The Reliability of the Projection Area per Length Squared for Measuring Lumbar Lordosis on Lateral Radiographs: A Comparison with Cobb Method

2021 ◽  
Author(s):  
Murat Golpinar ◽  
◽  
Erdal Komut ◽  
Keyword(s):  
Lumbar Lordosis ◽  
Projection Area ◽  
Cobb Method

scholarly journals Problems with diagnosing early stadia of scoliosis due to discrepancies between ATR and the Cobb angle

2020 ◽  
Author(s):  
Marek Kluszczyński ◽  
Jacek Wąsik ◽  
Dorota Ortenburger
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Clinical Parameters ◽  
Trunk Rotation ◽  
X Ray ◽  
False Diagnosis ◽  
Cobb Method ◽  
Threshold Rule

Abstract Background This research analysed discrepancies between the angle of trunk rotation (ATR) and the Cobb angle, in order to study if the commonly used 7° cut-off threshold for ATR helps diagnose scoliosis. In early stadia of scoliosis in children, ATR and the Cobb angle often disagree, increasing the risk of a false diagnosis: while the former does not suggest scoliosis, the latter does. Methods The study analysed ATR clinical parameters and the Cobb angle in the X-ray pictures of 117 (23 boys and 94 girls, aged 6–17 years) children who had not yet started treatment and whose X-ray pictures showed the Cobb angle of at least 10°, indicating idiopathic scoliosis. The degrees of lumbar lordosis and thoracic kyphosis were measured using the Saunders inclinometer, and back asymmetry was measured with Adam’s forward bend test using the Bunnell scoliometer. In the X-ray pictures, the curvature angle was plotted according to the Cobb method. The patients were stratified based on their age, and their ATRs and Cobb angles were compared. Results Although all the children had the Cobb angle over 10°, in 69 out of 117 (59%), ATR was below 7%. So, using the 7° cut-off threshold rule, scoliosis would not be diagnosed in those children. This shows that the two tests often disagree, suggesting that the 7° cut-off threshold or ATR is ineffective in diagnosing scoliosis. Conclusions To improve the method for diagnosing scoliosis based on ATR, consideration should be given to lowering the 7° ATR cut-off threshold.

scholarly journals CHANGES IN THE SAGITTAL BALANCE IN CONGENITAL SCOLIOSIS CORRECTION SURGERY

2016 ◽  
Vol 15 (4) ◽  
pp. 272-274
Author(s):  
José Antonio Mancuso Filho ◽  
Paulo Alvim Borges ◽  
Eduardo Hideo Tsuchiya ◽  
Olavo Biraghi Letaif ◽  
Raphael Martus Marcon ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Congenital Scoliosis ◽  
Tertiary Hospital ◽  
Sacral Slope ◽  
Spinopelvic Parameters ◽  
Scoliosis Correction ◽  
Correction Surgery ◽  
Sagittal Deformity ◽  
Cobb Method

ABSTRACT Objective: This study aimed to determine whether surgery leads to changes in sagittal balance in patients with congenital scoliosis. Methods: We retrospectively reviewed all cases of scoliosis operated in a tertiary hospital between January 2009 and January 2013. In all cases the deformity in the coronal and sagittal planes, kyphosis, and lordosis were measured, using the Cobb method, and spinopelvic parameters: pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). Results A hundred and eleven medical records were analyzed, but the sample resulted in 10 patients, six of whom were females (60%). The average age was 13.4 years. In the comparative analysis between pre and postoperative, only the coronal deformity (12.37; CI 95% [7.88-16.86]; p<0.001), the sagittal deformity (12.71; CI 95% [4.21-21.22]; p=0.011), and the lumbar lordosis (9.9; CI 95% [0.38-19.42]; p=0.043) showed significant change. Conclusion: There was no change in the spinopelvic parameters of patients with congenital scoliosis undergoing surgery at IOF-FMUSP between 2009 and 2013; however, it was observed decrease in lumbar lordosis, and deformity angle in the sagittal and coronal planes.

