scholarly journals Clinical, functional and radiological spinopelvic balance parameters assessment after transforaminal lumbar interbody fusion in grade 1 spondylolisthesis

2020 ◽  
Vol 8 (1) ◽  
pp. 232
Author(s):  
Ninad Sawant ◽  
Mathew Abraham ◽  
Tobin George ◽  
Easwer H. V. ◽  
Ganesh Divakar
Keyword(s):  
Short Form ◽  
Degenerative Spondylolisthesis ◽  
Vertical Axis ◽  
Transforaminal Lumbar Interbody Fusion ◽  
General Information ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Spinal Balance ◽  
Functional Parameters ◽  
Sagittal Spinal Balance

Background: The aim was to study effectiveness of TLIF procedure by assessing clinical and radiological spinal sagittal parameters pre and postoperatively.Methods: 8 patients who underwent TLIF procedure after diagnosis of spondylolisthesis studied prospectively. After recording general information, symptomatology, functional parameters were evaluated using visual analogue scale (VAS), Oswestry disability index (ODI), short form 12 (SF 12) and radiological sagittal balance parameters were assessed by calculating sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), preoperatively and postoperatively during follow up at 1 and 3 months.Results: We operated 4 (50%) patients at L4-L5 level of degenerative spondylolisthesis, 1 (12.5%) patient of degenerative spondylolisthesis at L5-S1 level and 3 (12.5%) patients of isthmic spondylolisthesis at L5-S1 level. All patients were grade 1 spondylolisthesis according Meyerding classification. After surgery all sagittal spinal balance parameters were not found to be statistically changed from the baseline, although there was minimum improvement. Regarding the clinical outcome measures, both VAS (<0.0001), ODI (<0.0001), and SF12 (<0.0001) improved after surgery significantly.Conclusions: In most case of grade 1 spondylolisthesis, there was only a minimal imbalance of the sagittal spinal balance parameters and so in situ fusion can be done. Even if a complete reduction of spondylolisthesis was not achieved during surgery, there was correction of a few of the parameters of spinal balance which were deranged preoperatively. Overall TLIF is very good procedure in terms of improvement in clinical and functional parameters in grade 1 spondylolisthesis. 

Detection of mild cognitive impairment by spinal posture assessment in health exams of the general older population: A Japanese cohort survey randomly sampled from a basic resident registry

2021 ◽  
Author(s):  
Hikaru Nishimura ◽  
Shota Ikegami ◽  
Masashi Uehara ◽  
Jun Takahashi ◽  
Ryosuke Tokida ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Adult Population ◽  
Vertical Axis ◽  
Community Dwelling ◽  
Sagittal Vertical Axis ◽  
Spinal Balance ◽  
Japanese Cohort ◽  
Sagittal Spinal Balance

Abstract The recent increase in the older adult population has led to a higher prevalence of cognitive impairment, which is often overlooked in routine health examinations. Citizens aged 50 to 89 years were targeted for this cohort survey by random sampling from the resident registry of a cooperating town in 2014. A total of 413 participants (203 male and 210 female) were enrolled. We analyzed the distribution of cognitive function test scores as determined by Montreal Cognitive Assessment and Mini-Mental State Examination tests in each age (50’s, 60’s, 70’s and 80’s) and sex group to examine whether mild cognitive impairment (MCI) could be detected by sagittal spinal balance measurement based on a radiological approach. Sagittal spinal balance was quantitatively measured as sagittal vertical axis (SVA). We observed significant associations for higher age and/or SVA anteriorization with lower cognitive function. In men, spinal balance anteriorization was associated with MCI independently of age, with combinations of age and SVA also making valid MCI determinations; male cases of SVA ≥ 100 mm at any age, SVA ≥ 90 mm at ≥ 70 years, and SVA ≥ 70 mm at ≥ 80 years were all more likely to have MCI than cases below those values. For women, MCI was more likely in cases of SVA ≥ 70 mm, regardless of age. Thus, spinal balance anteriorization can be regarded as an easily visible indicator of latent MCI in community-dwelling older people.

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 Relationship between hip joint proximity area and sagittal balance parameters: an upright computed tomography study

2020 ◽  
Author(s):  
Shunsuke Kikuchi ◽  
Daisuke Nakashima ◽  
Yoshitake Yamada ◽  
Minoru Yamada ◽  
Yoichi Yokoyama ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hip Joint ◽  
Sagittal Balance ◽  
Dimensional Space ◽  
Hip Osteoarthritis ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Spinal Balance ◽  
Offset Distance ◽  
Sagittal Spinal Alignment

Abstract Purpose A close relationship between sagittal spinal alignment and hip osteoarthritis (OA) has been documented. This study aimed to examine the relationship between hip joint proximity area and sagittal balance parameters in healthy subjects. Methods This prospective study enrolled 47 healthy volunteers who underwent 320-detector row upright computed tomography. Acquired data were reconstructed in a virtual three-dimensional space. The proximity area was determined by < 1 mm of the Hausdorff distance between the acetabulum and the femoral head. Volunteers were divided into the anterior and posterior proximity groups depending on the position of the closest area. Sagittal balance parameters [sagittal vertical axis (SVA), T1 spinopelvic inclination (T1-SPi), T1-pelvic angle, pelvic tilt, sacral slope, pelvic incidence, lumbar lordosis, thoracic kyphosis), offset distance between the centre of the acoustic meati (CAM) and C7 plumb line (CAM-C7-offset), and offset distance between the CAM and hip axis (HA) (CAM-HA-offset)] were compared between the two groups using independent sample t test. Results The anterior proximity group (n = 24) had higher SVA (p = 0.016) and T1-Spi (p = 0.015) than the posterior proximity group (n = 23). CAM-HA-offset was higher in the posterior than in the anterior proximity group (p < 0.000). There was no difference in other parameters (p > 0.05). Conclusion The anterior proximity group had a positive anterior spinal balance; the posterior proximity group may have a more posterior gravity line than the hip joint centre. The anterior spinal balance may contribute to the anterior loading of the hip joint, with known relation with the initiation and onset of hip OA.

