scholarly journals Influence of comorbid knee osteoarthritis on surgical outcome and sagittal spinopelvic/lower-extremity alignment in elderly patients with degenerative lumbar spondylolisthesis undergoing transforaminal lumbar interbody fusion

2020 ◽  
Vol 32 (6) ◽  
pp. 850-858
Author(s):  
Motonori Kohno ◽  
Yuichi Iwamura ◽  
Riki Inasaka ◽  
Gosuke Akiyama ◽  
Shota Higashihira ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Elderly Patients ◽  
Knee Osteoarthritis ◽  
Surgical Outcome ◽  
Knee Flexion ◽  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
The Other ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis

OBJECTIVEThis retrospective study aimed to clarify the influence of comorbid severe knee osteoarthritis (KOA) on surgical outcome in terms of sagittal spinopelvic/lower-extremity alignment in elderly patients with degenerative lumbar spondylolisthesis (DLS).METHODSIn total, 110 patients aged at least 65 years (27 men, 83 women; mean age 74.0 years) who underwent short-segment lumbar fusion were included in the present study. Using the Kellgren-Lawrence (KL) grading system, patients were categorized into those with no to mild KOA (the mild-OA group: KL grades 0–2), moderate KOA (moderate-OA group: KL grade 3), or severe KOA (severe-OA group: KL grade 4). Surgical results were assessed using the Japanese Orthopaedic Association (JOA) scoring system, and spinopelvic/lower-extremity parameters were compared among the 3 groups. Adjacent-segment disease (ASD) was assessed over a mean follow-up period of 4.7 years (range 2–8.1 years).RESULTSThe study cohort was split into the mild-OA group (42 patients), the moderate-OA group (28 patients), and the severe-OA group (40 patients). The severe-OA group contained significantly more women (p = 0.037) and patients with double-level listhesis (p = 0.012) compared with the other groups. No significant differences were found in mean postoperative JOA scores or recovery rate among the 3 groups. The mean postoperative JOA subscore for restriction of activities of daily living was only significantly lower in the severe-OA group compared with the other groups (p = 0.010). The severe-OA group exhibited significantly greater pelvic incidence, pelvic tilt, and knee flexion angle (KFA), along with a smaller degree of lumbar lordosis than the mild-OA group both pre- and postoperatively (all p < 0.05). Overall, the rate of radiographic ASD was observed to be higher in the severe-OA group than in the mild-OA group (p = 0.015). Patients with ASD in the severe-OA group exhibited significantly greater pelvic tilt, pre- and postoperatively, along with less lumbar lordosis, than the patients without ASD postoperatively (all p < 0.05).CONCLUSIONSA lack of lumbar lordosis caused by double-level listhesis and knee flexion contracture compensated for by far greater pelvic retroversion is experienced by elderly patients with DLS and severe KOA. Therefore, corrective lumbar surgery and knee arthroplasty may be considered to improve sagittal alignment, which may contribute to the prevention of ASD, resulting in favorable long-term surgical outcomes.

Understanding sagittal compensation in adult spinal deformity patients: relationship between pelvic tilt and lower-extremity position

2021 ◽  
pp. 1-8
Author(s):  
Takayoshi Shimizu ◽  
Meghan Cerpa ◽  
Lawrence G. Lenke
Keyword(s):  
Lower Extremity ◽  
Spinal Deformity ◽  
Knee Flexion ◽  
Pelvic Tilt ◽  
Adult Spinal Deformity ◽  
The Other ◽  
Whole Body ◽  
Shift Group ◽  
Posterior Shift ◽  
Full Body

OBJECTIVE In adult spinal deformity (ASD), quantifying preoperative lower-extremity (LE) compensation is important in formulating an operative plan to achieve optimal global sagittal alignment. Whole-body radiographs are not always available. This study evaluated the possibility of estimating LE compensation without whole-body radiographs. METHODS In total, 200 consecutive ASD patients with full-body radiographic assessment were categorized into the following three groups according to their cranio-hip balance (distance from the cranial sagittal vertical axis to the hip axis [CrSVA-H]): group 1, anterior-shift (A-shift) group (CrSVA-H > 40 mm); group 2, balanced group, −40 mm < CrSVA-H < 40 mm; and group 3, posterior-shift (P-shift) group, CrSVA-H < −40 mm. After analyzing the correlation between CrSVA-H, pelvic tilt (PT), and LE parameters, the cutoff PT and PT/pelvic incidence (PI) values that correlated with the presence of LE compensation were determined. Previously published data from asymptomatic volunteers were used as a baseline threshold (sacrofemoral angle [SFA] > 217.0° and knee flexion angle [KA] > 11.0°). RESULTS Among the hip, knee, and ankle, only KA showed a significant increase in the A-shift group compared to the other two groups (p < 0.01). With a wide threshold (SFA > 208.0° and KA > 5.0°), 84.9% of the A-shift group showed LE compensation (hip or knee or both), which was a significantly greater percentage than those in the balanced and P-shift groups (48.4% and 51.9%, p < 0.01). With a narrow threshold (SFA > 217.0° and KA > 11.0°), 62.2% of the A-shift group showed any LE compensation, which was also a higher percentage than the other two groups. The CrSVA-H was moderately correlated with KA (r = 0.502), but had no correlation with PT, SFA, and ankle dorsiflexion angle (AA). PT showed a moderate/strong correlation with SFA, KA, and AA (r = 0.846, 0.624, and 0.622, respectively). With receiver operating characteristic curves, the authors determined that a 23.0° PT with PT/PI > 0.46 predicts the presence of any type of LE compensation with use of the wide threshold. CONCLUSIONS ASD patients with increased CrSVA-H, which represents cranio-hip anterior imbalance, demonstrated a higher prevalence of LE compensation, especially knee flexion, compared to those with neutral and posterior shift of CrSVA. PT represents the extent of LE compensation in patients with spinal sagittal malalignment. Using the cutoff value of PT determined in this study, surgeons can preoperatively estimate the extent of LE compensation without obtaining a full-body radiograph.