Lordosis restoration after anterior longitudinal ligament release and placement of lateral hyperlordotic interbody cages during the minimally invasive lateral transpsoas approach: a radiographic study in cadavers

2012 ◽  
Vol 17 (5) ◽  
pp. 476-485 ◽  
Author(s):  
Juan S. Uribe ◽  
Donald A. Smith ◽  
Elias Dakwar ◽  
Ali A. Baaj ◽  
Gregory M. Mundis ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lumbar Lordosis ◽  
Anterior Longitudinal Ligament ◽  
Maximum Increase ◽  
Transpsoas Approach ◽  
Before And After ◽  
Fresh Frozen ◽  
The Mean ◽  
Segmental Lordosis ◽  
Cobb Method

Object In the surgical treatment of spinal deformities, the importance of restoring lumbar lordosis is well recognized. Smith-Petersen osteotomies (SPOs) yield approximately 10° of lordosis per level, whereas pedicle subtraction osteotomies result in as much as 30° increased lumbar lordosis. Recently, selective release of the anterior longitudinal ligament (ALL) and placement of lordotic interbody grafts using the minimally invasive lateral retroperitoneal transpsoas approach (XLIF) has been performed as an attempt to increase lumbar lordosis while avoiding the morbidity of osteotomy. The objective of the present study was to measure the effect of the selective release of the ALL and varying degrees of lordotic implants placed using the XLIF approach on segmental lumbar lordosis in cadaveric specimens between L-1 and L-5. Methods Nine adult fresh-frozen cadaveric specimens were placed in the lateral decubitus position. Lateral radiographs were obtained at baseline and after 4 interventions at each level as follows: 1) placement of a standard 10° lordotic cage, 2) ALL release and placement of a 10° lordotic cage, 3) ALL release and placement of a 20° lordotic cage, and 4) ALL release and placement of a 30° lordotic cage. All four cages were implanted sequentially at each interbody level between L-1 and L-5. Before and after each intervention, segmental lumbar lordosis was measured in all specimens at each interbody level between L-1 and L-5 using the Cobb method on lateral radiography. Results The mean baseline segmental lordotic angles at L1–2, L2–3, L3–4, and L4–5 were –3.8°, 3.8°, 7.8°, and 22.6°, respectively. The mean lumbar lordosis was 29.4°. Compared with baseline, the mean postimplantation increase in segmental lordosis in all levels combined was 0.9° in Intervention 1 (10° cage without ALL release); 4.1° in Intervention 2 (ALL release with 10° cage); 9.5° in Intervention 3 (ALL release with 20° cage); and 11.6° in Intervention 4 (ALL release with 30° cage). Foraminal height in the same sequence of conditions increased by 6.3%, 4.6%, 8.8% and 10.4%, respectively, while central disc height increased by 16.1%, 22.3%, 52.0% and 66.7%, respectively. Following ALL release and placement of lordotic cages at all 4 lumbar levels, the average global lumbar lordosis increase from preoperative lordosis was 3.2° using 10° cages, 12.0° using 20° cages, and 20.3° using 30° cages. Global lumbar lordosis with the cages at 4 levels exhibited a negative correlation with preoperative global lordosis (10°, R = −0.756; 20°, −0.730; and 30°, R = −0.437). Conclusions Combined ALL release and placement of increasingly lordotic lateral interbody cages leads to progressive gains in segmental lordosis in the lumbar spine. Mean global lumbar lordosis similarly increased with increasingly lordotic cages, although the effect with a single cage could not be evaluated. Greater global lordosis was achieved with smaller preoperative lordosis. The mean maximum increase in segmental lordosis of 11.6° followed ALL release and placement of the 30° cage.

scholarly journals The Validity and Reliability of Kinovea Software in Measuring Thoracic Kyphosis and Lumbar Lordosis

2021 ◽  
Vol 19 (2) ◽  
pp. 129-136
Author(s):  
Ali Sharifnezhad ◽  
◽  
Gholam Reza Raissi ◽  
Bijan Forogh ◽  
Hosniyeh Soleymanzadeh ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pearson Correlation ◽  
Intraclass Correlation ◽  
Standing Position ◽  
Cross Sectional Study ◽  
Validity And Reliability ◽  
Cross Sectional ◽  
Cobb Method

