Degeneration of the Lumbar Paravertebral Muscle in Patients With Dynamic Sagittal Imbalance, A Retrospective Cohort Study

Abstract Study Design: A retrospective cohort study.Background: Sagittal imbalance of the spine is a comprehensive concept ..In appearance, it is often manifested as body leaning forward instability; whereas on standing full-spine lateral digital radiographs, it shows an increased sagittal vertical axis (SVA) .Clinically, we found that some patients showed normal sagittal balance at initiation, but hunched or leaned forward after a period of walk or activity. This condition is called dynamic sagittal imbalance(DSI). There is no systematic study to explore the paravertebral muscles changes of dynamic sagittal imbalance.Method: The study group comprised 31 DSI patients and 42 control patients. All subjects underwent radiologic whole spine X-ray examination and lumbar MRI( Magnetic Resonance Imaging) scanning. Spinal-pelvic parameters at initiation such as sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI) was measured. The cross-sectional areas CSA of the erector spinae (ES), multiﬁdus (MF), and vertebral body area were measured at L2/L3 and L4/L5. The fat infiltration (FI) and relative cross-sectional area (RCSA)of muscle of these above muscles were quantitatively measured though Image J softwore.Result : Compared with the control group, the DSI group had a smaller lumbar lordosis, more severe fat infiltration and lower relative functional cross-sectional area(RFCSA) of paravertebral muscle (erector spinae and multifidus) . In DSI group, the point-in-time of occurrence of dynamic sagittal imbalance was statistically correlated with degeneration of paravertbral muscles at L4/L5 level, whereas no correlation between the two above at L2/L3 level.Conclusion: In conclusion, DSI an normal SVA (SVA＜40mm) at initiation, and prominent increase in SVA after activity with thunks marked inclined. Paravertebral muscle degeneration plays an important role in the DSI process, Patients in the DSI group had more severe paravertebral muscle degeneration compared with patients in control group. There was a significant correlation between the severity of DSI symptoms and the degeneration of lower lumbar paravertebral muscles. These findings may help spinal surgeons better understand sagittal balance of spine.

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Moderate Degeneration of the Lumbar Paravertebral Muscle in Patients With Dynamic Sagittal Imbalance,A retrospective cohort study

10.21203/rs.3.rs-51797/v1 ◽

2020 ◽

Author(s):

Nan Ru ◽

Guodong Wang ◽

Yang Li ◽

Xingang Cui ◽

Jianmin Sun

Keyword(s):

Retrospective Cohort ◽

Lumbar Lordosis ◽

Vertical Axis ◽

Erector Spinae ◽

Sagittal Imbalance ◽

Mineral Density ◽

Sagittal Vertical Axis ◽

Cross Sectional ◽

Paravertebral Muscle ◽

Pelvic Parameters

Abstract Study Design: A retrospective cohort study.Background: Sagittal imbalance of the spine is a comprehensive concept and can be caused by many causes. Paravertebral muscle is an important factor in the stabilization of spine.The active subsystem formed by the muscles around the lumbar spine plays an important role in maintaining lumbar spine stability and extendding the spine . Clinically, we found that some patients showed spinal sagittal balance when they were energetic, but hunched or leaning forward after a period of walking or working.Standing full-spine lateral digital radiographs shows increased sagittal vertical axis (SVA)dynamically.We call this symptoms a dynamic sagittal imbalance（DSI. However, the sagittal sequence, paravertebral muscle changes, and the correlation between them in DSI patients have not been clearly explored. The purpose of this study was to investigate the changes of spinal-pelvic parameters; paravertebral muscle; and the relationship between the two in DSI patients .Method: The study group comprised 31 patients with DSI and 42 control patients.All subjects underwent radiologic whole spine X-ray examination and lumbar MRI( Magnetic Resonance Imaging) scanning. Spinal-pelvic parameters such as sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI) was measured. The cross-sectional areas （CSA）of the erector spinae (ES),multiﬁdus (MF), and vertebral body were measured at L2/L3 and L4/L5. The fat infiltration (FI) and relative cross-sectional area (RCSA)of muscle of these muscles were quantitatively measured though Image J. All subjects were examined for bone mineral density and pulmonary function to test the overall skeletal muscle capacity.Result: Compared with the control group,the DSI group had a smaller lumbar lordosis，more severe fat infiltration and lower Relative functional cross-sectional area(RFCSA) of paravertebral muscle ES(erector spinae)&MF(multifidus). There was no correlation between muscle degeneration and spinal-pelvic parameters in DSI patients.In addition,There were no statistically significant differences in bone mineral density test and pulmonary function test which reflected systemic skeletal muscle capacity of whole body.Conclusion: DSI，along with moderate degeneration of the paravertebral muscles of the lumbar spine.Usually accompanied by a reduction in lumbar lordosis. DSI is regards as the pre-state of PDSI.

