Impact of an intraoperative coronal spinal alignment measurement technique using a navigational tool for a 3D spinal rod bending system in adult spinal deformity cases

OBJECTIVE In corrective spinal surgery for adult spinal deformity (ASD), the focus has been on achieving optimal spinopelvic alignment. However, the correction of coronal spinal alignment is equally important. The conventional intraoperative measurement methods currently used for coronal alignment are not ideal. Here, the authors have developed a new intraoperative coronal alignment measurement technique using a navigational tool for a 3D spinal rod bending system (CAMNBS). The purpose of this study was to test the feasibility of using the CAMNBS for coronal spinal alignment and to evaluate its usefulness in corrective spinal surgery for ASD. METHODS In this retrospective cohort study, patients with degenerative lumbar kyphoscoliosis, a Cobb angle ≥ 20°, and lumbar lordosis ≤ 20° who had undergone corrective surgery (n = 67) were included. The pelvic teardrops on both sides, the S1 spinous process, the central point of the apex, a point on the 30-mm cranial (or caudal) side of the apex, and the central point of the upper instrumented vertebra (UIV) and C7 vertebra were registered using the CAMNBS. The positional information of all registered points was displayed as 2D figures on a monitor. Deviation of the UIV plumb line from the central sacral vertical line (UIV-CSVL) and deviation of the C7 plumb line from the CSVL (C7-CSVL) were measured using the 2D figures. Nineteen patients evaluated using the CAMNBS (BS group) were compared with 48 patients evaluated using conventional intraoperative radiography (XR group). The UIV-CSVL measured intraoperatively using the CAMNBS was compared with that measured using postoperative radiography. The prevalence of postoperative coronal malalignment (CM) and the absolute value of postoperative C7-CSVL were compared between the groups on radiographs obtained in the standing position within 4 weeks after surgery. Postoperative CM was defined as the absolute value of C7-CSVL ≥ 30 mm. Further, the measurement time and amount of radiation exposure were measured. RESULTS No significant differences in demographic, sagittal, and coronal parameters were observed between the two groups. UIV-CSVL was 2.3 ± 9.5 mm with the CAMNBS and 1.8 ± 16.6 mm with the radiographs, showing no significant difference between the two methods (p = 0.92). The prevalence of CM was 2/19 (10.5%) in the BS group and 18/48 (37.5%) in the XR group, and absolute values of C7-CSVL were 15.2 ± 13.1 mm in the BS group and 25.0 ± 18.0 mm in the XR group, showing statistically significant differences in both comparisons (p = 0.04 and 0.03, respectively). The CAMNBS method required 3.5 ± 0.9 minutes, while the conventional radiograph method required 13.3 ± 1.5 minutes; radiation exposure was 2.1 ± 1.1 mGy in the BS group and 2.9 ± 0.6 mGy in the XR group. Statistically significant differences were demonstrated in both comparisons (p = 0.0002 and 0.03, respectively). CONCLUSIONS From this study, it was evident that the CAMNBS did not increase postoperative CM compared with that seen using the conventional radiographic method, and hence can be used in clinical practice.

COMPARATIVE ANALYSIS OF GEODYNAMIC PARAMETERS OBTAINED FROM ASTRONOMIC AND GPS OBSERVATIONS IN POLTAVA

The functioning of the GPS station and regular astrometric observations with a prismatic astrolabe in Poltava provides series of local displacements of the earth's crust and plumb line in time, characterizing the changes in the gravitational field. The analysis of the N-component of the earth's crust movement and the displacement of the meridional projection of the plumb line was carried out on the basis of GPS data and from observations on the astrolabe, respectively, for the period 2002-2020. Comparison of the trends of these series showed that their shifts occur in opposite directions. It is noted that the movement of the point occurs in the northern direction at a speed of +0.3mm/yr, and the displacement of the plumb line - to the south, at a speed of -2.6mas/year. Similarly, an abrupt displacement of the N-component to the north by + 2mm at the turn of 2014 was accompanied by a displacement of the plumb line to the south by approximately -50 mas. These facts can be explained within the framework of the hypothesis of the existence of a deep structure in the vicinity of Poltava, in which a significant change in mass occurs. The spectra of both series show the presence of cyclicities with close periods: about 3.2, 2.8, 1.0, 0.5, and 0.3 yr. It is known that harmonics with those periods are present in many astrometric series. The geodynamic interpretation of the presented facts requires additional confirmation in observations of neighboring GPS stations, as well as a theoretical explanation and justification.