scholarly journals Outcomes and Risks With Age in Spondylolisthesis: A Comparison of the Elderly From the Quality Outcomes Database

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Michael Karsy ◽  
Andrew Kai-Hong Chan ◽  
Michael S Virk ◽  
Praveen V Mummaneni ◽  
Mohamad Bydon ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Rating Scale ◽  
Age Groups ◽  
The Elderly ◽  
Quality Outcomes ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis ◽  
The Impact

Abstract INTRODUCTION Degenerative lumbar spondylolisthesis affects 3% to 20% of the population with an increasing incidence of up to 30% in the elderly. The impact of age on surgical complication and patient reported outcomes (PRO) have yet to be evaluated in a modern, multicenter study. METHODS The Quality Outcomes Database (QOD) multicenter, prospective registry was used to evaluate patients from 12 US centers, including academic and private institutions, between July 2014 and June 2016 who underwent surgical treatment for grade 1 lumbar spondylolisthesis. All patients received at least 12 mo of follow-up RESULTS A total of 608 patients were divided into < 60 (n = 239), 60 to 70 (n = 209), 71 to 80 (n = 128), and > 80 (n = 32) categories. Older patients showed lower body mass index (BMI) (P = .00001), increased diabetes (P = .007), coronary artery disease (P = .0001), and osteoporosis (P = .005). A lower likelihood for home disposition was seen with the elderly (89.1% in < 60 yr olds vs 75% in > 80 yr olds), with more elderly patients discharged to skilled nursing facilities or rehabilitation (P = .002). No baseline differences in PROs (Oswestry Disability Index [ODI], EQ-5D [EuroQol healthy survey], Numeric Rating Scale for leg pain [NRS-LP] and back pain [NRS-BP]) were seen among age categories. A significant improvement for all QOLs was seen regardless of age (P < .05). Minimal clinically important differences (MCID) in QOLs were seen after surgery for all age groups. No differences in hospital readmissions (30-d, 3-mo) or reoperations (30-d, 1-yr, 2-yr, and 3-yr) were seen among age groups (P < .05). CONCLUSION Despite increased presurgical comorbidities and risk, well-selected elderly patients undergoing surgical treatment of grade 1 spondylolisthesis can achieve meaningful outcomes without increases in complications or readmission. However, PRO do not improve to the same degree in the elderly as in younger adults. This modern, multicenter US study reflects the current use and limitation of spondylolisthesis treatment in the elderly, which may be informative to patients and providers.

Calculation of the Target Lumbar Lordosis Angle for Restoring an Optimal Pelvic Tilt in Elderly Patients With Adult Spinal Deformity

Spine ◽  
2016 ◽  
Vol 41 (4) ◽  
pp. E211-E217 ◽  
Author(s):  
Yu Yamato ◽  
Tomohiko Hasegawa ◽  
Sho Kobayashi ◽  
Tatsuya Yasuda ◽  
Daisuke Togawa ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
Adult Spinal Deformity

THE ASSOCIATIONS BETWEEN KNEE FLEXION, VERTICAL CENTER-OF-MASS EXCURSIONS AND LOWER-EXTREMITY MUSCLE WORK FOR END-STAGE KNEE OSTEOARTHRITIS

2009 ◽  
Vol 12 (02) ◽  
pp. 77-84 ◽  
Author(s):  
David Mandeville ◽  
Louis R. Osternig ◽  
Li-Shan Chou
Keyword(s):  
Lower Extremity ◽  
Knee Osteoarthritis ◽  
Knee Flexion ◽  
Stance Phase ◽  
Center Of Mass ◽  
Osteoarthritis Of The Knee ◽  
Strong Positive Correlation ◽  
Muscle Work ◽  
Lower Extremity Muscle ◽  
End Stage

