scholarly journals Biomechanical aspects of spinal sagittal balance in achondroplasia patients during Ilizarov limb lengthening

2018 ◽  
Vol 15 (4) ◽  
pp. 7-14
Author(s):  
O. G. Prudnikova ◽  
A. M. Aranovich ◽  
Yu. A. Mushtaeva ◽  
A. V. Gubin
Keyword(s):  
Lower Limb ◽  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Clinical Manifestations ◽  
Limb Lengthening ◽  
Neurological Status ◽  
Ilizarov Method ◽  
Sagittal Imbalance ◽  
Cross Sectional

To review specific features of spinal sagittal balance in achondroplasia patients at stages of lower limb lengthening using the Ilizarov method. Material and Methods. Cross-sectional clinical and radiological study was performed in 29 achondroplasia patients prior to lower limb lengthening and at lengthening stages using the Ilizarov method. Parameters of sagittal balance of the spine and pelvis were evaluated radiologically. Clinical evaluation included examination, and assessment of neurological status and pain level. Results. Clinical manifestations of sagittal imbalance included hypokyphosis of the thoracic spine in 44.8 % of cases and increased lumbar lordosis in 55.2 %. No neurological disorders were diagnosed in patients. Pain scores 2 to 4 were observed in 17.2 % ofcases. After staged lower limb lengthening by 19.8 ± 3.3 cm, it was revealed that the values of the thoracic kyphosis, lumbar lordosis and the angle of the sacrum tilt improved and approached those of healthy peers. Vertical sagittal alignment measurements correlated with those of thoracic kyphosis. Thoracic kyphosis showed a correlation with lumbar lordosis. Pelvic indices had a moderate correlation with lumbar lordosis. Conclusion. Biomechanically substantiated transosseous compression-distraction osteosynthesis by Ilizarov technique used for lower limb lengthening in achondroplasia patients improves spinal sagittal balance parameters.

scholarly journals Clinical and radiological aspects of the sagittal balance of the spine in children with achondroplasia

2018 ◽  
Vol 6 (4) ◽  
pp. 6-12
Author(s):  
Oksana G. Prudnikova ◽  
Anna M. Aranovich
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Lower Limbs ◽  
Sagittal Imbalance ◽  
Compensatory Mechanisms ◽  
Lateral Instability ◽  
Hip Joints ◽  
Cross Sectional

Background. Changes in the spine with achondroplasia are represented by disorders of synostosis, the presence of wedge-shaped vertebrae, underdevelopment of the sacrum, changes in the size of the roots of the arches, stenosis of the spinal canal, and changes in the sagittal balance. Aim. To investigate the clinical and radiological features of the sagittal balance of the spine in children with achondroplasia. Materials and methods. We performed a cross-sectional clinical and radiological study of 16 patients with achondroplasia aged 6–17 years (mean, 9.2 ± 3.3 years). Radiographically, the parameters of the sagittal balance of the spine and pelvis and scoliosis were evaluated. Clinical evaluation included orthopedic and neurological status and back pain syndrome. Results. The anatomic features of patients with achondroplasia are limb shortening, O-shaped curvature of the lower extremities with lateral instability of the knee joints, and flexural contractures of the hip joints. With restriction of mobility in the hip joints, compensatory mechanisms for correcting sagittal imbalance are triggered: pelvic incline, lumbar lordosis, and thoracic kyphosis change. The clinical manifestations of sagittal imbalance in enrolled children were hypokyphosis of the thoracic spine in 100% and an increase in lumbar lordosis in 56.25% of patients. In 50% of patients, wedge-shaped deformation of vertebral bodies was diagnosed at the level of the thoracolumbar transition with the formation of local kyphosis. Neurological disorders have not been diagnosed in children. Conclusions. The anatomical features of the lower limbs and hip joints in achondroplasia reflect the biomechanical features of the relationship between the spine, pelvis, and lower limbs, which should be considered when planning for orthopedic and spinal surgery after prediction.