Prevalence and Levels of Forward Head Posture among School Going Children

Introduction: Exposure of overloaded bag packs and early usage of digital gadgets amongst school going children alters the cervical spine posture. The present research work intends to study the prevalence of forward head posture in school going children. The study also elucidates the ranges to consider for mild, moderate and severe forward head posture prevalence. Methods: A total of 100 school students (50 males and 50 females) were recruited for cross-sectional study. Assessment of forward head posture was done using plumb line. The students were made to stand at a point marked 25 cm distance away from the plumb line. The researcher, from the side view, using a meter scale, measured the distance between the tragus of the ear and plumb line and record it. The weight of the school bag was measured using the weighing machine and the time for which gadgets were used was recorded as per the subject/parents feedback. Results: The mean values for age, height, weight and BMI are 13.67 ± 0.55 years, 158.56 ± 7.71 cms, 46.47 ± 10.50 kgs and 18.40 ± 3.48 kg /m2 respectively. The mean values for gadgets time use, distance plumb line and weight bag are 130.50 ± 67.07 min, 1.96 ± 1.19 cm and 4.32 ± 1.70 kgs respectively. About ~27% children having mild or no FHP (less than or equal to 1 cm), ~37% children having moderate FHP (ranging between 1.01 cm to 2.49 cm) and ~36% children found to have severe FHP (more than or equal to 2.5 cm). Conclusion: The study showed that the FHP is developing at early stage in the school going children and it has the potential of altering cervical spine biomechanics. Early screening is much essential aspect to prevent FHP. The ergonomic based awareness programs should be organized to sensitize children about the right posture and to indulge them in physical activity.

Adolescent idiopathic scoliosis screening: Could a school-based assessment protocol be useful for an early diagnosis?

BACKGROUND: Adolescent idiopathic scoliosis screening still needs a considerable implementation, particularly throughout a school-based assessment protocol. OBJECTIVE: This study aims to evaluate the effectiveness of clinical examinations currently in use for the diagnosis of adolescent idiopathic scoliosis, through a survey carried out in secondary schools to standardize a screening protocol that could be generalized. METHODS: In their classrooms, the adolescents underwent an idiopathic scoliosis screening through three examinations: Adam’s test, axial trunk rotation (ATR) and plumb line. In case of single positivity to one of the three examinations, a column X-ray examination was recommended. RESULTS: The sensitivity and diagnostic specificity of Adam’s test or ATR were 56.3% and 92.7%, respectively. The positivity to at least one between ATR or plumb line showed that sensitivity was higher than specificity: 91.3% versus 80.8%; the positivity to at least one between Adams’s test or plumb line showed a sensitivity of 95.2% and a specificity of 81.5%. Finally, the positivity to all three examinations showed an increase in specificity (99.7%). CONCLUSIONS: Taken together, our findings show that this school-based screening protocol had a very high specificity in early diagnosis of adolescent idiopathic scoliosis.