Purpose: The purpose of this study was to assess the association of the knee flexion excursion to the vertical center-of-mass (COM) amplitude and to the lower-extremity muscle work during stance phase for subjects with knee osteoarthritis. Method: Twenty subjects scheduled for total knee replacement and 20 controls performed level walking during standard gait analysis. Dependent variables included stance-phase knee flexion excursion, vertical COM amplitude, and lower-extremity muscle work. Results: Compared to healthy control, subjects with knee osteoarthritis walked with significantly less stance-phase knee flexion and vertical COM excursion. Knee flexion excursion was found to have a strong positive correlation to vertical COM amplitude. The lower-extremity muscle work during single stance phase was found to have a moderate negative correlation to vertical COM amplitude. Conclusions: Osteoarthritis of the knee alters both the stance-phase knee flexion and vertical COM excursions. As these variables show a strong positive relation, efforts to restore stance-phase knee flexion based on the 3rd determinant of gait require a new justification.

scholarly journals Effect of Whole-Body Vibration Training on Muscle Activation for Individuals with Knee Osteoarthritis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Juan Zhang ◽  
Rui Wang ◽  
Yili Zheng ◽  
Jiao Xu ◽  
Ya Wu ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Knee Osteoarthritis ◽  
Vibration Frequency ◽  
Knee Flexion ◽  
Muscle Activation ◽  
Whole Body Vibration ◽  
Whole Body ◽  
Vibration Frequencies ◽  
Activation Rate ◽  
Vibration Parameters

Whole-body vibration (WBV) training may improve the strength of lower extremity muscles in patients with knee osteoarthritis (KOA), but the inconsistency in vibration parameters leads to differences in findings. This cross-sectional study is aimed at observing the effects of different vibration frequencies and knee flexion angles on the activation of lower extremity muscles in patients with KOA. Enrolled participants received WBV training at 0, 30, and 60° knee flexion angles with vibration frequencies of 0, 5, 10, and 20 Hz. Activation rates for vastus medialis, vastus lateralis, rectus femoris, biceps femoris, and semitendinosus in different combinations were collected through surface electromyography. The effects of frequency and angle on muscle activation rate were quantified by repeated measures ANOVA. Individual and synergistic effects of frequency and angle were also analysed. Twenty-six participants with KOA were included. Muscle activation increased with the vibration frequency in 0–20 Hz range and with knee flexion angle in 0–60° range. WBV training at 20 Hz was the most effective for knee muscle activation, and static squatting at 60° was the most suitable for WBV training. Therefore, WBV training can increase the activation rate of knee flexor and extensor muscles in patients with KOA, and the most efficient combination was 20 Hz vibration frequency and 60° knee flexion. When applying WBV to patients with KOA, individual differences and rehabilitation purposes should be considered in selecting vibration parameters and knee angle to effectively increase neuromuscular activity.

scholarly journals Complications rate of and risk factors for the unplanned reoperation of degenerative lumbar spondylolisthesis in elderly patients: a retrospective single-centre cohort study of 33 patients

2020 ◽  
Author(s):  
Weiyang Zhong ◽  
Xinjie Liang ◽  
Xiaoji Luo ◽  
Tianji Huang ◽  
Zhengxue Quan
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Wound Infection ◽  
Neurological Deficit ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Screw Misplacement ◽  
Group A ◽  
Group B ◽  
Lumbar Spondylolisthesis ◽  
Complications Rate

Abstract Background: The study aimed to investigate the complications rate of and risk factors for unplanned reoperation among elderly patients who underwent posterior lumbar fusion (PLF) for degenerative lumbar spondylolisthesis (DLS).Methods: A total of 1100 DLS patients who were older than 60 years were reviewed from January 2006 to December 2016; 33 patients underwent unplanned reoperations and were analysed and divided into two groups (group A: posterolateral fusion, 650 patients; group B: intervertebral fusion, 450 patients). Sex, body mass index (BMI), radiographic data and clinical outcome data were analysed to evaluate the complications rate of and the risk factors for unplanned reoperations.Results: A total of 33 patients underwent unplanned reoperations (3%). The patients were followed for an average of 4.20±2.25 years (group A) and 4.32±2.54 years (group B) without a significant difference. Significant differences were found in mean age, levels of involvement, hospital stay, surgery time, and blood loss between the groups. The causes of unplanned operation were wound infection, screw misplacement, neurological deficit, nonunion, and screw fracture, which were significant except for wound infection between the groups. Higher BMI (obesity), diabetes mellitus (DM), more bleeding and sex (female) were risk factors for complications. Cases of screw misplacement, neurological deficit, nonunion and screw fracture in group A were more significant than those in group B.Conclusion: Patients with higher BMI, DM, older age, posterolateral fusion, and female sex predicted a higher incidence of unplanned reoperations. Spine surgeons may need to pay more attention to their preoperative training and to improving surgical techniques that could reduce the reoperation rate.

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