Study on Outcome of Complex Lower Limb Problems treated by Ring External Fixator and Evolvement of Practices toward its Acceptability

2017 ◽  
Vol 3 (2) ◽  
pp. 35-40
Author(s):  
Sandeep Shrivastava ◽  
Sohael M Khan ◽  
Romil Rathi ◽  
Gaurav Mundada ◽  
Pradeep K Singh ◽  
...  
Keyword(s):  
External Fixator ◽  
Lower Limb ◽  
Rural Population ◽  
Age Groups ◽  
Limb Lengthening ◽  
Lower Limbs ◽  
Ilizarov Method ◽  
Cross Sectional ◽  
Ilizarov Fixator ◽  
Ring External Fixator

ABSTRACT Introduction In the developing world, there is still lack of accessibility and availability of adequate health care. In rural population this further gets limited, due to meager immediate resource at disposition and lack of availability of transports to adequate set ups. This cross-sectional study is undertaken among our rural patients who had undergone this treatment to understand what difficulties they had faced during such treatments and their acceptability toward such treatment. This study was undertaken with the aim to find out the acceptability and adaptability among the rural population for Ilizarov ring fixators. Materials and methods The study consisted of 88 consecutive cases (91 lower limbs) of all age groups, who completed the treatment by Ilizarov methodology between July 2005 and July 2012. A retrospective analysis of the procedure was done through the medical records in terms of preoperative, intra­operative, and after the complete treatment. These were analyzed for limb lengthening in centimeters, correction of deformities, total wearing duration, and final outcome. Subsequently, these patients/parents were interviewed with a questionnaire to assess the self-accessibility (ease) toward self-care; self-distraction; self-adaptability–comfort during wearing time and the difficulties faced. Results Overall the functional outcome was excellent in 18, good in 50, fair in 8, and poor in 4. Out of 91 patients, 67 (73.6%) followed up and could be evaluated for adaptability toward Ilizarov fixator. Overall, 91.04% were satisfied with the treatment by Ilizarov fixator. In the remaining the main reason for not accepting the Ilizarov method was difficulty in commuting in the public transport, ugly and threatening looks of fixator with so many wires crossing the leg. Conclusion Ilizarov method is a very effective tool for manag­ing the complex lower limb problems, especially among the population with low resources. It will ensure delivery of a very low-cost solution offered to the needy patients, wherein otherwise due to multiplicity of problems, integral solution is difficult to achieve within their resources. How to cite this article Shrivastava S, Khan SM, Rathi R, Mundada G, Singh PK, Taywade S. Study on Outcome of Complex Lower Limb Problems treated by Ring External Fixator and Evolvement of Practices toward its Acceptability. J Med Sci 2017;3(2):35-40.

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

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.

Implications of Spinopelvic Alignment for the Spine Surgeon

Neurosurgery ◽  
2011 ◽  
Vol 70 (3) ◽  
pp. 707-721 ◽  
Author(s):  
Vivek A. Mehta ◽  
Anubhav Amin ◽  
Ibrahim Omeis ◽  
Ziya L. Gokaslan ◽  
Oren N. Gottfried
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Degenerative Spondylolisthesis ◽  
Disease Process ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Spinopelvic Parameters ◽  
Spinopelvic Alignment ◽  
Spinopelvic Balance

Abstract The relation of the pelvis to the spine has previously been overlooked as a contributor to sagittal balance. However, it is now recognized that spinopelvic alignment is important to maintain an energy-efficient posture in normal and disease states. The pelvis is characterized by an important anatomic landmark, the pelvic incidence (PI). The PI does not change after adolescence, and it directly influences pelvic alignment, including the parameters of pelvic tilt (PT) and sacral slope (SS) (PI = PT 1 SS), overall sagittal spinal balance, and lumbar lordosis. In the setting of an elevated PI, the spineadapts with increased lumbar lordosis. To prevent or limit sagittal imbalance, the spine may also compensate with increased PT or pelvic retroversion to attempt to maintain anupright posture. Abnormal spinopelvic parameters contribute to multiple spinal conditions including isthmic spondylolysis, degenerative spondylolisthesis, deformity, and impact outcome after spinal fusion. Sagittal balance, pelvic incidence, and all spinopelvic parameters are easily and reliably measured on standing, full-spine (lateral) radiographs, and it is essential to accurately assess and measure these sagittal values to understand their potential role in the disease process, and to promote spinopelvic balance at surgery. In this article, we provide a comprehensive review of the literature regarding the implications of abnormal spinopelvic parameters and discuss surgical strategies for correction of sagittal balance. Additionally, the authors rate and critique the quality of the literature cited in a systematic review approach to give the reader an estimate of the veracity of the conclusions reached from these reports.