Objectives: The present study evaluated the inter-rater and intra-rater validity and reliability of posturography by Kinovea software to measure the thoracic kyphosis and lumbar lordosis. Methods: Eighteen subjects (10 females & 8 males) referring for radiographic imaging were included in this cross-sectional study. For evaluating the validity, the thoracic kyphosis and lumbar lordosis were measured according to the Cobb method and Kinovea in standing position. The inter-rater and intra-rater reliability of Kinovea were tested by 3 evaluators and one expert evaluator, respectively. Results: Pearson correlation coefficient data suggested that the validity of measuring the thoracic kyphosis depends on the evaluator’s expertise. Besides, the correlation was not significant in measuring the lumbar lordosis angle (P>0.05). The inter-rater and intra-rater repeatability revealed that the correlation was significant in all angles by the intraclass correlation coefficient (P<0.001). Discussion: Posturography by Kinovea, as a noninvasive method presents an excellent inter-rater and intra-rater repeatability for measuring thoracic kyphosis and lumbar lordosis. This reliable method is simple, efficient, and inexpensive.

The impact of increasing interbody fusion levels at the fractional curve on lordosis, curve correction, and complications in adult patients with scoliosis

2020 ◽  
pp. 1-10
Author(s):  
Dominic Amara ◽  
Praveen V. Mummaneni ◽  
Shane Burch ◽  
Vedat Deviren ◽  
Christopher P. Ames ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Revision Surgery ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Pelvic Incidence ◽  
Secondary Analysis ◽  
Lumbar Interbody Fusion ◽  
Curve Correction ◽  
Surgery Rates

OBJECTIVERadiculopathy from the fractional curve, usually from L3 to S1, can create severe disability. However, treatment methods of the curve vary. The authors evaluated the effect of adding more levels of interbody fusion during treatment of the fractional curve.METHODSA single-institution retrospective review of adult patients treated for scoliosis between 2006 and 2016 was performed. Inclusion criteria were as follows: fractional curves from L3 to S1 > 10°, ipsilateral radicular symptoms concordant on the fractional curve concavity side, patients who underwent at least 1 interbody fusion at the level of the fractional curve, and a minimum 1-year follow-up. Primary outcomes included changes in fractional curve correction, lumbar lordosis change, pelvic incidence − lumbar lordosis mismatch change, scoliosis major curve correction, and rates of revision surgery and postoperative complications. Secondary analysis compared the same outcomes among patients undergoing posterior, anterior, and lateral approaches for their interbody fusion.RESULTSA total of 78 patients were included. There were no significant differences in age, sex, BMI, prior surgery, fractional curve degree, pelvic tilt, pelvic incidence, pelvic incidence − lumbar lordosis mismatch, sagittal vertical axis, coronal balance, scoliotic curve magnitude, proportion of patients undergoing an osteotomy, or average number of levels fused among the groups. The mean follow-up was 35.8 months (range 12–150 months). Patients undergoing more levels of interbody fusion had more fractional curve correction (7.4° vs 12.3° vs 12.1° for 1, 2, and 3 levels; p = 0.009); greater increase in lumbar lordosis (−1.8° vs 6.2° vs 13.7°, p = 0.003); and more scoliosis major curve correction (13.0° vs 13.7° vs 24.4°, p = 0.01). There were no statistically significant differences among the groups with regard to postoperative complications (overall rate 47.4%, p = 0.85) or need for revision surgery (overall rate 30.7%, p = 0.25). In the secondary analysis, patients undergoing anterior lumbar interbody fusion (ALIF) had a greater increase in lumbar lordosis (9.1° vs −0.87° for ALIF vs transforaminal lumbar interbody fusion [TLIF], p = 0.028), but also higher revision surgery rates unrelated to adjacent-segment pathology (25% vs 4.3%, p = 0.046). Higher ALIF revision surgery rates were driven by rod fracture in the majority (55%) of cases.CONCLUSIONSMore levels of interbody fusion resulted in increased lordosis, scoliosis curve correction, and fractional curve correction. However, additional levels of interbody fusion up to 3 levels did not result in more postoperative complications or morbidity. ALIF resulted in a greater lumbar lordosis increase than TLIF, but ALIF had higher revision surgery rates.

