Cervical Sagittal Alignment ◽  
Global Sagittal Alignment

Study Design: This was a prospective clinical study.Purpose: Previous studies have indicated that cervical lordosis is a parameter influenced by segmental and global spinal sagittal balance parameters. However, this correlation still remains unclear. Therefore, a better understanding of the normal values and interdependencies between inter-segmental alignment parameters is needed. This is a preliminary analysis that helps to understand these factors.Overview of Literature: Change in global sagittal alignment is associated with poor health-related quality of life. Questions regarding which parameters play the primary roles in the progression of spinal sagittal imbalance and which might be compensatory factors remain unanswered.Methods: Prospectively, 420 adults (105 asymptomatic, 105 cervical symptomatic, 105 lumbar symptomatic, and 105 post-surgical) were selected. Whole-spine standing lateral radiographs were taken, and spinopelvic, thoracic, and cervical parameters were measured. Then, the data were analyzed using correlation coefficient test and multiple regression analysis.Results: All the parameters showed a normal distribution. The mean values of the cervical parameters are as follows: C<sub>1</sub>C<sub>2</sub> Cobb angle, −27.07°±4.3°; C<sub>2</sub>C<sub>7</sub> Cobb angle, −16.4°±5.6°; O<sub>C</sub>C<sub>2</sub> Cobb angle, −14.5°±3.8°; O<sub>C</sub>C<sub>7</sub> Cobb angle, −29.8°±5.6°; C<sub>2</sub>C<sub>7</sub> Harrison angle, 20.4°±4.3°; and C<sub>7</sub> slope, −25.4°±5.6°. The analysis of these parameters revealed no statistically significant difference between asymptomatic, symptomatic, and post-surgical patients. C<sub>7</sub> sagittal vertical axis (SVA) correlated with the C<sub>2</sub>C<sub>7</sub> Cobb angle (<i>r</i> =0.7) in all groups. No significant correlation was noted between cervical and spinopelvic parameters in asymptomatic patients. However, C<sub>1</sub>C<sub>2</sub> Cobb angle correlated significantly with pelvic incidence (PI, <i>r</i> =−0.2), lumbar lordosis (LL, <i>r</i> =0.2), and pelvic tilt (PT, <i>r</i> =−0.2) in cervical symptomatic patients. Irrespective of the patient symptom sub-group (n=420), C<sub>1</sub>C<sub>2</sub> Cobb angle correlated with LL (<i>r</i> =0.1) and C<sub>2</sub>C<sub>7</sub> Harrison angle correlated with PI and PT (<i>r</i> =0.1).Conclusions: Our results indicate significant interdependence between the spinopelvic and cervical alignment, especially in cervical symptomatic patients. In addition, strong correlation was found between the C<sub>7</sub> SVA and C<sub>2</sub>C<sub>7</sub> Cobb angle. Overall, the results of this study could help to better understand the cervical sagittal alignment and serve as preliminary data for planning surgical reconstruction procedures.

scholarly journals Biomechanical aspects of spinal sagittal balance in achondroplasia patients during Ilizarov limb lengthening

2018 ◽  
Vol 15 (4) ◽  
pp. 7-14
Author(s):  
O. G. Prudnikova ◽  
A. M. Aranovich ◽  
Yu. A. Mushtaeva ◽  
A. V. Gubin
Keyword(s):  
Lower Limb ◽  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Clinical Manifestations ◽  
Limb Lengthening ◽  
Neurological Status ◽  
Ilizarov Method ◽  
Sagittal Imbalance ◽  
Cross Sectional

To review specific features of spinal sagittal balance in achondroplasia patients at stages of lower limb lengthening using the Ilizarov method. Material and Methods. Cross-sectional clinical and radiological study was performed in 29 achondroplasia patients prior to lower limb lengthening and at lengthening stages using the Ilizarov method. Parameters of sagittal balance of the spine and pelvis were evaluated radiologically. Clinical evaluation included examination, and assessment of neurological status and pain level. Results. Clinical manifestations of sagittal imbalance included hypokyphosis of the thoracic spine in 44.8 % of cases and increased lumbar lordosis in 55.2 %. No neurological disorders were diagnosed in patients. Pain scores 2 to 4 were observed in 17.2 % ofcases. After staged lower limb lengthening by 19.8 ± 3.3 cm, it was revealed that the values of the thoracic kyphosis, lumbar lordosis and the angle of the sacrum tilt improved and approached those of healthy peers. Vertical sagittal alignment measurements correlated with those of thoracic kyphosis. Thoracic kyphosis showed a correlation with lumbar lordosis. Pelvic indices had a moderate correlation with lumbar lordosis. Conclusion. Biomechanically substantiated transosseous compression-distraction osteosynthesis by Ilizarov technique used for lower limb lengthening in achondroplasia patients improves spinal sagittal balance parameters.

