Evaluation of Sagittal Spine-Pelvis-Lower Limb Alignment in Elderly Women with Pelvic Retroversion while Standing and Walking Using a Three-Dimensional Musculoskeletal Model

STUDY DESIGN: In vivo biomechanical study using a three-dimensional (3D) musculoskeletal model for elderly individuals with or without pelvic retroversion. PURPOSE: To evaluate the effect of pelvic retroversion on the sagittal alignment of the spine, pelvis, and lower limb in elderly females while standing and walking. OVERVIEW OF LITERATURE: Patients with hip–spine syndrome have concurrent hip-joint and spine diseases. However, the dynamic sagittal alignment between the hip joint and spine has rarely been investigated. We used a 3D musculoskeletal model to evaluate global spinopelvic parameters, including spinal inclination and pelvic tilt (PT). METHODS: A total of 32 ambulant females (mean age=78 years) without assistance were enrolled in the study. On the basis of the radiographic measurement for PT, participants were divided into the pelvic retroversion group (R-group; PT≥20°) and the normal group (N-group; PT<20°). A 3D musculoskeletal motion analysis system was used to analyze the calculated value for the alignment of spine, pelvis, and lower limb, including calculated (C)-PT, sagittal vertical axis (C-SVA), pelvic incidence, lumbar lordosis, T1 pelvic angle (C-TPA), as well as knee and hip flexion angles while standing and walking. RESULTS: While standing, C-PT and C-TPA in the R-group were significantly larger than those in the N-group. Hip angle was significantly smaller in the R-group than in the N-group, unlike knee angle, which did not show difference. While walking, C-SVA and C-TPA were significantly increased, whereas C-PT decreased compared with those while standing. The maximum hip-flexion angle was significantly smaller in the R-group than in the N-group. There was a significant correlation between the radiographic and calculated parameters. CONCLUSIONS: The 3D musculoskeletal model was useful in evaluating the sagittal alignment of the spine, pelvis, and leg. Spinopelvic sagittal alignment showed deterioration while walking. C-PT was significantly decreased while walking in the R-group, indicating possible compensatory mechanisms attempting to increase coverage of the femoral head. The reduction in the hip flexion angle in the R-group was also considered as a compensatory mechanism.

A Case of Sudden Onset Septicemia in Recurred Gastric Cancer Following S1 Plus Docetaxel Treatment

Pyogenic liver abscess in patients with malignant disease is a fatal state and is easily diagnosed. We presented a rare case of sudden fatal septicemia following anticancer treatment for recurred gastric cancer due to multiple liver abscesses which could not be diagnosed. A 72-year-old male with recurred gastric cancer received anticancer agents. He had a history of distal gastrectomy with right hepatic lobectomy for hepatic metastasis. He received anticancer treatment in the outpatient's service center periodically, and his performance status was preserved with nothing in particular. After administrating docetaxel, he suddenly developed septicemia and multiple organ failure and died 5 days after strong medical supports. Pathological autopsy revealed that multiple minute abscesses of the liver which could not be detected macroscopically were the causes of fatal septicemia. The etiology, therapies and prognosis of rare entity are being discussed.