Characteristics of calcaneal inclination of children in the upright standing position / 体力科学

Calcaneal inclination in children may influence their standing posture. However, the calcaneal inclination of modern children is unclear. This study aimed to clarify the characteristics of calcaneal inclination and its effects on spinal alignment and the center of pressure (COP) position in children. The study included 402 elementary school children (208 boys, 194 girls). The variables measured included calcaneal inclination, lower leg lateral inclination angle, spinal alignment, and COP position. The mean calcaneal inclination was 4.40 ± 3.5°, indicating mild eversion. Calcaneal inclination was classified into calcaneal eversion (+), calcaneal introversion (-), and a mid-heel position. Overall, 3.7% (15/402) of the subjects had bilateral calcaneal introversion (-), 18.2% (73/402) had unilateral calcaneal introversion (-), and 21.9% (88/402) had calcaneal introversion (-). An examination of the relationship between calcaneal inclination and each measured variable showed a significance level of <5% between calcaneal inclination and age, height, and body weight, but the correlation coefficients were <0.2 each, indicating little correlation. However, a significant correlation was found between right and left calcaneal inclination and the right and left lower leg lateral inclination angles. Overall, 21.9% (88/402) of the elementary school children had calcaneal inclination in a standing posture. These results suggest that calcaneal inclination may not affect spinal alignment and COP position.

Effect of pursed lip breathing on respiratory function and respiratory muscle strength while using a spine mat / 体力科学

It has been reported that using of the spine mat increases chest expansion, inspiratory capacity (IC) and maximum inspiratory mouth pressure (PImax). However, no changes were observed in other respiratory functions and the respiratory muscle strength. The purpose of this study was to clarify the effects of pursed-lip breathing lying on the spine mat to the respiratory function and respiratory muscle strength. Forty-two adult male participants were assigned to two groups; an intervention group (IG group) of 21 participants who performed pursed-lip breathing on top of a spine mat and a control group (CG group) of 21 participants who performed pursed-lip breathing only. The intervention period was 5 days, and the respiratory features evaluated were chest expansion, respiratory function, respiratory muscle strength, and spinal alignment. A significant increase between the Pretest and the Posttest in chest expansion at the circumference of the axilla level, of the xiphoid process level and of the 10th rib level was observed only in IG group. For the respiratory function and the respiratory muscle strength, intervention group showed significant increases in percentage of vital capacity (%VC), tidal volume (TV), PImax, and maximum expiratory mouth pressure (PEmax). In the control group, only the TV indicated a significant increase. Regarding changes before and after the intervention, the intervention group showed significantly higher PImax and PEmax than the control group. No significant difference in spinal alignment was observed between the two groups. These results showed that pursed-lip breathing lying on the spine mat would increase the PImax, PEmax and the chest expansion.

Postoperative Radiographic Early-Onset Adjacent Segment Degeneration after Single-Level L4–L5 Posterior Lumbar Interbody Fusion in Patients without Preoperative Severe Sagittal Spinal Imbalance

STUDY DESIGN: Retrospective study. PURPOSE: To investigate the relationship between preoperative total spinal sagittal alignment and the early onset of adjacent segment degeneration (ASD) after single-level posterior lumbar interbody fusion (PLIF) in patients with normal sagittal spinal alignment. OVERVIEW OF LITERATURE: Postoperative early-onset ASD is one of the complications after L4–L5 PLIF, a common surgical procedure for lumbar degenerative disease in patents without severe sagittal imbalance. A better understanding of the preoperative characteristics of total spinal sagittal alignment associated with early-onset ASD could help prevent the condition. METHODS: The study included 70 consecutive patients diagnosed with lumbar degenerative disease who underwent single-level L4–L5 PLIF between 2011 and 2015. They were divided into two groups based on the radiographic progression of L3–L4 degeneration after 1-year follow-up: the ASD and the non-ASD (NASD) group. The following radiographic parameters were preoperatively and postoperatively measured: sagittal vertebral axis (SVA), thoracic kyphosis (TK), lumbar lordosis, pelvic tilt, and pelvic incidence (PI). RESULTS: Eight of the 70 patients (11%) experienced ASD after PLIF (three males and five females; age, 64.4±7.7 years). The NASD group comprised 20 males and 42 females (age, 67.7±9.3 years). Six patients of the ASD group showed decreased L3–L4 disc height, one had L3–L4 local kyphosis, and one showed both changes. Preoperative SVA, PI, and TK were significantly smaller in the ASD group than in the NASD group (p <0.05). CONCLUSIONS: A preoperative small SVA and TK with small PI were the characteristic alignments for the risk of early-onset ASD in patients without preoperative severe sagittal spinal imbalance undergoing L4–L5 single-level PLIF.