ALIGNING METHOD OF STRUCTURES DURING INSTALLATION IN VERTICAL PLANE

This article presents the results of the research methods of structures aligning during installation in the vertical plane. The analysis and research of existing methods of structures alignment in the vertical plane, used in the conditions of enterprises engaged in the installation of metal tanks. The results of the research showed that the applied alignment methods in the vertical plane have some drawbacks, in particular, after aligning, additional calculations are required. And also for alignment of sliding timbering, columns and wall panels use some theodolites, including vertical allotment. Laser devices and theodolites with visual system were also investigated. However, all the methods considered with the use of these devices are quite time-consuming and a significant number of tools and equipment are used. A device is proposed to control the shape and location of flat surfaces using the principle of similarity of triangles allowing obtaining a straight line of intersection of lasers in space parallel to the plumb line. Developed devices are cheap, easy to use and manufacture. With the use of the proposed technique, there is no need to use several working and expensive devices. The developed devices can significantly reduce the alignment time of building structures in the vertical and horizontal planes.

Orientation of L4 coronal tilt relative to C7 plumb line as a predictor for postoperative coronal imbalance in patients with degenerative lumbar scoliosis

The study design is case–control. To evaluate the impact of preoperative coronal patterns based on the relationship between orientation of L4 coronal tilt and C7 plumb line on immediate postoperative coronal imbalance in degenerative lumbar scoliosis (DLS) patients. Although lumbosacral fractional curve has been long stressed in correction surgery of DLS, there is paucity of literature focusing on preoperative coronal pattern based on the relationship between orientation of L4 coronal tilt and C7 plumb line and its impact on immediate postoperative coronal imbalance in DLS patients. A consecutive series of DLS patients who underwent deformity correction surgery via posterior-only approach were reviewed. According to the relationship between orientation of L4 coronal tilt and C7 plumb line preoperatively, a total of 77 DLS patients who underwent posterior spinal corrective surgery were classified into: 1. Coronal consistency pattern, L4 coronally tilts toward C7 plumb line; 2. Coronal opposition pattern, L4 coronally tilts opposite C7 plumb line. Coronal imbalance was defined as global coronal malalignment (GCM) on either side more than or equal to 20 mm. Whole-spine standing radiographs of both pattern groups were assessed preoperatively and postoperatively. There were 37 patients with coronal consistency pattern and 40 patients with coronal opposition pattern. Compared to patients with coronal opposition pattern, patients with coronal consistency pattern had significantly higher postoperative GCM (P = 0.028), lower amount of GCM correction (P = 0.013) and higher incidence of postoperative coronal imbalance (P = 0.001); further logistic regression analysis revealed coronal consistency pattern was associated with increased odds of postoperative coronal imbalance (odds ratio: 5.981; 95% confidence interval 2.029–17.633; P = 0.001). DLS patients with preoperative coronal consistency pattern carried greater risk for immediate postoperative coronal imbalance following posterior long correction surgery. Level of evidence 3

Assessment of Early Juvenil Idiopathic Scoliosis: Clinical Trial for the Evaluation of A School-Based Screening Protocol

This study aims to evaluate the effectiveness of clinical tests currently in use for the diagnosis of JIS, through a survey, carried out in secondary schools in the province of Palermo, in order to standardize a school screening protocol that could be extended to the whole regional territory. The adolescents underwent a specialist physiatric examination in their classrooms; moreover three screening tests have been administred: Adams test, Bunnel Inclinometer and Plumb line test. In case of single positivity to one of the three tests, the adolescent underwent to radiography of the whole column. Then we examined the sensitivity and diagnostic specificity of the Adams or inclinometer test, respectively: 56.3% and 92.7%. On the other hand, the positivity to at least one between inclinometer or plumb line sensitivity was higher than the specificity: 91.3% versus 80.8%. The same happened for the positivity to at least one test between Adams index or plumb line test, which showed a sensitivity of 95.2% compared to a specificity of 81.5%. Finally, taking into consideration patients with triple test positivity, a clear increase in specificity compared to sensitivity was demonstrated, reaching 99.7% Performing a single test cannot be considered a sufficient tool aiming to detect potential scoliotic subjects. To conclude, an effective screening program can reduce health care expenditure related to specialist medical examinations as well as unnecessary instrumental exams such as X-rays.