Implications of Spinopelvic Alignment for the Spine Surgeon

Neurosurgery ◽  
2011 ◽  
Vol 76 (suppl_1) ◽  
pp. S42-S56 ◽  
Author(s):  
Vivek A. Mehta ◽  
Anubhav Amin ◽  
Ibrahim Omeis ◽  
Ziya L. Gokaslan ◽  
Oren N. Gottfried
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Degenerative Spondylolisthesis ◽  
Disease Process ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Spinopelvic Parameters ◽  
Spinopelvic Alignment ◽  
Spinopelvic Balance

Abstract The relation of the pelvis to the spine has previously been overlooked as a contributor to sagittal balance. However, it is now recognized that spinopelvic alignment is important to maintain an energy-efficient posture in normal and disease states. The pelvis is characterized by an important anatomic landmark, the pelvic incidence (PI). The PI does not change after adolescence, and it directly influences pelvic alignment, including the parameters of pelvic tilt (PT) and sacral slope (SS) (PI = PT 1 SS), overall sagittal spinal balance, and lumbar lordosis. In the setting of an elevated PI, the spineadapts with increased lumbar lordosis. To prevent or limit sagittal imbalance, the spine may also compensate with increased PT or pelvic retroversion to attempt to maintain anupright posture. Abnormal spinopelvic parameters contribute to multiple spinal conditions including isthmic spondylolysis, degenerative spondylolisthesis, deformity, and impact outcome after spinal fusion. Sagittal balance, pelvic incidence, and all spinopelvic parameters are easily and reliably measured on standing, full-spine (lateral) radiographs, and it is essential to accurately assess and measure these sagittal values to understand their potential role in the disease process, and to promote spinopelvic balance at surgery. In this article, we provide a comprehensive review of the literature regarding the implications of abnormal spinopelvic parameters and discuss surgical strategies for correction of sagittal balance. Additionally, the authors rate and critique the quality of the literature cited in a systematic review approach to give the reader an estimate of the veracity of the conclusions reached from these reports.

scholarly journals Sagittal imbalance of the spine is associated with poor sitting posture among primary and secondary school students in China: A cross-sectional study

2021 ◽  
Author(s):  
Li Chaoqun ◽  
Zhao Yuqi ◽  
Yu Zhenghui ◽  
Han Xu ◽  
Wen Li ◽  
...  
Keyword(s):  
Secondary School ◽  
Lumbar Lordosis ◽  
Secondary School Students ◽  
Thoracic Kyphosis ◽  
Sagittal Plane ◽  
Spinal Injury ◽  
Assessment System ◽  
Sagittal Imbalance ◽  
School Students ◽  
Sitting Posture

Abstract Background There's no definite answer as to how writing posture affects students' spine. This study attempted to compare the sagittal curvature of the spine between sitting and standing postures in adolescents. To reveal the variation rule of spinal sagittal curvature of students with learning posture, and to discover the key factors that may affect students' spinal health. Methods 1138 participants (male, 604; female, 534; age range, 6–18 y) from three schools in Tianjin, China, including 570 primary school students and 568 secondary school students. This study used SpineScan and PA200 Station Posture Assessment System to assess the sagittal curvature of the spine for three postures: sitting on a chair in an upright position, seated at a desk while reading/writing, and standing in a natural relaxed position. Analyze the difference of the spine angle of the three postures and the correlation between the sagittal plane angle of the spine and body posture. Results When some teenagers sat reading/writing, the sagittal angle of the spine markedly changed, with the lumbar lordosis angle significantly decreased (p < 0.05) and the thoracic kyphosis angle significantly increased (p < 0.05). These angles interact with each other and were positively correlated with the height of the teenager (R2 = 0.179; p < 0.05). By contrast, teenagers with lumbar lordosis and thoracic kyphosis angles within standard references ranges in a seated reading/writing posture also had good spine shape while standing. Conclusions Compared with standing posture, the angle of thoracic kyphosis gradually increases from upright sitting to reading/writing., Lumbar lordosis significantly decreasing or even disappearing, and the flexion of whole spine will increase the risk of spinal injury. Height is an important factor affecting the shape of students' sitting spine.