Normal Age-Adjusted Sagittal Spinal Alignment Is Achieved with Surgical Correction in Adolescent Idiopathic Scoliosis

STUDY DESIGN: Retrospective analysis. PURPOSE: Our hypothesis is that the surgical correction of adolescent idiopathic scoliosis (AIS) maintains normal sagittal alignment as compared to age-matched normative adolescent population. OVERVIEW OF LITERATURE: Sagittal spino-pelvic alignment in AIS has been reported, however, whether corrective spinal fusion surgery re-establishes normal alignment remains unverified. METHODS: Sagittal profiles and spino-pelvic parameters of thirty-eight postsurgical correction AIS patients ≤21 years old without prior fusion from a single institution database were compared to previously published normative age-matched data. Coronal and sagittal measurements including structural coronal Cobb angle, pelvic incidence, pelvic tilt, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, C2–C7 cervical lordosis, C2–C7 sagittal vertical axis, and T1 pelvic angles were measured on standing full-body stereoradiographs using validated software to compare preoperative and 6 months postoperative changes with previously published adolescent norms. A sub-group analysis of patients with type 1 Lenke curves was performed comparing preoperative to postoperative alignment and also comparing this with previously published normative values. RESULTS: The mean coronal curve of the 38 AIS patients (mean age, 16±2.2 years; 76.3% female) was corrected from 53.6° to 9.6° (80.9%, p<0.01). None of the thoracic and spino-pelvic sagittal parameters changed significantly after surgery in previously hypo- and normo-kyphotic patients. In hyper-kyphotic patients, thoracic kyphosis decreased (p=0.003) with a reciprocal decrease in lumbar lordosis (p=0.01), thus lowering pelvic incidence-lumbar lordosis mismatch mismatch (p=0.009). Structural thoracic scoliosis patients had slightly more thoracic kyphosis than age-matched patients at baseline and surgical correction of the coronal plane of their scoliosis preserved normal sagittal alignment postoperatively. A sub-analysis of Lenke curve type 1 patients (n=24) demonstrated no statistically significant changes in the sagittal alignment postoperatively despite adequate coronal correction. CONCLUSIONS: Surgical correction of the coronal plane in AIS patients preserves sagittal and spino-pelvic alignment as compared to age-matched asymptomatic adolescents.

Effects of Fast Treadmill Training on Spinal Alignment and Muscles Thickness

PURPOSE: This study examined the effects of fast walking training on a treadmill on the spinal alignment and muscle thickness of normal adults. METHODS: A total of 36 college students in their twenties participated in the study for eight weeks, and they were divided into the normal walking, fast walking, and speed change groups. All the groups were measured in a pre-test before training. The subjects performed exercise three times per week for six weeks. A post-test was conducted six weeks after training began, and a follow-up test was done two weeks after the training ended.Trunk and pelvic tilts were measured in Formetric 4D for the spinal alignment of the subjects. The muscle thickness was examined in the trunk with an ultrasound test. Repeated-measures ANOVA was conducted to test the main effects and interactions among the measurement variables according to time and group. RESULTS: ignificant differences were observed in the pelvic tilt according to time. There were significant differences in the external oblique, internal oblique, transverse abdominal muscle according to time. The post-test results showed significant differences in the left external oblique, internal oblique muscles between before training, six weeks into training, and two weeks after the completion of training. There were significant interactions in the left oblique muscles according to the time and group. CONCLUSION: These findings have some value for patient rehabilitation and clinical applications and interventions through walking training.