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Degeneration of lumbar paravertebral muscles in lumbar degenerative kyphosis with dynamic sagittal imbalance

10.21203/rs.3.rs-498662/v1 ◽

2021 ◽

Author(s):

Nan Ru ◽

Guodong Wang ◽

Yang Li ◽

Xingang Cui ◽

Jianmin Sun

Keyword(s):

Erector Spinae ◽

Magnetic Resonance Imaging Examination ◽

Control Group ◽

P Value ◽

Sagittal Imbalance ◽

Paravertebral Muscle ◽

Muscle Strengthening ◽

Paravertebral Muscles ◽

Before And After ◽

And Control

Abstract Background: The aim of this study was to probe the degeneration of lumbar paravertebral muscles in lumbar degenerative kyphosis (LDK) with dynamic sagittal imbalance (DSI).Method: A total of 132 patients with LDK were enrolled in the study. According to the ΔSVA of the full-spine lateral radiographs before and after walking, enrolled patients were divided into two groups: DSI group (31 cases) and control group (42 case). Lumbar magnetic resonance imaging examination was taken for each subject. Fat infiltration area (FIA)and muscle muscularity of multifidus (MF) and erector spinae (ES) were quantitatively measured though Image J software. Independent-sample t test were performed for comparison of quantitative variables between two groups. P value<0.05 was considered statistically significant.Result: DSI group had lower muscle muscularity both in ES and MF than control group. ES muscularity at L2 level was 0.42±0.08 in DSI group and 0.82±0.17 in control group. (p=0.016). ES muscularity at L4 level was 0.36±0.11in DSI group and 0.76± 0.22 in control group. (p＜0.001).MF muscularity at L2 level was 0.17±0.08 in DSI group and 0.36±0.07in control group. (p＜0.001). MF muscularity at L4 level was 0.34±0.18 in DSI group and 0.48±0.14 in control group. (p＜0.001).DSI group had higher FIA both in ES and MF than control group.ES FIA at L2 level was 0.50±0.17 in DSI group and 0.31±0.10 in control group. (p=0.023). ES FIA at L4 level was 0.55±0.27 in DSI group and 0.34±0.07 in control group. (p＜0.001).MF FIA at L2 level was 0.63±0.22 in DSI group and 0.36±0.12 in control group. (p＜0.001). MF FIA at L4 level was 0.76±0.31 in DSI group and 0.40±0.19 in control group. (p＜0.001). Conclusions: LDK patients with DSI suffered lower muscle muscularity and higher FIA both in ES and MF compared to control group. Our study revealed that the weakness of the paravertebral muscles plays an important role in DSI process, targeted paravertebral muscle strengthening training may be a potentially effective treatment for this disease.

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Degeneration of lumbar paravertebral muscles in lumbar degenerative kyphosis with dynamic sagittal imbalance: A case-control study.

10.21203/rs.3.rs-510603/v1 ◽

2021 ◽

Author(s):

Nan Ru ◽

Guodong Wang ◽

Yang Li ◽

Jianmin Sun ◽

Xingang Cui

Keyword(s):

Erector Spinae ◽

Magnetic Resonance Imaging Examination ◽

Control Group ◽

P Value ◽

Sagittal Imbalance ◽

Paravertebral Muscle ◽

Muscle Strengthening ◽

Paravertebral Muscles ◽

Before And After ◽

And Control

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

10.21203/rs.2.16543/v1 ◽

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.

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195794 ◽

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

Background: 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.Methods: 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.Results: 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.Conclusions: 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.