scholarly journals Vertebral fractures in patients treated for femur proximal third fractures

2014 ◽  
Vol 13 (3) ◽  
pp. 228-231
Author(s):  
Gabriel Gomes Freitas de Castro ◽  
Marcelo Italo Risso Neto ◽  
Guilherme Rebechi Zuiani ◽  
Paulo Tadeu Maia Cavali ◽  
William Dias Belangero ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Femur Fracture ◽  
Cross Sectional Study ◽  
Proximal Femur Fracture ◽  
Spine Fractures ◽  
Sectional Study ◽  
Cross Sectional ◽  
Vertebral Bodies ◽  
Epidemiological Association

OBJECTIVE: To investigate the prevalence of fractures of the vertebral bodies in patients with femur proximal third fracture. METHODS: Cross-sectional study conducted at Hospital de Clínicas, Unicamp, SP, Brazil, between May and December 2012, which referred the patients with proximal femur fracture to radiographs of the spine. Fractures were evaluated according to number, severity and localization, applying the Genant index. RESULTS: Of the 15 subjects who completed the study, 14 had fractures of the vertebral bodies. The most commonly affected level was T8. There was no increased prevalence of fractures at the apex of the thoracic kyphosis and lumbar lordosis. CONCLUSION: There is strong epidemiological association between femur proximal third fractures and fractures of vertebral bodies caused by insufficiency.

scholarly journals Postural analysis in female Bharatanatyam dancers: a cross-sectional study

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Vrushali P. Panhale ◽  
Prachita P. Walankar ◽  
Aishwarya Sridhar
Keyword(s):  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pelvic Tilt ◽  
Sagittal Plane ◽  
Cross Sectional Study ◽  
The Body ◽  
Cervical Lordosis ◽  
Sectional Study ◽  
Cross Sectional ◽  
Significant Difference

Abstract Background Gaining proficiency in Bharatanatyam dance form necessitates maintenance of different postures for prolonged duration. These repetitive movements place tremendous physical demands on the body at young age and may alter the postural profile of the dancer. The study aimed to evaluate the differences in terms of posture between female Bharatanatyam dancers and age-matched non-dancers. A cross-sectional study was conducted in 40 female Bharatanatyam dancers and 40 age-matched female non-dancers in the age group of 18 to 30 years. Analysis of erect standing posture of dancers and non-dancers was conducted in a reserved environment using a photogrammetric method. Static photographs of the subjects were taken in the sagittal plane. The measurement of the angles of the digitized photographs was performed using KINOVEA 0.8.15 software. Head protrusion angle, cervical lordosis angle, thoracic kyphosis angle, lumbar lordosis angle, and pelvic tilt angle were evaluated. Results There was no significant difference between the dancers and non-dancers with respect to head protrusion angle (p = 0.081), cervical lordosis (p = 0.15), and thoracic kyphosis (p = 0.33). Significant differences were identified between the dancers and non-dancers for lumbar lordosis (p = 0.00) and pelvic tilt (p = 0.00) using independent t test with dancers. Higher values of lumbar lordosis and pelvic tilt were observed in dancers. Conclusion Increased lumbar lordosis and anterior pelvic tilt were observed in Bharatanatyam dancers as compared to non-dancers. Hence, it is vital to establish preventive measures like postural re-education, muscular balance, and flexibility to prevent erroneous postural patterns capable of causing pain and injuries.

scholarly journals Spinal curvatures of yoga practitioners compared to control participants—a cross-sectional study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12185
Author(s):  
Małgorzata Grabara
Keyword(s):  
Body Mass ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Sagittal Plane ◽  
Body Height ◽  
Cross Sectional Study ◽  
Control Group ◽  
Cross Sectional ◽  
Spinal Curvatures ◽  
Yoga Practitioners