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.

scholarly journals Effect of sagittal imbalance on functional disability in patients with degenerative spondylolisthesis

2019 ◽  
Vol 6 (1) ◽  
pp. 31
Author(s):  
Ramdas Maloth
Keyword(s):  
Functional Disability ◽  
Pelvic Incidence ◽  
Sagittal Plane ◽  
Degenerative Spondylolisthesis ◽  
Vertical Axis ◽  
P Value ◽  
Sagittal Imbalance ◽  
Sagittal Vertical Axis ◽  
Cross Sectional ◽  
Digital Radiograph

<p class="abstract"><strong>Background:</strong> Deformity of spine in sagittal plane is a major cause of pain and disability among patients presenting with low back pain to spine clinic. We have studied the effect of spinal sagittal imbalance on functional disability in these patients.</p><p class="abstract"><strong>Methods:</strong> Cross sectional observational study in 50 patients with degenerative spondylolisthesis of more than 45 years age group study done in period of1 years. Subjects underwent standing lateral radiographs of the spine in a relaxed position, facing forward, with their knees maximally extended and their arms raised horizontally forward resting on a support. 2 radiographic films are stitched at baseline using digital radiograph operating console (DROC) software.</p><p class="abstract"><strong>Results: </strong>In our study out of 50 patients we observed female preponderance, female:male 3:1, degenerative spondylolisthesis more commonly involves L4-L5 level (46 patients). 58% of patients with severe degenerative spondylolisthesis. There is significant correlation between sagittal vertical axis (SVA) and severity (p=0.015) in both grade 1 and grade 2 DS, there is significant correlation between pi and functional disability (p=0.001 and 0.010 respectively) it is found that pelvic tilt with p=0.02 and sagittal vertical axis with p value 0.036 are the two most significant variables at the end of backward elimination analysis.</p><p class="abstract"><strong>Conclusions:</strong> Sagittal imbalance is seen in degenerative spondylolisthesis which needs further evaluation with spinopelvic parameters. Pelvic incidence and sagittal vertebral axis are important determinants of functional disability in patients with degenerative spondylolisthesis. Individuals with high pelvic incidence and more lumbo pelvic kyphosis showed more functional disability compared to others.</p>

scholarly journals Analysis of Spinopelvic Parameters with L5 as the New Sacrum after Fusion in High-Grade Spondylolisthesis: A Possible Explanation for Satisfactory Results with <italic>In-Situ</italic> Fusion

2018 ◽  
Vol 12 (1) ◽  
pp. 103-111
Author(s):  
Shanmuganathan Rajasekaran ◽  
Gurudip Das ◽  
Siddharth Narasimhan Aiyer ◽  
Rishi Mugesh Kanna ◽  
Ajoy Prasad Shetty
Keyword(s):  
Functional Outcomes ◽  
Short Form ◽  
Case Series ◽  
Sacral Slope ◽  
High Grade ◽  
Spinopelvic Parameters ◽  
Sagittal Vertical Axis ◽  
Surgical Methods ◽  
Reduction Group

<sec><title>Study Design</title><p>Retrospective case series.</p></sec><sec><title>Purpose</title><p>To correlate functional outcomes with spinopelvic parameters in patients with high-grade spondylolisthesis (HGS) treated with instrumented <italic>in-situ</italic> surgery or reduction and fusion.</p></sec><sec><title>Overview of Literature</title><p>Satisfactory functional outcomes are reported with reduction and <italic>in-situ</italic> fusion strategies in HGS. However, reasons for this are unclear. We hypothesize that following lumbosacral fusion, the L5 becomes part of the sacrum, which improves spinopelvic parameters, resulting in equivalent functional outcomes in both surgical methods.</p></sec><sec><title>Methods</title><p>Twenty-six patients undergoing HGS (reduction group A, 13; <italic>in-situ</italic> group B, 13) were clinically evaluated using the Oswestry Disability Index (ODI), short form-12 (SF-12), and Visual Analogue Scale (VAS) scores. Spinopelvic parameters, including pelvic incidence, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), lumbosacral kyphosis (LSK) angle, and sacrofemoral distance (SFD) were measured preoperatively from S1 and postoperatively from L5 as the new sacrum at 1 year follow-up. Sagittal alignment was assessed using the sagittal vertical axis.</p></sec><sec><title>Results</title><p>Both groups were comparable in terms of age, sex, severity of slip, and preoperative spinopelvic parameters (<italic>p</italic>&gt;0.05). Postoperative VAS, SF-12, and ODI scores significantly improved in both groups (<italic>p</italic>&lt;0.05). Compared with preoperative values, the mean postoperative PT, SFD, and LSK significantly changed in both groups. In reduction group, PT changed from 26.98° to 10.78°, SFD from 61.24 to 33.56 mm, and LSK from 74.76° to 109.61° (<italic>p</italic>&lt;0.05). In <italic>in-situ</italic> fusion group PT changed from 26.78° to 11.08°, SFD from 62.9 to 36.99 mm, and LSK from 67.23° to 113.38° (<italic>p</italic>&lt;0.05 for all). In both groups, SS and LL did not change significantly (<italic>p</italic>&gt;0.05).</p></sec><sec><title>Conclusions</title><p>After fusion, the L5 becomes the new sacrum and influences spinopelvic parameters to change favorably. This possibly explains why reduction and <italic>in-situ</italic> fusion achieve equivalent functional outcomes in HGS.</p></sec>

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