scholarly journals Outcomes of Oblique Lateral Interbody Fusion for Adult Spinal Deformity: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822097914
Author(s):  
Lei Zhu ◽  
Jun-Wu Wang ◽  
Liang Zhang ◽  
Xin-Min Feng
Keyword(s):  
Systematic Review ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Meta Analysis ◽  
Fusion Rate ◽  
The Mean ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Study Design: A systematic review and meta-analysis. Objectives: To evaluate clinical and radiographic outcomes, and perioperative complications of oblique lateral interbody fusion (OLIF) for adult spinal deformity (ASD). Methods: We performed a systematic review and meta-analysis of related studies reporting outcomes of OLIF for ASD. The clinical outcomes were assessed by visual analogue scale (VAS) and Oswestry Disability Index (ODI). The radiographic parameters were evaluated by sagittal vertical axis (SVA), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence-lumbar lordosis (PI-LL), Cobb angle and fusion rate. A random effects model and 95% confidence intervals (CI) were performed to investigate the results. Results: A total of 16 studies involving 519 patients were included in the present study. The mean difference of VAS-back score, VAS-leg score and ODI score before and after surgery was 5.1, 5.0 and 32.3 respectively. The mean correction of LL was 20.6°, with an average of 6.9° per level and the mean correction of Cobb was 16.4°, with an average of 4.7° per level. The mean correction of SVA, PT, SS, TK and PI-LL was 59.3 mm, 11.7°, 6.9°, 9.4° and 20.6° respectively. The mean fusion rate was 94.1%. The incidence of intraoperative and postoperative complications was 4.9% and 29.6% respectively. Conclusions: OLIF is an effective and safe surgery method in the treatment of mild or moderate ASD and it has advantages in less intraoperative blood loss and lower perioperative complications.

Significance of Lower Body Postures in Chair Design

2021 ◽  
pp. 001872082110270
Author(s):  
Seulgi Kim ◽  
Ilseok Lee ◽  
Sang Hyeon Kang ◽  
Sangeun Jin
Keyword(s):  
Lower Extremity ◽  
Lumbar Lordosis ◽  
System Level ◽  
Lumbar Region ◽  
Muscle Recruitment ◽  
Knee Angle ◽  
Activity Measures ◽  
Head Flexion ◽  
Kinematic Measures ◽  
The Cost

Objective This study examined a system-level perspective to investigate the changes in the whole trunk and head postures while sitting with various lower extremity postures. Background Sitting biomechanics has focused mainly on the lumbar region only, whereas the anatomy literature has suggested various links from the head and lower extremity. Method Seventeen male participants were seated in six lower extremity postures, and the trunk kinematics and muscle activity measures were captured for 5 s. Results Changes in the trunk-thigh angle and the knee angle affected the trunk and head postures and muscle recruitment patterns significantly, indicating significant interactions between the lower extremity and trunk while sitting. Specifically, the larger trunk-thigh angle (T135°) showed more neutral lumbar lordosis (4.0° on average), smaller pelvic flexion (1.8°), smaller head flexion (3.3°), and a less rounded shoulder (1.7°) than the smaller one (T90°). The smaller knee angle (K45°) revealed a more neutral lumbar lordosis (6.9°), smaller pelvic flexion (9.2°), smaller head flexion (2.6°), and less rounded shoulder (2.4°) than the larger condition (K180°). The more neutral posture suggested by the kinematic measures confirmed significantly less muscular recruitment in the trunk extensors, except for a significant antagonistic co-contraction. Conclusion The lower and upper back postures were more neutral, and back muscle recruitment was lower with a larger trunk-thigh angle and a smaller knee angle, but at the cost of antagonistic co-contraction. Application The costs and benefits of each lower extremity posture can be used to design an ergonomic chair and develop an improved sitting strategy.

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