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NATURAL HISTORY OF LUMBAR CANAL STENOSIS: CLINICAL ASPECTS AND SAGITTAL BALANCE

Coluna/Columna ◽

10.1590/s1808-185120191803179255 ◽

2019 ◽

Vol 18 (3) ◽

pp. 209-213

Author(s):

VAGNER CLAYTON DE PAIVA ◽

MARCELO ITALO RISSO NETO ◽

GUILHERME REBECHI ZUIANI ◽

IVAN GUIDOLIN VEIGA ◽

WAGNER PASQUALINI ◽

...

Keyword(s):

Case Control Study ◽

Vertical Axis ◽

Case Control ◽

Surgical Indication ◽

Clinical Aspects ◽

Control Group ◽

Level Of Evidence ◽

Sagittal Vertical Axis ◽

Cross Sectional ◽

Control Study

ABSTRACT Objective To compare the sagittal alignment (SA) parameters in individuals with LCS and surgical indication with a control group and to study the correlations between SA parameters and ODI, VAS and EQ-5D in individuals with LCS and surgical indication. Methods In this multicenter cross-sectional case-control study, the individuals were allocated as follows. A stenosis group (SG) composed by patients with LCS confirmed by magnetic resonance imaging with surgical indication, treated between July 2010 and August 2016 and a control group (CG), without LCS. All subjects underwent anamnesis, completed the Health-related Quality of Life (HRQoL) and total spine radiographs were taken. Clinical data, HRQoL and radiographic parameters were correlated. Results Sixty-four individuals formed the SG and 14 the CG. The SG had higher values of mean age, coronal imbalance, sagittal vertical axis (SVA), pelvic tilt (PT), sacrofemoral distance (SFD), overhang (OH), PI-LL mismatch, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain and smaller thoracic kyphosis (TK), total (TLPL) and regional lumbopelvic lordosis (RLPL) in all vertebrae, sagittal offset (SO) in all evaluated vertebrae and EuroQol-5D (EQ-5D) with p <0.05. In the SG, the only significant correlations (p <0.05) were between TK and ODI and EQ-5D; all the other sagittal parameters did not correlated with VAS, ODI or EQ-5D. Conclusion SG had SA parameters altered in relation to CG. There was a direct correlation between decrease in TK and worsening of ODI and EQ-5D in SG. Level of evidence: III; Case Control Study.

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Association between back muscle degeneration and spinal-pelvic parameters in patients with degenerative spinal kyphosis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2837-0 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Weiwei Xia ◽

Han Fu ◽

Zhenqi Zhu ◽

Chenjun Liu ◽

Kaifeng Wang ◽

...

Keyword(s):

Erector Spinae ◽

Sacral Slope ◽

Muscle Degeneration ◽

Imaging Data ◽

Spinal Level ◽

Sagittal Vertical Axis ◽

Cross Sectional ◽

Pelvic Parameters ◽

Lumbar Level ◽

Psoas Muscles

Abstract Background The paraspinal and psoas muscles have been considered to be essentially important for stabilizing the spinal column, and the muscle degeneration was found to exist in degenerative spinal kyphosis (DSK) patients. However, it is still not clear the relationship between muscle degeneration and spinal-pelvic alignment. The purpose of this study was to determine the correlations between the individual muscle degeneration at each lumbar spinal level and spinal-pelvic parameters in DSK patients. Methods The imaging data of 32 patients with DSK were retrospectively analyzed. The fat infiltration (FI) and relative cross-sectional area of muscle (RCSA) were quantitatively measured for multifidus (MF), erector spinae (ES) and psoas (PS) at each spinal level from L1/2 to L5/S1. The correlations were analyzed between RCSA and the sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI). Results The FI of MF and ES at L3/4, L4/5 and L5/S1 were higher than that at L1/2 and L2/3. The FI of PS at L4/5 and L5/S1 were lower than that of L1/2, L2/3 and L3/4. The RCSA of ES and PS from L1/2 to L5/S1 gradually increased, whereas the RCSA of ES from L1/2 to S5/S1 gradually decreased. The RCSA of MF at the L1/2 level was negatively correlated SVA (r = − 0.397,p = 0.024); the RCSA at L3/4, L4/5 and L5/S1 levels were negatively correlated with TK (r = − 0.364, p = 0.04; r = − 0.38, p = 0.032; r = − 0.432, p = 0.014); the RCSA at L4/5 level was positively correlated with LL (r = 0.528, p = 0.002). The RCSA of ES at L3/4 and L4/5 levels were positively correlated with PI (r = 0.377, p = 0.037) and SS (r = 0.420, p = 0.019). Conclusions FI of MF and ES at lower lumbar level is higher than that at upper level, but FI of PS at upper lumbar level is higher than that at lower level. MF and ES have different roles for maintaining the sagittal spinal-pelvic balance.