Purpose The angles of thoracic kyphosis and lumbar lordosis determine the spinal alignment in the sagittal plane. The aim of this study was to compare the thoracic kyphosis and lumbar lordosis of male and female yoga practitioners with non-practicing participants and to determine the possible dependencies between sagittal spinal curvatures and somatic parameters, time spent on yoga exercise, and undertaking other physical activities in yoga practitioners. Methods The study involved 576 women and 91 men ages 18–68 years (mean = 38.5 ± 9) who were practicing yoga, and 402 women and 176 men ages 18–30 years (mean = 20.2 ± 1.3) as a control group. The angles of thoracic kyphosis and lumbar lordosis were measured using a Plurimeter-V gravity inclinometer. Results The two-way ANOVA demonstrated the influence of group (p < .0001) and sex (p = .03) on the angle of thoracic kyphosis, as well as the influence of group (p < .0001) and sex (p < .0001) on the angle of lumbar lordosis. It was noted that yoga practitioners had less pronounced thoracic kyphosis and lumbar lordosis and were more often characterized by normal or smaller thoracic kyphosis and lumbar lordosis than students from the control group. In yoga practitioners, the angle of thoracic kyphosis was positively correlated with age, body mass, BMI, and undertaking other forms of physical activity. The angle of lumbar lordosis was negatively correlated with body height and body mass. Conclusions The results suggest that yoga exercises can affect the shape of the anterior-posterior curves of the spine and may be an efficient training method for shaping proper posture in adults.

RADIOGRAPHIC RESTORATION OF LUMBAR ALIGNMENT AFTER TRANSFORAMINAL LUMBAR INTERBODY FUSION

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 955-964 ◽  
Author(s):  
Jay Jagannathan ◽  
Charles A. Sansur ◽  
Rod J. Oskouian ◽  
Kai-Ming Fu ◽  
Christopher I. Shaffrey
Keyword(s):  
Surgical Technique ◽  
Cobb Angle ◽  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Sagittal Imbalance ◽  
X Rays ◽  
Lumbar Interbody Fusion ◽  
Spinal Alignment

Abstract OBJECTIVE Restoration of lumbar lordosis is a critical factor in long-term success after lumbar fusions. Transforaminal lumbar interbody fusion (TLIF) is a popular surgical technique in the lumbar spine, but few data exist on change in spinal alignment after the procedure. METHODS Eighty patients who underwent TLIF surgery were retrospectively reviewed (minimum follow-up period, 2 years). Standing x-rays were assessed for changes in focal and segmental kyphosis, and restoration of lumbar lordosis. Improvement in spondylolisthesis, sagittal balance, and scoliosis were also assessed. Fusion was assessed as well. RESULTS Eighty operations were performed at 107 levels. Mean presenting lumbar Cobb angle measurement (L1–S1) was 36.3 ± 4.5 degrees (range, 12–77 degrees). Forty patients (50%) had sagittal imbalance. Mean postoperative Cobb angle (L1–S1) was 55.1 ± 6.6. Thirty-three of 36 patients with segmental kyphosis (92%) had restoration of lordosis. Improvement in alignment was most prominent at the surgical level (mean increase in lordosis, 20.2 ± 4.2 degrees). The improvement in lumbar lordosis among patients undergoing multilevel TLIFs (27.3 ± 3.4 degrees) was significantly higher compared with patients undergoing single-level operations (17.4 ± 4.4) (Student's t test, P = 0.0004). Thirty of the 40 patients with sagittal imbalance (75%) achieved immediate restoration of normal sagittal balance. The ability to restore normal sagittal balance was correlated with a sagittal imbalance of less than 10 cm (P = 0.0001). Spondylolisthesis was completely corrected at the TLIF site in 90 of 99 levels (91%). Three patients (4%) required reoperation, 2 for implant disengagement and 1 for worsening kyphoscoliosis above the original surgical levels. Two of the 80 patients had pseudoarthrosis; hence, the rate of pseudoarthrosis was 2.5%. CONCLUSION The TLIF operation is highly effective in improving spinal alignment in patients with degenerative spinal disorders when the appropriate surgical technique is implemented.

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