ABSTRACT
Distal junctional kyphosis [DJK] is a radiographic finding in patients that undergo spinal instrumentation and fusion, since there is an abrupt transition between fixed and mobile spinal segments.The true incidence of DJK is variable in literature and seems that has a multifactorial etiology. A consecutive series of 130 patients [mean age 15.6 years] with Adolescent Idiopathic Scoliosis who underwent posterior spinal fusion and instrumentation were evaluated by analyzing coronal and sagittal angulation and balance measurements from standing radiographs obtained pre-operatively, within 6 weeks post-operation, at two years postoperative and at the latest follow-up. There was 35 male and 95 female. The mean time of followup was 36 months. The incidence of DJK at latest follow-up was 6.9% [9 patients]. In DJK group, distal junctional angle from pre-operative of-12.5 lordosis [-30 to 0] reached to-5.5 [P=0.015] at 6 weeks postoperation and to-1.4 [-20 to 12] [P=0.000] at 2 years follow-up, with mean of 12.1 kyphotic change [10-20]. In non DJK group, distal junctional angle from pre-operative angle of-7.5 reached-8.1 at 2 years follow-up [P=0.43]. The mean age of DJK group at surgery was 17 years and for non-DJK group was 15.4 years [P=0.022]. Distal junctional kyphosis was less common in this study than previous reports and stabilized after two years. The magnitude of coronal cobb angles or multiplicity of coronal curves had no effect in developing DJK that may be prevented by incorporation of the first lordotic disc into the fusion construct
Subject(s)
Humans , Male , Female , Scoliosis , Adolescent , Arthrodesis , Prevalence , Spinal FusionABSTRACT
The theraputic exercise is regarded as one of the most important theraputic interventions in the chronic low back pain patients. Stabilization exercise is among the most significant practical ones in these patients. The study of the effects of these exercises on the variability of trunk muscles postural strategies and the ability in normalizing these strategies are among the uncertainties that have remained unknown up to the present time. The purpose of this research is the study of the effect of stabilization exercises on the variability of postural control strategies in these patients. The study was performed on 21 [14 males, 7 females] recurrent non-specific low back pain patients. The electromyographic activity of Deltoid, Transverse Abdominis/Internal Oblique, External Oblique and Erector Spinae muscles of each person was recorded in 75 rapid arm flexion with maximum acceleration. Then, 14 individuals were placed in the experimental group and 7 in the control group randomly. The experimental group performed isolated abdominal hollowing and bracing exercises using pressure biofeedback with the supervision of a physiotherapist in different positions including supine, sitting on a chair, standing still and standing with rapid arm raises with maximum acceleration once a day, for 20 sessions. The variables studied in this research were evaluated in both experimental and control groups after the training sessions. The standard deviation of the trunk muscles onset latencies relative to deltoid muscle was statistically analyzed by a dependent t-test in both groups. The results revealed that performing the stabilization exercises increases the variability of the timing of anticipatory postural adjustments in TrA/IO in the experimental group [P=.037], while there were no significant changes in the variability of EO [P=.0346] and ES [P=.673] muscles in these patients. The variability of the timing of the anticipatory postural adjustment in TrA/IO [P=.199], EO [P=.702] and ES [P=.465] muscles did not show any significant changes in the control group. The study of the results showed that the reduction in the variability of postural control system in recurrent non-specific low back pain patients as a factor that causes the continuity of back pain can be improved by goal-directed stabilization exercises