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The Pelvic Incidence Stratified Sagittal Spinopelvic Alignment in Asymptomatic Chinese Population With Different Age Groups

Global Spine Journal ◽

10.1177/2192568221989647 ◽

2021 ◽

pp. 219256822198964

Author(s):

Siyu Zhou ◽

Zhuoran Sun ◽

Wei Li ◽

Da Zou ◽

Weishi Li

Keyword(s):

Chinese Population ◽

Pelvic Incidence ◽

Sagittal Alignment ◽

Age Groups ◽

Vertical Axis ◽

Elderly Subjects ◽

Sagittal Vertical Axis ◽

Cross Sectional ◽

Sagittal Parameters ◽

Very High

Study Design: Cross-sectional study. Objective: To provide the age- and pelvic incidence-related variations of sagittal alignment in asymptomatic Chinese population. Methods: This study recruited asymptomatic adult subjects. All subjects undertook the standing whole spinal radiograph and the sagittal parameters were measured: sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI) and pelvic tilt (PT). All subjects were divided into young, middle aged and elderly groups, then each age group was further divided into 5 subgroups (very low, low, average, high and very high) based on PI values. The relations between PI, age and other parameters were evaluated. The differences in sagittal parameters of each PI subgroup were compared. Results: 546 subjects were included with an average age of 38.6 years (18 to 81). The number of subjects over 70 years and with very low PI was relatively small. The average of PI, TPA, PT and LL were 45.9° ± 8.4°, 6.4° ± 6.2°, 11.9° ± 6.6° and 49.2° ± 10.1°, respectively. SVA, TPA, TK and PT increased with age ( P < 0.05), while SVA, TPA, PT, PI-LL also increased with PI ( P < 0.05). LL, PT, TPA, PI-LL and LL-TK were different among the 5 PI subgroups ( P < 0.05). However, the values of LL in elderly subjects with high and very high PI were similar. Conclusion: The age- and PI-related variations in sagittal alignment of Chinese population were provided. The sagittal parameters were significantly influenced by age and PI. The individual pelvic morphology should be carefully considered during the assessment and restoration of sagittal balance.

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Gender-specific analysis for the association between trunk muscle mass and spinal pathologies

Scientific Reports ◽

10.1038/s41598-021-87334-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yusuke Hori ◽

Masatoshi Hoshino ◽

Kazuhide Inage ◽

Masayuki Miyagi ◽

Shinji Takahashi ◽

...

Keyword(s):

Muscle Mass ◽

Bioelectrical Impedance ◽

Vertical Axis ◽

Impedance Analysis ◽

Poor Quality ◽

Trunk Muscle ◽

Sagittal Vertical Axis ◽

Cross Sectional ◽

Lower Trunk ◽

Significant Difference

AbstractWe investigated the relationship between trunk muscle mass and spinal pathologies by gender. This multicenter cross-sectional study included patients aged ≥ 30 years who visited a spinal outpatient clinic. Trunk and appendicular muscle mass were measured using bioelectrical impedance analysis. The Oswestry Disability Index (ODI), visual analog scale (VAS) score for low back pain, sagittal vertical axis (SVA), and EuroQol 5 Dimension (EQ5D) score were investigated to evaluate spinal pathology. The association between trunk muscle mass and these parameters was analyzed by gender using a non-linear regression model adjusted for patients’ demographics. We investigated the association between age and trunk muscle mass. We included 781 men and 957 women. Trunk muscle mass differed significantly between men and women, although it decreased with age after age 70 in both genders. Lower trunk muscle mass was significantly associated with ODI, SVA, and EQ5D score deterioration in both genders; its association with VAS was significant only in men. Most parameters deteriorated when trunk muscle mass was < 26 kg in men and < 19 kg in women. Lower trunk muscle mass was associated with lumbar disability, spinal imbalance, and poor quality of life in both genders, with significant difference in muscle mass.

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

Journal of Orthopaedic Surgery ◽

10.1177/2309499020948266 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902094826 ◽

Cited By ~ 1

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.

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