Radiologic Measurement of Pelvic Sagittal Incidence and Lordosis in Young Korean Women / 대한정형외과학회잡지

PURPOSE: To determine the normative data for the pelvic morphology parameters in the young Korean female population. MATERIALS AND METHODS: Young Korean female patients in 20s and 30s who had visited the outpatient clinic for a first attack acute sprain underwent a telephone interview at a minimum of 1 year after their last hospital visit. Those who had recovered completely and had no back-related complaints were selected for the pelvic lordosis angle (PRS1)and pelvic angle of incidence (AOI)measurements (n=40 each age group). RESULTS: There was no age difference in both parameters. The PRS1 in the young female population was 38.7+/-8.3 degrees (range: 13.6-52.9 degrees and the AOI was 48.5 +/-9.4 degrees(range: 30.5-74.7 degrees, which shows a close correlation between the two parameters (correlation coefficient, r=-0.965). The linear regression equation obtained is as follow; Equation I: PRS1=79.909-0.850 x AOI, Equation II: AOI=90.902-1.096xPRS1 (linear regression analysis, p=0.000, R2 =0.931). CONCLUSION: The data obtained from the study may be used for future studies related to the sagittal spinopelvic balance.

A Comparative Analysis of Sagittal Spinal Balance in 100 Asymptomatic Young and Older Aged Volunteers / 대한척추외과학회지

STUDY DESIGN: A radiological analysis of the sagittal balance in younger and older aged volunteers. OBJECTIVES: To determine the normal range of the sagittal spinal alignment, and define significant spinopelvic compensations over the hip axis for the sagittal balance with aging. SUMMARY OF LITERATURE REVIEW: Normative data of the sagittal spinal alignment has wide variation and limited clinical usefulness. In addition, the extent to which the "normal"sagittal spinal contour changes with aging remains unknown. MATERIALS AND METHODS: Inclusion criteria were an age between 20 and 29 years (n=50), group A, and between 55 and 65 years (n=50), group B, for the asymptomatic subjects. Measurements made on the standing lateral radiographs included the following: thoracic kyphosis, lumbar lordosis and sagittal vertical axis. In addition, measurements of the sacropelvic translation, spinopelvic balance, pelvic incidence, pelvic tilting and sacral slope were made. RESULTS: The average thoracic kyphosis was 24 degrees, ranging from 3 to 42 degrees, in group A, and 33 degrees, ranging from 9 to 53 degrees, in group B (p0.05). The C7 plumb line, on average, fell 15.4 mm more anteriorly to the posterosuperior corner of S1 in group B than in group A (p<0.05). The anterior positioning of the C7 was also positively correlated with decreasing lordosis (p<0.001). The average sacropelvic translation was -41mm, ranging from -76 to 20 mm, and -48 mm, ranging from -76 to -17 mm, in groups A and B, respectively (p<0.05). The average spinopelvic balance was -57 mm, ranging from -104 to -4 mm, and -49 mm, ranging from -101 to -3 mm, in groups A and B, respectively. The C7 plumb line fell posterior to the hip axis in all cases. The average pelvic incidence was 46 degrees, ranging from 30 to 61 degrees, and 54 degrees, ranging from 28 to 76 degrees, in groups A and B, respectively (p<0.05). The average pelvic tilt was 14 degrees, ranging from 4 to 33 degrees, and 19 degrees, ranging from 3 to 37 degrees, in groups A and B, respectively (p<0.05). The average sacral slope was 32 degrees, ranging from 17 to 47 degrees, and 35 degrees, ranging from 25 to 50 degrees, in groups A and B, respectively (p<0.05). There was significant correlation between pelvic incidence and lumbar lordosis (p<0.001). CONCLUSIONS: The sagittal spinal balance is maintained by spinopelvic compensations over the hip axis with aging, and sacropelvic parameters over the hip axis are important for the evaluation of the sagittal spinal balance.

