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

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.

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

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.

The Impact of Spinopelvic Mobility on Arthroplasty: Implications for Hip and Spine Surgeons

Spinopelvic mobility represents the complex interaction of hip, pelvis, and spine. Understanding this interaction is relevant for both arthroplasty and spine surgeons, as a predicted increasing number of patients will suffer from hip and spinal pathologies simultaneously. We conducted a comprehensive literature review, defined the nomenclature, summarized the various classifications of spinopelvic mobility, and outlined the corresponding treatment algorithms. In addition, we developed a step-by-step workup for spinopelvic mobility and total hip arthroplasty (THA). Normal spinopelvic mobility changes from standing to sitting; the hip flexes, and the posterior pelvic tilt increases with a concomitant increase in acetabular anteversion and decreasing lumbar lordosis. Most classifications are based on a division of spinopelvic mobility based on ΔSS (sacral slope) into stiff, normal, and hypermobile, and a categorization of the sagittal spinal balance regarding pelvic incidence (PI) and lumbar lordosis (LL) mismatch (PI–LL = ± 10° balanced versus PI–LL > 10° unbalanced) and corresponding adjustment of the acetabular component implantation. When performing THA, patients with suspected pathologic spinopelvic mobility should be identified by medical history and examination, and a radiological evaluation (a.p. pelvis standing and lateral femur to L1 or C7 (if EOS (EOS imaging, Paris, France) is available), respectively, for standing and sitting radiographs) of spinopelvic parameters should be conducted in order to classify the patient and determine the appropriate treatment strategy. Spine surgeons, before planned spinal fusion in the presence of osteoarthritis of the hip, should consider a hip flexion contracture and inform the patient of an increased risk of complications with existing or planned THA.

Can C7 Slope Be Used as a Substitute for T1 Slope? A Radiographic Analysis

Study Design: Retrospective radiographic study. Objectives: T1 slope is an important parameter of sagittal spinal balance. However, the T1 superior endplate can be difficult to visualize on radiographs due to overlying anatomical structures. C7 slope has been proposed as a potential substitute for T1 slope when the T1 superior endplate is not well visualized. The objective of this study was 2-fold: (1) to assess the correlation between C7 and T1 slopes on upright cervical spine radiographs and (2) to evaluate the interrater reliability of C7 slope. Methods: Cervical spine radiographs taken between December 2017 and June 2018 at a single institution were reviewed. Two observers measured upper C7 slope, lower C7 slope, and T1 slope. The correlations between upper and lower C7 slope and T1 slope were evaluated, and linear regression analyses were performed. Interrater reliability of C7 slope was also assessed. Results: In this cohort of 152 patients, there was a strong correlation between upper C7 slope and T1 slope ( r = 0.91, P < .001), as well as between lower C7 slope and T1 slope ( r = 0.90, P < .001). T1 slope could be estimated from the linear regression equation, T1 slope = 0.87 × C7 slope + 7, with an overall model fit of R 2 = 0.8. There was strong interrater reliability for upper (intraclass correlation coefficient [ICC] = 0.95, P < .001) and lower C7 slope (ICC = 0.96, P < .001). Conclusions: Both the upper and lower C7 slope are strongly correlated with T1 slope and can be used as a substitute to estimate T1 slope when the superior endplate of T1 is not well visualized.

Sacral pedicle subtraction osteotomy for an extreme case of positive sagittal balance: case report

The importance of sagittal spinal balance and lumbopelvic parameters is now well understood. The popularization of various osteotomies, including Smith-Peterson, Ponte, and pedicle subtraction osteotomies (PSOs), as well as vertebral column resections, have greatly enhanced the spine surgeon’s ability to recognize and effectively treat sagittal imbalance. Yet rare circumstances remain, most notably in distal kyphotic deformities and patients with extremely elevated pelvic incidences, where these techniques remain inadequate. In this article, the authors describe a patient with severe sagittal imbalance despite multiple prior anterior and posterior reconstructive surgeries in which a sacral PSO was performed with good results. A description of this technique as well as a brief review of the literature is provided.