Optimization of diagnostic system of hand diseases in employees working under combined effects of vibration and physical overloads

2019 ◽  
pp. 950-955
Author(s):  
M. M. Poroshina ◽  
E. M. Vlasova ◽  
A. Ya. Perevalov
Keyword(s):  
Working Conditions ◽  
Comparison Group ◽  
Clinical Manifestations ◽  
Diagnostic System ◽  
Pain Syndrome ◽  
Observation Group ◽  
Combined Effects ◽  
X Rays ◽  
Industrial Enterprises ◽  
Special Assessment

The results of research carried out by theFederalScientificCenterfor Medical and Preventive Technologies of Public Health Risk Management Technologies for the period 2013–2018 showed that diseases associated with the combined effects of vibration and physical overload, employees of hazardous industries develop with experience of 15 years or more. The risk group is women older than 35 years and men older than 40 years. Pathology at the stage of detailed clinical manifestations is characterized by persistent pain syndrome, and, as a consequence, a decrease in the ability to work of workers.The aim of the study was to optimize the system of diagnosis of hand diseases in workers of industrial enterprises engaged in labor activities under the combined effects of vibration and physical overload, for the development of primary prevention programs.The observation group consisted of 32 employees aged 39.3±4.3 years, with an experience of 17.4±4.3 years; the comparison group consisted of 30 employees whose working conditions are not related to the studied factors; the average age was 40.6±3.4 years, experience was 19.1±3.1 years. The examination included analysis of the results of a special assessment of working conditions; assessment of neurological status; functional tests; laboratory studies (assessment of inflammation), hand dynamometry, stimulation electroneuromyography; x-rays of the hands and wrist joints, ultrasound examination of the hands.More than half of the surveyed persons of the observation group and 3/4 of the workers of the comparison group did not make complaints. Indicators of dynamometry of workers in both groups corresponded to physiological norm (p>0.05). Analysis of the results of dynamometer with data from previous years of PMO showed a decrease in strength of muscles of the hand leading hands on 2je,0–16. 7% and from 83.3% of the employees of the monitoring group and in 44.4% of the comparison group (p<0.05), in 50 % of the cases there was a decrease in the percentage of changes in the hand force variation (HFV) in the observation group, and in 38.9% of the cases the indicators remained unchanged. According to ultrasound of the hands, signs of tendinopathy were established in 85% of the employees of the observation group in the absence of persons with similar changes in the comparison group.In order to optimize the diagnosis of diseases of the hand in industrial workers who carry out their work under the combined effects of vibration and physical overload, in the case of a decrease in the rate of carpal dynamometry by 5% or more during the year, it is recommended to conduct ultrasound of the tendon-ligamentous apparatus of the hand, which will allow timely identification of early signs of tendinopathy.

Spinal Balance/Alignment—Clinical Relevance and Biomechanics

2019 ◽  
Vol 141 (7) ◽  
Author(s):  
Anoli Shah ◽  
Justin V. C. Lemans ◽  
Joseph Zavatsky ◽  
Aakash Agarwal ◽  
Moyo C. Kruyt ◽  
...  
Keyword(s):  
Social Interaction ◽  
Sagittal Balance ◽  
Sagittal Plane ◽  
The Body ◽  
Optimal Configuration ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Compensatory Mechanisms ◽  
Spinal Balance ◽  
Spinal Imbalance

In the anatomy of a normal spine, due to the curvatures in various regions, the C7 plumb line (C7PL) passes through the sacrum so that the head is centered over the pelvic-ball and socket hip and ankle joints. A failure to recognize malalignment in the sagittal plane can affect the patient's activity as well as social interaction due to deficient forward gaze. The sagittal balance configuration leads to the body undertaking the least muscular activities as possible necessary to maintain spinal balance. Global sagittal imbalance is energy consuming and often results in painful compensatory mechanisms that in turn negatively influence the patient's quality of life, self-image, and social interaction due to inability to maintain a horizontal gaze. Deformity, scoliosis, kyphosis, trauma, and/or surgery are some ways that this optimal configuration can be disturbed, thus requiring higher muscular activity to maintain posture and balance. Several parameters such as the thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and hip and leg positions influence the sagittal balance and thus the optimal configuration of spinal alignment. This review examines the clinical and biomechanical aspects of spinal imbalance, and the biomechanics of spinal balance as dictated by deformities—ankylosing spondylitis (AS), scoliosis and kyphosis; surgical corrections—pedicle subtraction osteotomies (PSO), long segment stabilizations, and consequent postural complications like proximal and distal junctional kyphosis. The study of the biomechanics involved in spinal imbalance is relatively new and thus the literature is rather sparse. This review suggests several potential research topics in the area of spinal biomechanics.