A Comparative Analysis of Sagittal Spinal Balance in 100 Asymptomatic Young and Older Aged Volunteers / 대한척추외과학회지

STUDY DESIGN: A radiological analysis of the sagittal balance in younger and older aged volunteers. OBJECTIVES: To determine the normal range of the sagittal spinal alignment, and define significant spinopelvic compensations over the hip axis for the sagittal balance with aging. SUMMARY OF LITERATURE REVIEW: Normative data of the sagittal spinal alignment has wide variation and limited clinical usefulness. In addition, the extent to which the "normal"sagittal spinal contour changes with aging remains unknown. MATERIALS AND METHODS: Inclusion criteria were an age between 20 and 29 years (n=50), group A, and between 55 and 65 years (n=50), group B, for the asymptomatic subjects. Measurements made on the standing lateral radiographs included the following: thoracic kyphosis, lumbar lordosis and sagittal vertical axis. In addition, measurements of the sacropelvic translation, spinopelvic balance, pelvic incidence, pelvic tilting and sacral slope were made. RESULTS: The average thoracic kyphosis was 24 degrees, ranging from 3 to 42 degrees, in group A, and 33 degrees, ranging from 9 to 53 degrees, in group B (p0.05). The C7 plumb line, on average, fell 15.4 mm more anteriorly to the posterosuperior corner of S1 in group B than in group A (p<0.05). The anterior positioning of the C7 was also positively correlated with decreasing lordosis (p<0.001). The average sacropelvic translation was -41mm, ranging from -76 to 20 mm, and -48 mm, ranging from -76 to -17 mm, in groups A and B, respectively (p<0.05). The average spinopelvic balance was -57 mm, ranging from -104 to -4 mm, and -49 mm, ranging from -101 to -3 mm, in groups A and B, respectively. The C7 plumb line fell posterior to the hip axis in all cases. The average pelvic incidence was 46 degrees, ranging from 30 to 61 degrees, and 54 degrees, ranging from 28 to 76 degrees, in groups A and B, respectively (p<0.05). The average pelvic tilt was 14 degrees, ranging from 4 to 33 degrees, and 19 degrees, ranging from 3 to 37 degrees, in groups A and B, respectively (p<0.05). The average sacral slope was 32 degrees, ranging from 17 to 47 degrees, and 35 degrees, ranging from 25 to 50 degrees, in groups A and B, respectively (p<0.05). There was significant correlation between pelvic incidence and lumbar lordosis (p<0.001). CONCLUSIONS: The sagittal spinal balance is maintained by spinopelvic compensations over the hip axis with aging, and sacropelvic parameters over the hip axis are important for the evaluation of the sagittal spinal balance.

The Relationship between Sagittal Spinal Alignment and Surgical Results in Degenerative Lumbar Scoliosis with Spinal Stenosis / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the correlation between clinical results and sagittal vertical axis, clinical results and total lumbar lordosis in degenerative lumbar scoliosis with spinal stenosis. SUMMARY OF LITERATURE REVIEW: There has been no report about the relation between sagittal spinal alignment and surgical outcome of degenerative lumbar scoliosis. MATERIALS AND METHODS: We reviewed 38 surgical cases of degenerative lumbar scoliosis from February 1997 to February 2001 with an average follow-up of 35 months. In whole spine standing AP and lateral radiographs, scoliotic angle(Cobb method), total lumbar lordosis(L1-S1) and the sagittal vertical axis(C7 plumb line) were measured. In lumbar flexion-extension and standing side bending views, the lateral translation was measured and instability was determined. Clinical results were evaluated based on the Kirkaldy-Willis criteria. RESULTS: The scoliotic angles at preoperative, postoperative and follow-up were 15.0+/-4.9, 5.3+/-3.1 and 7.1+/-3.7 degrees retro-spectively. Total lumbar lordosis were 28.7+/-6.1, 40.6+/-7.3 and 35.1+/-10.2 degrees retrospectively. Sagittal vertical axis at preoperative and the last follow-up were 3.3+/-3.2 and 0.1 +/-3.3 cm retrospectively. According to Kirkaldy-Willis criteria, 6 cases were excellent, 24 cases good, 7 cases fair and 1 case poor. There was no statistical correlation between total lumbar lordosis and the clinical results (r=-0.061, p=0.717). Sagittal vertical axis was significantly correlated with the clinical results (r=0.519, p=0.001). CONCLUSIONS: For improvement of surgical outcome of degenerative lumbar scoliosis, the sagittal vertical axis should be used as a parameter of sagittal alignment rather than the total lumbar lordosis.