scholarly journals POS0385 DURING DEVELOPMENT OF RHEUMATOID ARTHRITIS, INTERMETATARSAL BURSITIS MAY OCCUR BEFORE CLINICAL JOINT SWELLING: A LARGE MRI STUDY IN PATIENTS WITH CLINICALLY SUSPECT ARTHRALGIA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 422.2-423
Author(s):  
B. van Dijk ◽  
F. Wouters ◽  
E. van Mulligen ◽  
M. Reijnierse ◽  
A. van der Helm - van Mil
Keyword(s):  
Rheumatoid Arthritis ◽  
Cox Regression ◽  
Clinical Expertise ◽  
Synovial Lining ◽  
Recent Onset ◽  
Clinical Arthritis ◽  
Joint Examination ◽  
Using Data ◽  
Mri Study ◽  
Subclinical Synovitis

Background:Inflammation of the synovial lining is a hallmark of rheumatoid arthritis (RA). A synovial lining is not only present at synovial joints and tendon sheaths but also at bursae. Inflammation of the synovium-lined intermetatarsal bursae in the forefoot, intermetatarsal bursitis (IMB), was recently identified with MRI. It is specific for early RA and present in the majority of RA patients at diagnosis. During development of RA, MRI-detectable subclinical synovitis and tenosynovitis often occur before clinical arthritis presents. Whether IMB is also present in a pre-arthritis stage is unknown.Objectives:To assess the occurrence of IMB in patients with clinically suspect arthralgia (CSA) and its association with progression to clinical arthritis in a large MRI-study.Methods:We studied 524 consecutive patients presenting with CSA. CSA was defined as recent-onset arthralgia of small joints that is likely to progress to RA based on the clinical expertise of the rheumatologist. Participants underwent unilateral contrast-enhanced 1.5T MRI of the forefoot, metacarpophalangeal (MCP) joints and wrist at baseline. Thereafter patients were followed for detection of clinical arthritis, as identified at physical joint examination by the rheumatologist. Baseline MRIs were evaluated for IMB at all 4 intermetatarsal spaces. Also synovitis, tenosynovitis and osteitis were assessed in line with the RA MRI scoring system (summed as RAMRIS-inflammation). Both IMB and RAMRIS-inflammation were dichotomised into positive/negative using data from age-matched symptom-free controls as a reference. Cox regression analysed the association of IMB with progression to clinical arthritis; multivariable analyses were used to adjust for RAMRIS-inflammation which is known to associate with progression to clinical arthritis. Analyses were repeated stratified for ACPA-status, since ACPA-positive and ACPA-negative RA are considered separate entities with differences in pathophysiology.Results:The baseline MRIs showed ≥1 IMB in 35% of CSA-patients. Patients with IMB were more likely to also have synovitis (OR 2.5 (95%CI 1.2–4.9)) and tenosynovitis (8.9 (3.4–22.9)) on forefoot MRI, but not osteitis (0.9 (0.5–1.8)). Patients were followed for median 25 months (IQR 19–27). IMB-positive patients developed clinical arthritis more often than IMB-negative patients (HR 3.0 (1.9-4.8)). This association was independent of RAMRIS-inflammation (adjusted HR 2.2 (1.4–3.6)). In stratified analyses, IMB was more frequent in ACPA-positive than in ACPA-negative CSA (68% vs. 30%, p<0.001). Moreover IMB predicted clinical arthritis development in ACPA-positive CSA (HR 2.5 (1.1–5.7)) but not in ACPA-negative CSA patients (1.0 (0.5–2.2)).Conclusion:One-third of CSA patients have IMB. IMB is frequently present in conjunction with subclinical synovitis and tenosynovitis. It precedes the development of clinical arthritis, and in particular the development of ACPA-positive RA. These results reinforce the notion that not only intra- but also juxta-articular synovial inflammation is involved in the development of RA.Disclosure of Interests:None declared

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